Left atrial myxomas are the most common type of benign primary cardiac tumor. Patients can present with generalized symptoms, such as fatigue, symptoms from obstruction of the myxoma, or even embolization of the myxoma causing distal thrombosis. We describe a case with several-month duration of syncopal episodes that occurred after coughing and with exertion. Computed tomography of the chest showed a 6.1 cm by 4.5 cm mass in the left atrium, later evaluated with an echocardiogram. Cardiothoracic surgery removed the mass, and it was determined to be an atrial myxoma. It is important for an internist to be able to diagnose an atrial myxoma because of the risks associated with embolization and even sudden death as myxoma can block blood supply from atrium to ventricle.

Background and Objectives: Pertussis is an infectious disease caused by the Gram-negative bacterium Bordetella pertussis. In Peru, actual public health programs indicate that vaccination against B. pertussis must be mandatory and generalized, be-sides all detected cases must be reported. The objective of this study was to determine the prevalence of B. pertussis among children under five years of age with a presumptive diagnosis of whopping cough in Cajamarca, a region located in northern Peru. Materials and Methods: The population of this cross-sectional study were children under 5 years old hospitalized as presumptive cases of pertussis during December 2017 to December 2018. The nasopharyngeal samples were analyzed by real-time PCR for the detection of B. pertussis. Results: B. pertussis was identified as PCR + in 42.3% of our sample (33/78). The clinical presentation that was observed most frequently includes paroxysmal coughing (97%), difficulty breathing (69.7%), cyanosis (72.7%) and post-tussive em-esis (60.6%). Additionally, pneumonia was the most observed complication (33.3%). Four of the patients with PCR+ for B. pertussis presented only lymphocytosis, five only leukocytosis, two patients with decreased leukocytosis and lymphocytes and only one patient with leukopenia and relative lymphocytosis. There was a percentage of 84.8% of unvaccinated children in the PCR+ group. Finally, the mother was the most frequent symptom carrier (18.2%). Conclusion: In conclusion, in the studied population there is a high rate of PCR+ cases for B. pertussis. Laboratory values may show leukopenia or lymphopenia in patients with pertussis. It is necessary to use appropriate laboratory diagnostic tests in all infants with respiratory symptoms for B. pertussis. Since, the clinical diagnosis overestimates the diagnosis of pertussis. / Revisión por pares

No description available.

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 1998. / Typescript. Bibliography: leaves 118-128.

