Bacterial communities along parrot digestive and respiratory tracts: the effects of sample type, species and time / Comunidades bacterianas a lo largo del tracto digestivo y respiratorio de los loros: los efectos del tipo de muestra, especie y tiempo

Digestive and respiratory tracts are inhabited by rich bacterial communities that can vary between their different segments. In comparison with other bird taxa with developed caeca, parrots that lack caeca have relatively lower variability in intestinal morphology. Here, based on 16S rRNA metabarcoding, we describe variation in microbiota across different parts of parrot digestive and respiratory tracts both at interspecies and intraspecies levels. In domesticated budgerigar (Melopsittacus undulatus), we describe the bacterial variation across eight selected sections of respiratory and digestive tracts, and three non-destructively collected sample types (faeces, and cloacal and oral swabs). Our results show important microbiota divergence between the upper and lower digestive tract, but similarities between respiratory tract and crop, and also between different intestinal segments. Faecal samples appear to provide a better proxy for intestinal microbiota composition than the cloacal swabs. Oral swabs had a similar bacterial composition as the crop and trachea. For a subset of tissues, we confirmed the same pattern also in six different parrot species. Finally, using the faeces and oral swabs in budgerigars, we revealed high oral, but low faecal microbiota stability during a 3-week period mimicking pre-experiment acclimation. Our findings provide a basis essential for microbiota-related experimental planning and result generalisation in non-poultry birds.(AU)

Postintubation airway injury in the pediatric intensive care unit / Lesiones de la vía aérea postintubación en la unidad de terapia intensiva pediátrica

Introduction and objectives Airway injury caused by endotracheal intubation (ETI) is a common event in children who require ETI in the pediatric intensive care unit (PICU). The main aim of our study was to determine the incidence and the predisposing factors for the development of airway injury in PICU patients who need ETI. Secondary objectives were to evaluate the reasons for the request of airway endoscopy examination and the tracheostomy rate in this population. Materials and methods A retrospective, observational, descriptive study was conducted evaluating 1854 patients who were intubated in the PICU of a tertiary-care center between May 2015 and April 2019. Results The mean age of all intubated patients was 35.6 months and of those who required endoscopy 27.3 months (p = 0.04). Mean length of intubation was 7.2 days for all intubated patients and 23.5 days for those who required endoscopy (p = 0.0001). Extubation failure and stridor were significantly associated with the finding of airway injury (p = 0.0001 and p = 0.0006, respectively). Conclusions The incidence rate of ETI-related injury was 3%. Age younger than 27 months and intubation for more than 7 days were predisposing factors for the development of injury.The main indications for endoscopy were extubation failure and stridor, both related to the presence of injury. Tracheostomy rate in the PICU was 3.34%. (AU)

Introducción y objetivos Las lesiones de la vía aérea por intubación endotraqueal (IET) son procesos patológicos causados por el trauma de los tejidos durante dicha condición. El principal objetivo fue determinar la incidencia y los factores predisponentes para el desarrollo de lesión de la vía aérea en pacientes que requirieron IET en la Unidad de Terapia Intensiva Pediátrica (UTIP). Los objetivos secundarios fueron evaluar las indicaciones de endoscopía y el porcentaje de pacientes traqueostomizados en dicha población. Materiales y métodos Estudio retrospectivo, observacional y descriptivo, de 1854 pacientes intubados en un centro de tercer nivel de complejidad entre Mayo de 2015 y Abril de 2019.ResultadosLa media de edad de los pacientes intubados fue de 35,6 meses y la de los que requirieron endoscopía de la vía aérea fue de 27,3 meses (p = 0,04). El promedio de días de intubación de los pacientes intubados fue de 7,2 días y el de los que requirieron endoscopía fue de 23,5 días (p = 0,0001). El fallo de extubación programada y el estridor se relacionaron con la presencia lesión (p = 0,0001 y p = 0,0006, respectivamente). Conclusiones La incidencia de lesiones asociadas a la IET fue del 3%. La edad menor a 27 meses y la intubación por más de 7 días fueron los factores predisponentes para el desarrollo de lesiones. Las principales indicaciones de endoscopía fueron el fallo de extubación programada y el estridor; ambas se relacionaron con la presencia de lesión. El porcentaje de traqueostomías realizadas en la UTIP fue del 3,34%. (AU)

