Consultas por enfermedades respiratorias agudas en la población pediátrica y su relación con el material particulado atmosférico en Bahía Blanca: un estudio ecológico / Consultations for acute respiratory diseases in the pediatric population and their relationship with atmospheric particulate matter in Bahía Blanca: an ecological study

Introducción. El material particulado (PM) es uno de los contaminantes del aire que mayor implicación tienen en la aparición o exacerbación de cuadros respiratorios en niños. Objetivo. Describir las características de las consultas por enfermedades respiratorias agudas en menores de 15 años, los niveles de PM en el aire, y analizar la asociación existente entre ellos en un sector de Bahía Blanca entre abril de 2019 y marzo de 2020. Población y métodos. Estudio ecológico de series temporales y grupos múltiples. Análisis descriptivo de consultas totales, por área, diagnóstico, y del PM. Modelo de correlación y regresión lineal generalizado para determinar la relación entre las variables. Se utilizó el programa SPSS®. Resultados. Se recopilaron 4787 consultas. Un 38,6 % (1846) correspondieron a rinitis y un 21,1 % (1011) a broncoespasmo. El PM de 10 nm (PM10) superó su valor límite el 31 % (115) de los días de estudio y el de 2,5 nm (PM2,5) un 3 % (8). Un aumento del 10 % del PM2,5 demostró incrementos de 1,3 % en las consultas totales; el incremento llegó al 2,1 % en el área más cercana al sector industrial (p <0,05). En esta última, el aumento del 10 % de los valores de PM10 se asoció al aumento del 1,8 % de las consultas (p <0,05). Conclusión. Se demostró asociación positiva entre las consultas por enfermedad respiratoria aguda y los niveles de PM del aire, sobre todo con el PM2,5 y en el área más cercana al sector industrial.

Introduction. Particulate matter (PM) is one of the air pollutants most involved in the onset or exacerbation of respiratory conditions in children. Objective. To describe the characteristics of consultations for acute respiratory diseases in children younger than 15 years and the levels of PM in the air and to analyze their association in a sector of Bahía Blanca between April 2019 and March 2020. Population and methods. Ecological, time-series study with multiple groups. Descriptive analysis of total number of consultations, by area, diagnosis, and PM. Generalized linear correlation and regression model to determine the relationship among variables. The SPSS® software was used. Results. Data from 4787 consultations were collected. Of these, 38.6% (1846) were related to rhinitis and 21.1% (1011), to bronchospasm. PM of 10 nm (PM10) exceeded its limit value on 31% (115) of the study days, and PM of 2.5 nm (PM2.5), on 3% (8). A 10% increase in PM2.5 showed increases of 1.3% in total consultations; the increase reached 2.1% in the area closest to the industrial sector (p < 0.05). In the latter, a 10% increase in PM10 was associated with an increase of 1.8% in consultations (p < 0.05). Conclusion. A positive association was evidenced between consultations for acute respiratory diseases and PM levels in the air, especially with PM2.5 and in the area closest to the industrial sector.

Función pulmonar oscilometría de impulso en pediatría: procedimiento y aplicación clínica / Pulmonary function impulse oscillometry in pediatrics: procedure and clinical application

La Oscilometría de Impulso (IOS) es una técnica no invasiva que evalúa las propiedades mecánicas de todo el sistema respiratorio durante la respiración tranquila. Mide la impedancia total del sistema respiratorio, evaluando la resistencia total de la vía aérea, la resistencia de la vía aérea alta y las propiedades elásticas del pulmón. Detecta el compromiso de la vía aérea periférica en forma muy precoz, antes que la espirometría, y es útil en niños pequeños porque no requiere maniobras de espiración forzada. Permite evaluar la respuesta broncodilatadora y broncoconstrictora a través de pruebas de provocación bronquial para el diagnóstico de hiperreactividad bronquial. La IOS tiene un rol en la evaluación temprana y seguimiento de la función pulmonar en niños con enfermedades respiratorias crónicas, principalmente asma bronquial, displasia broncopulmonar y fibrosis quística. Este artículo revisa los aspectos fisiológicos, técnicos y aplicación clínica de la IOS, considerando las últimas recomendaciones para la estandarización del examen y las limitaciones que dificultan su interpretación .

Impulse Oscillometry (IOS) is a non-invasive technique that assesses the mechanical properties of the entire respiratory system during quiet breathing. It measures the total impedance of the respiratory system by evaluating total airway resistance, upper airway resistance, and elastic properties of the lung. It detects peripheral airway compromise very early, before spirometry, and is useful in young children because it does not require forced expiration maneuvers. It allows evaluating the bronchodilator and bronchoconstrictor response through bronchial provocation tests for the diagnosis of bronchial hyperreactivity. The IOS has a role in the early evaluation and monitoring of lung function in children with chronic respiratory diseases, mainly bronchial asthma, bronchopulmonary dysplasia and cystic fibrosis. This article reviews the physiological, technical, and clinical application aspects, considering the latest recommendations for the standardization of the test and the limitations that hinder its interpretation.

