Standard operating procedure of the indwelling nasal cannula with or without anchoring for the treatment of pulmonary mycosis / 天津医药

Systemic application of effective antifungal drugs is the basic treatment for pulmonary mycosis,meanwhile,drug spraying under bronchoscope is one of the most important treatment options for tracheal,bronchial and pulmonary mycosis.Compared with bronchoscopic drug injection,indwelling guided drug injection cannula through nasal suspension with or without anchoring has more advantages in the treatment of pulmonary mycosis,including the ability to connect to a syringe pump for continuous and slow injection of drugs,which can avoid repeatedly performing bronchoscopy.This article describes the standard operating procedure of indwelling nasal cannula with or without anchoring for the treatment of pulmonary mycosis.

Anti-synthase syndrome complicated by multiple organ damage: one-case report and literature analysis / 中国基层医药

Objective:By analyzing the characteristics, diagnosis, and treatment process of anti-synthetase syndrome complicated by interstitial pneumonia and cardiac dysfunction, we aim to enhance general practitioners' understanding and diagnosis of this disease, thereby improving their level of diagnosis and treatment and reducing misdiagnoses and missed diagnoses.Methods:A patient with anti-synthase syndrome complicated by interstitial pneumonia and cardiac dysfunction, who was admitted to The First Affiliated Hospital of Xi'an Medical University in February 2020 due to limb weakness accompanied by paroxysmal cough for 2 years and aggravated symptoms for 10 days, was included in this study. The patient's clinical symptoms, physical signs, laboratory examination results, diagnosis and treatment process, and follow-up were retrospectively analyzed based on previous literature.Results:Through the general practitioner's SOAP consultation, physical examination, and imaging examination, the patient was diagnosed with anti-synthase syndrome complicated by interstitial pneumonia and cardiac dysfunction. Then rheumatology and immunology experts, respiratory medicine experts, and cardiovascular experts collaborated to provide a specialist diagnosis and treatment plan for the patient. Subsequently, the patient was referred to the department of rheumatology and immunology for specialized disease management. Finally, the patient was followed up in the general clinic. After the patient's condition stabilized, she gradually resumed her health.Conclusion:The multidisciplinary diagnosis and treatment scheme for anti-synthase syndrome can enhance general practitioners' understanding of the disease, make the diagnosis of the disease, and fully leverage the advantages of multi-disciplinary consultation and primary diagnosis in general medicine.

Clinical features and risk factors in 126 patients with anti-MDA5 antibody positive dermatomyositis / 中华风湿病学杂志

Objective:To explore clinical factors of poor prognosis in patients with anti-melanoma differentiation-associated gene 5 andtibody positive dermatomyositis (MDA5-DM).Methods:One hundred and twenty-six enrolled adults with MDA5-DM were divided into the survival group and the deceased group according to the outcomes. Survival time, clinical manifestations, laboratory tests, pulmonary function tests, myositis antibodies and treatments were collected for statistical analysis. Serum concentrations of IL-15, HMGB1, and sCD163 were measured by ELISA in MDA5-DM patients and healthy controls. Mann-Whitney U nonparametric test and Student′s t-test were used to compare the continuous variables between the two groups, and χ2 or Fisher′s exact test were used for comparison of categorical variables. Cox regression analysis was used to assess the survival predictors in MDA5-DM patients. The cumulative survival rate was calculated by Kaplan-Meier curve analysis, and Log-rank tests were used to examine differences in survival curves. P<0.05 was considered statistically significant. Results:Cox multivariate regression analysis revealed that age > 57 years [ HR (95% CI)=3.05 (1.20, 7.80), P=0.020], RP-ILD [ HR (95% CI)=25.07 (5.42, 115.98), P<0.001], and levels of anti-Ro52 antibody [ HR (95% CI)=3.41 (1.36, 8.53), P=0.009] were important prognostic factors independent of multiple clinical parameters. The ELISA test results showed that the levels of serum IL-15[0.91 (0.66, 2.00)pg/ml vs. 0.51(0.39, 0.72)pg/ml, Z=-4.57, P<0.001] and HMGB1 [230.53(90.40, 394.31)ng/ml vs. 32.66 (17.82, 46.21)ng/ml, Z=-6.52, P<0.001] in MDA5-DM patients were significantly higher than those in healthy controls, but there were no significant differences in the level of serum IL-15 [1.21(0.63, 2.12)pg/ml vs. 0.91(0.68, 1.66)pg/ml, Z=-0.30, P=0.766], HMGB1[267.61(167.03, 444.23)ng/ml vs. 228.35(74.74, 344.32)ng/ml, Z=0.82, P=0.413], and sCD163 [112.70(93.45, 148.51)ng/ml vs. 132.72(96.79, 203.18)ng/ml, Z=-0.62, P=0.536] between the survival group and the deceased group. Conclusion:Older age, RP-ILD, and high levels of anti-Ro52 antibody significantly increase the risk of death in MDA5-DM patients. Intensive follow-up of patients with the above factors in the early stages may help to improve the prognosis.

