Chest
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We undertook systematic reviews to examine key questions (KQs) related to pediatric chronic wet cough. In children with chronic (>4-weeks) wet/productive cough not related to bronchiectasis; (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should they be referred for further investigations? ⋯ There is high quality evidence that in children aged ≤14-years with chronic (>4-weeks duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high quality evidence that when specific cough pointers (e.g. digital clubbing) are present in children with wet cough, further investigations (e.g. flexible bronchoscopy, chest CTs and immunity tests) should be undertaken. When the wet cough does not improve by 4-weeks of antibiotics, there is moderate quality evidence that children should be referred to a major center for consideration of further investigations to determine whether an underlying lung or other disease are present.
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Randomized Controlled Trial
Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Woodsmoke Exposure: Results From RESPIRE and CRECER.
COPD is the third most frequent cause of death globally, with much of this burden attributable to household biomass smoke exposure in developing countries. As biomass smoke exposure is also associated with cardiovascular disease, lower respiratory infection, lung cancer, and cataracts, it presents an important target for public health intervention. ⋯ In these young Guatemalan women, there was no association between lung function and early randomization to a chimney stove or personal wood smoke exposure. Future stove intervention trials should incorporate cleaner stoves, longer follow-up, or potentially susceptible groups to identify meaningful differences in lung function.
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Randomized Controlled Trial
A double-blind placebo-controlled study of the effects of olprinone, a specific phosphodiesterase-III inhibitor, for preventing postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer.
We previously reported that patients with elevated preoperative B-type natriuretic peptide (BNP) levels have an increased risk for postoperative atrial fibrillation following lung cancer surgery. The present study evaluated whether the specific phosphodiesterase III inhibitor olprinone can reduce the incidence of postoperative atrial fibrillation in patients with elevated BNP levels undergoing pulmonary resection for lung cancer. ⋯ Continuous infusion of olprinone during lung cancer surgery was safe and reduced the incidence of postoperative atrial fibrillation following pulmonary resection in patients with elevated preoperative BNP levels.
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Randomized Controlled Trial Multicenter Study
Delirium and circadian rhythm of melatonin during weaning from mechanical ventilation: An ancillary study of a weaning trial.
Delirium is frequent in patients in the ICU, but its association with the outcome of weaning from mechanical ventilation has not been assessed. Circadian rhythm alteration may favor delirium. In the current study, we assessed the impact of delirium during weaning and associated alterations in the circadian rhythm of melatonin excretion. ⋯ Delirium is frequent at the initiation of ventilator weaning. It is associated with a prolongation of weaning and an alteration in the circadian rhythm of melatonin excretion.
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Randomized Controlled Trial
Simvastatin suppresses airway IL-17 and upregulates IL-10 in patients with stable COPD.
Statins have immunomodulatory properties that may provide beneficial effects in the treatment of COPD. We investigated whether a statin improves the IL-17/IL-10 imbalance in patients with COPD, as has previously been demonstrated in patients with asthma. ⋯ Simvastatin reversed the IL-17A/IL-10 imbalance in the airways and reduced sputum macrophage but not neutrophil counts in patients with COPD.