Diagnosis of patients with blood cell count for COVID-19: An explainable artificial intelligence approach / Diagnóstico de pacientes com hemograma para COVID-19: Uma abordagem com inteligência artificial explicável / Diagnóstico de pacientes con hemograma para COVID-19: un enfoque explicable de inteligencia artificial

Objective: Present an explainable artificial intelligence (AI) approach for COVID-19 diagnosis with blood cell count. Methods: Five AI algorithms were evaluated: Logistic Regression, Random Forest, Support Vector Machine, Gradient Boosting and eXtreme Gradient Boosting. A Bayesian optimization with 5-Fold cross-validation was used to hyper-parameters tuning. The model selection evaluated three results: cross validation performance, test set prediction performance and a backtest: performance on identifying patients negative for COVID-19, but positive for others respiratory pathologies. Shapley Additive explanations (SHAP) was used to explain the chosen model. Results: A Random Forest model was obtained with 77.7% F1-Score (IC95%:57.1;92.3), 85.9% AUC (IC95%:73.7;95.9), 74.4% Sensitivity (IC95%:50.0;92.1) and 97.5% Specificity (IC95%:93.6;100.0). The main features were leukocytes, platelets and eosinophils. Conclusion: The research highlights the importance of model interpretability, demonstrating blood cell count as a possibility for COVID-19 diagnosis. The methodological structure developed, using TRIPOD's guidelines, can be extrapolated to other pathologies.

Objetivo: Propor uma abordagem com inteligência artificial explicável para diagnóstico de COVID-19 com hemograma. Métodos: Cinco algoritmos de IA foram testados: Regressão Logística, Florestas Aleatórias, Máquina de Vetores de Suporte, Gradient Boosting e eXtreme Gradient Boosting. Os hiper-parâmetros foram definidos através da otimização bayesiana com validação cruzada 5-Fold. A seleção de modelo utilizou três resultados de desempenho para definir o melhor modelo: validação cruzada, conjunto de teste e rendimento na identificação de pacientes negativos para COVID-19, porém positivos para outras patologias respiratórias (backtest). Ao final, Shapley Additive explanations (SHAP) foi utilizado para explicar o modelo escolhido. Resultados: Obteve-se um modelo Random Forest com F1-Score de 77.7% (IC95%:57.1;92.3), AUC de 85.9% (IC95%:73.7;95.9), Sensibilidade de 74.4% (IC95%:50.0;92.1) e Especificidade de 97.5% (IC95%:93.6;100.0). As principais variáveis foram leucócitos, plaquetas e eosinófilos. Conclusão: A pesquisa destaca a importância da interpretabilidade do modelo, demonstrando o hemograma como uma possibilidade para diagnosticar COVID-19. A estrutura metodológica desenvolvida no estudo, utilizando as diretrizes do TRIPOD, pode ser extrapolada para detecção de outras patologias.

Objetivo: Proponer un enfoque explicable de inteligencia artificial (IA) para el diagnóstico de COVID-19 con el uso de hemograma. Métodos: Cinco modelos de IA fueron evaluados: Logistic Regression, Random Forest, Support Vector Machine, Gradient Boosting e eXtreme Gradient Boosting. Los hiper-parámetros fueron definidos a través de optimización bayesiana con validación cruzada 5-Folds. La selección del modelo se utilizó tres resultados: rendimiento del validación cruzada, rendimento en conjunto de pruebas y el análisis de desempeño en identificación de pacientes negativos para COVID-19, pero positivos para otras patologías respiratorias (backtest). Shapley Additive explanations (SHAP) fue utilizado para explicar el modelo elegido. Resultados: Se obtuvo un modelo Random Forest con F1-Score de 77.7% (IC95%:57.1;92.3), AUC de 85.9% (IC95%:73.7;95.9), Sensibilidad de 74.4% (IC95%:50.0;92.1) y Especificidad de 97.5% (IC95%:93.6;100.0). Las principales variables fueron leucocitos, plaquetas y eosinófilos. Conclusión: La investigación presenta la importancia de la interpretabilidad del modelo, demostrando el uso de hemograma como posibilidad para diagnosticar COVID-19. La estructura elaborada, siguiendo las directrices de TRIPOD, puede ser extrapolar para otras patologías.

