Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. A total face mask, which has no contact with the more sensitive areas of the face, is a possible option. We describe 3 patients with acute respiratory failure due to amyotrophic lateral sclerosis, who developed nasal bridge skin necrosis during continuous NIV, and one patient with post-extubation respiratory failure due to a high spinal cord injury, who had facial trauma with contraindication for conventional mask use. The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.
BACKGROUNDInfection risk of laboratory personnel has long been recognised and has led to the elaboration of standards of practice to prevent them. Laboratory infections risk is estimated at 16.2/100 000 person-years, and generally full recovery can be achieved after treatment. 1 However, the increasing numbers of diseases like multiresistant tuberculosis (TB) and HIV infection, in which the available treatment is not fully effective, raises new public health concerns. TB remains an important risk for healthcare personnel since infections are higher among forensic and microbiology laboratory staff, 2 these occurrences being probably under-reported. 3 Cutaneous TB is nowadays a rare disease in developed countries, occurring mainly in healthcare workers. 3 It can present in various forms depending on the mechanism of propagation and the bacterial load implicated. We report a rare case of primary inoculation TB in a microbiology laboratory technician.
CASE PRESENTATIONThe patient was a 42-year-old Caucasian woman, and her medical history included a glomerulopathy of unknown cause detected at the age of 18 and kidney stones. She was medicated with losartan 50 mg/day. She worked in a microbiology laboratory, handling biologic products with mycobacteria. She presented with a cutaneous lesion in the left index fi nger about 4 weeks after an accidental needle prick while transferring samples of a cultural exam of previously identifi ed Mycobacterium tuberculosis complex (by molecular typing) to proceed to drug susceptibility testing. The lesion was roughly rounded, elevated, 3 mm in diameter, rugous and exhibited the same colour of the skin surrounding it. No pain or other infl ammation signs were present and she had no other alterations at physical examination. Surgical excision of the lesion was performed and the resulting wound scarred normally within a week. Pathology analysis of the tissue revealed a dermic chronic infl ammatory process with lymphocytes and histiocytes in predominantly perivascular distribution. The epidermis showed reactive-type alterations. No granulomas were identifi ed and no microbiological examination was performed.A few days later, a non-painful lymphadenopathy appeared in the left axilla and she decided to consult a pulmonologist. At this time, the patient had no respiratory symptoms. Besides the palpable node, physical examination also revealed rounded, brownish indurated skin lesions in the anterior aspect of lower limbs bilaterally, consistent with erythema nodosum. No other adenopathies were found, namely in supraclavicular or cervical chains.
INVESTIGATIONSChest radiography and laboratory routine tests, including renal function were normal. Mantoux test showed a positive reaction with an induration of 17 mm in diameter. Ultrasonographic study revealed three enlarged nodes on the left axilla, the largest measuring 10 × 22 mm. Pathologic analysis of fi ne needle aspiration biopsy revealed epithelioid granulomas ( fi gure 1 ) and Langhans multinucleated giant cells. Ziehl-Neelsen stain det...
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a whole-lung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response.
Acute improvement in 6MWT parameters was not predictive of enhancement of outdoor activities and QoL with AO. More detailed studies are needed to achieve evidence based AO benefits.
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a wholelung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered.The mechanisms of respiratory impairment are discussed as well as treatment options and response.
Foi recentemente aprovada a Autorização de Introdução no Mercado Português de três biológicos para a rinossinusite crónica com polipose nasal, com indicação em doentes graves e não controlados com corticoides intranasais. O objetivo desta publicação é propor um protocolo de avaliação de doentes sob tratamento com biológicos, útil e exequível na prática clínica, e que permita a realização futura de eventuais estudos observacionais multicêntricos.
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