Management strategy for cancer patients in the context of the COVID-19 epidemic
А. А. ИзмайловOzal BeylerliВ. Н. ПавловIlgiz GareevМ. В. ЗабелинRustem AyupovШ. И. МусинА. В. Султанбаев
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This prospective study examined the frequency and severity of respiratory illnesses in survivors of preterm birth compared with those in full-term infants. Although preterm infants did not demonstrate an inherent risk of subsequent respiratory illness when compared with full-term infants, earlier and more severe lower respiratory illnesses were observed among survivors of idiopathic respiratory distress syndrome (RDS). Infants who survived RDS but who developed residual lung disease had a greater risk of both more frequent and more severe subsequent lower respiratory illnesses than did RDS survivors who did not have persistent roentgenographic changes. We suggest that the risk of increased respiratory illness in these infants was a consequence of residual pulmonary abnormalities apparent on the chest roentgenogram at discharge from the nursery. Agents associated with respiratory illnesses were similar in all groups of study patients.
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Respiratory distress syndrome, previously called hyaline membrane disease, is a common cause of morbidity and mortality associated with premature delivery. The incidence and severity of respiratory distress syndrome generally increase with decreasing gestational age at birth, and its occurrence in the at-term baby is rare. We report a male newborn who was born via elective cesarean section at 38 4/7 weeks gestation. After birth, he subsequently had severe respiratory distress typical of surfactant deficiency severe enough to be managed with ventilator support. He showed no evidence of intrapartum infection or aspiration. After two doses of surfactant were instilled via endotracheal tube, his respiratory condition showed dramatic improvement and recovered fully without complication before discharge. We report this case to emphasize the possibility that a term baby may develop surfactant-deficient respiratory failure and to suggest that elective delivery before 39 weeks gestation should be undertaken only for good medical reasons. In addition, the pathogenesis of acute respiratory distress syndrome in full-term neonates is discussed.
Meconium aspiration syndrome
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A 10-year-old boy presented with facial swelling, thick exudates in the nasal cavities with membranes covering the nasopharynx, shock and respiratory distress. X-ray of the paranasal sinuses showed opacification of both maxillary sinuses. Nasal diphtheria was suspected but culture of the membranes grew Bacillus anthracis. Chest X-ray showed mediastinal widening and extensive pulmonary infiltrates compatible with respiratory anthrax.
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Atypical pneumonia
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BACKGROUND: Tumour necrosis factor alpha may contribute to the lung damage that occurs in the adult respiratory distress syndrome. Whether it occurs in the lungs of preterm infants with respiratory distress syndrome is unknown. METHODS: Tumour necrosis factor alpha concentrations in the bronchopulmonary secretions of 28 ventilated preterm infants were determined by the enzyme linked immunosorbent assay. RESULTS: Concentrations were low in the first three days of life, being undetectable in nine of the 20 infants whose bronchopulmonary secretions were sampled. From day 4 concentrations were increased and detectable in all but two of 14 infants. Similar concentrations were found in samples taken on days 8-20 and 21-40. Greater mean concentrations occurred in those infants requiring oxygen for a long time. In six infants who received dexamethasone treatment for prolonged ventilator dependency treatment was associated with a reduction in tumour necrosis factor alpha concentrations. CONCLUSIONS: Tumour necrosis factor may contribute to the neonatal respiratory distress syndrome, as suggested for the adult respiratory distress syndrome. The therapeutic effects of dexamethasone treatment in neonatal respiratory distress syndrome may be mediated, at least in part, by reduced production of pulmonary tumour necrosis factor.
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L-arginine is the precursor of nitric oxide which plays an important role on pulmonary circulation and pulmonary vascular tone. Our aim was to compare the levels of L-arginine between infants with respiratory distress syndrome and infants without respiratory distress syndrome and to determine the relationship between plasma L-arginine concentrations and severity of disease. Thirty premature infants who were admitted to our neonatal intensive care unit were included the study. Seventeen of these infants with respiratory distress syndrome were study group and the other 13 infants without respiratory distress syndrome served as controls. Blood collection was made before any treatment or intervention given to infants and tandem mass spectrometry was used for laboratory testing. In the respiratory distress syndrome group mean L-arginine level was 33.0 (± 11.5) mM/l, and in controls it was 79.0 (± 23) mM/l. This difference was statistically significant (P < 0.05). There was a reverse relationship between L-arginine levels and oxygenation index (r = 0.732, P = 0.001). If level of L-arginine is low or insufficient in respiratory distress syndrome patients' nitric oxide level would decrease in pulmonary circulation and results increased pulmonary resistance and severity of respiratory distress syndrome. We concluded that L-arginine levels are low in patients with rspiratory distress syndrome and for further investigations, supplementation of respiratory distress syndrome patients with L-arginine may decrease disease severity. Pediatr Pulmonol. © 2005 Wiley-Liss, Inc.
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