Spirometry for the diagnosis of airway obstruction in patients with risk factors for COPD: the GOLD and lower limit of normal criteria / Espirometria para o diagnóstico de obstrução das vias aéreas em pacientes com fatores de risco para DPOC: os critérios GOLD e limite inferior da normalidade

ABSTRACT Objective: The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. Methods: This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD−, respectively) and according to the LLN criterion (LLN+ and LLN−, respectively). We also evaluated the level of agreement between the two criteria. Results: A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN− category (p = 0.03), as was the median DLCO (p = 0.04). Conclusions: The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.

RESUMO Objetivo: A identificação de obstrução persistente das vias aéreas é fundamental para o diagnóstico de DPOC. As diretrizes da GOLD sugerem um critério fixo - relação VEF1/CVF pós-broncodilatador < 70% - para definir obstrução, embora outras diretrizes sugiram que a relação VEF1/CVF pós-broncodilatador < o limite inferior da normalidade (LIN) é o critério mais preciso. Métodos: Estudo observacional com indivíduos ≥ 40 anos de idade com fatores de risco para DPOC encaminhados ao nosso laboratório de função pulmonar para espirometria. Também foram registrados sintomas respiratórios. Calculamos a prevalência de obstrução e de ausência de obstrução das vias aéreas segundo o critério GOLD (GOLD+ e GOLD−, respectivamente) e segundo o critério LIN (LIN+ e LIN−, respectivamente). Avaliamos também o grau de concordância entre os dois critérios. Resultados: Foram incluídos 241 indivíduos. Obstrução das vias aéreas foi identificada segundo o critério GOLD em 42 indivíduos (17,4%) e segundo o critério LIN em 23 (9,5%). A concordância global entre os dois critérios foi boa (k = 0,67; IC95%: 0,52-0,81), embora tenha sido menor entre os indivíduos ≥ 70 anos de idade (k = 0,42; IC95%: 0,12-0,72). A proporção de obesos foi menor na categoria GOLD+/LIN+ do que na categoria GOLD+/LIN− (p = 0,03), assim como a mediana de DLCO (p = 0,04). Conclusões: A utilização do critério GOLD parece estar associada a uma maior prevalência de DPOC. A concordância entre os critérios GOLD e LIN também parece ser boa, embora seja mais fraca em indivíduos mais velhos. A utilização de diferentes critérios para definir obstrução das vias aéreas parece identificar indivíduos com diferentes características. É essencial compreender o significado clínico da discordância entre esses critérios. Até que mais dados estejam disponíveis, recomendamos uma abordagem holística e individualizada e também um acompanhamento cuidadoso dos pacientes com resultados discordantes para obstrução das vias aéreas.

Baby-led weaning, an overview of the new approach to food introduction: integrative literature review / Baby-led weaning, panorama da nova abordagem sobre introdução alimentar: revisão integrativa de literatura

ABSTRACT Objective: To analyze the scientific literature on Baby-Led Weaning with an integrative literature review to identify risks and benefits. Data source: The databases used were: National Library of Medicine (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS - Literatura Latino-Americana e do Caribe em Ciências da Saúde), US National Library of Medicine (PubMed), and Virtual Health Library (BVS - Biblioteca Virtual em Saúde) in December 2017. The inclusion criteria established were publications in English with the descriptor "baby-led weaning" in the heading, abstract, or keywords, classified as original articles, of primary nature, and available online and in full. We excluded review articles, editorials, letters to the editor, critical commentaries, and books on the subject, as well as articles not available in full and duplicates. Data summary: We identified 106 articles, of which 17 met the selection criteria. The Baby-Led Weaning method was significantly associated with the baby's satiety, the start of complementary feeding, and adequacy of weight gain. On the other hand, choking and the intake of micronutrients were negatively associated, however with no statistical differences. Conclusions: Despite the benefits found, the risks still deserve attention and should be investigated with longitudinal randomized controlled studies to ensure the safety of the method when practiced exclusively.