Clinical characteristics of 272 cases with anti-MDA5 antibody positive dermatomyositis / 中华风湿病学杂志

Objective:To analyze the clinical features of MDA5 antibody positive dermatomyositis (MDA5-DM) and to provide evidence for early diagnosis and treatment.Methods:From March 2019 to June 2021, 272 patients with anti-MDA5-DM from the Nanjing Medical University myositis-associated interstitial lung disease cohort were enrolled, with 76 patients with anti-synthetase syndrome (ASS) as the control group. The clinical characteristics and the occurrence of interstitial lung disease were analyzed. T-test was used for normally distributed and variance-homogeneous independent samples, Mann-Whitney U test for non-normally distributed data, and chi-square test or Fisher′s exact test for dichotomous variables. Results:Among the 272 anti-MDA5-DM patients, 88.6% (241/272) developed interstitial lung disease (ILD), and 33.8% (92/272) developed rapidly progressive ILD (RP-ILD). The six-month all-cause mortality rate of anti-MDA5-DM patients was 16.9% (46/272), and it was as high as 47.8% (44/92) for those with RP-ILD. Compared with ASS patients, anti-MDA5-DM patients had a significantly higher proportion of males, arthritis, Gottron's sign, heliotrope rash, V-sign, periungual erythema, and skin ulcers ( P<0.05). The levels of ALT, AST, and ferritin were significantly increased ( P<0.05). Compared with non-RP-ILD patients, RP-ILD patients had a significantly higher proportion of males [35.9%(33/92) vs. 23.3%(42/180), χ2=4.79, P=0.029], higher levels of LDH [387 (276, 547) U/L vs. 310 (245, 400) U/L, Z=-3.67, P<0.001], ESR [45.5 (29.25, 63.25) mm/1 h vs. 31.2 (20, 51) mm/1 h, Z=-3.71, P<0.001], CRP [10.9 (4.1, 25.2) mg/L vs. 4.54 (2.58, 9.08) mg/L, Z=-4.97, P<0.001], ferritin [1 340 (650, 2 000) ng/ml vs. 556 (203, 1 186) ng/ml, Z=-4.40, P<0.001], and a higher proportion of anti-Ro52 antibody and anti-MDA5 antibody co-positivity [87.0%(80/92) vs. 52.2%(94/180), χ2=31.87, P<0.001]. Conclusion:Anti-MDA5-DM patients are prone to develop RP-ILD and have poor prognosis.

Pertussis toxin in involves the development of interstitial lung disease in an experimental autoimmune myositis mice modelby inducing the formation of neutrophil extracellular traps / 中华风湿病学杂志

Objective:To test the hypothesis that Pertussis toxin (PTX) can promote the occurrence of interstitial lung disease (ILD) in experimental autoimmune myositis (EAM) model and clarify the potential pathogenic mechanism.Methods:EAM mice model were induced by Skeletal muscle thomogenate with or without PTX, and the relationship between ILD phenotypes and neutrophil extracellular traps (NETs) infiltration was analyzed by histopathological and serological studies in EAM with PTX group and EAM without PTX group. Healthy mice were given PTX alone intraperitoneally to clarify whether NETs formation could be induced in vivo, and neutrophils separated from healthy human blood were intervened with PTX to induce NETs formation in vitro. The data was tested for normality using Shapiro-Wilk. Statistical methods and were analyzed using t-test or ANOVA, and multiple comparisons between different groups were tested using Tukey test. Results:Compared with EAM without PTX group, lung tissues in EAM with PTX group had multiple pathological changes similar to polymyositis/dermatomyositis-related ILD. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the main pathological types. The pulmonary interstitial lesions were accompanied by significant infiltration of NETs; and serum NETs markers levels were obviously elevated in EAM with PTX group, compared with the control group [ n=5, (87±10) ng/ml], cfDNA levels were statistically significantly elevated in both the EAM without PTX group [ n=4, (115±27) ng/ml] and the EAM with PTX group [ n=7, (150±50) ng/ml] ( F=4.24, P=0.038); Cit-H3-DNA levels were elevated in the EAM without PTX group ( n=4, 0.24±0.09), and in the EAM EAM with PTX group ( n=6, 0.33±0.11) compared with the control group ( n=4, 0.13±0.02) ( F=6.21, P=0.016). After PTX intervention, serum cfDNA levels were higher in the PTX group [ n=3, (100±40) ng/ml] than in the control group [ n=3, (45±12) ng/ml, t=2.27, P=0.086]; PTX also induced neutrophils to form NETs in vitro. Conclusion:PTX may promote the development of ILD in EAM mice model by inducing the formation of NETs, indicating that EAM mice can serve as a model for targeting NETs to study the pathogenesis ILD.

