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48 results

Page 1 of 3

  • Chapter 54 - Antiviral Drugs

  • from Section 5 - Patient Management
  • Tim Wreghitt, Addenbrooke’s Hospital, Goura Kudesia, Sheffield Teaching Hospitals
  • Book:
    Clinical and Diagnostic Virology
    Published online:
    11 April 2024
    Print publication:
    18 April 2024, pp 263-273

  • Summary

    This chapter provides an overview of the antiviral drugs currently available, including maraviroc, aciclovir, penciclovir, ganciclovir, amantadine, zydovudine, adefovir, ribavirin, indinavir , oseltamivir, zanamivir, interferon alpha, rituximab , palivizumab, cidofovir, brincidofovir, foscarnet, remdesivir and paxlovid with an indication of their modes of action for treating virus infections, including HIV, herpes viruses, respiratory viruses, HBV, HCV, CMV, adenoviruses , BK, EBV (especially for PTLD), RSV, poxviruses and SARS-CoV-2.

  • Chapter 56 - Infection Control

  • from Section 5 - Patient Management
  • Tim Wreghitt, Addenbrooke’s Hospital, Goura Kudesia, Sheffield Teaching Hospitals
  • Book:
    Clinical and Diagnostic Virology
    Published online:
    11 April 2024
    Print publication:
    18 April 2024, pp 282-285

  • Summary

    This chapter deals with how infection control procedures can be used to minimise the spread of viral infections transmitted via the respiratory, gastrointestinal, blood-borne, sexual, vertical and vector-borne routes. It also details infection control strategies in hospitals and in the community via universal precautions, respiratory precautions, enteric precautions and those for highly dangerous pathogens. Post-exposure prophylaxis and management of outbreaks is also discussed along with a list of notifiable infections.

  • Chapter 40 - Respiratory Virus Infections

  • from Section 3 - Clinical Syndromes
  • Tim Wreghitt, Addenbrooke’s Hospital, Goura Kudesia, Sheffield Teaching Hospitals
  • Book:
    Clinical and Diagnostic Virology
    Published online:
    11 April 2024
    Print publication:
    18 April 2024, pp 192-196

  • Summary

    This chapter details the epidemiology, route of spread, prevalence and incubation periods of viruses causing respiratory symptoms (adenoviruses, SARS-CoV-2, enteroviruses, influenza, HMPV, parainfluenzaviruses, RSV, rhinoviruses). It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

A Review of Blastozoan Echinoderm Respiratory Structures

A Review of Blastozoan Echinoderm Respiratory Structures
  • Sarah L. Sheffield, Maggie R. Limbeck, Jennifer E. Bauer, Stephen A. Hill, Martina Nohejlová
  • Published online:
    16 December 2022
    Print publication:
    26 January 2023
  • Echinoderms have evolved diverse and disparate morphologies throughout the Phanerozoic. Among them, blastozoans, an extinct group of echinoderms that were an important component of Paleozoic marine ecosystems, are primarily subdivided into groups based on the morphology of respiratory structures. However, systematic and phylogenetic research from the past few decades have shown that respiratory structures in blastozoans are not group-defining and they have re-evolved throughout echinoderm evolution. This Element provides a review of the research involving blastozoan respiratory structures, along with research concerning the morphology, paleoecology, and ontogeny of each of the major groupings of blastozoans as it relates to their corresponding respiratory structures. Areas of future research in these groups are also highlighted.

  • Chapter 20 - Anaesthetic Breathing Systems

  • Edited by Daniel Rodger, Kevin Henshaw, Paul Rawling, Scott Miller
  • Book:
    Fundamentals of Operating Department Practice
    Published online:
    18 August 2022
    Print publication:
    08 September 2022, pp 218-223

  • Summary

    Anaesthetic breathing systems are used to deliver oxygen and anaesthetic gases to patients and remove carbon dioxide. A breathing system is most commonly attached to an anaesthetic machine, which is designed to deliver the fresh gas flow to the patient via a facemask, a supraglottic device or an endotracheal tube. The breathing system used can affect the composition of the gas and volatile anaesthetic mixture inhaled by the patient, and so it is important to understand the different breathing systems used in anaesthesia. This chapter describes the key components of the different breathing systems and explores the benefits and disadvantages of the circuits in the Mapleson classification.