RESUMO Objetivo: Analisar a literatura científica referente ao desmame guiado pelo bebê (Baby-Led Weaning) por meio de revisão integrativa de literatura a fim de identificar riscos e benefícios. Fonte de dados: As bases de dados utilizadas foram: National Library of Medicine (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS); e a busca foi realizada em dezembro de 2017. Os critérios de inclusão estabelecidos foram publicações em inglês com o descritor "baby-led weaning" no título, resumo ou palavras-chave em artigos classificados como originais de natureza primária, disponibilizados online e na íntegra. Excluíram-se artigos de revisão, editoriais, cartas ao editor, comentários críticos e livros abordando o assunto, assim como artigos não disponíveis na íntegra e duplicatas. Síntese dos dados: Identificaram-se 106 artigos, dos quais 17 faziam parte do critério de seleção. O método Baby-Led Weaning teve associação significativa com a saciedade do bebê, início da alimentação complementar e adequação de ganho de peso. Já o engasgo e a ingestão de micronutrientes foram associados negativamente, contudo sem diferenças estatísticas. Conclusões: Apesar dos benefícios apontados, os riscos ainda merecem atenção por meio de pesquisas longitudinais controladas e randomizadas para fornecer mais segurança para a sua prática de forma exclusiva.

Intervención del enfermero intensivista ante un paciente con atelectasia. Reporte de un caso / The intervention of the intensive care nurse in front of a patient with atelectasis. A case report

RESUMEN En la aspiración por cuerpo extraño en vías respiratoria, los síntomas van desde el paro cardiorrespiratorio, tos de intensidad y características variables como obstrucción bronquial difusa o localizada. Como complicación puede aparecer la neumonía y atelectasias. La atelectasia es el colapso de una parte periférica del pulmón o de todo el pulmón, debido a la obstrucción de la vía aérea en bronquios o bronquiolos. El objetivo de este trabajo es presentar un caso clínico y la importancia de la intervención de Enfermería en una Transicional, de 1 año y 9 meses de edad, sexo femenino. Ingresó en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial de Matanzas, con diagnóstico de aspiración de cuerpo extraño en vías aéreas. El desarrollo de las habilidades prácticas del enfermero intensivista fomenta el razonamiento crítico en aras de brindar cuidados con calidad y enfoque científico que repercuten en la mejoría de los pacientes (AU).

ABSTRACT This paper´s aim is to present a clinical case and the importance of the nursing interventions in a female transitional patient, aged 1 years and 9 months. She entered the Intensive Care Unit of the Provincial Pediatric Hospital of Matanzas, with a diagnosis of foreign body aspiration in the airways. The development of the intensive care nurses´ practical skills promotes the critical reasoning for the sake of giving qualitative care with a scientific approach striking on the improvement of the patients (AU).

Caracterización clinicoterapéutica de niños y adolescentes con cuerpos extraños aerodigestivos / Clinical therapeutical characterization of children and adolescents with aerodigestive foreign bodies

Se realizó una investigación descriptiva, observacional y longitudinal en el Servicio de Otorrinolaringología del Hospital Infantil Sur Dr. Antonio María Béguez César de Santiago de Cuba, que abarcó desde enero de 2015 hasta diciembre de 2017, con el objetivo de caracterizar a los 341 niños y adolescentes atendidos en el cuerpo de guardia por presentar cuerpos extraños aerodigestivos. En la casuística primaron el grupo etario de menores de 5 años (62,5 por ciento), el sexo masculino (52,8 por ciento), la procedencia urbana (65,1 por ciento), los cuerpos extraños orgánicos (67,4 por ciento), la fosa nasal como localización anatómica, la obstrucción nasal como síntoma principal y la extracción manual a través de rinoscopia anterior. En 11,1 por ciento de los exámenes radiográficos se observó el cuerpo extraño. Solo falleció un paciente durante el estudio