Variación de los biomarcadores tumorales en pacientes con enfermedades respiratorias crónicas / Variation of tumoral biomarkers in patients with chronic respiratory diseases

Introducción: Los biomarcadores son sustancias biológicas o bioquímicas que aparecen como respuesta del organismo ante ciertos tipos de tumores y que reflejan la etapa y el grado de estos. Objetivo: Determinar la asociación de los marcadores tumorales con los procesos respiratorios crónicos. Métodos: Se realizó un estudio descriptivo y transversal de 306 pacientes diagnosticados con enfermedades respiratorias crónicas, atendidos en las consultas comunitarias de neumología de la provincia de Santiago de Cuba, de enero del 2014 a diciembre del 2018. Resultados: En la serie predominaron el sexo masculino y las edades de 60 a 69 años, así como las enfermedades intersticiales, la bronquitis crónica y la enfermedad pulmonar obstructiva crónica. De igual modo, resultaron importantes los estudios radiológicos para la detección de procesos neoplásicos, sobre todo el empleo de la tomografía axial computarizada. Por otra parte, los marcadores que presentaron valores alterados fueron el CYFRA 21.1 y el CA 72.4, de manera que se demostró su asociación con los procesos respiratorios crónicos. Conclusiones: Los biomarcadores tumorales son una herramienta útil en el seguimiento de pacientes con neoplasias malignas, pero también muestran valores alterados ante la presencia de varias enfermedades respiratorias crónicas sin que ello represente la existencia de un proceso maligno.

Introduction: Biomarkers are biological or biochemical substances which emerge as a response of the organism on certain types of tumors and which reflect the stage or degree of them. Objective: To determine the association of tumoral markers with the chronic respiratory events. Methods: A descriptive and cross-sectional study of 306 patients diagnosed with chonic respiratory diseases and assisted at the Pneumology community outpàtients from Santiago de Cuba province was carried out from January, 2014 to December, 2018. Results: Male sex and ages between 60 o 69 years as well as interstitial diseases, chronic bronchitis and the chronic obstructive pulmonary disease predominated in the series. Likewise, radiological studies were also important for detecting neoplasic processes, mainly with the use of the axial computerized tomography. On the other side, markers presenting altered values were the CYFRA 21.1 y el CA 72.4, so that its association with the chronic respiratory processes. Conclusions: Tumoral biomarkers are an usefull tool in the follow-up of patients with malignant neoplasies, but also they show altered values in the presence of different chronic respiratory diseases, which doesn´t mean there is a malignant process.

Patologías del niño inmigrante en la Unidad de Cuidados Intensivos: actualización / Pathologies of the immigrant child in the Intensive Care Unit: update

Resumen: Cada vez es más frecuente la atención médica en la Unidad de Cuidados Intensivos (UCI) de niños o adolescentes inmigrantes como también de aquellos nacidos en nuestro país con padres en tal condición. Esto ha ocasionado, en la actualidad, que el equipo de salud se deba enfrentar con problemas diagnósticos derivados del escaso conocimiento de condiciones genéticas propias de esta población y/o el desarrollo de diversas patologías infrecuentes en nuestro país, algunas resultantes de su condi ción sanitaria. En esta revisión se abordan diversos aspectos de la patología hematológica, infecciosa, parasitaria, respiratoria y cardiovascular, todos tópicos relevantes de conocer durante su estadía en la UCI. Es un deber del equipo de salud actualizarse sobre patologías de baja prevalencia en nuestro país, algunas de ellas muy poco conocidas hasta hace una década, pero que, actualmente, están cada vez más presentes en las UCI del sistema de salud público chileno.

Abstract: It is increasingly common to provide medical care in the Intensive Care Unit (ICU) for immigrant children and adolescents as well as those born in Chile with parents in such condition. Currently, this has caused that the health team has to face diverse infrequent pathologies in our country and/ or diagnostic problems derive from the poor knowledge of genetic conditions of this population, some resulting from their health conditions. This review addresses several aspects of hematological, infectious, parasitic, respiratory, and cardiovascular pathologies, all relevant topics to know during their stay in the ICU. It is a duty of the health team to be updated on pathologies of low prevalence in our country, some of them very little known until a decade ago, but which are currently increasingly present in the ICUs of the Chilean public health system.

Caracterización de pacientes geriátricos ingresados en una Unidad de Cuidados Intensivos Municipal / Characterization of geriatric patients admitted in a Municipal Intensive Care Unit

RESUMEN Introducción: con el incremento de la esperanza de vida al nacer, la morbimortalidad en la población geriátrica es alta, y con ello la necesidad de atención médica especializada, que incluye los cuidados intensivos. Objetivo: caracterizar a la población geriátrica que ingresó en una Unidad de Cuidados Intensivos (UCI) Municipal. Materiales y método: se realizó un estudio de corte transversal en el Hospital General Docente "Orlando Pantoja Tamayo" en el municipio Contramaestre. El universo estuvo constituido por 658 pacientes de ambos sexos, con edades mayor e igual a 60 años. En el período de enero de 2015 a diciembre de 2018, admitidos en la UCI. Las variables estudiadas fueron edad, sexo, principales diagnósticos al ingreso, ventilación mecánica, procederes invasivos, estado del paciente al egreso y complicaciones. Se utilizó el porcentaje para resumir la información, así como el test Ji cuadrado para identificar asociación estadística entre las variables estudiadas. Resultados: predominó el sexo masculino en 51,8 % y 50,3 % tenían edades entre 60 y 74 años. 73,1 % tuvo estadía inferior a siete días. Predominaron las patologías cardiovasculares. El porcentaje de fallecidos 26,3 %, 58,5 % se le implantó sonda vesical y 63,0 % de pacientes necesitaron de ventilación mecánica invasiva. Prevalecieron los ingresos por enfermedades clínicas. Conclusión: los pacientes geriátricos del sexo masculino ingresaron con más frecuencia en terapia intensiva. Predominó el grupo de edades 60 - 74 años. Las enfermedades clínicas cardiovasculares y respiratorias fueron las más frecuentes, la mayoría de pacientes que fallecieron necesitaron ventilación mecánica invasiva (AU).