Chung Hoi Sing. / "August 2001." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 186-204) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Bioassays of total alkaloids of S. tuberosa samples representing the four types of chemical profiles were conducted on guinea pigs using citric acid aerosol for inducing cough. These results demonstrated their antitussive properties and thus suggested the possibility of other antitussive alkaloids than neotuberostemonine in S. tuberosa. So it became necessary to identify the major components in the samples of S. tuberosa representing the four types of chemical profiles. / Bioassays on guinea pigs of the four major components of S. tuberosa demonstrated their antitussive properties. Except a lower potency in tuberostemonine, antitussive effects of croomine and stemoninine showed similar or even stronger potency than neotuberostemonine at 25 and 50 mg/kg by intragastric administration. These four antitussive alkaloids could be used as lead compounds for the development of new antitussive drugs and as bioactive markers in quality control of the herb S. tuberosa and related products. / Cough is an airway defensive reflex, which is responsible for keeping the airway free of obstruction and harmful substances. As the commonest symptom for which medical advices is sought, enormous costs are spent on cough treatments. Regretfully, currently used antitussives are less than satisfactory due to their low potency or obvious side effects. So it is necessary to continue developing new and better antitussives. / Electrical stimulation of the superior laryngeal nerve on guinea pigs at 100 mg/kg through intraperitoneal administration indicated that croomine acted on the central pathway of cough reflex accompanied by respiratory depression. On the other hand, neotuberostemonine, tuberostemonine and stemoninine acted on the peripheral pathway without any observable side effects. These three alkaloids could be promising for developing new peripherally acting antitussives. Further, tuberostemonine was tested on primary cultured nodose ganglion cells by patch clamp and, at 0.5 mM, was demonstrated to significantly decrease the change amplitude of membrane potential induced by 1.0 mM citric acid solution. The results suggested that tuberostemonine could depress electrical excitability of nodose ganglion cells and thus inhibit the afferent signals of cough reflex leading to its antitussive activity. / In order to determine if the different chemical profiles of Stemona total alkaloids were the result of species difference or variations within the same species, the three Stemona species registered in the PRC Pharmacopoeia were collected from different areas in China. They were planted to flowering in our greenhouse and authenticated by both reproductive and vegetative characters. Microscopic examination on these authentic species showed that tuberous roots of S. tuberosa differed by epidermal cells with smooth outer surface and fibers in the cortex and pith from those of S. japonica and S. sessilifolia. The chemical profiles of authentic samples were analyzed on a HPLC-ELSD system. The results indicated that species-specific differences were present in the HPLC profiles of the three Stemona species. Within S. tuberosa, the chemical profiles of different samples were found to be very variable and they could be roughly divided into four types in the tested samples. Neotuberostemonine was present in one of the four types of S. tuberosa. Since antitussive effects of neotuberostemonine were demonstrated by Chung et al. (2003), it became necessary to determine if the samples containing alkaloids other than neotuberostemonine had antitussive properties. / The Chinese herb Radix Stemonae (Baibu) has long been used as an antitussive in Chinese medicine for some two thousand years. Its source materials, according to the Pharmacopoeia of the People's Republic of China (PRC Pharmacopoeia), come from the tuberous roots of three Stemona species, namely, S. japonica (Blume) Miq., S. sessilifolia (Miq.) Miq. and S. tuberosa Lour. However, hardly any experimental study is available to document their antitussive functions. Chung et al. (2003) reported that the antitussive components of S. tuberosa were neotuberostemonine and related stenine type Stemona alkaloids. And the antitussive potency of neotuberostemonine through intraperitoneal administration was reported to be comparable to codeine but not involving opioid receptors. In continuation with the study of the antitussive properties of the herb, it was found that total alkaloids of different samples of the herb appeared to vary in chemical profiles, whereas neotuberostemonine was found in only a few samples. / The major components of S. tuberosa including stemoninine, croomine and neotuberostemonine were isolated and determined by spectroscopic methods. It was the first time to isolate croomine from Stemona species, lending support to retaining the two genera Stemona and Croomina in the family Stemonaceae according to chemotaxonomy. Tuberostemonine, another major component of S. tuberosa was also isolated and determined in our team. Neotuberostemonine and tuberostemonine were two isomers but mutually exclusive in our tested samples. Moreover, these major components of S. tuberosa belonged to three types in molecular structure. Stemoninine was stemonamide type, croomine tuberostemospironine type and both neotuberostemonine and tuberostemonine stenine type. These results suggested that antitussive effects of S. tuberosa might be related to the components belonging to these three molecular types. / Xu Yantong. / "March 2006." / Adviser: Paul But. / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6231. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 137-155). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Introduction: Cough is the commonest reason for which medical advice is sought. In assessment of chronic cough and in developing anti-tussive medications, inhalational cough challenges with capsaicin and citric acid are commonly employed. However the ability of these inhalational cough challenges to distinguish health and disease is not clear and it is not known which end point is best in making such assessments. Methods: Subjects belonging to five different categories (healthy volunteers, subjects with COPD, asthma, healthy current smokers and chronic cough) were compared with each another by using the standard cough challenges employing Capsaicin and Citric acid and also by using newer inhalational cough challenge agents such as prostaglandin E2 and bradykinin. In addition adaptation to repeated inhalations of tussive agents was also assessed. The relationship between the cough reflex sensitivity as gauged by using inhalational cough challenge tests and objective cough recording was explored in all five groups. Finally the change in C5 in Capsaicin evoked cough by using a substance to block TRPV1 channel and its effect on objective cough recording was assessed in subjects with chronic cough. Results: Different tussive agents have different abilities to distinguish between different diagnostic categories and a combination of inhalational cough challenge tests have a better accuracy of predicting diagnostic groups as compared to one on its own. There are significant differences in the rates of adaptation to repeated inhalations of PGE2 and there is a significant reduction in cough response over period of time in all disease groups. Using the TRPV1 antagonist resulted in a modest increase in the Log C5 concentration of capsaicin but this was not matched by a change in objective cough recording or CQLQ scores. Conclusions: The different abilities of tussive agents to distinguish between different diagnostic categories suggest that the information conveyed by the one inhalational cough challenge test is different from that by another test. The choice of the inhalational cough challenge test should therefore depend on which groups are included in the study. There was no significant difference in the rate of adaptation to prolonged challenge with citric acid or capsaicin and no significant correlation of the magnitude of adaptation with objective cough recording suggesting that this is unlikely to be responsible for the increased cough rates seen in diseases such as chronic cough, COPD or asthma. The TRPV1 antagonist did not result in a significant change in objective cough recording or CQLQ scores. The change in C5 with the TRPV1 antagonist was however modest and this may be reason for this study failing to show a relationship between these different measures.

No description available.