The Role of Inflammatory Phenotype in Patients With Exacerbation-prone Asthma and Ongoing Therapy

Introduction: The risk factors for having frequent exacerbations are not well documented in cohort studies of patients with asthma on existing therapy. The objective of the present study was to compare the clinical and inflammatory characteristics of patients with exacerbation-prone asthma (EPA) with a history of two or more exacerbations in the previous year with those who had presented just one or no exacerbation. Methods: An ambispective observational study was conducted in a tertiary hospital. Patients diagnosed with moderate or severe asthma and ongoing therapy, whose inflammatory profile was determined by means of allergy and atopy status, blood eosinophilia and induced sputum were included. Patients were classified according to the number of asthma exacerbations in EPA (≥2 exacerbations in the previous year) vs. non-exacerbators (≤1 exacerbation in the previous year). Clinical, lung function and inflammatory characteristics of the two groups were compared. Results: Three hundred ten patients were visited in the Asthma Unit in 2018 and the combination of atopy and allergy status, blood eosinophilia and induced sputum was obtained in 96 (31%) patients. Of this latter group, 46 patients (47%) presented EPA compared to 50 (53%) non-exacerbators. Airway and blood eosinophilic inflammation did not differ between EPA and non-exacerbators in patients with asthma and ongoing therapy, and it was not a risk factor for EPA in our cohort. Conclusion: Airway or blood type 2 inflammation status is not a valid tool for recognizing EPA or predicting asthma exacerbations in asthma patients following controller therapy. (AU)

Pathophysiology of Chronic Bronchial Infection in Bronchiectasis

Bronchiectasis is a complex and heterogeneous disease. Its pathophysiology is poorly understood, but chronic bronchial infection plays an important role in its natural history, and is associated with poor quality of life, more exacerbations and increased mortality. Pseudomonas aeruginosa, Haemophilus influenzae and Staphylococcus aureus are the most common bacteria related to chronic bronchial infection. Non-tuberculous mycobacteria, fungi and respiratory viruses are also present during clinical stability, and may increase the risk of acute exacerbation. Chronic inflammation is present in bronchiectasis, especially neutrophilic inflammation. However, macrophages and eosinophils also play a key role in the disease. Finally, airway epithelium has innate mechanisms such as mucociliary clearance and antibacterial molecules like mucins and antimicrobial peptides that protect the airways from pathogens. This review addresses how the persistence of microorganisms in the airways and the imbalance of the immune system contribute to the development of chronic bronchial infection in bronchiectasis. (AU)

Comparative effectiveness of Yoga and Pilates intervention on respiratory function of patients with breast cancer / Efectividad de la intervención de Yoga vs Pilates en la función respiratoria de pacientes con cáncer de mama

Objective:Most modern breast cancer treatments are shown to be effective in terms of survival but lead to side effects such as dysfunction of the upperlimb, lymphedema, pain syndrome, plexitis, ardiotoxicity, fatigue, and pulmonary complications. Applied radiotherapy enhances the number of sideсardiotoxicity, fatigue, and pulmonary complications. Applied radiotherapy enhances the number of sideeffects that patients with breast cancer experience over a long period. The aim of this study was to compare effectiveness of Hatha Yoga and Pilatesinterventions on respiratory function in patients with breast cancer.Methods:95 women completed the interventions and were included in the final analysis. The participants, staged I-II, were randomly assigned to 2groups. Group A (n = 48, 57.53 ± 1.92 years) received Hatha Yoga intervention and group B (n = 47, 58.00 ± 1.27 years) received Pilates intervention.Both programs were conducted for 12 weeks, with three 60-min sessions per week. Spirometry was used to measure pre- and post-interventionfunctional capacity of the respiratory system.Results:Significant differences (p<0.05) were found in Vital Capacity, Forced Vital Capacity, Peak Expiratory Flow, Maximum Expiratory Flow25,Expiratory Reserve Volume and Maximal Voluntary Ventilation in Hatha Yoga group compared with Pilates group. There was no significant differencebetween both groups in Force Expiratory Volume and Maximum Expiratory Flow50 (p>0,05) Conclusions: Hatha Yoga and Pilates interventions are both effective in respiratory function, but Hatha Yoga turns out more beneficial.(AU)