ABSTRACT Introduction: with the increase in life expectancy at birth, morbidity and mortality are high among geriatric population, and so are the needs for specialized medical care, including the intensive care. Objective: to characterize the geriatric population admitted in a Municipal Intensive Care Unit. Materials and Method: a cross-sectional study was carried out at the Teaching General Hospital "Orlando Pantoja Tamayo" in the municipality of Contramaestre. The universe was formed by 658 patients of both sexes, aged 60 years and older, during the period from January 2015 to December 2018, admitted in the Intensive Care Unit. The studied variables were age, sex, main diagnoses at admission; mechanical ventilation; invasive procedures; patient status at discharge and complications. The percentage was used to summarize the information, as well as the Chi square test to identify statistical association between the variables studied. Results: male sex predominated in 51.8%, and 50.3 % were aged 60 - 74 years old. 73.1% had a stay of less than seven days; cardiovascular diseases predominated. 26.3% of patients died, 58.5% received a bladder catheter implantation. 63.0% of patients required invasive mechanical ventilation. Admittance due to clinical diseases prevailed. Conclusion: male geriatric patients were more frequently admitted in intensive care; the 60-74 years-old age group prevailed; cardiovascular and respiratory clinical diseases were the most frequent; most of the dead patients needed invasive mechanical ventilation (AU).

ELISA of amyloid A in paired bronchoalveolar lavage fluid and serum samples of healthy horses / Detecção de amilóide A no lavado broncoalveolar de equinos hígidos

Pulmonary disorders are common in horses, and treatment efficiency depends on an adequate diagnosis. Amyloid A is the most sensitive indicator of pathology in horses. The objective of this study was to establish the concentration of amyloid A of bronchoalveolar lavage fluid (BALF) in healthy horses. Health condition of horses was considered normal based on physical examination, complete blood count, biochemical parameters, and BALF cytology. Blood and BALF were collected from thirty adult female horses. Amyloid A concentrations in serum and BALF were measured using commercial ELISA tests. Amyloid A was detected in serum (mean ± SD = 3.71±2.51) and BALF (mean ± SD = 0.000745±0.000785) of all horses. In conclusion, SAA can also be measured in bronchoalveolar fluid, affording early detection of respiratory infections or inflammatory conditions.(AU)

Distúrbios pulmonares são comuns nos cavalos e a eficiência do tratamento depende de um diagnóstico adequado e precoce. A amilóide A é um biomarcador sensível na deteccção de patologias inflamatórias e infecciososa em cavalos. O objetivo deste estudo foi estabelecer a concentração de amilóide A no líquido broncoalveolar (LBA) em cavalos saudáveis. Os cavalos foram considerados saudaveis baseado nos achados de normalidade do exame físico, hemograma, parâmetros bioquímicos e citologia do LBA. Sangue e LBA foram coletados de 30 fêmeas equinas adultas. Os níveis de Amilóide A no soro e no LBA foram mensurados por meio do teste de ELISA. A amilóide A foi detectada no soro (média ± DP = 3,71±2,51) e no LBA (média ± DP = 0,000745±0,000785) de todos os animais. Conclui-se que a amilóide A também pode ser mensurada no LBA, auxiliando no diagnóstico precoce de processos inflamatórios e infecciosos pulmonares.(AU)

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Sintomáticos respiratorios en personas atendidas en establecimientos de salud del Ministerio de Salud en Lima, Perú / Respiratory symptoms in people attended in health facilities of the Ministry of Health in Lima, Peru

RESUMEN Objetivo. El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. Materiales y métodos. Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. Resultados. Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. Conclusión. El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.

ABSTRACT Objective. The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. Materials and Methods. Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. Results. A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. Conclusions. The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.

