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1
Ryland, Shane. Childhood morbidity and treatment patterns. Calverton, MD: Macro International, Inc., 1998.
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2
Gardiner, Kerry. The effects on respiratory morbidity of occupational exposure to carbon black in the European manufacturing workforce. Birmingham: University of Birmingham, 1994.
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3
Hoyles, Rachel K., and Athol U. Wells. Respiratory system. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0020.
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Pulmonary involvement is common in the connective tissue diseases (CTDs) and is associated with significant morbidity and mortality. Improved management of systemic disease has led to increasing numbers of surviving patients with clinically significant pulmonary disease. Screening for pulmonary complications highlights the frequency of subclinical involvement. In this chapter, the pulmonary manifestations of the more common CTDs are detailed, including rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM), Sjögren's syndrome (SS), and, more briefly, ankylosing spondylitis (AS). A broad spectrum of pulmonary disorders are seen in association with the CTDs or the drugs used to treat the underlying disorder, including interstitial lung disease, pulmonary infections, airways disease, pulmonary nodules, pleural disease, chest wall pathology and pulmonary vascular disease; the discussion is stratified by pulmonary complication. In many cases, two or more pulmonary manifestations of CTD coexist or there are other concurrent diseases such as asthma and lung cancer, resulting in potentially confusing mixed imaging and pulmonary function abnormalities. This chapter presents a comprehensive approach to the investigation, screening, prognostic evaluation, and treatment decisions in pulmonary disease associated with the CTDs.
4
Lulé, Dorothée, Albert C. Ludolph, and Andrea Kübler. Psychological morbidity in amyotrophic lateral sclerosis: Depression, anxiety, hopelessness. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757726.003.0003.
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Amyotrophic lateral sclerosis is a devastating condition with progressive loss of movement, speech, and respiratory function, and no available cure. Following the development of clinical symptoms and after receiving a diagnosis, patients may develop psychological morbidity, such as depression, anxiety, and hopelessness. However, many patients adjust successfully in the course of the disease and maintain good psychological well-being, so that a decline in psychological well-being does not necessarily accompany loss of physical function. There are several major determinants of good psychological adjustment to chronic and terminal disease—intrinsic factors such as coping strategies and internal locus of control, and extrinsic factors such as high (perceived and actual) social support by families and multidisciplinary professional teams. Providing care with a holistic view of the patient is probably the most effective approach to supporting patients’ psychosocial adjustment to the disease and minimizing depression, anxiety, and hopelessness.
5
Robinson, Terry, and Jane Scullion. Oxford Handbook of Respiratory Nursing. 2nd ed. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198831815.001.0001.
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Respiratory disease is one of the leading causes of both mortality and morbidity, causing a significant burden on healthcare resources, the economy, and on individual patients and their carers. Respiratory conditions are managed in many different settings, from home and residential care through the full range of primary to tertiary care. The multifaceted nature of both diseases affecting respiration and the care options is comprehensively covered in this second edition of the Oxford Handbook of Respiratory Nursing. Offering a systematic description of the main respiratory diseases found in adults, the Handbook covers the assessment, diagnosis, and nursing management of each condition. With a special focus on the role of the multidisciplinary team in meeting the multiple care needs of respiratory patients, the Handbook covers both physical and psychosocial concerns, and both pharmacological and non-pharmacological therapies.
6
Jeffrey, Andrew. Psychology in respiratory disease, including dysfunctional breathing. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0145.
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The real burden to any sufferer of respiratory disease is shown in the human suffering of the individual. It is increasingly understood that there is a link between the psychological aspects of respiratory disease and morbidity and that patients’ attitudes to illness can affect their ways of coping and, indeed, impact upon their compliance with treatment. Breathlessness is a symptom of many psychological states, both positive and negative; indeed, it is embedded within the English language: ‘It took my breath away! I was breathless with anticipation!’ An understanding of the links between psychological factors and physical symptoms and behaviours is essential to achieve the best possible outcomes for many patients.
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Jacobs, Samantha E., Catherine B. Small, and Thomas J. Walsh. Fungal diseases of the respiratory tract. Edited by Christopher C. Kibbler, Richard Barton, Neil A. R. Gow, Susan Howell, Donna M. MacCallum, and Rohini J. Manuel. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755388.003.0030.
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Fungal respiratory infections are important causes of morbidity and mortality in immunocompromised patients. Invasive aspergillosis remains the most common invasive fungal infection whereas other filamentous fungi, such as Fusarium spp., Mucorales, and Scedosporium spp., are increasing in frequency, particularly in neutropenic hosts. Endemic mycoses, including those due to Histoplasma capsulatum, Coccidioides spp., and Talaromyces marneffei, are increasingly prevalent in patients with cell-mediated immunodeficiencies in respective geographic regions. Culture remains the gold standard of diagnosis but has limited sensitivity and often requires invasive procedures. Non-invasive diagnostic tests, including the serum sandwich enzyme immunoassay for the detection of galactomannan, the (1→3)-β-D-glucan assay, and molecular amplification methods have been developed to facilitate early and accurate diagnosis. Successful therapy depends upon early initiation of antifungal agents and reversal of immunosuppression. Lipid formulations of amphotericin B and newer generation triazoles including voriconazole, posaconazole, and isavuconazole have expanded the ability to treat multi-drug resistant pathogens more effectively and with less toxicity.