Objetivo: La mayoría de los tratamientos modernos contra el cáncer de mama han demostrado ser efectivos en términos de supervivencia, pero provocanefectos secundarios como disfunción del miembro superior, linfedema, síndrome de dolor, plexitis, cardiotoxicidad, fatiga y complicaciones pulmonares.La radioterapia aplicada aumenta la cantidad de efectos secundarios que experimentan los pacientes con cáncer de mama durante un períodoprolongado. El objetivo de este estudio fue comparar la efectividad de las intervenciones de Hatha Yoga y Pilates sobre la función respiratoria enpacientes con cáncer de mama.Métodos: 95 mujeres completaron las intervenciones y fueron incluidas en el análisis final. Los participantes, estadios I-II, fueron asignadosaleatoriamente a 2 grupos. El grupo A (n = 48, 57.53 ± 1.92 años) recibió intervención de Hatha Yoga y el grupo B (n = 47, 58.00 ± 1.27 años) recibióintervención de Pilates. Ambos programas se realizaron durante 12 semanas, con tres sesiones de 60 min por semana. La espirometría se utilizó paramedir la capacidad funcional del sistema respiratorio antes y después de la intervención.Resultados: Se encontraron diferencias significativas (p<0.05) en Capacidad Vital, Capacidad Vital Forzada, Flujo Espiratorio Pico, Flujo EspiratorioMáximo25, Volumen de Reserva Espiratorio y Ventilación Voluntaria Máxima en el grupo de Hatha Yoga comparado con el grupo de Pilates. No hubodiferencia significativa entre ambos grupos en Volumen Espiratorio Forzado y Flujo Espiratorio Máximo50 (p>0.05).Conclusiones: Las intervenciones de Hatha Yoga y Pilates son efectivas en la función respiratoria, pero Hatha Yoga resulta más beneficiosa.(AU)

A systematic literature review and expert consensus on risk factors associated to infection progression in adult patients with respiratory tract or rectal colonisation by carbapenem-resistant Gram-negative bacteria / Revisión sistemática de la literatura y consenso de expertos sobre los factores de riesgo asociados a la progresión de la infección en pacientes adultos con colonización del tracto respiratorio o rectal por bacterias gramnegativas resistentes a carbapenémicos

Objective. Risk factors (RFs) associated with infection progression in patients already colonised by carbapenem-resistant Gram-negative bacteria (CRGNB) have been addressed in few and disperse works. The aim of this study is to identify the relevant RFs associated to infection progression in patients with respiratory tract or rectal colonisation.Material and methods. A systematic literature review was developed to identify RFs associated with infectionprogression in patients with CRGNB respiratory tract or rectal colonisation. Identified RFs were then evaluated and discussed by the expert panel to identify those that are relevant according to the evidence and expert’s experience.Results. A total of 8 articles were included for the CRGNB respiratory tract colonisation and 21 for CRGNB rectal colonisation, identifying 19 RFs associated with pneumonia development and 44 RFs associated with infection progression, respectively. After discussion, the experts agreed on 13 RFs to be associated with pneumonia development after respiratory tract CRGNB colonisation and 33 RFs to be associated with infection progression after rectal CRGNB colonisation. Respiratory tract and rectal colonisation, previous stay in the ICU and longer stay in the ICU were classified as relevant RF independently of the pathogen and site of colonisation. Previous exposure to antibiotic therapy or previous carbapenem use were also common relevant RF for patients with CRGNB respiratory tract and rectal colonisation. (AU)

