Ards

Kehamilan adalah masa dimulai dari konsepsi sampai lahirnya janin lamanya adalah 280 hari (40 minggu atau 9 bulan 7 hari) dihitung dari hari pertama haid terakhir (Saifudin, 2006). Namun, dalam kehamilan terpadat kelainan lama kehamilan, kelainan tersebut antara lainprematur. Prematur adalah kehamilan yang lama usianya kurang dari 37 minggu. Bayi yang lahir pada kehamilan ini disertai dengan keadaan BBLR (berat bayi lahir rendah). (Kapita Selekta Kedokteran Jilid I edisi III 2008)

BULLET POINT SUMMARY
 COVID‐19 Coronavirus is as much an ecological disaster as it is a medical
one. Initially it appears to be a unique experience centered in Wuhan,
China. It emanates from an environment of incinerated pig waste, airborne
particles, and low vitamin D blood levels in winter, and weakened immune
systems, particularly among smokers, drinkers and the elderly.
 It is believed both the Spanish flu of 1918 and the COVID‐19 coronavirus
began as zoonotic (animal to human) infections. Not from bats as first
reported in the Wuhan COVID‐19 outbreak, but rather from pigs, and pig
waste.
 The 1918 Spanish flu pandemic began in the midst of an infectious pig
slaughter of undiscovered cause, a few hundred miles from Camp Funston,
what is Fort Riley today. Similarly, the outbreak of the COVID‐19
coronavirus outbreak began in the Wuhan, China area in the wake of a
massive kill‐off of pigs who were dying from African Swine Flu.
 Viral outbreaks arise in winter, but so does tuberculosis.
 Some types of mycobacteria do not have cell walls and can mimic the
appearance of a virus under the microscope.
 Antibiotics cannot be used for viruses. If a virus, then why aren’t antiviral
drugs working but antibiotics are?
 COVID‐19 coronavirus may just be a “passenger virus,” not the primary
microbial organism that kills by filling the lower lungs with fluid.
 Both the current Wuhan COVID‐19 coronavirus and tubercular
mycobacteria do not tend to infect or cause serious disease in young
children roughly 5‐12 years of age.
 Fear of the COVID‐19 coronavirus may be misplaced. More people are
killed by Mycobacterium tuberculosis (1.7 million) in a year than the few
who have been infected (~80,000) or have died (less than 2000) of the
COVID‐19 coronavirus.
 It is projected that the "COVID‐19 Coronavirus" will peak worldwide in
March and then return in a second but lesser peak in September, in
accordance with Yang’s Wuhan study from 2004 to 2013, describing the
annual TB surges in Wuhan, China.

The objective of mechanical ventilation used in the management of Acute Respiratory Distress Syndrome (ARDS) to ensure adequate tissue oxygenation and alveolar ventilation while limiting the patients' work of breathing and preventing further damage to the lungs. Although the " partial support " ventilation modes were initially developed to assist weaning or liberation from supported ventilation, they have gained increasing popularity as primary ventilation modes, even in patients in with severe acute pulmonary dysfunction. Allowing spontaneous breathing is known to alter both lung mechanics and physiological effects of ventilation, therefore has potential influence on important patho-physiological changes and complications that occur. Spontaneous ventilation has the potential to improve outcomes in ARDS, and therefore is worthy of an intensivist's attention. A clinical trial of the use of pharmaceutical paralysis suggest a protective effect against worsening respiratory failure by ablating spontaneous breathing in ARDS. Over-distension of alveoli, even at low ventilator driving pressures may be as dangerous as high tidal volume (TV) controlled ventilation and thus naïve use of unrestricted spontaneous breathing techniques may be detrimental. As evidence of both improvement and deterioration exist the hypothesis remains controversial , and warrants a properly conducted randomised trial.

Quelle place occupe l’Égypte dans l’histoire de la traction animale ? De quels savoir-faire étrangers hérite-t-elle ? Dans quels domaines innove-t-elle ? La comparaison des représentations nilotiques avec celles du Proche-Orient, du Moyen-Orient et des régions pontiques, permet de dresser un bilan.
What place occupies Egypt in the history of the animal drive? In what foreign knowledge does she inherit? In what domains does she innovate? The comparison of the nilotiques representations with those of the Near East, the Middle East and the pontiques regions,  allows us to draw up an assessment.