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Jacquet, Gabrielle, and Andrea Dugas. Influenza. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0026.
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Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard precautions, and minimizing visitors for patients in isolation for influenza.
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Ryan, Laura, and Paul Hopkins. Obstructive Sleep Apnea. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0011.
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Adenotonsillectomy is one of the most commonly performed surgeries in children and is the mainstay treatment for obstructive sleep apnea (OSA). Children with OSA have a higher risk of perioperative respiratory morbidity. Diagnosis of OSA is made by overnight polysomnography, but this resource is rare and expensive so children at risk for OSA must be identified based on parental history. Patients with risk factors for postoperative respiratory complications may need to be monitored in the hospital overnight. Anesthetic challenges associate with adenotonsillectomy include perioperative analgesia, prevention and treatment of postoperative nausea and vomiting, risk of airway fire, and management of airway obstruction.
10
Rafferty, Gerrard, and John Moxham. Assessment of Peripheral and Respiratory Muscle Strength in ICU. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0047.
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Skeletal muscle weakness affecting the respiratory and peripheral muscles is common in critically ill patients and can lead to difficulties in weaning, prolonged ICU admission, and significant morbidity in survivors. A number of techniques can be used to assess muscle strength. In the peripheral muscles, volitional techniques employing scoring systems or portable hand dynamometers are relatively simple and quick to use, requiring little or no specialist equipment. Such techniques can, however, only be applied to conscious and cooperative patients, preventing assessment of muscle weakness in many ICU patients. The volitional requirement also limits the ability to distinguish poor motivation and impaired cognition from true loss of muscle function. Non-volitional techniques involving motor nerve stimulation provide measures of muscle force production in non-cooperative patients but require specialist equipment. Normative data for comparative purposes are limited. Also, it is not clear which peripheral muscle best reflects generalized muscle weakness. Measurements of maximal inspiratory and expiratory pressures are widely used to assess respiratory muscle strength in ICU patients and are applicable to patients who can make some respiratory effort. As with all tests requiring patient cooperation, reliability is limited. Phrenic nerve stimulation allows direct, non-volitional assessment of diaphragm and phrenic nerve function, and normative values for comparative purposes are available. Magnetic phrenic nerve stimulation is well tolerated, can be performed in the presence of vascular catheters, and is used to document respiratory muscle weakness and track progression in critically ill patients.
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Williams, Erin S. Asthmatic for Adenotonsillectomy. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0005.
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Asthma is a chronic reversible pulmonary condition. It is the most common respiratory disease as it affects 6 million to 9 million children in the United States. The patient with asthma can experience reversible bronchoconstriction, airway inflammation, airway hyperresponsivness, and increased mucus production. Inflammation is the fundamental abnormality. This dynamic process exists on a spectrum of mild, moderate, or severe. Patients may exhibit expiratory wheezing, obstruction to expiration, and/or inspiration, cough, and respiratory distress. Given the prevalence of asthma and its potential for significant morbidity and mortality, it is important that the anesthesiologist be able to determine the severity of disease and prevent and/or treat bronchospasm.
12
Herridge, Margaret. Introduction: Life after the ICU. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0001.
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Chapter 1 introduces a section about recovery from critical illness, and discusses the magnitude and burden of critical illness (including acute respiratory distress syndrome (ARDS) and post-ARDS residual pulmonary disease, and compromised health-related quality of life (HRQoL)), its mortality, detailed morbidity (ICU-based risk factors for long-term disability), and costs. It also examines the central role of the family caregiver as outcome and risk modifier.
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Khan, Sabina A., and Nitin Wadhwa. Congenital Diaphragmatic Hernia. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0016.
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Congenital diaphragmatic hernia (CDH) is characterized by malformation of the diaphragm, allowing for herniation of abdominal contents into the thoracic cavity. The most significant sequelae of this herniation are pulmonary hypoplasia and pulmonary hypertension, both contributing to significant morbidity and mortality. Multiple strategies exist to minimize respiratory compromise and improve outcome in a patient with CDH, including fetal intervention in selective cases, medical and pharmaceutical management, advanced ventilation strategies, extracorporeal membrane oxygenation (ECMO), and complete surgical repair. Veno-arterial ECMO (circuit between the internal jugular vein and the carotid artery) is used in infants who are unstable and require aggressive cardiopulmonary support, and veno-venous ECMO (circuit with a double lumen catheter in the internal jugular vein) is used in infants who only need respiratory support.
14
Kreeger, Renee Nierman, and James P. Spaeth. Muscular Dystrophy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0063.
