Clinical characteristics of plastic bronchitis and risk factors for recurrence in children / 中国当代儿科杂志

OBJECTIVES@#To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB.@*METHODS@#This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed.@*RESULTS@#A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05).@*CONCLUSIONS@#Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.

Paradigma manicomial e proibicionismo como operadores da guerra de raças no Brasil / Asylum paradigm and prohibitionism operating the racial war in Brazil / Paradigma asilar y prohibicionismo como operadores de la guerra racial en Brasil

Este artigo relaciona o paradigma manicomial, relativo à assistência psiquiátrica, à compreensão e ao manejo do campo da saúde mental, ao paradigma proibicionista, referente ao porte, uso e à circulação de drogas, como duas séries de políticas e práticas sociais que operam a guerra de raças que está na base do Estado brasileiro. Com isso, propomos uma investigação arqueogenealógica acerca do emaranhado de condições de emergência das práticas e objetos de saber-poder mobilizados por esses dois paradigmas, atentando ao caráter político das verdades que as sustentam. Dedicamo-nos especialmente ao período entre o final do século XIX e o começo do XX ao interrogar as dinâmicas de forças que constituem as práticas sociais e seus efeitos de subjetivação, produzidos pela sujeição de corpos por meio de uma diversidade de mecanismos morais, disciplinares, eugênicos, higienistas e biopolíticos que articulam os anseios de modernização e produtividade do Estado brasileiro à gestão dos problemas de saúde e segurança do país, colocando a pobreza, o vício e a doença como desdobramento da sua constituição racial. Concluímos, por fim, que o conflito de raças aparece como fundo intrínseco que se atualiza no cerne e a partir dos campos problemáticos da saúde mental e das drogas, colocando como saída dos impasses sociais e políticos eliminar ou pelo menos diluir, via miscigenação ou submissão para integração, o elemento físico e cultural do negro do Brasil.(AU)

This article puts in relation the asylum paradigm, associated to psychiatric care, to the understanding and management of the mental health field, to the prohibitionist paradigm, that refers to the possession, use and circulation of drugs, as two series of social policies and practices that operate racial war that is in the base of the Brazilian State. So on, we propose an archeogenealogical investigation about the emergency conditions of the practices and objects of knowledge-power organized by these two paradigms, paying attention to the political character of the truths that support them. Looking especially at the period between the end of the 19th century and the beginning of the 20th, we questioned the dynamics of forces that constitute social practices and their effects of subjectivation, produced by the subjection of bodies through moral, disciplinary, eugenic, hygienist and biopolitics mechanisms that articulate the modernization and productivity aspirations of the Brazilian State to the management of the country's health and safety problems, understanding poverty, addiction and disease as consequences of its racial constitution. We conclude that the conflict of races is an intrinsic background that is updated at the heart of the problematic fields of mental health and drugs. Considering this, the solution for social and political impasses is the elimination or at least dilution, through miscegenation or submission for integration, of the physical and cultural element of black people in Brazil.(AU)

Este artículo relaciona el paradigma asilar de atención psiquiátrica, comprensión y manejo del campo de la salud mental, con el paradigma prohibicionista, referente a al uso y circulación de drogas, como dos series de políticas y prácticas sociales que operan la guerra racial que está en el fundamento del Estado brasileño. Así, proponemos una investigación arqueogenealógica sobre las condiciones de emergencia de prácticas y objetos de saber-poder movilizados por estos dos paradigmas, prestando atención al carácter político de las verdades que los sustentan. Nos dedicamos especialmente al período entre finales del siglo XIX y principios del XX buscando la dinámica de fuerzas que constituyen a las prácticas sociales y sus efectos de subjetivación, producidos por la sujeción de los cuerpos a través de una diversidad de mecanismos morales, disciplinarios, eugenésicos, higienistas y biopolíticos que articulan las aspiraciones de modernización y productividad del Estado brasileño a la gestión de los problemas de salud y seguridad del país, comprendiendo la pobreza, la adicción y la enfermedad como resultado de su constitución racial. Finalmente, concluimos que el conflicto racial aparece como un trasfondo intrínseco que se actualiza en el cerne y desde los campos problemáticos de la salud mental y de las drogas, tomando como soluciones a los impasses sociales y políticos nacionales, la eliminación o al menos la dilución, a través del mestizaje o de la sumisión para fines de integración, del elemento físico y cultural del negro en Brasil.(AU)