Abstrak ARDS adalah keadaan gangguan pernapasan yang disebabkan atau memiliki beberapa faktor yaitu syok, trauma, gangguan metabolisme, emboli lemak infeksi dan masih banyak yang lainnya. Tanda dan gejala dari ARDs tegrgantung pada penyebabnya namun yang paling banyak adalah sesak napas, suara napas tambahan. Patofisiologi dari ARDS dibagi menajdi 3 fase yaitu eksudasi, fibropolerasi dan resolusi. ARDS tetap menjadi komplikasi yang mengancam jiwa yang ditangani dengan intubasi dan ventilasi tekanan positif. Adult Respiratory distress syndrome adalah keadaan dari gagal napas yang ditandai dengan, hipoksemia, penurunan fungsi paru bilateral tanpa gagal jantung dan infiltrat yang menyebar.(Padila, 2012, p. 88). Beberapa faktor yang dapat menyebabrkan ARDS adalah 1. Shock 2. Trauma (memar pada paru-paru, multiple fraktur, cedera kepala) 3. Cedera sistem yang serius (trauma, CVA, tumor, dan Peningkatan TIK) 4. Gangguan metabolisme (pancreatitis, dan uremia) 5. Emboli lemak dan cairan amnion 6. Infeksi paru paru difusi (bakteri, virus, dan jamur) 7. Inhalasi gas beracun 8. Aspirasi (sekresi gastric, tenggelam, dan keracunan hidokarbon)

The trajectory from moderate and severe COVID-19 into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) is a field of active research. We determined serum levels within 24 h of presentation of 20 different sets of mediators (calprotectin, pro- and anti-inflammatory cytokines, interferons) of patients with COVID-19 at different stages of severity (asymptomatic, moderate, severe and ARDS/MV). The primary endpoint was to define associations with critical illness, and the secondary endpoint was to identify the pathways associated with mortality. Results were validated in serial measurements of mediators among participants of the SAVE-MORE trial. Levels of the proinflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were significantly higher in patients with ARDS and MV. Levels of the anti-inflammatory IL-1ra and IL-33r were also increased; IL-38 was increased only in asy...

IMPORTANCE Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. OBJECTIVE To determine whether metabolic syndrome is associated with an increased risk of ARDS and death from COVID-19. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study used data from the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study collected from 181 hospitals across 26 countries from February 15, 2020, to February 18, 2021. Outcomes were compared between patients with metabolic syndrome (defined as Ն3 of the following criteria: obesity, prediabetes or diabetes, hypertension, and dyslipidemia) and a control population without metabolic syndrome. Participants included adult patients hospitalized for COVID-19 during the study period who had a completed discharge status. Data were analyzed from February 22 to October 5, 2021. EXPOSURES Exposures were SARS-CoV-2 infection, metabolic syndrome, obesity, prediabetes or diabetes, hypertension, and/or dyslipidemia. MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included ARDS, intensive care unit (ICU) admission, need for invasive mechanical ventilation, and length of stay (LOS). Open Access. This is an open access article distributed under the terms of the CC-BY License.

While there has been considerable progress in building deep learning models based on clinical time series data, overall machine learning (ML) performance remains modest. Typical ML applications struggle to combine various heterogenous sources of Electronic Medical Record (EMR) data, often recorded as a combination of free-text clinical notes and structured EMR data. The goal of this work is to develop an approach for combining such heterogenous EMR sources for time-series based patient outcome predictions. We developed a deep learning framework capable of representing free-text clinical notes in a low dimensional vector space, semantically representing the overall patient medical condition. The free-text based time-series vectors were combined with time-series of vital signs and lab results and used to predict patients at risk of developing a complex and deadly condition: acute respiratory distress syndrome. Results utilizing early data show significant performance improvement and validate the utility of the approach.

Drowning incidents involve two million people each year, mostly children and young adults, and lead to 400,000 deaths worldwide. Acute respiratory distress syndrome (ARDS) is the leading cause of death in the patients that are successfully rescued. Whereas the literature on the use of cardiac bypass for rewarming hypothermic patients in cardiac arrest (CA) after drowning is abundant, evidence on the use of extra corporeal membrane oxygenation (ECMO) for the treatment of ARDS secondary to water aspiration is scarce. We report the case of a patient who was rescued in CA after a drowning attempt and presented with a refractory ARDS after return of spontaneous circulation, successfully treated with ECMO.