Impacto del Material Particulado aéreo (MP 2, 5 ) sobre las hospitalizaciones por enfermedades respiratorias en niños: estudio caso-control alterno / Impact of Particulate Matter (PM 2, 5 ) and children's hospitalizations for respiratory diseases: a case cross-over study

INTRODUCCIÓN: Santiago de Chile con 7 millones de habitantes alcanza elevados niveles de contaminación atmosférica en invierno, el material particulado habitualmente excede los estándares de la OMS. OBJETIVO: Evaluar la influencia de la contaminación atmosférica por material particulado en las hospitalizaciones por enfermedades respiratorias en niños, entre 2001 y 2005 en la Región Metropolitana de Chile, independientemente de la presencia ambiental de virus sincicial respiratorio (VRS). MATERIAL Y MÉTODO: 72.479 hospitalizaciones públicas y privadas por enfermedades respiratorias de niños menores de 15 años residentes en la región del estudio se analizaron con un diseño de caso control alternante, con estratificación temporal. Se evaluó principalmente: hospitalizaciones por enfermedades respiratorias (J00-J99), neumonía (J12-J18); asma (J21.0 - J21.9) y bronquiolitis (J45 - J46). Recopilándose diariamente temperatura, MP10, MP2,5, ozono, virus respiratorios (VRS) y humedad ambientales. RESULTADOS: Los promedios de MP10 y MP2,5 fueron 81,5 y 41,2 pg/m3 respectivamente. El promedio de temperatura fue 12,8 °C y de la humedad del aire 72,6 %. Un aumento de 10 pg/m3 de MP25 con 1 y 2 días de rezago se asoció con un incremento de las hospitalizaciones por enfermedades respiratorias cercano a 2%, este porcentaje aumentó a 5% cuando la exposición fue con 8 días de rezago, reflejando sinergismo entre material particulado y virus respiratorio (VRS). CONCLUSIÓN: La exposición breve a contaminación atmosférica puede provocar hospitalizaciones por enfermedades respiratorias en niños.

INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2,5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2.5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.

Symptomatic and asymptomatic smokers without airflow obstruction: a new clinical entity?

Abstract Non-obstructed ever-smokers, with or without symptoms, have generated a great deal of information recently, but few reviews. Even individuals with normal spirometry can present changes in sputum with inflammatory biomarkers (cellular and molecular) and airways and parenchyma with remodeling; when symptomatic (cough, sputum, wheezing, and dyspnea) exacerbations are frequent affecting the individuals’ quality of life, there is an increased use of health resources: more medication, emergency visits, and hospital admissions. Non-obstructed smokers may have exercise limitations, increased lung volumes, low diffusion capacity, air entrapment, peripheral airways obstruction, elevated airways resistance, and abnormal multiple breath nitrogen washout, as well as abnormalities in computed tomography studies, such as airway wall thickening, emphysema, or interstitial lung abnormalities. Quitting smoking comprises a first, inexpensive, and often abandoned intervention to arrest respiratory impairment. It is controversial whether or not this population should be treated with other medications. Further studies should be conducted to elucidate the consequences of follow-up and prognosis in this clinical entity.

Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry / Velhice extrema em um centro diagnóstico respiratório: frequência e qualidade técnica da espirometria

ABSTRACT Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

RESUMO Objetivo: Determinar a frequência de idosos que realizaram espirometria num serviço de função pulmonar, e avaliar a qualidade da realização do exame na velhice extrema e se a idade cronológica influencia essa qualidade. Métodos: Estudo transversal retrospectivo utilizando informações (espirometria e questionário respiratório) de um banco de dados de um serviço de função pulmonar em Aracaju (SE) entre janeiro de 2012 e abril de 2017. Com base na amostra geral, determinou-se o número total de espirometrias realizadas em todas as idades, em idosos ≥ 60 anos, ≥ 65 anos, e por década de idade a partir da sexta década. Na velhice extrema, avaliou-se a qualidade da espirometria utilizando critérios de aceitabilidade e reprodutibilidade, e investigaram-se variáveis que influenciam essa qualidade, tal como déficit cognitivo. Resultados: A amostra geral foi composta por 4.126 espirometrias. Dessas, 961 (23,30%), 864 (20,94%), 102 (2,47%) e 26 (0,63%) foram realizadas em idosos com ≥ 60 anos de idade, ≥ 65 anos, ≥ 86 anos e ≥ 90 anos (velhice extrema), respectivamente. Na velhice extrema, os critérios de aceitabilidade e reprodutibilidade foram preenchidos em 88% (IC95%: 75,26-100,00) e 60% (IC95%: 40,80-79,20) das espirometrias, respectivamente. O déficit cognitivo influenciou negativamente a aceitabilidade e a reprodutibilidade (p ≤ 0,015; e p ≤ 0,007, respectivamente). Conclusões: Idosos na velhice extrema são uma realidade atual nos serviços de função pulmonar, e a maioria deles é capaz de realizar espirometrias adequadamente, apesar da idade avançada. O déficit cognitivo influencia negativamente a qualidade da espirometria.