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Gastrostomy tube placement is typically a routine surgical procedure with little concern for morbidity and mortality. However, in patients with Duchenne muscular dystrophy (DMD), this is not the case. Patients with DMD present a unique clinical dilemma since they often do not require gastrostomy tube placement until their physical status has deteriorated to the point that they have respiratory insufficiency or failure and clinically significant cardiomyopathy. An understanding of the pathophysiology of this disorder and a proactive approach to perioperative management are important to ensure a positive patient outcome.
15
Squire, Peter. Obstructive Sleep Apnea. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0012.
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Adenotonsillectomy has become first-line treatment for obstructive sleep apnea (OSA) and it is increasingly performed as a day-case procedure. A diagnosis of OSA increases the risk for postoperative respiratory morbidity from 1% to approximately 20% and unfortunately, the clinical history may be unreliable at distinguishing which children are at greatest risk. The gold standard investigation is overnight polysomnography (PSG), but this is a scarce resource considering the number of procedures performed. Fortunately, overnight home pulse oximetry also provides a useful stratification of severity and may predict postoperative problems. Children with OSA have a respiratory drive and airway tone that may be exquisitely sensitive to anesthetic and analgesic agents. Accordingly, the anesthesiologist needs to identify which patients are most at risk, and therefore which patients can be managed as “day cases,” what is an appropriate anesthetic regimen, and how best to monitor these patients postoperatively.
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Fowler, Robert, and Abhijit Duggal. Management of pandemic critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0009.
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Adequate and appropriate provision of critical care services during pandemics may dramatically alter vital outcomes of patients who develop acute respiratory distress syndrome and critical illness. Specific anti-viral therapy, antibiotics directed towards probable secondary infections, supportive ventilation and oxygenation, and adherence to multisystem critical care ‘best practices’ can prevent substantial mortality and morbidity, and lessen the pandemic’s impact on global health. However, severe acute respiratory syndrome and the 2009 H1N1 pandemic also highlighted the limited capacity for increased provision of critical care, even in well-resourced settings, and the potential for dramatic differences in mortality in under-resourced settings. Pandemic preparedness hinges on the development of appropriately-trained staff with well-defined roles, and the ability to manage surge in the number of patients. A rigorous infection control programme, and triage protocols based on equitable distribution of resources and ethical principles of justice, beneficence and non-maleficence. Research preparedness, with approved protocols, electronic case report forms and harmonized clinical trials is necessary.
17
Harbison, Joe. Sleep in older people. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199689644.003.0011.
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Key points• Sleep structure and pattern change with age, sleep typically becoming lighter and more fragmented.• While sleep disorders may not be independently associated with age, they occur more commonly in older people due to co-morbidity.• Common ‘minor’ medical conditions may seriously impair sleep quality.• Neurological conditions such as stroke, Parkinson’s, and dementia are often associated with sleep disorders which can be difficult to treat.• Circadian rhythm disorders are common in older people; primary insomnia is rare.• Respiratory sleep disorders are also common but their significance in many people is uncertain.• Effective treatments are available for restless legs syndrome and related disorders.
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Mitchell, John D., and Marek Brzezinski. Introduction to Pulmonary Urgencies and Emergencies. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0013.
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The lungs exchange gases and also provide for some metabolic functions. Respiratory failure can be grouped into types I-IV. Type I (hypoxemic) and type II (hypercapnic) are the most prominent; type III is perioperative and often considered a subset of type I, while type IV is due to shock. Pulmonary urgencies and emergencies require rapid diagnosis and treatment in order to avoid morbidity and mortality. Identification of risk factors for desaturation and the application of an appropriate management algorithm can facilitate diagnosis and management. The ABCD-A SWIFT CHECK algorithm and its subalgorithms represent a logical approach to rapid diagnosis and management.
19
Carlucci, Annalisa, and Paolo Navalesi. Weaning failure in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0103.
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Weaning failure has been defined as failure to discontinue mechanical ventilation, as assessed by the spontaneous breathing trial, or need for re-intubation after extubation, so-called extubation failure. Both events represent major clinical and economic burdens, and are associated with high morbidity and mortality. The most important mechanism leading to discontinuation failure is an unfavourable balance between respiratory muscle capacity and the load they must face. Beyond specific diseases leading to loss of muscle force-generating capacity, other factors may impair respiratory muscle function, including prolonged mechanical ventilation, sedation, and ICU-acquired neuromuscular dysfunction, potentially consequent to multiple factors. The load depends on the mechanical properties of the respiratory system. An increased load is consequent to any condition leading to increased resistance, reduced compliance, and/or occurrence of intrinsic positive-end-expiratory pressure. Noteworthy, the load can significantly increase throughout the spontaneous breathing trial. Cardiac, cerebral, and neuropsychiatric disorders are also causes of discontinuation failure. Extubation failure may depend, on the one hand, on a deteriorated force-load balance occurring after removal of the endotracheal tube and, on the other hand, on specific problems. Careful patient evaluation, avoidance and treatment of all the potential determinants of failure are crucial to achieve successful discontinuation and extubation.
20
Kreit, John W. Noninvasive Mechanical Ventilation. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0016.