Potencial cariogênico e erosivo de xaropes infantis / Cariogenic and erosive potential of children's syrups

Introdução: doenças crônicas como asma brônquica, alergias respiratórias ou doenças agudas recorrentes, como gripes, frequentemente acometem as crianças. Tais condições exigem o uso de medicamentos, normalmente sob a forma de xaropes, que podem se apresentar como genéricos ou de referência. A alta concentração em sacarose e o baixo pH dessas formulações, assim como o uso noturno e a falta de higienização após sua administração, são alguns fatores que podem contribuir para o potencial cariogênico e erosivo desses medicamentos. Objetivo: o objetivo deste estudo foi avaliar in vitro o potencial cariogênico e erosivo de xaropes infantis, de referência e genéricos, a partir de suas propriedades físico-químicas e identificar seus principais componentes a partir da análise de bulas e rótulos. Metodologia: foram analisados oito medicamentos de referência e os oito genéricos equivalentes, os quais foram avaliados quanto ao pH, a acidez titulável, a presença de sólidos solúveis totais (ºBrix) e a composição em sacarose e conservantes através da análise de bulas e rótulos. Resultados: constatou-se que 75% da amostra apresentou pH abaixo do crítico para desmineralização do esmalte dentário. A presença da sacarose e do ácido cítrico foi observada em 43,75% dos medicamentos, especialmente entre aqueles com altos valores de titulação. Conclusão: a maioria dos medicamentos apresentou pH abaixo do pH crítico para dissolução do esmalte dentário, havendo uma ampla variação da acidez titulável. As bulas dos medicamentos não informavam quanto ao risco de erosão dentária e de cárie, apesar da presença de sacarose em algumas formulações.

Introduction: chronic illnesses such as bronchial asthma, respiratory allergies or recurrent acute illnesses, such as the flu, often affect children. Such conditions require the use of medications, usually in the form of syrups, which can be presented as generic or reference ones. The high concentration of sucrose and the low pH of these formulations, as well as the night use and the lack of hygiene after its administration, are some factors that can contribute to the cariogenic and erosive potential of these drugs. Objective: the aim of this study was to evaluate in vitro the cariogenic and erosive potential of infant reference and generic syrups, based on their physical and chemical properties and to identify their main components from the analysis of package inserts and labels. Methodology: eight reference drugs and eight generic equivalents were analyzed, which were evaluated for pH, titratable acidity, the presence of total soluble solids (ºBrix) and the composition in sucrose and preservatives through the analysis of package inserts and labels. Results: it was found that 75% of the sample had a pH below the critical level for tooth enamel demineralization. The presence of sucrose and citric acid was observed in 43.75% of the drugs, especially among those with high titration values. Conclusion: most drugs had pH below the critical pH for tooth enamel dissolution, with a wide range of titratable acidity between them. The package inserts of the medications did not inform about the risk of dental erosion and caries, despite the presence of sucrose in some formulations.

Association of temperament type and mother's emotional state with acute respiratory infection in children / 南方医科大学学报