Purpose : In young adults (18 to 49 years old), investigation of the acute respiratory distress syndrome (ARDS) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been limited. We evaluated the risk factors and outcomes of ARDS following infection with SARS-CoV-2 in a young adult population. Methods  : A retrospective cohort study was conducted between January 1st, 2020 and February 28th, 2021 using patient-level electronic health records (EHR),  across 241 United States hospitals and 43 European hospitals participating in the Consortium for Clinical Characterization of COVID-19 by EHR (4CE). To identify the risk factors associated with ARDS, we compared young patients with and without ARDS through a federated analysis. We further compared the outcomes between young and old patients with ARDS. Results  : Among the 75,377 hospitalized patients with positive SARS-CoV-2 PCR, 1001 young adults presented with ARDS ( 7.8% of young hospitalized adults). Their ...

Gamma/Delta T lymphocytes are a unique T cell population with
important anti-inflammatory capabilities. Their role in
acute lung injury, however, is poorly understood but may
provide significant insight into lung-protective mechanisms
occurring after injury. In a murine model of lung
injury, wild-type C57BL/6 and TCRd2/2 mice were exposed
to Escherichia coli LPS, followed by analysis of gd
T cell and macrophage subsets. In the absence of gd
T cells, TCRd2/2 mice developed increased inflammation
and alveolar-capillary leak compared with wild-type
C57BL/6 mice after LPS exposure that correlated with
expansion of distinct macrophage populations. Classically
activated M1 macrophages were increased in the
lung of TCRd2/2 mice at d 1, 4, and 7 after LPS exposure
that peaked at d 4 and persisted at d 7 compared with
wild-type animals. In response to LPS, Vg1 and Vg7 gd
T cells were expanded in the lung and expressed IL-4.
Coculture experiments showed decreased expression
of TNF-a by resident alveolar macrophages in the
presence of gd T cells that was reversed in the presence
of an anti-IL-4-blocking antibody. Treatment of mice with
rIL4 resulted in reduced numbers of M1 macrophages,
inflammation, and alveolar-capillary leak. Therefore, one
mechanism by which Vg1 and Vg7 gd T cells protect
against LPS-induced lung injury is through IL-4 expression,
which decreases TNF-a production by resident
alveolar macrophages, thus reducing accumulation of
M1 macrophages, inflammation, and alveolar-capillary
leak. J. Leukoc. Biol. 99: 373–386; 2016.

RATIONALE: Despite numerous past clinical trials, no pharmacological therapy has improved outcomes of ARDS. Therefore, the paradigm has recently shifted to earlier treatment to prevent ARDS. Treatment with inhaled corticosteroids and beta agonists prior to onset of ARDS has several potential benefits. Besides established anti-inflammatory and enhanced alveolar fluid clearance functions, direct delivery to the target organ allows potential therapeutic benefits with less adverse systemic effects. Early treatment prior to the onset of ARDS may also allow more efficient drug delivery and provide more clinically relevant benefit by preventing acute respiratory failure.

METHODS: This was a double-blind, multicenter, randomized clinical trial of adults admitted through the emergency department at high-risk for ARDS (Lung Injury Prediction Score ≥ 4 and acute hypoxemia). Patients received combined aerosolized budesonide (0.5 mg) and formoterol (2 mg) vs. placebo (normal saline) twice daily for 5 days. The primary outcome was change in oxygen saturation to fraction of inspired oxygen (S/F) ratio from baseline to day 5, analyzed as both a longitudinal continuous variable by mixed effects model and a trichotomous variable (> 20% decrease, no change, or >20% increase). Secondary outcomes included rate of progression to ARDS, ICU and hospital length of stay, and need for invasive mechanical ventilation.

RESULTS: We enrolled 59 patients between September 2013 and June 2015. Patients in the treatment group were older (70±15 vs. 57±13) but less likely to have shock (10% vs. 47%) at enrollment. Median time from emergency department presentation to first study drug was < 9 hours. The longitudinal increase in S/F ratio over the treatment period was greater in the treatment group (p < 0.01) and independent of age and shock, although the absolute change in S/F from baseline was not significant (p=0.20). S/F ratio as a trichotomous variable improved significantly in the treatment group (p=0.01), in which no patient had a decline in S/F ratio. Also, ARDS developed in 7 placebo patients and no treated patients. Placebo patients were more likely to need ICU admission and mechanical ventilation, and longer ICU and hospital lengths of stay.

CONCLUSIONS: This trial establishes the feasibility of inhaled budesonide and formoterol in patients at high-risk for ARDS. Treated patients demonstrated improved oxygenation, lower rates of acute respiratory failure and ARDS, and a shorter hospital length of stay. This is the first prevention trial to suggest efficacy of the intervention for prevention/amelioration of ARDS.