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Although so-called invasive ventilation can be life-saving, it can also cause significant morbidity. It has long been recognized that positive pressure ventilation can also be delivered “non-invasively” to critically ill patients through several different types of “interfaces” (usually a tight-fitting face mask). Noninvasive Mechanical Ventilation explains when and how to use noninvasive ventilation to treat patients with respiratory failure. It provides a detailed explanation of how noninvasive (bi-level) ventilators differ from the standard ICU ventilators, describes the available modes and breath types as well as the indications and contraindications for noninvasive ventilation, and explains how to initiate, monitor, and adjust noninvasive ventilation.
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Shah, Anand, and Andrew Menzies-Gow. Severe asthma. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0002.
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Poorly controlled asthma is a common reason for referral to the respiratory clinic, and the majority of cases can be managed effectively by ensuring the correct diagnosis and ensuring good compliance with inhaled therapy. However, severe asthma affects up to 10% of patients with asthma and is associated with substantial morbidity and mortality, along with significant health-care costs from both inpatient treatment and lost work days. This chapter covers two cases of difficult-to-control asthma and highlights the role of detailed investigations when asthma control is not straightforward. It will cover the diagnostic criteria for allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization and discuss the role of omalizumab in managing severe asthma.
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Lynde, Grant C. Asthma and Pregnancy. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0054.
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Asthma’s progression during pregnancy is highly variable. Improvement in symptoms can be seen in 18%–34% of patients, while worsening of symptoms can be seen in 20%–42% of patients. Acute exacerbations of asthma are most frequently seen late in the second trimester and are associated with a viral upper-respiratory infection. An acute exacerbation of asthma in the parturient can result in increased risk of maternal mortality, preterm delivery, and low-birth-weight infants. In patients with moderate to severe asthma, good control with inhaled corticosteroids, such as budesonide, is a cornerstone of reducing morbidity and mortality. The four components of care for the asthmatic patient are education, control of environmental factors, medications, and monitoring of symptoms.
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McAuley, Danny F., and Thelma Rose Craig. Measurement of extravascular lung water in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0140.
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The accumulation of fluid in the interstitium and alveolar space is known as extravascular lung water (EVLW). EVLW is associated with increased morbidity and mortality in critically ill patients and is elevated in patients with cardiogenic pulmonary oedema, acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS). Pulmonary oedema is a consequence of increased pulmonary capillary hydrostatic pressure and/or an increased capillary permeability. The quantity of pulmonary oedema fluid is dependent on the balance of fluid formation and clearance, and this contributes to the overall dynamic net lung fluid balance. Measurement of EVLW is therefore an indirect surrogate measurement of the alveolar epithelial and endothelial damage in ALI/ARDS. The single indicator transpulmonary thermodilution technique is an available bedside technique to measure EVLW.
24
Henggeller, Michelle. Infections in the HIV Patient. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0055.
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The hallmark of the human immunodeficiency virus (HIV) patient with a cluster of differentiation 4 (CD4) T lymphocyte count below 200 is the development of opportunistic infections. Although the use of antiretroviral therapy (ART) has decreased the incidence of these infections, they continue to be a major case of morbidity and mortality in the patient with HIV. These infections can be respiratory in nature and present with cough or shortness of breath: Pneumocystis pneumonia (PCP), tuberculosis (TB), aspergillosis, and coccidioidomycosis. Neurological infections, which can present with change in mental status, include toxoplasmosis encephalitis (TE), meningoencephalitis, John Cunningham (JC) virus, and progressive multifocal leukoencephalopathy (PML). Gastrointestinal infections, such as Cryptosporidium, present with abdominal pain and diarrhea. Viral changes can result from cytomegalovirus retinitis. Fever or nonspecific symptoms can result from disseminated Mycobacterium Avium complex disease, histoplasmosis, bartonellosis, and cytomegalovirus.
25
Klein, Eili Y. Antibiotic Resistance. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0068.
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Antibacterial resistance threatens the ability of physicians to treat infections, reversing medical gains and increasing the probability of morbidity and mortality in infected patients. Decreased antibiotic efficacy also threatens advanced surgical procedures dependent on antibiotic effectiveness, such as organ and prosthetic transplants. Even simple procedures consider antibiotic prophylaxis to be a standard means of controlling surgical site infections. Despite the link between increased antibiotic use and resistance, a large fraction of antimicrobial use is inappropriate, particularly for acute respiratory tract infections. Methicillin-resistant Staphylococcus aureus (MRSA) is the most significant antibiotic-resistant pathogen, but new pathogens such as carbapenem-resistant enterobacteriaceae (CRE) are increasing in clinical significance. Antibiotic use and resistance is rising rapidly in developing countries, particularly India, China, and various African countries. The inappropriate use of antibiotics must be reduced, and incentives for the development of new antibiotics should be increased.
26
Gibson, K. Michael, Cornelis Jakobs, and Philip L. Pearl. Succinic Semialdehyde Dehydrogenase Deficiency. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0029.