OBJECTIVE@#To explore the correlation of temperament type and mother's emotional state with acute respiratory tract infections in children so as to provide evidence for comprehensive treatment of the infections.@*METHODS@#A total of 200 children aged between 3 and 6 were enrolled in this study from two kindergartens of Guangzhou and Hengyang. The mothers were invited to complete a questionnaire of the children's general information followed by assessment using children's temperament scale and the Depression-Anxiety-Stress Scale.@*RESULTS@#The total incidence of acute respiratory infection was significantly higher in children with a hard- to-raise temperament than the easy- to-raise children (P < 0.05); the incidences of acute rhinitis, acute pharyngitis, acute laryngitis and acute bronchitis were all significantly higher in the hard-to-raise children (P < 0.05). A significant positive correlation was identified between the total number of episodes of acute respiratory tract infection in children and their mothers' stress and anxiety levels (P < 0.01). Acute rhinitis and acute tracheitis in the children were both positively correlated with the mothers' stress scores (P < 0.05), while acute pharyngitis and acute laryngitis were positively correlated with the mothers' anxiety scores (P < 0.05), while acute bronchitis was positively correlated with the mothers' stress and anxiety scores (P < 0.05). Multiple linear regression analysis with the factors influencing the types of acute respiratory tract infections in children as the independent variables suggested that the easy-to-raise type of temperament was a protective factor against acute rhinitis in children (P < 0.05), while mothers' anxiety was a risk factor of acute laryngitis in children (P < 0.05); the mothers' stress was a risk factor for acute bronchitis in children (P < 0.05).@*CONCLUSION@#Acute respiratory tract infection in children is closely related to the temperament type of the children and the emotional state of the mothers, which are important therapeutic targets in comprehensive interventions of acute respiratory tract infection in children.

Síntomas respiratorios en agentes civiles de tránsito expuestos a smog en Quito en el año 2021 / Respiratory symptoms in civil traffic police agents exposed to smog in Quito in 2021

INTRODUCCIÓN. Existe relación entre la exposición de contaminantes en el aire y problemas respiratorios que van desde síntomas leves en vías respiratorias altas hasta enfermedades que pueden comprometer la vida de los pacientes como: neumonía, enfermedad pulmonar obstructiva crónica y cáncer pulmonar. OBJETIVO. Registrar los síntomas respiratorios presentados por agentes civiles de tránsito expuestos a smog. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 3 458 y muestra de 454 participantes entre agentes civiles de tránsito, fiscalizadores de tránsito y personal administrativo de la Agencia Metropolitana de Tránsito en el año 2021, seleccionados por muestreo aleatorio simple estratificado para los dos grupos de participantes; se aplicó un sondeo digital basado en las encuestas: European Community Respiratory Health Survey y condiciones de trabajo. Para el análisis de datos se utilizó la herramienta EPI INFO, donde se realizó pruebas estadísticas bivariadas de Chi2 y análisis multivariado como regresiones logísticas crudas y ajustadas. RESULTADOS. Se observó que la población de trabajadores operativos en vía tuvo alrededor de dos veces más riesgo de desarrollar sibilancias en comparación a la población administrativa OR=2,1 (IC 95% 1,01­4,39); el personal operativo tuvo más del doble de riesgo de desarrollar bronquitis crónica versus la población administrativa OR=2,5 (IC 95% 1,14­5,73). Los resultados fueron ajustados mediante regresión logística con variables de condiciones de trabajo y salud (p=<0,05). CONCLUSIÓN. Se registró una relación significativa entre la contaminación ambiental por smog y enfermedades respiratorias a largo plazo.

INTRODUCTION. There is a relationship between exposure to air pollutants and respiratory problems ranging from mild upper respiratory symptoms to life-threatening diseases such as pneumonia, chronic obstructive pulmonary disease and lung cancer is evident. OBJECTIVE. To record the respiratory symptoms presented by civilian traffic officers exposed to smog. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 3 458 and sample of 454 participants among civilian traffic agents, traffic inspectors and administrative personnel of the Metropolitan Traffic Agency in the year 2021, selected by simple stratified random sampling for the two groups of participants; a digital survey was applied based on the European Community Respiratory Health Survey and working conditions. For data analysis, the EPI INFO tool was used, where bivariate Chi2 statistical tests and multivariate analysis such as crude and adjusted logistic regressions were performed. RESULTS. It was observed that the population of operational track workers had about twice the risk of developing wheezing compared to the administrative population OR=2,1 (95% CI 1,01-4,39); operational personnel had more than twice the risk of developing chronic bronchitis versus the administrative population OR=2,5 (95% CI 1,14­5,73). Results were adjusted by logist regression with working conditions and health variables (p=<0,05). CONCLUSION. There was a significant relationship between smog pollution and long-term respiratory diseases.