A descriptive, observational and longitudinal investigation in the Otolaryngology Service of Dr. Antonio María Béguez César Southern Children Hospital was carried out in Santiago de Cuba from January, 2015 to December, 2017, aimed at characterizing the 341 children and adolescents assisted in the emergency room because they presented aerodigestive foreign bodies. In the case material There was a prevalence of under 5 age group (62.5 percent), male sex (52.8 percent), urban origin (65.1 percent), organic foreign bodies (67.4 percent), the nasal cavity as anatomical localization, nasal obstruction as main symptom and the manual extraction through previous rhinoscopy. In 11.1 percent of the radiographic exams the foreign body was observed. Just a patient died during the study

Sibilancias recurrentes: prevalencia y factores asociados en lactantes de Buenos Aires, Argentina / Recurrent wheezing: prevalence and associated factors in infants from Buenos Aires City, Argentina

Resumen: Introducción: Los episodios de obstrucción bronquial a temprana edad constituyen un problema frecuente en pediatría. El objetivo de este estudio, además de conocer la prevalencia de sibilancias recurrentes en lactantes de Buenos Aires, fue identificar los factores asociados. Métodos: Estudio de tipo transversal realizado durante 2011 y 2012, en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, como parte del Estudio Internacional de Sibilancias en Lactantes, mediante una encuesta validada para padres de lactantes de 12 a 15 meses. Se evaluó la prevalencia de sibilancias, fundamentalmente de tipo recurrentes (tres o más episodios) y los posibles factores asociados. El análisis estadístico se realizó por prueba de χ2, prueba de Fisher y análisis de regresión logística univariada y multivariada. El nivel de significación fue de 0.05. Resultados: De 1063 lactantes, el 58.9% (intervalo de confianza (IC) 95% 55.9-61.9) presentaron al menos un episodio de sibilancia y el 26.3% (IC 95% 23.8-29.9), tres o más episodios (sibilancias recurrentes). Los factores vinculados a padecer al menos un episodio de sibilancia fueron el sexo masculino (p = 0.001), seis o más resfríos en el primer año (p < 0.0001), edad del primer resfrío < 4 meses (p < 0.0001), neumonía (p < 0.0001), tabaquismo durante el embarazo (p = 0.01). Los factores relacionados con sibilancias recurrentes fueron seis o más resfríos en el primer año de vida (p < 0.0001), tener el primer episodio de sibilancia antes del cuarto mes de vida (p < 0.0001) y sibilancias nocturnas (p < 0.0001). Conclusiones: La prevalencia de sibilancias recurrentes en Buenos Aires es alta (26.3%). Algunos de los factores asociados serían prevenibles.

Abstract: Background: The episodes of bronchial obstruction at early age constitute a frequent problem in Pediatrics. The aim of this study was to evaluate the prevalence of recurrent wheezing in infants in Buenos Aires City, as well as to identify any associated factors. Methods: Cross-sectional study performed from 2011 to 2012 in the Children Hospital Ricardo Gutiérrez, Buenos Aires City, as part of the International Study of Wheezing in Infants. A validated questionnaire was applied to parents of infants aged between 12 and 15 months. The prevalence of wheezing, mostly the recurrent episodes (three or more), and their probable associated factors were evaluated. Data were statistically analyzed with χ2, Fisher's test, binary and logistics multiple regression analysis. The significance level was 0.05. Results: Over 1063 infants, 58.9% (confidence interval (CI) 95% 55.9-61.9) presented at least one episode of wheezing and 26.3% (CI95% 23.8-29.9) three or more episodes (recurrent wheezing). Risk factors associated to wheezing were male gender (p = 0.001), six or more episodes of cold during the first year of life (p < 0.0001), age at first cold < 4 months (p < 0.0001); pneumonia (p < 0.0001) and smoking during pregnancy (tobacco) (p = 0.01). For recurrent wheezing, risk factors we considered as six or more episodes of cold during the first year of life (p < 0.0001), early (< 4 month of age) onset wheezing (p < 0.0001) and nocturnal wheezing (p < 0.0001). Conclusions: The prevalence of recurrent wheezing among infants in Buenos Aires Ciy was high (26.3%). Some identified associated factors can be preventable.