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Succinic semialdehyde dehydrogenase (SSADH) deficiency presents with intellectual disability, disproportionate deficit in expressive language, hypotonia, ataxia, and seizures.1,2 (1 Pearl et al 2011; 2 Vogel et al 2012). A diagnosis of autism spectrum disorder frequently occurs, correlated with neuropsychiatric morbidity (ADHD, OCD, PDD). 1,3 The biochemical hallmark, γ-hydroxybutyric acid (GHB), is elevated in physiological fluids, as is γ-aminobutyrate (GABA) in cerebrospinal fluid (CSF).4,5 Both species are neuroactive. Clinical manifestations are universally present in early childhood, although diagnosis delayed to adulthood has been reported.6 Acute decompensation or complications relate primarily to seizures, intercurrent illnesses sometimes associated with respiratory dysfunction in the setting of hypotonia, or adverse medication responses. Diagnostic confirmation requires urine organic acid analysis (increased GHB) with confirmation via enzyme assay (white cells) and/or molecular characterization of the aldehyde dehydrogenase 5a1 (ALDH5A1) gene.
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Cardona-Arias, Jaiberth Antonio, Luis Felipe Higuita Gutiérrez, and Juan Carlos Cataño Correa. Vínculos entre minería aurífera y salud: un estudio en Buriticá, Antioquia. Ediciones Universidad Cooperativa de Colombia, 2021. http://dx.doi.org/10.16925/9789587602876.
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The research about the relation of mining and health has traditionally been carried out ex post, that is, with evaluation of the effects of mining on the health profiles of miners or exposed people, time after to the start of this economic activity. This limits the evaluation of the impact of mining on health, given the lack of knowledge about health indicators prior to the start of mining, or due to the absence of a baseline to analyze series of time. In addition, specific indicators such as vector-borne diseases (for example, malaria morbidity or mortality in endemic areas with mining activity), respiratory problems, effects of contamination with materials used in mining, among other topics, are generally investigated in illegal mining contexts. In Colombia there are few publications about the health profiles in legal mining areas, prior to the mining phase, as a determining aspect to establish a baseline that allows quantitative evaluation of the impacts of this economic activity on the health of the exposed people. This research analyzes the health profile of the residents of a geographic area with the presence of underground gold mining in Buriticá-Antioquia, according to sociodemographic conditions during 2019. The central outcomes of this profile were risk factors related to health services and lifestyle, felt morbidity, overweight and obesity, high blood pressure, STIs, breast disorders, lung conditions, all with their potential socio-economic risks.
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Launois, Sandrine H., and Patrick Lévy. Pulmonary disorders and sleep. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0041.
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Sleep disorders and pulmonary diseases are closely associated, a fact clearly underestimated in routine patient care, despite evidence that these disorders interact to impact on quality of life as well as on morbidity and mortality. The prevalence of chronic insomnia, sleep-related breathing disorders, and restless leg syndrome is high in patients with chronic pulmonary disorders such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, chest wall and neuromuscular disorders, and chronic respiratory failure. This association may be fortuitous and reflect the impact of a chronic condition on sleep quality, or it may be due to specific sleep-related phenomena adversely affecting an underlying pulmonary disorder. Furthermore, obstructive sleep apnea has been implicated as a risk factor for pulmonary hypertension and pulmonary embolism. This chapter outlines the implications for both pulmonary and sleep specialists, in terms of clinical management and treatment strategies.
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Tuxen, David V. Pathophysiology and causes of airflow limitation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0110.
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Exacerbations of asthma or chronic obstructive pulmonary disease (COPD) can be life-threatening emergencies, and require careful management to minimize the risks of morbidity and mortality. Prompt, full bronchodilator therapy, careful observation and appropriate mechanical ventilation technique is required. Dynamic hyperinflation of the lungs occurs in all patients, and must be careful assessed and regulated. Excessive dynamic hyperinflation can result in respiratory tamponade, hypotension, circulatory failure, pneumothoraces and, in severe cases, cardiac arrest. Intravenous or continuous nebulized salbutamol commonly causes lactic acidosis that should be detected and managed. Prolonged paralysis during difficult mechanical ventilation can result in severe necrotizing myopathy. Pneumothoraces in ventilated patients with asthma are usually under tension, redistribute ventilation to the contralateral lung, and risk a second tension pneumothorax. Patients surviving mechanical ventilation for asthma and COPD have an increased risk of recurrence and death. All these problems require awareness, avoidance or detection and management
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Purandare, Amol, and Barbara A. Jantausch. Parvovirus. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190604813.003.0012.
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Parvovirus B19 is a common infection in humans that occurs worldwide. Parvovirus B19 is transmitted through exposure to respiratory droplets, blood, and blood products, and through mother-to-child transmission (MTCT) in utero. Intrauterine parvovirus B19 infection is a rare occurrence during pregnancy but can result in significant morbidity and mortality for the fetus, including severe fetal anemia and nonimmune fetal hydrops (NIFH). Intrauterine transfusion can be successful in treating fetal anemia. Neurodevelopmental impairment has been reported in infants with congenital infection who have received intrauterine transfusion (IUT). Future research on the development of antiviral agents for the treatment of parvovirus B19 infection in pregnant women is needed, along with the development of a parvovirus B19 vaccine. Longitudinal studies to evaluate neurodevelopmental outcome of infants with a history of congenital parvovirus B19 infection are needed in order to facilitate the optimal evaluation and management of these infants.