Evidencia científica y recomendaciones sobre el manejo de la bronquiolitis en pediatria / Cientific evidence and recommendations on the bronchiolitis management in pediatry

En los ámbitos científico e institucional existe controversia sobre el manejo idóneo de la bron- quiolitis en pacientes pediátricos. El objetivo de este trabajo es valorar el nivel de evidencia cientí- fica que existe sobre el manejo de la bronquiolitis para determinar si las recomendaciones actuales son o no adecuadas. Se realizó una revisión sis- temática de artículos científicos consultando di- versas bases de datos, sin restricción de fecha, en los idiomas español e inglés. Se incluyó literatura gris mediante búsqueda manual. No se hicieron restricciones respecto al tipo de estudio. Se re- visaron los resúmenes y en los casos necesarios los artículos completos, teniéndose en cuenta fi- nalmente todos los artículos que incluían apor- tes sobre el manejo adecuado de la bronquiolitis. Como resultado la mayoría de las recomenda- ciones realizadas por las sociedades fueron a tra- vés de guías de práctica clínica o artículos de opinión, concluyendo que no se cuenta con un esquema de tratamiento adecuado para tratar la bronquiolitis aguda, existiendo un manejo erróneo con el uso de esteroides y antibióticos, mientras que uno de los tratamiento más viables y costo efectivos queda en el olvido como es la solución hipertónica al 3%, la cual ha demostra- do reducción de la estancia hospitalaria...(AU)

Eficacia y seguridad de solución salina hipertónica nebulizada con o sin epinefrina en el manejo de bronquiolitis aguda / Efficacy and safety of nebulized hypertonic saline with or without epinephrine in management of acute bronchiolitis

Antecedentes: La bronquiolitis es una enfermedad viral aguda del tracto respiratorio inferior en niños menores de dos años, con una tasa máxima de aparición entre 2-10 meses de edad. Objetivo: Evaluar eficacia y seguridad de solución salina hipertónica nebulizada con o sin epinefrina en el manejo de la bronquiolitis aguda. Materiales y métodos:Estudio cuasi-experimental longitudinal, en lactantes ingresados en Hospital Nacional Mario Catarino Rivas (HNMCR), con bronquiolitis aguda leve. Se analizaron 26 casos, asignados al azar, 12 recibieron nebulizaciones con solución salina hipertónica al 3% mas 1 ml de epinefrina (SSH+E) y 14 recibieron 3 ml de solución hipertónica al 3% (SSH), administrados cada 4 horas, y se realizaron análisis de la Escala de Wood Downes- Ferres, saturación de oxígeno y complicaciones posteriores a las nebulizaciones cada 6 horas, por un periodo de 24 horas. El estudio fue aprobado por un comité de ética. Resultados: La estancia hospitalaria se redujo significativamente en el grupo de SSH en comparación con el grupo SSH+E (1,79±0,80 días: 2,50±0,79 días, P = 0,032). El score clínico disminuyo en ambos grupos, pero no hubo diferencia estadísticamente significativa (p=0,187 vs p=0,074, al llegar y luego de 24 horas) Las complicaciones encontradas fueron estadísticamente significativas para el grupo de SSH+E, posterior a las primeras 3 nebulizaciones P = 0,007 y a las 12 horas P = 0,019. Conclusión: Las nebulizaciones con SSH y con SSH+E son igualmente eficaces, sin embargo, la SSH demostró mayor seguridad y acortó significativamente la estancia hospitalaria de los lactantes hospitalizados con bronquiolitis aguda leve...(AU)

Caracterización de las infecciones en niños portadores de cánula de traqueotomía: revisión sistemática de la literatura / Characterization of infections in children with Tracheostomy Tube: A Systematic Review of the Literature

Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.

Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.