  • Obesity and loss of ambulation are associated with lower extremity oedema in Duchenne muscular dystrophy

  • Joshua M Freytag, Thomas D Ryan, Jean E Bange, Kelly C Bonarrigo, Wendy A Chouteau, Samuel G Wittekind, Cuixia Tian, Zhiqian Gao, Chet R Villa
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 4 / April 2023
    Published online by Cambridge University Press:
    13 May 2022, pp. 597-602
    • Article
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  • Patients with Duchenne muscular dystrophy have multiple risk factors for lower extremity oedema. This study sought to define the frequency and predictors of oedema. Patients aged 15 years and older were screened by patient questionnaire, and the presence of oedema was confirmed by subsequent physical exam. Twenty-four of 52 patients (46%) had oedema, 12 of whom had swelling extending above the foot and two with sores/skin breakdown. There was no significant difference in age, frequency, or duration of glucocorticoid use, non-invasive respiratory support use, forced vital capacity, cardiac medication use, or ejection fraction between patients with and without oedema (all p > 0.2). Those with oedema had a greater time since the loss of ambulation (8.4 years versus 3.5 years; p = 0.004), higher body mass index (28.3 versus 24.8; p = 0.014), and lower frequency of deflazacort use (67% versus 89%; p = 0.008). Multivariate analysis revealed a longer duration of loss of ambulation (p = 0.02) and higher body mass index (p = 0.009) as predictors of oedema. Lower extremity oedema is common in Duchenne muscular dystrophy but independent of cardiac function. Interventions focused on minimising body mass index increases over time may be a therapeutic target.

  • Effectiveness of Mask-Wearing on Respiratory Illness Transmission in Community Settings: A Rapid Review

  • Megan Baier, Mary Jo Knobloch, Fauzia Osman, Nasia Safdar
  • Journal:
    Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
    Published online by Cambridge University Press:
    07 March 2022, e96
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  • Objective:

    Respiratory illnesses, including coronavirus disease 2019 (COVID-19), have resulted in millions of deaths globally. Guidance on mask-wearing in community settings has been inconsistent. This review examined the effectiveness of mask-wearing on respiratory virus transmission in community settings.

    Methods:

    A search was conducted for English language reports of randomized controlled trials of mask-wearing in the community and effect on laboratory-confirmed respiratory infections or influenza-like illness. Investigators abstracted study characteristics and assessed bias. Meta-analysis was conducted to calculate pooled risk estimates.

    Results:

    Eleven studies were included. In 7 studies that evaluated influenza-like illness symptoms as an outcome (3029 participants), this study found mask-wearing associated with a decreased risk of influenza-like illness (overall risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.96). Studies examining laboratory-confirmed respiratory infections as an outcome (10,531 participants) showed no statistically significant association between mask-wearing and infections (RR, 1.04; 95% CI, 0.60-1.80). However, masking combined with enhanced hand hygiene was associated with a decreased risk for both influenza-like illness symptoms (RR, 0.88; 95% CI, 0.51-1.51) and laboratory-confirmed respiratory infection (RR, 0.79; 95% CI, 0.52-1.18).

    Conclusions:

    Masking in community settings decreases transmission of influenza-like illness. Mask-wearing combined with enhanced hand hygiene reduces transmission of influenza-like illness and laboratory-confirmed respiratory infection.

  • 5.1.4 - Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient

  • from Section 5.1 - Practical Respiratory System
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 534-537

  • Summary

    Key Learning Points

    1. 1. Fibreoptic bronchoscopy (FOB) is generally a safe procedure that is performed at the bedside in the ICU, thus avoiding potentially dangerous transfers out of the ICU.

    2. 2. FOB is utilised for both diagnostic and therapeutic purposes.

    3. 3. FOB-guided broncho-alveolar lavage (BAL) and protected brush specimen (PSB) are extremely valuable procedures and have a high diagnostic yield in identification of the causative organism in pneumonia.

    4. 4. FOB is increasingly used in managing difficult airway and in inserting percutaneous tracheostomy devices.

    5. 5. In intubated patients, FOB increases airway resistance during the procedure. This causes an increase in the peak inspiratory pressure (PIP) and peak end-expiratory pressure (PEEP), which may result in barotrauma.

  • Improving antibiotic prescribing for pediatric acute respiratory tract infections: A cluster randomized trial to evaluate individual versus clinic feedback

  • Herbert W. Clegg, Stephen J. Ezzo, Kelly B. Flett, William E. Anderson
  • Journal:
    Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue 1 / 2021
    Published online by Cambridge University Press:
    03 November 2021, e43
    • Article
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  • Objective:

    To assess the effect of individual compared to clinic-level feedback on guideline-concordant care for 3 acute respiratory tract infections (ARTIs) among family medicine clinicians caring for pediatric patients.

    Design:

    Cluster randomized controlled trial with a 22-month baseline, 26-month intervention period, and 12-month postintervention period.

    Setting and participants:

    In total, 26 family medicine practices (39 clinics) caring for pediatric patients in Virginia, North Carolina, and South Carolina were selected based upon performance on guideline-concordance for 3 ARTIs, stratified by practice size. These were randomly allocated to a control group (17 clinics in 13 practices) or to an intervention group (22 clinics in 13 practices).

    Interventions:

    All clinicians received an education session and baseline then monthly clinic-level rates for guideline-concordant antibiotic prescribing for ARTIs: upper respiratory tract infection (URI), acute bacterial sinusitis (ABS), and acute otitis media (AOM). For the intervention group only, individual clinician performance was provided.