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Almond, Mark H., and Mark J. Griffiths. Swine ‘flu’ in pregnancy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0020.
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Influenza viruses are a significant cause of morbidity and mortality globally, resulting in severe illness in 3-5 million people and death in up to 500,000 during epidemic years. In March 2009, a novel H1N1 virus emerged in Mexico, spreading rapidly around the globe and achieving pandemic status within 3 months. Although it is now generally considered that the 2009 pandemic resulted in mild disease in most individuals, serious complications still occurred, with 12,000 deaths by mid-February 2010 in the United States alone. Risk factors for severe disease included asthma, cardiac disease, immunosuppression, pregnancy, diabetes mellitus, and obesity. The chapter outlines the case of a young pregnant female who presented with an influenza-like illness and subsequently developed acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. The origins, presentation, diagnosis, complications, and management of pandemic influenza are discussed, in addition to a summary of the pulmonary physiology and pathology of pregnancy.
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Berrill, Andrew, Will Jones, and David Pegg. Regional anaesthesia of the trunk. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0053.
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Analgesia of the thorax and abdomen can be challenging. Surgical incisions are commonly associated with severe postoperative pain. Whilst continuous epidural analgesia remains the ‘gold standard’ in terms of postoperative pain relief after major surgery, there remain concerns regarding rare serious side effects. It has been difficult to demonstrate conclusive evidence of improvement in outcomes when epidural analgesia is used. Superior pain relief and a reduction in postoperative respiratory morbidity are, however, clear advantages of regional anaesthesia. Interest has increased in techniques such as paravertebral and rectus sheath blocks in part due to the ready availability of high-definition portable ultrasound equipment, but also in response to concerns regarding neuraxial blockade and the development of enhanced recovery pathways. In addition, novel approaches to analgesia of the trunk, such as the transversus abdominis plane block, have been developed and are now widely used as part of a multimodal analgesic regimen. In this chapter, techniques of neuraxial and peripheral nerve block are discussed along with their indications and complications.
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Whittle, Ian. Raised intracranial pressure, cerebral oedema, and hydrocephalus. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0604.
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The brain is protected by the cranial skeleton. Within the intracranial compartment are also cerebrospinal fluid, CSF, and the blood contained within the brain vessels. These intracranial components are in dynamic equilibrium due to the pulsations of the heart and the respiratory regulated return of venous blood from the brain. Normally the mean arterial blood pressure, systemic venous pressure, and brain volume are regulated to maintain physiological values for intracranial pressure, ICP. There are a range of very common disorders such as stroke, and much less common, such as idiopathic intracranial hypertension, that are associated with major disturbances of intracranial pressure dynamics. In some of these the contribution to pathophysiology is relatively minor whereas in others it may be substantial and be a major contributory factor to morbidity or even death.Intracranial pressure can be disordered because of brain oedema, disturbances in CSF flow, mass lesions, and vascular engorgement of the brain. Each of these may have variable causes and there may be interactions between mechanisms. In this chapter the normal regulation of intracranial pressure is outlined and some common disease states in clinical neurological practice that are characterized by either primary or secondary problems in intracranial pressure dynamics described.
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The Case for Investment in Prevention and Control of Noncommunicable Diseases in Jamaica: Evaluating the return on investment of selected tobacco, alcohol, diabetes, and cardiovascular disease interventions. Organización Panamericana de la Salud, 2018. http://dx.doi.org/10.37774/9789275120545.
Full textAbstract:
Noncommunicable diseases (NCDs) are a major driver of morbidity and mortality in Jamaica. Beyond the toll on health, NCDs also impose a significant burden on the national economy since individuals with NCDs are more likely to exit the labor force, miss days of work, and/or work at reduced capacity. In addition, high expenditures to treat NCDs impose a direct economic burden to the health system, the society and to the nation of Jamaica, which can lead to reduced investments in areas like education and physical capital, which increase gross domestic product (GDP) in the long run. Unless urgently and adequately addressed, the health and economic burden of NCDs will continue to rise. To help strengthen Member States’ capacity to generate and use economic evidence on NCDs, the Pan American Health Organization (PAHO) partnered with the Ministry of Health of Jamaica, the World Health Organization (WHO), the United Nations Development Programme (UNDP), and RTI International to develop an Investment Case for NCDs in Jamaica […] It should be noted that the focused nature of the case underestimates the true costs associated with NCDs in Jamaica: only 17 out of the 88 interventions cited in the updated Appendix 3 of the WHO Global NCD Action Plan 2013-2020 are modeled; cancer and chronic respiratory disease interventions are not considered; not all the health benefits of the interventions (for example, the impact of tobacco control policies on lung cancer or chronic respiratory diseases) are accounted for; and for alcohol policies, only the economic impact of adverted mortality is included (the benefits of reducing absenteeism and presenteeism are not) due to methodological limitations. Acknowledgments: We would like to express our appreciation to the following institutions for their contributions to the successful implementation of NCD Investment Case in Jamaica and to the preparation of this Report: Ministry of Health of Jamaica, RTI International, Pan American Health Organization, United Nations Development Programme, and the United Nations Interagency Task Force on Noncommunicable Diseases.