"Bronquitis aguda" en paciente de 88 años de edad / "Acute Bronchitis" In An 88-Year-Old Patient

Paciente de 88 años que consultó por presentar tos productiva con expectoración mucopurulenta de 15 días de evolución. Equivalentes febriles. No refirió pérdida de peso ni inapetencia. Al examen clínico, cicatriz de toracotomía en el hemitórax izquierdo. A la auscultación, hipoventilación generalizada en ambas playas pulmonares, con rales subcrepitantes húmedos en base derecha. La Rx. de Tórax solicitada reveló en la playa pulmonar derecha, retracción lobular superior y en la playa izquierda, múltiples imágenes circulares y geométricas, que ocupaban campos pulmonares superior y medio. Signo de la columna vertebral desnuda por retracción de la imagen cardiovascular hacia dicho hemitórax en el campo inferior

Experiencia de una unidad aerodigestiva pediátrica en Latinoamérica / Case management experience in a pediatric aerodigestive unit in Latin-America

Introducción: las unidades aerodigestivas proveen un cuidado complejo coordinado a pacientes pediátricos con condiciones congé-nitas o adquiridas de grados variables que afectan la vía respiratoria, el tracto gastrointestinal, la deglución y el crecimiento. La primera unidad aerodigestiva de Guatemala fue fundada en el año 2018 en un hospital privado, y por ser la única de su tipo en el país, no se tenían datos locales al respecto. Pacientes y métodos: se llevó a cabo un estudio retrospectivo cuantitativo; se analizó el total de casos reportados en la unidad aerodigestiva pediátrica desde el 1 de enero de 2018 hasta el 31 de mayo de 2019, se contó con un total de 69 casos. Resultados: el 79% de los pacientes presentaron más de una patología de diferente etiología. La indicación principal para realizar la triple endoscopia fue tos crónica. Los diagnósticos encontrados como comorbilidades con mayor frecuencia fueron bronquitis bacteriana recurrente y enfermedad por reflujo gastroesofágico. Conclusión: la triple endoscopia es útil tanto en el diagnóstico como en la toma de decisiones en el manejo de las patologías aerodigestivas pediátricas de alta complejidad. Es una herramienta útil que pone en evidencia que múltiples etiologías pueden contribuir a síntomas crónicos de la vía aérea, y que estas pueden pasarse por alto si se realiza un solo procedimiento.

Introduction: Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or ac-quired conditions affecting breathing, the gastrointestinal tract, swallowing, and growth. The first aerodigestive program in Guatemala was founded in the year 2018 in a private hospital and, since it's one of its kind in the country, there was no local data reported. Patients and methods: A total of 69 cases of children who were evaluated at the aerodigestive program from January 1st, 2018 to May 31st, 2019, were retrospectively analyzed in a quantitative study. Results:79% of patients presented more than one pathology from different etio-logy. Overall the main indication for the triple scope was chronic cough. The findings reported that recurrent bacterial bronchitis and gastroesophageal reflux were the most common comorbidities present in the same patient. Conclusion:The triple scope procedure is a useful investigative tool for patients with recalcitrant aero-digestive complaints. In particular, the triple scope can yield more than one specialty-specific diagnosis normally missed by one procedure.

Traqueobronquitis necrotizante secundaria a aspergilosis invasiva en paciente inmunocompetente / Necrotizing tracheobronchitis due to invasive aspergillosis in an immunocompetent patient

Resumen La traqueobronquitis aspergilar es una forma poco frecuente de aspergilosis invasiva reportada excepcionalmente en el paciente inmunocompetente. Su diagnóstico es difícil, y los tratamientos propuestos hasta ahora son de escasa efectividad, todo lo cual constituye un verdadero problema para el equipo de salud. Presentamos el caso de una paciente de 28 años, inmunocompetente y sin antecedentes epidemiológicos, que desarrolló traqueobronquitis necrotizante por aspergilosis invasiva y recibió tratamiento con voriconazol con instilación local por broncoscopia con buena respuesta.