Factores de riesgo de complicaciones respiratorias en cirugía oncológica de mama con anestesia total intravenosa / Risk factors of respiratory complications in breast cancer surgery with total intravenous anesthesia

A prospective longitudinal cohort study was performed in patients with breast cancer operated surgically with the use of total intravenous anesthesia in the provincial hospital Carlos Manuel de Céspedes de Bayamo, from the Cauto region during the period from January 1 from 2014 to December 31, 2016, with the aim of identifying the risk factors hypothetically related to the appearance of respiratory complications. It was established that the exposed cohort was constituted by 79 patients who developed complications during the study period and met the inclusion criteria. The diagnosis of respiratory complications was made during the entire surgical procedure and finished. The magnitude of the associations was estimated by calculating the relative risks (RR) of complications. The age of the patient equal to or greater than 65 years, and smoking were the surgical risk factors depending on the patient related to the onset of respiratory complications in breast cancer surgery with total intravenous anesthesia, not alcoholism. Anemia, obesity, low weight and recent respiratory tract infection were surgical risk factors dependent on associated diseases related to the appearance of respiratory complications. The ASA III-IV classification and the surgical time of more than three hours were surgical risk factors related to surgery related to the appearance of respiratory complications.

Se realizó un estudio longitudinal prospectivo de cohorte en pacientes con cáncer de mama intervenidos quirúrgicamente con el empleo de anestesia total intravenosa en el hospital provincial "Carlos Manuel de Céspedes de Bayamo, procedentes de la región del Cauto durante el período comprendido desde el 1ro de enero de 2014 hasta 31 de diciembre de 2016, con el objetivo de identificar los factores de riesgo hipotéticamente relacionados con la aparición de complicaciones respiratorias. Se estableció que la cohorte expuesta estuvo constituida por 79 pacientes que desarrollaron complicaciones en el período de estudio y cumplieron con los criterios de inclusión. La evaluación del diagnóstico de complicaciones respiratorias se realizó durante todo el procedimiento quirúrgico y terminado éste. La magnitud de las asociaciones se estimó mediante el cálculo de los riesgos relativos (RR) de complicaciones. La edad de la paciente igual o superior a 65 años, y el tabaquismo fueron los factores de riesgo quirúrgico en función del enfermo relacionados con la aparición de complicaciones respiratorias en cirugía oncológica de mama con anestesia total intravenosa, no así el alcoholismo. La anemia, la obesidad, bajo peso y la infección reciente del tracto respiratorio fueron los factores de riesgo quirúrgico dependiente de enfermedades asociadas relacionados con la aparición de complicaciones respiratorias. La clasificación ASA III-IV y un tiempo quirúrgico superior a tres horas se constituyeron en los factores de riesgo quirúrgico en función de la cirugía relacionados con la aparición de complicaciones respiratorias.

Indicação, acesso e utilização de medicamentos para doenças respiratórias crônicas no Brasil: resultados da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), 2014 / Indication, access, and use of medicines for chronic respiratory diseases in Brazil: results from the National Survey on Access, Utilization, and Promotion of Rational Use of Medicines in Brazil (PNAUM), 2014 / Indicación, acceso y utilización de medicamentos para enfermedades respiratorias crónicas en Brasil: resultados de la Encuesta Nacional sobre Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM), 2014

O objetivo foi estimar a prevalência de doenças respiratórias crônicas autorreferidas, a indicação, o acesso e o uso de medicamentos, bem como fontes de obtenção, na população adulta brasileira. Foram analisados dados de adultos com idade maior ou igual a 20 anos, provenientes da Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), realizada entre setembro de 2013 e fevereiro de 2014. A prevalência de doenças respiratórias crônicas foi de 3% (IC95%: 2,7-3,3). Desses, 58,1% (IC95%: 51,8-64,0) tinham indicação de tratamento farmacológico. Daqueles com indicação de tratamento, 77,1% (IC95%: 71,0-82,8) estavam utilizando pelo menos um dos medicamentos indicados. O acesso total à terapia foi de 91,4% (IC95%: 79,9-96,6), sendo que mais da metade das pessoas com doenças respiratórias crônicas adquiria pelo menos um de seus medicamentos em farmácias comerciais (57,3%). A classe de medicamentos mais referida foi a associação beta-2 agonista de longa duração e corticosteroides sob a forma inalatória, cujo representante mais frequente foi a associação budesonida/formoterol (20,3%; IC95%: 16,0-25,4). De acordo com o nosso estudo, a prevalência de doenças respiratórias crônicas autorreferida foi inferior a trabalhos previamente publicados para a população brasileira. Verificou-se que quase metade da população que referiu doenças respiratórias crônicas não tinha indicação de tratamento farmacológico. Já aqueles com indicação, aproximadamente um quarto não utilizava os medicamentos no período do estudo e, para os que usavam, embora o acesso fosse elevado, precisavam pagar para adquirir seus tratamentos.