Cuerpos extraños en vía respiratoria: experiencia de 15 años. Universo estadístico de la provincia de Mendoza, Argentina / Foreign bodies in airway: experience of 15 years. Statistical universe of the province of Mendoza, Argentina

Objetivo. Presentar la experiencia de 15 años con extracción de cuerpos extraños. Se describen 277 procedimientos broncoscópicos realizados por sospecha de aspiración de cuerpo extraño desde diciembre de 1992 a diciembre de 2008. En 165 CE encontrados, se presentan las conclusiones derivadas de esa experiencia. Material y método. Rango de edades: 6 meses a 24 años. Se usó broncofibroscopio Pentax u Olympus, y broncoscopio rígido Storz. Resultados. El 69,70% de los pacientes tenía entre 6 a 25 meses; el 79% de los CE fueron extraídos antes de la semana de derivación por SP; el 40% correspondió a “semillas”; el síntoma más frecuente fue el SP: 91,5%, y la tos en el 85,5% de los casos; la radiología pulmonar fue normal en el 56,36%. Conclusiones. Debe ser un procedimiento centralizado por regiones que permita mantener la manualidad del operador. El centro de broncoscopía debe contar con la tecnología apropiada, en función de las edades que abarca. Deben ser más difundidas las características de la alimentación en los primeros 3 años de vida - edad más riesgosa- y los alimentos a evitar.

Objective. Experience of 15 years with bronchoscopic foreign bodies (FB) removal is presented 277 bronchoscopies for “probable foreign body aspiration” were per fomed from December 1992 to December 2008. In 165 cases a F.B. was found and conclusions are presented. Population. age range 6 mo to 24 yo. Results. 69,70% of patients were between 6 and 25 m.old.; 79% of F.B. were removed before 1 week of referral for suffocation event; 40% were classified as “seeds”; most frequent symptom was suffocation event in 91,5% and cough in 85,5% of cases; lung radiology was normal in 56%. F.B. successful extraction during first procedure was 154 cases out of 165 F.B. Complications were seen in 6,6%. Conclusions. F.B. extraction should be a procedure performed by geographic regions according to experience and population served. The F.B. extraction center should have instruments appropiate for ages and body sizes of its population. Feeding precautions and food preparation, during first 3 years of life, must be emphasized.

Síndrome Obstructivo Bronquial en el niño menor de 2 años. Área de Salud Integral José Félix Rivas. Estado Cojedes, Venezuela: 2007-2008 / Bronchial Obstructive Syndrome in the child aged less than 2 years old. Integral Health Area Jose Felix Rivas. Cojedes State, Venezuela: 2007-2008

Se realizó un estudio descriptivo prospectivo de los pacientes asistidos en la consulta de urgencias del Área de Salud Integral José Félix Rivas, del municipio San Carlos, Estado Cojedes, República Bolivariana de Venezuela, por presentar Síndrome Bronquial Obstructivo, en el período comprendido entre el 1 de noviembre de 2007 y el 31 de octubre de 2008, con el objetivo de caracterizar a los pacientes según variables clínicas y epidemiológicas, y establecer una estrategia de tratamiento para su manejo en las consultas de urgencia de las áreas de salud integral. Se analizó 200 fichas, en las que se registró sexo, edad, antecedentes patológicos, así como características de la enfermedad actual. El 80 por cidento de los pacientes fueron menores de 1 año. En más de la mitad de los mismos, se trató del primer episodio broncobstructivo y de una enfermedad de corta duración y generalmente clasificada como leve o moderada. El diagrama de tratamiento y decisiones aplicado al Síndrome Bionquial Obstructivo, según grado de intensidad clasificado de acuerdo a la Escala de Tal modificada, resultó muy eficaz. En relación a las causas etiológicas quedó evidenciado que las infecciones respiratorias agudas de posible etiología viral son las más frecuentes.