Introdução: As complicações respiratórias, somadas a baixos volumes pulmonares e tosse ineficiente, decorrentes da fraqueza da musculatura respiratória nas doenças neuromusculares (DNM), são as principais causas de morbidade e mortalidade. Objetivo: Verificar os efeitos do treinamento de empilhamento de ar na função respiratória de pacientes com DNM. Métodos: Estudo prospectivo em 21 pacientes com DNM, idade entre 7 e 23 anos. Todos foram submetidos a avaliações respiratórias a cada 4 e 6 meses. Realizou-se espirometria e medida do pico de fluxo de tosse não assistido e assistido (PFTNA e PFTASS) com insuflações e empilhamento de ar com ressuscitador manual. Os pacientes e cuidadores foram treinados e orientados a realizar o treinamento das manobras de empilhamento de ar diariamente no domicílio. A análise estatística utilizou o pacote estatístico como médias ± desvios-padrão, foram submetidas ao teste de normalidade de D\'Agostino-Pearson. Utilizou-se ANOVA para medidas repetidas, seguidas do teste Post Hoc de Tukey. O pico de fluxo expiratório (PFE) não exibiu distribuição normal e, por isso, foi submetido ao teste de Friedman seguido do teste Post Hoc de Dunn. Os coeficientes de correlação de Pearson foram calculados e nível de significância estabelecido foi p < 0,05. Resultados: Houve aumento na estatura média dos pacientes de 2,5 cm (p < 0,0001). A média da capacidade de insuflação máxima (CIM) foi maior que a capacidade vital forçada (CVF) basal em todas as avaliações (p < 0,0001). Houve aumento na média da CVF e CIM (p < 0,01), PFTNA (p < 0,05) e no PFTASS após período de treinamento nos pacientes com escoliose não estruturada ou ausente. Conclusão: O treinamento domiciliar com insuflações e empilhamento de ar deve ser enfatizado nas DNM, pois aumenta o PFT. Tal treinamento aumenta a CVF basal e o PFTNA nos pacientes sem deformidades torácicas. / Introduction: Respiratory complications, low lung volumes and inefficient cough, resulting from weakness of respiratory muscles are the major causes of morbidity and mortality in neuromuscular patients (NMD). Objective: To assess the effects of air stacking training on lung function in patients with NMD. Methods: Prospective study in 21 patients with NMD aged 7 to 23 years. Al patients underwent respiratory evaluations every 4 to 6 months. Was performed spirometry and measurement of unassisted peak cough flow (UPCF) and assisted peak cough flow (APCF) with insufflations and air stacking with manual resuscitator. The patients and caregivers were trained and were prescribed lung insufflations by air stacking three times each day at home. The statistical analysis used the statistical package GraphPad Prism 5.0 for Windows. Spirometric variables were expressed as means ± standard deviations, were subject to normality test D\'Agostino-Pearson. We used ANOVA for repeated measures followed by post hoc Tukey test. The peak expiratory flow (PEF) did not exhibit normal distribution and therefore was subjected to the Friedman test followed by Dunn´s post hoc test. The Pearson correlation coefficients were calculated and significance level was set at p < 0.05. Results: There was in increase in the average height of 2.5 cm, of the patients (p < 0.0001). The mean maximum insufflation capacity (MIC) was greater than forced vital capacity (FVC) baseline for all evaluations (p < 0.0001). There was increase in mean FVC and MIC (p < 0.001), UPCF (p < 0.05) and APCF (p < 0.01) after air stacking training period in patients without scoliosis or unstructured. Conclusion: The air stacking training home should be emphasized in NMD. This training increases the FVC and UPCF in patients without scoliosis or unstructured.