The study aimed to estimate the prevalence of self-reported chronic respiratory diseases and the indication, access to, and use of medicines, as well as their sources, in the Brazilian adult population. Data were analyzed on adults 20 years and older from the National Survey on Access, Utilization, and Promotion of Rational Use of Medicines in Brazil (PNAUM), conducted from September 2013 to February 2014. Prevalence of chronic respiratory diseases was 3% (95%CI: 2.7-3.3). Of these individuals, 58.1% (95%CI: 51.8-64.0) had an indication for pharmacological treatment. Of those with indication for treatment, 77.1% (95%CI: 71.0-82.8) were using at least one of the prescribed drugs. Total access to therapy was 91.4% (95%CI: 79.9-96.6), and more than half of individuals with chronic respiratory diseases purchased at least one of the drugs in retail pharmacies (57.3%). The most frequently reported drug class was the association of a corticosteroid plus a long-acting beta-2 agonist in inhalation form, the most common example of which was the association budesonide/formoterol (20.3%; 95%CI: 16.0-25.4). According to our study, prevalence of self-reported chronic respiratory diseases was lower than in previous studies published on the Brazilian population. Nearly half of the population reporting chronic respiratory diseases did not have an indication for pharmacological treatment. Among those with such indication, approximately one-fourth were not using medications during the study period, and for those who were on medication, although access was high, they had to pay for their medicines.

El objetivo fue estimar la prevalencia de enfermedades respiratorias crónicas autoinformadas, la indicación, el acceso y el uso de medicamentos, así como fuentes de obtención, en población adulta brasileña. Se analizaron datos de adultos con una edad mayor o igual a 20 años, provenientes de la Encuesta Nacional sobre Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM), realizada entre septiembre de 2013 y febrero de 2014. La prevalencia de enfermedades respiratorias crónicas fue de un 3% (IC95%: 2,7-3,3). De estos, un 58,1% (IC95%: 51,8-64,0) tenían indicación de tratamiento farmacológico. De aquellos con indicación de tratamiento, un 77,1% (IC95%: 71,0-82,8) estaban utilizando, por lo menos, uno de los medicamentos indicados. El acceso total a la terapia fue de un 91,4% (IC95%: 79,9-96,6), siendo que más de la mitad de las personas con enfermedades respiratorias crónicas adquiría por lo menos uno de sus medicamentos en farmacias comerciales (57,3%). La clase de medicamentos más referida fue la asociación beta-2 agonista de larga duración y corticosteroides en forma inhalatoria, cuyo representante más frecuente fue la asociación budesonida/formoterol (20,3%; IC95%: 16,0-25,4). De acuerdo con nuestro estudio, la prevalencia de enfermedades respiratorias crónicas autoinformada fue inferior a trabajos previamente publicados para la población brasileña. Se verificó que casi la mitad de la población que refirió enfermedades respiratorias crónicas no tenía indicación de tratamiento farmacológico. Ya aquellos que tenían indicación, aproximadamente un cuarto, no utilizaba los medicamentos en el período del estudio y, para los que lo usaban, aunque el acceso fuese elevado, necesitaban pagar para adquirir sus tratamientos.

Complicaciones durante la esofagoscopía con o sin dilatación con globo y con anestesia general en pacientes pediátricos: estudio prospectivo y observacional / Complications during esophageal endoscopy with or without baloon dilation under general anesthesia in pediatric patients: a prospective and observational study

Antecedentes. Durante una esofagoscopía en niños, pueden ocurrir complicaciones durante la dilatación. Identificamos alteraciones cardiorrespiratorias durante la esofagoscopía con o sin dilatación con globo y las complicaciones posoperatorias, en niños con anestesia. Métodos. Estudio prospectivo, observacional de procedimientos endoscópicos en niños de 0-16 años. Se dividieron en dos grupos: con endoscopía-dilatación (Grupo ED) y dilatación con globo por estenosis esofágica, y con endoscopía sin dilatación (Grupo E): endoscopía diagnóstica, esofagoscopía de control o escleroterapia. Registramos parámetros hemodinámicos y ventilatorios y las complicaciones durante la endoscopía, la dilatación y el seguimiento de dos horas en la sala de recuperación. Resultados. Incluimos 102 procedimientos en 60 pacientes. La presión inspiratoria máxima (PIM) aumentó significativamente en ambos grupos (p < 0,001) y aumentó significativamente durante el procedimiento en el grupo ED (p < 0,001). La diferencia en la PIM antes y después de la endoscopía se correlacionó negativamente en ambos grupos. Al subdividir los grupos según el punto de corte de 2 años para comparar la diferencia en la PIM antes y después de la endoscopía, la PIM aumentó de manera estadísticamente significativa en ambos grupos en los menores de 2 años. En el grupo ED, la frecuencia cardíaca aumentó estadísticamente significativa (p < 0,001). Conclusión. Durante la endoscopía, la PIM aumentó en niños con o sin dilatación con globo, especialmente en el grupo ED, y fue mayor en los niños más pequeños. Es necesario observar y tratar atentamente las complicaciones cardiorrespiratorias graves durante la dilatación con globo y con anestesia general.

Background. Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications. Methods. Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded. Results. 102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p<0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p<0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p<0,001). Conclusion. During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.