We carried out a descriptive prospective study of the patients assisted at the urgency consultation of the Integral Health Area Jose Felix Rivas of the municipality San Carlos, Cojedes States, Bolivarian Republic of Venezuela, presenting Bronchial Obstructive Syndrome, in the period from November 1st 2007 to October 31st 2008 with the objective of characterizing the patients according to the clinical and epidemiological variables, and establishing a treatment strategy for their management in the urgency consultations of the integral health areas. We analyzed 200 cards where we registered genre, age, pathologic antecedents, and also the characteristics of the current disease. 80 per cent of the patients were less than 1 year old. In more than half of them, we treated the first bronchi-obstructive episode of a short term disease, generally classified as mild or moderated. The diagram of treatment and decisions applied to the Bronchial Obstructive Syndrome, according to the intensity level in accordance with the Modified Tal Scale, was very efficacious. In relation to the etiologic causes it was evidenced that the acute respiratory infections of possible viral causes are the most frequent.

Ocorrência de sintomas asmáticos e de distúrbio obstrutivo em nadadores amadores de 8 a 17 anos de idade / Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age

OBJETIVO: Analisar a prevalência de sintomas asmáticos e de obstrução ao fluxo aéreo em nadadores amadores de 8-17 anos de idade e avaliar a conscientização sobre asma e tratamento de asma entre nadadores, seus pais e treinadores. MÉTODOS: Uma amostra com 1.116 nadadores amadores respondeu a uma versão modificada do questionário escrito do International Study of Asthma and Allergies in Childhood, ao qual questões sobre as razões de início da natação e sobre gerenciamento de asma foram adicionadas. Os participantes realizaram espirometria antes de uma prova de natação. RESULTADOS: A prevalência de sintomas de asma nos últimos 12 meses foi de 11,5 por cento, e 327 participantes (29,4 por cento) relataram sibilos no passado. Dos 223 nadadores que relataram asma ou bronquite na vida, somente 102 (45,7 por cento) relataram algum tipo de tratamento: natação foi o "tratamento" mais frequente (37,3 por cento), e somente 12,7 por cento utilizavam corticosteroides inalatórios. Dos 254 participantes (22,7 por cento) com obstrução ao fluxo aéreo, somente 52 (20,5 por cento) relataram sintomas de asma. CONCLUSÕES: Os sintomas de asma estão presentes em nadadores amadores, e muitos deles têm obstrução ao fluxo aéreo sem sintomas, o que sugere uma subestimação da asma nessa população. É preocupante que os nadadores diagnosticados previamente com asma não utilizassem os tratamentos recomendados para asma. As implicações clínicas desses achados enfatizam a importância da implementação de medidas educacionais para nadadores amadores, pais e treinadores para auxiliá-los no reconhecimento dos sintomas de asma e de seus riscos no ambiente esportivo a fim de permitir o diagnóstico e a intervenção clínica precoce.

OBJECTIVE: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. METHODS: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. RESULTS: The prevalence of asthma symptoms in the last 12 months was 11.5 percent, and 327 (29.4 percent) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7 percent) reported having ever been treated: the most common "treatment" was swimming (in 37.3 percent), and only 12.7 percent used inhaled corticosteroids. Of the 254 participants (22.7 percent) with airflow obstruction, only 52 (20.5 percent) reported having asthma symptoms. CONCLUSIONS: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.

Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

Smoking Rather than Diet Deficiency is Related with Airway Obstruction in Korea

No abstract available.