Abstract Aspergillus tracheobronchitis is a rare form of invasive aspergillosis reported exceptionally in the immunocompetent patient. Its diagnosis is difficult, and the treatments proposed so far are of little effectiveness, all of which constitute a real problem for the health team. We present the case of an immunocompetent 28 yearsold woman, with no epidemiological background, who developed necrotizing tracheobronchitis due to invasive aspergillosis and received voriconazole with local instillation by bronchoscopy with a good response.

Clinical features of severe type 7 adenovirus pneumonia: an analysis of 45 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of severe type 7 adenovirus pneumonia in children.@*METHODS@#A retrospective analysis was performed for the clinical data of children who were diagnosed with severe type 7 adenovirus pneumonia from February to June, 2019.@*RESULTS@#Among the 45 children, the male/female ratio was 3:2 and the median age was 14 months. All children had repeated fever, cough, and pulmonary moist rales, and the mean duration of fever was 14±4 days. The median time from fever to dyspnea was 8 days, and the time from fever to mechanical ventilation was 11.6±2.5 d. There was no significant increase in white blood cell count, with neutrophils as the main type. There were slight reductions in hemoglobin and albumin, while platelet and fibrinogen remained normal. There were increases in aspartate aminotransferase, lactate dehydrogenase, procalcitonin, and C-reaction protein. The detection rate of mixed pathogens was 84%. Effusion in both lungs was the major change on chest imaging (64%). Bronchoscopic manifestations were endobronchitis, tracheomalacia, and plastic bronchitis. The incidence rate of respiratory complications was 100%, and extrapulmonary complications mainly involved the circulatory system (47%), digestive system (36%), and nervous system (31%). Among the 45 children, 16 were administered with 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days, with a mean duration of fever of 16±5 days, and 29 were administered with 1 g/kg IVIG daily for 2 days, with a mean duration of fever of 13±4 days; there was a significant difference in the mean duration of fever between the two groups (P=0.046). The overall mortality rate was 11%.@*CONCLUSIONS@#Severe type 7 adenovirus pneumonia in children has severe conditions, with a high incidence rate of complications and a high mortality rate, so it should be diagnosed and treated as early as possible.

Clinical Characteristics of Chronic Cough in Korea / 결핵

Traqueobronquite associada à ventilação mecânica: uma atualização / Ventilator-associated tracheobronchitis: an update

RESUMO As infecções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia. Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes gravemente enfermos internados nas unidades de terapia intensiva, em contrapartida, demonstra associação significativa com o aumento dos custos hospitalares desses pacientes, assim como do tempo de internação na unidade de terapia intensiva e hospitalar, do uso de antibióticos, e da duração da ventilação mecânica. Embora ainda necessitemos de evidências científicas mais robustas, especialmente no que tange às modalidades terapêuticas, os dados atuais a respeito da traqueobronquite associada à ventilação mecânica salientam que há desfechos suficientemente importantes que exigem vigilância epidemiológica e controle clínico adequados.

ABSTRACT Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

Hospitalizações por doenças crônicas em crianças menores de cinco anos no sistema público de saúde no Brasil e no Rio Grande do Sul / Hospitalizations caused by chronic diseases among children under the age of five in the public health system in Brazil and in Rio Grande do Sul

Objective:to identify rates of hospitalizations fromchronic diseases among children under the age of five from 2010 to 2015. Method:Ecological study using a time series trend. Data were collected from the Hospital Information System of the Brazilian Public Health System between January and March 2016. After data were digitalized, descriptive analysis was performed using EpiInfo. Results:The frequency of hospitalizations caused by chronic diseases among children younger than 5 years old remained between 10.8% and 11.2% in Brazil and 13.8% to 16.1% in Rio Grande do Sul. Respiratory disorders were the most prevalent, both in the state of Rio Grande do Sul and at the national level. Asthma was themost prevalent reason for hospitalization. Final considerations:Even though, in general, the causes of hospitalizations tend to remain stable, emphasis is placed on the high prevalence of chronic conditions in childhood and their impact on the lives of children and their families.