Objetivo. Los factores de riesgo (FR) asociados a la progresión de la infección en pacientes ya colonizados por bacterias gramnegativas resistentes a carbapenémicos (BGNRC) han sido abordados en pocos y dispersos trabajos. El objetivo de este estudio es identificar los factores de riesgo relevantes asociados a la progresión de la infección en pacientes con colonización del tracto respiratorio o rectal.Material y métodos. Se realizó una revisión sistemática de la literatura para identificar los FR asociados a la progresión de la infección en pacientes con colonización del tracto respiratorio o rectal por BGNRC. Los FR identificados fueron luego evaluados y discutidos por el panel de expertos para identificar aquellos que son relevantes según la evidencia disponible y la experiencia de los expertos.Resultados. Un total de 8 artículos fueron incluidos en el análisis de los FR en la colonización del tracto respiratorio y 21 para la colonización rectal, identificándose 19 FR asociados al desarrollo de neumonía y 44 FR asociados a la progresión de la infección respectivamente. Tras la sesión de discusión, los expertos acordaron que 13 FR se asociaban al desarrollo de neumonía tras la colonización del tracto respiratorio por BGNRC y 33 FR a la progresión de la infección tras la colonización rectal por BGNRC. La colonización del tracto respiratorio y rectal, la estancia previa en la UCI y una estancia prolongada en la UCI se clasificaron como FR relevantes independientemente del patógeno y del lugar de colonización. La exposición previa a antibióticos o el uso previo de carbapenémicos se clasificaron como FR relevantes para varios de los patógenos tanto en pacientes con colonización del tracto respiratorio como rectal. (AU)

Broncoscopia guiada por navegación electromagnética / Electromagnetic navigation bronchoscopy

La broncoscopia guiada por navegación electromagnética es una técnica que posibilita el diagnóstico de lesiones pulmonares periféricas de pequeño tamaño con una gran precisión y seguridad, permitiendo en muchos casos la detección precoz de cáncer de pulmón. Facilita la realización tanto de biopsias transbronquiales como de punciones y cepillados. Este procedimiento ofrece la posibilidad de evitar métodos diagnósticos invasivos como la cirugía, con el consiguiente ahorro económico, de tiempo y de complicaciones. Asimismo, es útil para la colocación de marcadores fiduciales para la radioterapia estereotáxica en pacientes con cáncer de pulmón que no son candidatos a la resección pulmonar.(AU)

Electromagnetic navigation-guided bronchoscopy is a technique that enables the diagnosis of small peripheral lung lesions with great precision and safety, allowing early detection of lung cancer. It facilitates the performance of both transbronchial biopsies, punctures and brushings. This procedure offers the possibility of avoiding invasive diagnostic methods such as surgery, with the consequent economic, time and complication savings. It is also useful for placement of fiducial markers for stereotactic radiation therapy in lung cancer patients who are not candidates for lung resection.(AU)

Antimicrobial Peptides: Potential Therapeutics Against Drug-Resistant Pulmonary Infections / Péptidos antimicrobianos: un posible tratamiento frente a las infecciones pulmonares resistentes a antibióticos

No disponible

Secuestro pulmonar en pacientes adultos. Revisión de la literatura a partir de tres casos clínicos / Pulmonary sequestration in adult patients. Review of the literature from 3 clinical cases

El secuestro pulmonar es una rara enfermedad congénita del tracto respiratorio, en la cual existe un parénquima pulmonar no funcionante que presenta una circulación arterial aberrante. Puede acompañarse de otras alteraciones torácicas como enfisema lobar, el síndrome de la cimitarra o malformaciones adenomatoides quísticas. El diagnóstico en la edad adulta suele ser incidental, aunque también puede presentarse en un menor número de pacientes como infecciones respiratorias de repetición.(AU)

Pulmonary sequestration is a rare congenital disease of the respiratory tract, in which there is a non-functioning lung parenchyma that presents an aberrant arterial circulation. It can be accompanied by other thoracic alterations such as lobar emphysema, scimitar syndrome or cystic adenomatoid malformations. Diagnosis in adulthood is usually incidental, although it can also present in a smaller number of patients as recurrent respiratory infections.(AU)