Diet and Airway Obstruction: A Cross Sectional Study from the Second Korean National Health and Nutrition Examination Survey

BACKGROUND/AIMS: Several dietary factors, such as antioxidant vitamins, have potential roles in the development of obstructive lung diseases. However, the results of studies on the relationships between dietary factors and obstructive lung diseases are inconsistent. The aim of this study was to determine which nutrients are related to airway obstruction (AO) in the Korean population. METHODS: We used data obtained as part of the Korean National Health and Nutrition Examination Survey (NHANES II) in 2001. Analysis was restricted to 1,005 adults who were 18 years of age and older, who had two or more acceptable spirometry curves, and who had participated in the nutrition examination survey. AO was defined as the ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) of less than 0.7. RESULTS: Of the 1,005 study subjects, 78 (7.8%) had AO. Statistically significant factors associated with AO were 55 years of age or older (p = 0.032), central obesity (p = 0.047), hypertension (p < 0.001), smoking of 20 pack-years or more (p < 0.001), low income (p < 0.001), and low dietary protein intake expressed as a ratio of protein to recommended dietary allowance for Koreans (p = 0.037). Multiple logistic regression analyses revealed four factors that were independently associated with AO: smoking of 20 pack-years or more (odds ratio [OR], 5.801; p < 0.001), hypertension (OR, 3.905; p < 0.001), low protein intake (OR, 0.992; p = 0.004), and low income (OR, 1.962; p = 0.018). CONCLUSIONS: In the Korean NHANES, smoking, hypertension, and low income were related to AO. Among dietary factors, only low protein intake was associated with AO.

Air quality and emergency pediatric care for symptoms of bronchial obstruction categorized by age bracket in Rio de Janeiro, Brazil / Qualidade do ar e atendimentos pediátricos de emergência por sintomas de obstrução brônquica categorizados por faixas etárias no Rio de Janeiro, Brasil

The objective of this study was to estimate the association between levels of air pollutants and respiratory symptoms in children. An ecological time-series study was conducted between April 2002 and March 2003 with daily data on PM10, SO2, CO, NO2, and O3 and paediatric care in emergency rooms due to symptoms indicating bronchial obstruction. The potential confounding factors considered were: time trend, seasonality, meteorological variables, respiratory infections and the effects of weekends and holidays. A semi-parametric Poisson regression was used to model the time series. Splines (data smoothing functions), indicator variables and cubic polynomials were used to adjust the effects of the confounding variables. A 5 percent significance level was adopted for the study. A statistically significant increase of 6.7 percent in paediatric visits of children of less than 2 years of age was associated with PM10. A 3 percent positive association with O3 showed borderline significance (p < 0.06) in this age bracket. Our findings highlight the existence of an acknowledged public health problem in Rio de Janeiro, Brazil, and also emphasize the need to identify the principal sources of air pollutants.

O objetivo deste trabalho foi estimar a associação entre os níveis dos poluentes atmosféricos e sintomas respiratórios em crianças. Foi realizado um estudo ecológico de séries temporais, entre abril de 2002 e março de 2003, com dados diários de PM10, SO2, CO, NO2 e O3 e dos atendimentos pediátricos de emergência ocasionados por sintomas de obstrução brônquica. As variáveis de confusão foram: tendência temporal, sazonalidade, fatores meteorológicos, infecções respiratórias e os efeitos dos finais de semana e feriados. Regressão de Poisson semiparamétrica foi usada para modelar as séries temporais. Curvas suaves, splines, variáveis indicadoras e polinômios cúbicos foram empregadas para corrigir os efeitos dos fatores de confundimento. Foi adotado o nível de significância de 5 por cento. Um incremento estatisticamente significativo dos atendimentos, de 6,7 por cento, esteve associado com PM10 nas crianças menores do que dois anos. Associação positiva com o O3, em torno de 3 por cento, nessa faixa etária, teve significado estatístico limítrofe (p < 0,06). Esses resultados evidenciam um problema de saúde pública não reconhecido no Rio de Janeiro, Brasil, que reforça a necessidade de identificação das principais fontes de poluição.