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Nates, Joseph L., and Sharla K. Tajchman. Indirect calorimetry in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0205.
Full textAbstract:
Critically-ill patients have unpredictable and dynamic metabolic demands that are difficult to predict and quantify. Combined with the high incidence of pre-existing or development of malnutrition in the ICU, these metabolic demands have deleterious effects on outcomes when patients are provided with inadequate or inappropriate nutrition support. Providing adequate nutritional support that meets these varying metabolic demands is a long-standing challenge in the intensive care unit (ICU). Indirect calorimetry (ICal) is a tool that allows ICU practitioners to accurately assess energy expenditure (EE) in critically-ill patients with unpredictable metabolic demands to optimize nutrition support. ICal provides clinicians with a patient’s measured EE (MEE), a quantification of cellular metabolism, and respiratory quotient (RQ), a reflection of which substrates are primarily being utilized for fuel. Study results help clinicians target optimal nutritional goals and prevent adverse effects associated with both under- and overfeeding patients. Recent studies have suggested avoiding caloric deficits and providing tight caloric control may improve morbidity and mortality outcomes in critically-ill patients, though more studies are needed to verify this potential benefit. Currently, there are no specific guideline recommendations to help clinicians utilize ICal in the ICU. Although ICal is considered to be the gold standard for determining EE in critically-ill patients, its use remains limited by availability, cost, and the need for trained personnel for correct use.
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McGregor, Laura, Monica N. Gupta, and Max Field. Septic arthritis in adults. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0098.
Full textAbstract:
Septic arthritis (SA) is a medical emergency with mortality of around 15%. Presentation is usually monoarticular but in more than 10% SA affects two or more joints. Symptoms include rapid-onset joint inflammation with systemic inflammatory responses but fever and leucocytosis may be absent at presentation. Treatment according to British Society of Rheumatology/British Orthopaedic Association (BSR/BOA) guidelines should be commenced if there is a suspicion of SA. At-risk patients include those with primary joint disease, previous SA, recent intra-articular surgery, exogenous sources of infection (leg ulceration, respiratory and urinary tract), and immunosupression because of medical disorders, intravenous drug use or therapy including tumour necrosis factor (TNF) inhibitors. Synovial fluid should be examined for organisms and crystals with repeat aspiration as required. Most SA results from haematogenous spread-sources of infection should be sought and blood and appropriate cultures taken prior to antibiotic treatment. Causative organisms include staphylococcus (including meticillin-resistant Staphylococcus aureus, MRSA), streptococcus, and Gram-negative organisms (in elderly patients), but no organism is identified in 43%, often after antibiotic use before diagnosis. Antibiotics should be prescribed according to local protocols, but BSR/BOA guidelines suggest initial intravenous and subsequent oral therapy. Medical treatment may be as effective as surgical in uncomplicated native SA, and can be cost-effective, but orthopaedic advice should be sought if necessary and always in cases of infected joint prostheses. In addition to high mortality, around 40% of survivors following SA develop limitation of joint function. Guidelines provide physicians with treatment advice aiming to limit mortality and morbidity and assist future research.
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Jayne, David. Treatment of ANCA-associated vasculitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0132.
Full textAbstract:
The goals of treatment in anti-neutrophil cytoplasm antibody (ANCA) vasculitis are to stop vasculitic activity, to prevent vasculitis returning, and to address longer-term comorbidities caused by tissue damage, drug toxicity, and increased cardiovascular and malignancy risk. Cyclophosphamide and high-dose glucocorticoids remain the standard induction therapy with alternative immunosuppressives, such as methotrexate or azathioprine, to prevent relapse. Refractory disease resulting from a failure of induction or remission maintenance therapy requires alternative agents and rituximab has been particularly effective. Replacement of cyclophosphamide by rituximab for remission induction is supported by recent evidence. Additional therapy with intravenous methylprednisolone and plasma exchange is employed in severe presentations with failing vital organ function. Drug toxicity contributes to comorbidity and mortality and has led to newer regimens with reduced cyclophosphamide exposure. Glucocorticoid toxicity remains a major problem, with controversy over the rapidity with which glucocorticoids can be reduced or withdrawn. Disease relapse occurs in 50% and requires early detection at a stage when it will not adversely affect outcomes. Rates of cardiovascular disease and malignancy are higher than in control populations but strategies to reduce their risk, apart from cyclophosphamide-sparing regimens, have not been developed. Thromboembolic events occur in 10% and may be linked to the recently identified autoantibodies to plasminogen and tissue plasminogen activator. Outcomes of vasculitis depend heavily on the level of tissue damage at diagnosis, especially renal dysfunction, but are also influenced by patient age, ANCA subtype, disease extent, and response to therapy. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)is treated along similar principles to granulomatosis with polyangiitis (GPA) and microscopic polyangiitis but the persistence of steroid-dependent asthma in over one-third and differences in pathogenesis has suggested alternative treatment approaches. Chronic morbidity results from tissue damage and is especially common in the upper and lower respiratory tract and kidneys. Tracheobronchial disease is a severe late complication of GPA, while deafness, nasal obstruction, and chronic sinusitis are sequelae of nasal and ear vasculitis. Chronic infection of damaged epithelial surfaces acts as a drive for vasculitic activity and adequate infection control is necessary for stable remission. Chronic kidney disease can stabilize for many years but the risks of endstage renal disease (ESRD) are increased by acute kidney injury at presentation or renal relapse. Renal transplantation is successful, with similar outcomes to other causes of ESRD.