Introdução: a coqueluche é uma doença causada pela Bordetella pertussis (BP), sendo mais frequente e grave em lactentes menores de um ano de idade. Com a introdução da vacina, houve redução na incidência mundial da doença, porém nos últimos 10 anos observa-se uma recrudescência. Pode apresentar-se de forma menos característica em lactentes, especialmente antes do final do esquema vacinal para o primeiro ano de vida. O quadro clínico, nesses pacientes, pode ser semelhante ao das infecções por vírus respiratórios (VR) que são os agentes etiológicos mais frequentes nas infecções de vias aéreas, nessa faixa etária. São necessários estudos que avaliem a importância da pesquisa de VR em lactentes com suspeita clínica de coqueluche. Objetivos: em lactentes com suspeita de coqueluche: identificar as prevalências de BP, VR e codetecções; analisar e comparar as características clínicas e a evolução, segundo a etiologia identificada e analisar o impacto do diagnóstico etiológico sobre o uso de macrolídeos. Métodos: estudo de coorte prospectivo, com crianças menores de um ano de idade, hospitalizadas com suspeita clínica de coqueluche entre junho de 2014 e junho de 2016 e submetidas à pesquisa etiológica para identificação de BP (\"swab\" de nasofaringe para cultura e/ou PCR) e pesquisa de VR (aspirado de nasofaringe para imunofluorescência indireta). Dados clínicos, demográficos e evolutivos foram coletados com o preenchimento de protocolo clínico-laboratorial padronizado. Resultados: no período de estudo foram analisados 59 lactentes. Em 18 (30,5%) houve identificação de BP, em 23 (39%) de algum vírus respiratório. Em quatro (7%), houve codetecção de BP e algum VR. O vírus mais frequentemente identificado foi o VSR (73%). As características com maior sensibilidade para o diagnóstico de infecção por BP foram tosse seguida de cianose e ser filho de mãe não vacinada com dTpa. Sibilos e desconforto respiratório apresentaram alta sensibilidade para a identificação de VR. Na análise bivariada apresentaram maior chance de infecção por BP: menor idade (OR = 1,86), ausência de febre (OR = 4,9), não ser vacinado para coqueluche (OR = 4,4), leucocitose superior a 20.000/mm3 (OR = 5,4), linfocitose superior a 10.000/mm3 (OR = 4,0) e de infecção por VR: sibilos (OR = 4,33). Após o ajuste para confundidores, os maiores preditores para BP de forma independente foram: ausência de sibilos (OR =5,7) e leucocitose superior a 20.000/mm3 (OR = 5,38). O número de pacientes com codetecção não permitiu a análise comparativa de gravidade com aqueles com agente único. Em apenas um paciente o resultado da pesquisa viral positiva resultou em suspensão de macrolídeo. Conclusão: além da BP, os VR também foram etiologias frequentes nos lactentes com suspeita clínica de coqueluche, além de casos de codetecção de BP e VR. Foram identificadas características clínicas/laboratoriais sugestivas, porém não patognomônicas das etiologias identificadas o que corrobora a necessidade da pesquisa etiológica para VR, nessa situação clínica / Introduction: Pertussis is a disease caused by Bordetella pertussis (BP), being more frequent and severe in infants less than one year old. After vaccine introduction, there was a reduction in the global incidence of the disease, but in the last ten years there was a resurgence. It may present less characteristically in infants, especially before the end of the vaccine scheme for the first year of life. The clinical picture in these patients may be similar to that of respiratory virus infections (VR), which are the most frequent etiologic agents in airway infections in this age group. Studies is necessary to evaluate the importance of RV research in infants with clinical suspicion of pertussis. Objectives: In infants with suspected pertussis: identify the prevalence of BP, VR and codetections; analyze and compare the clinical characteristics and evolution according to the identified etiology and analyze the impact of the etiological diagnosis on the use of macrolides. Methods: A prospective cohort study with children under one year of age hospitalized with suspected clinical pertussis between June 2014 and June 2016 and submitted to etiological research to identify BP (nasopharynx swab for culture and/or PCR) and VR (nasopharyngeal aspirate for indirect immunofluorescence). Clinical, demographic and evolution data were collected with the completion of a standardized clinical-laboratory protocol. Results: During the study period, 59 infants were analyzed. In 18 (30.5%) there was identification of BP, in 23 (39%) of some respiratory virus. In four (7%), there was BP detection and some RV. The virus most frequently identified was RSV (73%). The characteristics with greater sensitivity for the diagnosis of BP infection were cough followed by cyanosis and the mother\'s non-vaccinated dTpa. Wheezing and respiratory distress presented high sensitivity for RV identification. In the bivariate analysis they presented a greater chance of BP infection: lower age (OR = 1.86), absence of fever (OR = 4.9), not being vaccinated for pertussis (OR = 4.4), leukocytosis higher than 20,000/mm3 (OR = 5.4), lymphocytosis greater than 10,000/mm3 (OR = 4.0) and RV infection: wheezing (OR = 4.33). After adjustment for confounders, the largest predictors for BP independently were: no wheezing (OR = 5.7) and leukocytosis higher than 20,000/mm3 (OR = 5.38). The number of patients with codetection did not allow the comparative analysis of severity with those with single agent. In only one patient, the result of positive viral research resulted in macrolide suspension. Conclusion: In addition to BP, RVs were also frequent etiologies in infants with clinical suspicion of whooping cough, as well as cases of BP and VR codetection. Clinical/laboratory characteristics suggestive, but not pathognomonic, of the identified etiologies have been identified, which corroborates the need for etiological research for RV in this clinical situation