Obstrução recorrente das vias aéreas em muares: relato de três casos / Airway recurrent obstruction in mules: report of three cases

Relatam-se três casos de obstrução recorrente das vias aéreas em muares com idade média de 10 anos. Os animais eram utilizados para concurso de marcha e criados em campo. Após serem mantidos em cocheiras com cama de serragem e alimentados com feno (tifton e alfafa) e ração comercial, começaram a manifestar intolerância ao exercício e episódios de tosse durante o exercício. Após exames clínico e laboratorial, instituiu-se terapia à base de clenbuterol, dexametazona e bromexina, além de controle ambiental. Após 21 dias de tratamento, ocorreu remissão dos sintomas clínicos. Para comprovação diagnóstica, os animais foram submetidos ao desafio ambiental, por um período de dois dias. Após o tratamento, os três animais voltaram a desempenhar suas atividades atléticas de modo satisfatório.

Three cases of airway recurrent obstruction in approximately 10-year-old mules are reported. The animals were raised free and used for marching competitions. After being stabled in boxes under a wood scrape bed and fed on tifton and alfalfa hay plus a commercial ration, they started to show intolerance to exercise and episodes of coughing during it. After clinical and laboratorial examinations, clenbuterol, dexametazone and bromexine were administrated, besides controlling the environment. After 21 days of treatment, the clinical symptoms ceased. In order to certify that diagnosis, the animals were submitted to an environmental challenge for two days. Then, the animals were back to their normal athletic activities in a satisfactory manner.

Síndrome da apnéia e da hipopnéia obstrutiva do sono em crianças / Obstructive sleep apnea syndrome in children

Os autores fazem uma revisão bibliográfica atualizada sobre a Síndrome de Apnéia e Hipopnéia Obstrutivas do Sono (SAHOS) em crianças. Sua incidência, etiopatogenia, diagnóstico, conseqüências relacionadas à doença, manejo e prognóstico são abordados

El paciente respirador bucal: una propuesta para el estado Nueva Esparta, 1996-2001 / The mouth-breather patient: a proposal for the Nueva Esparta state, 1996-2001

El presente trabajo trata sobre un estudio piloto realizado en un grupo de escolares de edades comprendidas entre 5 a 14 años, en la población de Manzanillo, municipio Antolín del Campo, estado Nueva Esparta, Venezuela, para evaluar, desde el punto de vista epidemiológico, el síndrome de insuficiente respirador nasal IRN, para lo cual se utilizó como metodología un examen clínico inicial, un examen clínico complementario y entrevistas para los padres o representantes. Se encontró un 63 por ciento de niños con características de insuficiente respirador nasal, una incompetencia labial del 68 por ciento. La característica más resaltante al examen esqueletal resultó ser la presencia de escápulas aladas en un 95 por ciento, lo que deja planteado la realización de un estudio más amplio en los distintos distritos sanitarios del estado Nueva Esparte, a fin de precisar la validez y significancia de estas observaciones antes citadas

Airway Obstruction in Rheumatoid Arthritis: CT Manifestations, Correlated with Pulmonary Function Testing

In the present study, the signs of airflow obstruction on inspiratory and expiratory CT scans in 45 patients with rheumatoid arthritis were investigated. Radiologic findings were evaluated and correlated with the clinical data, which included rheumatoid factors and pulmonary function tests results. A lung biopsy was performed in five patients. The pattern of CT findings was as follows: infiltrative (n=15), obstructive (n=12), mixed (infiltrative and obstructive; n=10), other complicating diseases (n=7), and normal (n=1). The rheumatologic factor between patients with bronchial wall thickenings and patients without thickenings was significantly different (p=0.009). The forced expiratory flow rate between 25% and 75% of the vital capacity (FEF25-75%) was significantly more reduced in patients with interlobular septal thickenings than in patients without these thickenings. The patients with mosaic attenuation had significantly lower mean values of FEF25-75% (p=0.001) and a lower peak expiratory flow (p=0.003) than patients without mosaic attenuation. On expiratory scans, the mean air-trapping score was 21%. These air-trapping scores were found to be well correlated with FEV1/FVC (r=0.230, p=0.0452), and FEF25-75% (r=-0.63, p= 0.05). It is widely known that a relatively higher percentage of mosaic attenuation with air-trapping and a good correlation between these and functional values contribute to the detection of early airway obstruction in patients with rheumatoid arthritis, and even in patients with infiltrative lung disease only.