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Frew, Anthony. Air pollution. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0341.
Full textAbstract:
Any public debate about air pollution starts with the premise that air pollution cannot be good for you, so we should have less of it. However, it is much more difficult to determine how much is dangerous, and even more difficult to decide how much we are willing to pay for improvements in measured air pollution. Recent UK estimates suggest that fine particulate pollution causes about 6500 deaths per year, although it is not clear how many years of life are lost as a result. Some deaths may just be brought forward by a few days or weeks, while others may be truly premature. Globally, household pollution from cooking fuels may cause up to two million premature deaths per year in the developing world. The hazards of black smoke air pollution have been known since antiquity. The first descriptions of deaths caused by air pollution are those recorded after the eruption of Vesuvius in ad 79. In modern times, the infamous smogs of the early twentieth century in Belgium and London were clearly shown to trigger deaths in people with chronic bronchitis and heart disease. In mechanistic terms, black smoke and sulphur dioxide generated from industrial processes and domestic coal burning cause airway inflammation, exacerbation of chronic bronchitis, and consequent heart failure. Epidemiological analysis has confirmed that the deaths included both those who were likely to have died soon anyway and those who might well have survived for months or years if the pollution event had not occurred. Clean air legislation has dramatically reduced the levels of these traditional pollutants in the West, although these pollutants are still important in China, and smoke from solid cooking fuel continues to take a heavy toll amongst women in less developed parts of the world. New forms of air pollution have emerged, principally due to the increase in motor vehicle traffic since the 1950s. The combination of fine particulates and ground-level ozone causes ‘summer smogs’ which intensify over cities during summer periods of high barometric pressure. In Los Angeles and Mexico City, ozone concentrations commonly reach levels which are associated with adverse respiratory effects in normal and asthmatic subjects. Ozone directly affects the airways, causing reduced inspiratory capacity. This effect is more marked in patients with asthma and is clinically important, since epidemiological studies have found linear associations between ozone concentrations and admission rates for asthma and related respiratory diseases. Ozone induces an acute neutrophilic inflammatory response in both human and animal airways, together with release of chemokines (e.g. interleukin 8 and growth-related oncogene-alpha). Nitrogen oxides have less direct effect on human airways, but they increase the response to allergen challenge in patients with atopic asthma. Nitrogen oxide exposure also increases the risk of becoming ill after exposure to influenza. Alveolar macrophages are less able to inactivate influenza viruses and this leads to an increased probability of infection after experimental exposure to influenza. In the last two decades, major concerns have been raised about the effects of fine particulates. An association between fine particulate levels and cardiovascular and respiratory mortality and morbidity was first reported in 1993 and has since been confirmed in several other countries. Globally, about 90% of airborne particles are formed naturally, from sea spray, dust storms, volcanoes, and burning grass and forests. Human activity accounts for about 10% of aerosols (in terms of mass). This comes from transport, power stations, and various industrial processes. Diesel exhaust is the principal source of fine particulate pollution in Europe, while sea spray is the principal source in California, and agricultural activity is a major contributor in inland areas of the US. Dust storms are important sources in the Sahara, the Middle East, and parts of China. The mechanism of adverse health effects remains unclear but, unlike the case for ozone and nitrogen oxides, there is no safe threshold for the health effects of particulates. Since the 1990s, tax measures aimed at reducing greenhouse gas emissions have led to a rapid rise in the proportion of new cars with diesel engines. In the UK, this rose from 4% in 1990 to one-third of new cars in 2004 while, in France, over half of new vehicles have diesel engines. Diesel exhaust particles may increase the risk of sensitization to airborne allergens and cause airways inflammation both in vitro and in vivo. Extensive epidemiological work has confirmed that there is an association between increased exposure to environmental fine particulates and death from cardiovascular causes. Various mechanisms have been proposed: cardiac rhythm disturbance seems the most likely at present. It has also been proposed that high numbers of ultrafine particles may cause alveolar inflammation which then exacerbates preexisting cardiac and pulmonary disease. In support of this hypothesis, the metal content of ultrafine particles induces oxidative stress when alveolar macrophages are exposed to particles in vitro. While this is a plausible mechanism, in epidemiological studies it is difficult to separate the effects of ultrafine particles from those of other traffic-related pollutants.