Indications, clinical outcomes and complications of 1, 949 flexible bronchoscopies / Indicações, resultados clínicos e complicações de 1. 949 broncoscopias flexíveis

ABSTRACT Objective To describe indications, clinical outcomes and complications of flexible bronchoscopy. Methods A descriptive observational study of bronchoscopies performed at the endoscopy service of Hospital Israelita Albert Einstein . Demographic (age, gender and origin) and medical (indications and results of endoscopy and diagnostic tests, such as biopsy collection, lavage, cytology and culture) data were analyzed. Electronic medical records with incomplete data or reporting interventional procedures were excluded. Results Over a three-year period (2013 to 2016), a total of 1,949 bronchoscopies were performed by respiratory endoscopy team and anesthesia specialists of the hospital. The mean age of patients was 57.7±21.9 years (range of 3 days to 99 years), with prevalence of males (56.4%). The procedures were mostly (86.3%) elective and 30.7% were carried out in the intensive care unit. Major indications for bronchoscopy were infection or secretion (42.4%), followed by suspected neoplasm (10.8%). Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients. Positive results were obtained via direct testing or culture in 36.3% and 53.9% of 1,399 bronchoalveolar lavages, respectively. The overall diagnostic yield (bronchoalveolar lavage and biopsy) was 72.6%. Mild adverse event rate was 7.2%. The rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%; severe bleeding with patient death, 0.1%). Conclusion Lower airway endoscopy is critical for respiratory disease assessment, diagnosis and treatment. Flexible bronchoscopy is associated with good diagnostic yield and minimal inherent risk.

RESUMO Objetivo Descrever as indicações, os resultados clínicos e as complicações associadas à broncoscopia flexível. Métodos Foi realizado um estudo observacional descritivo das broncoscopias realizadas no serviço de endoscopia do Hospital Albert Einstein. Foram analisados: informações demográficas, como idade, gênero e procedência; dados clínicos sobre a indicação do exame; e resultados endoscópicos e dos exames diagnósticos realizados, como biópsias, lavados, citologias e culturas. Os fatores de exclusão foram dados incompletos no sistema e procedimentos intervencionistas. Resultados No período de 3 anos, de 2013 a 2016, foram realizadas 1.949 broncoscopias no hospital pela equipe da endoscopia respiratória e anestesiologista. A média de idade dos pacientes foi de 57,7±21,9 anos, (variação: 3 dias a 99 anos), com prevalência do gênero masculino (56,4%). A maioria dos exames (86,3%) foi eletiva e 30,7% foram realizados na terapia intensiva. A indicação médica mais frequente para realização da broncoscopia foi infecção ou secreção (42,4%), seguida de suspeita de neoplasia (10,8%). Nas alterações endoscópicas das broncoscopias realizadas, obtivemos os dados em 91,9% dos exames. Cerca de 6,9% dos pacientes apresentaram mais de uma alteração endoscópica. Foram realizados 1.399 lavados, com positividade de 36,3% nas pesquisas diretas e 53,9% nas culturas. O rendimento geral com lavados broncoalveolares e biópsia foi de 72,6%. Em nossa série, a taxa de eventos adversos leves foi de 7,2%. Os eventos adversos graves, nos quais foi necessária alguma intervenção adicional, somaram 0,5%: 0,4% de pneumotórax e 0,1% de hemorragia grave com óbito. Conclusão A endoscopia das vias aéreas inferiores é imprescindível para avaliação, diagnóstico e tratamento de doenças respiratórias. A broncoscopia flexível tem bom rendimento diagnóstico e risco mínimo associado.

Espirometría forzada versus oscilometría de impulso / Forced spirometry versus impulse oscillometry

Impulse oscillometry (IOS) is an emerging tool in the study of pulmonary function in respiratory diseases. In this review we compare its usefulness with that of forced spirometry in children. Although these techniques measure different mechanical properties of the respiratory system, -the first, resistance, and the second, flow- they are, undoubtedly, complementary tests.. This review includes a brief description of some comparative studies since 1973, year of the first publication about children; then, with the advent of technology, its application in the mid-80s and 90s made it possible to include reference values in order to establish functional diagnoses. IOS measures airway, pulmonary and thoracic resistance, which is a primary function of the mechanics of ventilation, whereas spirometry measures the flow, which is a secondary function. This principle allows us to understand why IOS indices are more sensitive than those of spirometry

La Oscilometría de Impulso (IOS) es una herramienta emergente en el estudio de la función pulmonar y en esta revisión se compara su utilidad con la espirometría forzada en niños. Aunque ambas técnicas miden diferentes propiedades mecánicas del sistema respiratorio, resistencias la primera y flujos la segunda, tienen un carácter complementario incuestionable. Esta revisión describe brevemente algunos trabajos comparativos a partir de 1973, fecha de la primera publicación en niños y luego con el advenimiento tecnológico, su aplicación a mediados de los 80 y 90 permite incluir valores de referencia para poder establecer diagnósticos funcionales. La IOS se caracteriza por medir resistencia de la vía aérea y toracopulmonar y que desde el punto de vista de la mecánica respiratoria ésta es una función primaria versus los flujos, medidos por espirometría, que son una función secundaria, este principio es el que permite entender porque sus índices son más sensibles que los de la espirometría