Airway complications in neonates who received mechanical ventilation.

OBJECTIVE: To determine the incidence, type and severity of airway complications in high risk neonates who received conventional mechanical ventilation. METHOD: Forty-five infants who had received conventional mechanical ventilation in the Neonatal Intensive Care Unit, Department of Pediatrics, Faculty of Medicine Siriraj Hospital for at least 4 days were enrolled. Orotracheal intubation with blue line, non-cuffed, non-shouldered polyvinylchloride tube was used exclusively. The average number of intubations was 2 (range 1-7), and the average duration for intubation was 25 days. The details of the intubation, and the presence of respiratory distress after extubation were recorded. All of the infants had endoscopic examination of the airway within 5 days of extubation. RESULTS: Following extubation, 14 (31.1%) infants developed signs of upper airway obstruction, of which inspiratory dyspnea was the most common manifestation. Only 4 infants developed inspiratory stridor, three of them had a birth weight greater than 2,500 g. Abnormal bronchoscopic findings were found in 42 infants, 68.8 per cent had multiple sites of injury. Supraglottic lesions were found in 55.7 per cent of cases. Laryngomalacia was an associated finding in 8 and gastroesophageal reflux (GER) in 1 occasion. CONCLUSIONS: From the result of this study, the authors found that airway complications related to endotracheal intubation are common among survivors from the Neonatal Intensive Care Unit. When the diagnosis of airway complications only depends on symptoms and signs of upper airway obstruction, the incidence and extent of injuries may be under-estimated. When attempted extubation fails or when VLBW infants develop increasing respiratory distress that is not clearly explained by an apparent disorder involving the pulmonary parenchyma, flexible bronchoscopic examination should be performed at the bedside with minimal risk.

Estudio del niño con obstrucción recurrente de las vías respiratorias superiores / The study of the children wiht recurrent upper airway obstruction

Antecedentes. La indagación sistémica de la obstrucción recurrente de las vías respiratorias superiores en niños debe basarse en una historia clínica completa, el uso adecuado de los estudios de laboratorio, y procedimientos diagnósticos que ayuden a identificar las causas más comunes de obstrucción y su interrelación con otras afecciones como: alergia nasal, rinosinusitis y adenoiditis con o sin hipertrofia significativa. Objetivo. Proponer un protocolo de estudio del paciente con obstrucción recurrente de las vías respiratorias utilizado en el Instituto Privado de Alergia, Inmunología y Vías Respiratorias. Material y método. Se estudió en forma prospectiva una cohorte de 117 pacientes en edad pediátrica, con manifestaciones clínicas de obstrucción recurrente de las vías respiratorias superiores. Resultados. El 75 por ciento de los pacientes estudiados tuvieron un patrón histológico sugerente de alergia nasal e infección interecurrente siguiendo el método descrito por A. Jalowayski con el uso de Thinoprobe. Se comprobó que el uso de la radiología convencional para el diagnóstico de hipertrofia-hiperplasia del tejido adenoideo es útil y orienta al diagnóstico primario en 75 por ciento de los pacientes. Conclusiones. El procedimiento endoscópico de las vías aéreas superiores es la prueba más sensible y específica para valorar la situación real del tejido adenoideo y su relación con la cavidad nasal