Objetivo:identificar as taxas de hospitalização por doenças crônicas em crianças menores de cinco anos de 2010 a 2015. Método:estudo ecológico de tendência de série temporal. Os dados foram extraídos do Sistema de Informações Hospitalares do Sistema Único de Saúde e coletados entre janeiro e março de 2016. Após digitalização dos dados, foi realizada a análise descritiva, utilizando programa EpiInfo. Resultados:a frequência de hospitalizações por doenças crônicas em crianças menores de cinco anos vem se mantendo constante entre 10,8% a 11,2% no Brasil e 13,8% a 16,1% no Rio Grande do Sul. Identificou-se que os distúrbios respiratórios foram os mais prevalentes nos dois cenários, dando destaque à asma(como o motivo de internação mais prevalente. Considerações finais:apesar de as causas de internações apresentarem, de modo geral, uma tendência à estabilidade, dá-se ênfase à alta prevalência da agudização das condições crônicas na infância e à repercussão delaspara a vida da criança e sua família.

Value of Exhaled Nitric Oxide and FEF(25–75) in Identifying Factors Associated With Chronic Cough in Allergic Rhinitis

PURPOSE: Chronic cough in allergic rhinitis (AR) patients is common with multiple etiologies including cough variant asthma (CVA), non-asthmatic eosinophilic bronchitis (NAEB), gastroesophageal reflux-related cough (GERC), and upper airway cough syndrome (UACS). Practical indicators that distinguish these categories are lacking. We aimed to explore the diagnostic value of the fraction of exhaled nitric oxide (FeNO) and forced expiratory flow at 25% and 75% of pulmonary volume (FEF(25–75)) in specifically identifying CVA and NAEB in these patients. METHODS: Consecutive AR patients with chronic cough were screened and underwent induced sputum, FeNO, nasal nitric oxide, spirometry, and methacholine bronchial provocation testing. All patients also completed gastroesophageal reflux disease questionnaires. RESULTS: Among 1,680 AR patients, 324 (19.3%) were identified with chronic cough, of whom 316 (97.5%) underwent etiology analyses. Overall, 87 (27.5%) patients had chronic cough caused by NAEB, 78 (24.7%) by CVA, 16 (5.1%) by GERC, and 81 (25.6%) by UACS. Patients with either NAEB or CVA (n = 165, in total) were further assigned to a common group designated as CVA/NAEB, because they both responded to corticosteroid therapy. Receiver operating characteristic curves of FeNO revealed obvious differences among CVA, NAEB, and CVA/NAEB (area under the curve = 0.855, 0.699, and 0.923, respectively). The cutoff values of FeNO at 43.5 and 32.5 ppb were shown to best differentiate CVA and CVA/NAEB, respectively. FEF(25–75) was significantly lower in patients with CVA than in those with other causes. A FEF(25–75) value of 74.6% showed good sensitivity and specificity for identifying patients with CVA. CONCLUSIONS: NAEB, CVA, and UACS are common causes of chronic cough in patients with AR. FeNO can first be used to discriminate patients with CVA/NAEB, then FEF(25–75) (or combined with FeNO) can further discriminate patients with CVA from those with CVA/NAEB.

Genomic characteristics of natural recombinant infectious bronchitis viruses isolated in Korea / 대한수의학회지

Two infectious bronchitis virus (IBV) K046-12 and K047-12 strains were isolated and the nearly complete genomes of them were sequenced. Sequence comparisons showed that the K046-12 genome was most similar to Korean IBV strains, and the K047-12 genome was most similar to QX-like IBV strains. Phylogenetic analysis showed that nearly all K046-12 and most K046-12 genes were placed in the same cluster as Korean IBV isolates, but the S1 region was placed in the same cluster as Mass-type IBVs. For K047-12, nearly all K047-12 and most K047-12 genes were located in the same cluster as QX-like IBVs, but the M region was located in the same cluster as Korean IBV isolates with K047-12. Recombination analysis confirmed that K046-12 is a recombinant strain with the primary parental sequence derived from Korean IBVs and minor parental sequence derived from Mass-type IBV, and K047-12 is a recombinant strain with the major parental sequence derived from QX-IBV and minor parental sequence derived from Korean IBVs. This study showed that new IBV recombinants are constantly generated among various IBVs, including those used for vaccination. Therefore, genetic analysis of new virus isolates should be performed for effective infectious bronchitis control and appropriate vaccine development.