    Results:

    Both intervention and control groups demonstrated improvement from baseline, but the intervention group had significantly greater improvement compared with the control group: URI (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.37–1.92; P < 0.01); ABS (OR, 1.45; 95% CI, 1.11–1.88; P < 0.01); and AOM (OR, 1.59; 95% CI, 1.24–2.03; P < 0.01). The intervention group also showed significantly greater reduction in broad-spectrum antibiotic prescribing percentage (BSAP%): odds ratio 0.80, 95% CI 0.74-0.87, P < 0.01. During the postintervention year, gains were maintained in the intervention group for each ARTI and for URI and AOM in the control group.

    Conclusions:

    Monthly individual peer feedback is superior to clinic-level only feedback in family medicine clinics for 3 pediatric ARTIs and for BSAP% reduction.

    Trial registration:

    ClinicalTrials.gov identifier: NCT04588376, Improving Antibiotic Prescribing for Pediatric Respiratory Infection by Family Physicians with Peer Comparison.

  • The National Animal Health Monitoring System's perspective on respiratory disease in dairy cattle

  • Diana M. Short, Jason E. Lombard
  • Journal:
    Animal Health Research Reviews / Volume 21 / Issue 2 / December 2020
    Published online by Cambridge University Press:
    08 March 2021, pp. 135-138

  • In 1991, USDA's National Animal Health Monitoring System (NAHMS) conducted its first dairy study, a baseline assessment that focused on the health and management of heifer calves. During the study, producers ranked respiratory disease among the top two most common health problems affecting dairy calves. Over the last 25 years, U.S. dairy producers have participated in six NAHMS studies, yielding a rich repository of information that has helped identify needs for research, extension, and education in the dairy industry. NAHMS’ most recent dairy study, conducted in 2014, provides the latest estimates on dairy cattle health and includes another in-depth look at heifer-calf health. While overall mortality in calves has decreased, bovine respiratory disease (BRD) remains an important cause of morbidity in calves. This raises the concern that BRD mitigation may be at a standstill on dairies. Research and on-farm experience have done much to elucidate the challenges associated with detection and perceived impacts of this complex disease. Continued development and implementation of new methods for monitoring health and detecting disease will provide additional tools to upend stalemating factors associated with BRD control, helping the dairy industry ‘turn a corner’ on this important disease.

  • Immune status, well-being and gut microbiota in military supplemented with synbiotic ice cream and submitted to field training: a randomised clinical trial

  • Maria C. P. R. Valle, Isabel A. Vieira, Luciana C. Fino, Darlila A. Gallina, Andrea M. Esteves, Diogo T. da Cunha, Lucélia Cabral, Fabiana B. Benatti, Mario R. Marostica Junior, Ângela G. Batista, Rosangela Santos, Glaucia M. Pastore, Adilson Sartoratto, Katia Sivieri, Polyana C. Tizioto, Luiz L. Coutinho, Adriane E. C. Antunes
  • Journal:
    British Journal of Nutrition / Volume 126 / Issue 12 / 28 December 2021
    Published online by Cambridge University Press:
    17 February 2021, pp. 1794-1808
    Print publication:
    28 December 2021
    • Article
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  • Strenuous physical activity, sleep deprivation and psychological stress are common features of military field training. The present study aimed to evaluate the effects of supplementation with a synbiotic ice cream on salivary IgA, gastrointestinal symptoms, well-being indicators and gut microbiota in young military participants undergoing field training. Sixty-five military completed the study: one group was supplemented for 30 d with synbiotic ice cream containing: 2·1 × 108 CFU/g for Lactobacillus acidophilus LA-5 and 2·7 × 109 CFU/g for Bifidobacterium animalis BB-12 and 2·3 g of inulin in the 60 g of ice cream at manufacture, and the other with a placebo ice cream. Volunteers were evaluated at pre-supplementation (baseline), post-supplementation and after a 5-d military training. Bifidobacterium and Lactobacillus genera were measured in stool samples and both showed a higher differential abundance post-supplementation and training. Salivary IgA and gastrointestinal symptoms decreased at post-training in both groups (P < 0·05; main effect of time); however, supplementation with synbiotic did not mitigate this effect. Tenseness and sleepiness were decreased in the synbiotic-treated group, but not in the placebo group at post-military training (P = 0·01 and 0·009, respectively; group × time effect). The other well-being indicators were not affected by the synbiotic supplementation. In conclusion, 30 d of synbiotic ice cream supplementation containing inulin, L. acidophilus LA-5 and B. animalis BB-12 favourably modulated gut microbiota and improved tenseness and sleepiness in healthy young military undergoing a 5-d field training. These improvements may be relevant to this population as they may influence the decision-making process in an environment of high physical and psychological stress.

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