Infecção respiratória aguda baixa em crianças indígenas guarani, brasil / Acute lower respiratory infection in guarani indigenous children, brazil

RESUMO Objetivo: Descrever o perfil clínico e o tratamento realizado nas crianças da etnia Guarani menores de cinco anos hospitalizadas por infecção respiratória aguda baixa (IRAB), residentes em aldeias nos estados do Rio de Janeiro ao Rio Grande do Sul. Métodos: Das 234 crianças, 23 foram excluídas (dados incompletos), sendo analisadas 211. Os dados foram extraídos dos prontuários por meio de formulário. Com base no registro de sibilância e padrão radiológico, a IRAB foi classificada em: bacteriana, viral e viral-bacteriana. Foi utilizada regressão multinomial para análise bivariada. Resultados: A mediana de idade foi de 11 meses. Do total da amostra, os casos de IRAB foram assim distribuídos: viral (40,8%), bacteriana (35,1%) e viral-bacteriana (24,1%). Verificou-se que 53,1% das hospitalizações não possuíam evidências clínico-radiológico-laboratoriais que as justificassem. Na análise de regressão multinomial, ao comparar a IRAB bacteriana com a viral-bacteriana, a chance de ter tosse foi 3,1 vezes maior na primeira (intervalos de 95% de confiança - IC95% 1,11-8,70) e de ter tiragem 61,0% menor (Odds Ratio - OR 0,39, IC95% 0,16-0,92). Na comparação da IRAB viral com a viral-bacteriana, a chance de ser do sexo masculino foi 2,2 vezes maior na viral (IC95% 1,05-4,69) e de ter taquipneia, 58,0% menor (OR 0,42, IC95% 0,19-0,92) na mesma categoria. Conclusões: Identificou-se maior proporção de processos virais do que processos bacterianos, bem como a presença de infecção viral-bacteriana. A tosse foi um sintoma indicativo de infecção bacteriana, enquanto a tiragem e a taquipneia apontaram infecção viral-bacteriana. Parte da resolubilidade da IRAB não grave ocorreu em âmbito hospitalar; portanto, propõe-se que os serviços priorizem ações que visem à melhoria da assistência à saúde indígena na atenção primária.

ABSTRACT Objective: To describe the clinical profile and treatment of Brazilian Guarani indigenous children aged less than five years hospitalized for acute lower respiratory infection (ALRI), living in villages in the states from Rio de Janeiro to Rio Grande do Sul. Methods: Of the 234 children, 23 were excluded (incomplete data). The analysis was conducted in 211 children. Data were extracted from charts by a form. Based on record of wheezing and x-ray findings, ALRI was classified as bacterial, viral and viral-bacterial. A bivariate analysis was conducted using multinomial regression. Results: Median age was 11 months. From the total sample, the ALRI cases were classified as viral (40.8%), bacterial (35.1%) and viral-bacterial (24.1%). It was verified that 53.1% of hospitalizations did not have clinical-radiological-laboratorial evidence to justify them. In the multinomial regression analysis, the comparison of bacterial and viral-bacterial showed the likelihood of having a cough was 3.1 times higher in the former (95%CI 1.11-8.70), whereas having chest retractions was 61.0% lower (OR 0.39, 95%CI 0.16-0.92). Comparing viral with viral-bacterial, the likelihood of being male was 2.2 times higher in the viral (95%CI 1.05-4.69), and of having tachypnea 58.0% lower (OR 0.42, 95%CI 0.19-0.92). Conclusions: Higher proportion of viral processes was identified, as well as viral-bacterial co-infections. Coughing was a symptom indicative of bacterial infection, whereas chest retractions and tachypnea showed viral-bacterial ALRI. Part of the resolution of non-severe ALRI still occurs at hospital level; therefore, we concluded that health services need to implement their programs in order to improve indigenous primary care.