Development and validation of a diagnostic model based on machine learning algorithms for the development of interstitial lung diseases in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective:Screening factors that might influence rheumatoid arthritis (RA) complicating interstitial lung diseases (ILD) by constructing and validating a model for early diagnostic.Methods:The study subjects were composed of 712 RA patients in the Department of Rheumatology and Immunology of the Second Hospital of Shanxi Medical University during December 2019 to October 2022. Fifty-two variables such as their demographic data, clinical symptoms, and laboratory indexes were collected. Patients were categorized into RA-only group and RA-ILD group with or without the occurrence of ILD disease. After data preprocessing, subjects were randomly assigned to the modeling and validation groups in a 7:3 ratio.Univariate analysis comparing baseline characteristics of the two groups of patients. Feature selection was performed using LASSO and SVM-RFE regression algorithms.Screening indicators were analyzed by logistic regression and the results were used to develop a nomograms model for the early diagnosis of RA complicating interstitial lung disease; and the modeling group was evaluated for its performance for internal assessment of the model and internal validation using data from the validation group.Results:A total of 712 subjects participated in the study, of which 498 in the modeling group and 214 in the validation group. Univariate analysis showed that the differences between the two groups were statistically significant ( P<0.05) in 18 characteristic indexes, including male, gender, age, smoking history, drinking history, number of swollen joints, number of painful joints, use of prednisone, WBC, ESR, CRP, IL-2, IL-10, IL-17, TNF-α, INF-γ, AFA family, APF, and serum albumin. The LASSO algorithm identified 13 risk variables for RA-ILD, the SVM-RFE algorithm identified 12 variables for RA-ILD, and the intersecting risk variables were male, age, history of alcohol consumption, number of painful joints, prednisone acetate, IL-2, AFA family, TNF-α, serum albumin, and IL-10. The results of multifactorial logistic regression analysis confirmed that the differences between males [ OR(95% CI)=3.61(2.11, 6.18)], gender, age [ OR(95% CI)=1.05(1.03, 1.08)], number of painful joints [ OR(95% CI)=1.03(1.01, 1.06)], IL-2 [ OR(95% CI)=0.91 (0.84, 0.99)], and TNF-α[ OR (95% CI)=1.06 (1.02, 1.10)] were statistically significant ( P<0.05) and were independently influences on ILD complicated by RA. The modeling and validation groups that were used to construct early diagnostic Nomograms had high calibration curve accuracies, and the model had a high diagnostic power, which was mainly demonstrated by the receiver operating characteristic (ROC) area under the curve (AUC) and decision curve analysis(DCA), the model modeling group had an AUC of 0.76 (95% CI=0.71, 0.81), with net benefit rates of 3%~82% and 93%~99%, whereas the model validation group had an AUC of 0.71 (95% CI=0.64, 0.79), with net benefit rates of 5%~11%, 14%~60% and 85%~89%. Conclusion:Male, gender, age, number of painful joints, IL-2, and TNF-α are independent factors for RA complicated with ILD, and the Nomogram model constructed has good performance in early diagnosis of the disease.

Drug-induced lung disease: a narrative review

ABSTRACT Drug-induced lung disease (DILD) encompasses a broad, highly heterogeneous group of conditions that may occur as a result of exposure to numerous agents, such as antineoplastic drugs, conventional or biological disease-modifying antirheumatic drugs, antiarrhythmics, and antibiotics. Between 3% and 5% of prevalent cases of interstitial lung diseases are reported as DILDs. The pathogenesis of lung injury in DILD is variable, multifactorial, and often unknown. Acute presentation is the most common, can occur from days to months after the start of treatment, and ranges from asymptomatic to acute respiratory failure. The CT patterns are varied and include ground-glass opacities, organizing pneumonia, and diffuse alveolar damage. Notably, there are no clinical manifestations or CT patterns specific to DILD, which makes the diagnosis quite challenging and necessitates a high index of suspicion, as well as the exclusion of alternative causes such as infection, cardiac-related pulmonary edema, exacerbation of a preexisting ILD, and neoplastic lung involvement. Discontinuation of the offending medication constitutes the cornerstone of treatment, and corticosteroid treatment is usually necessary after the onset of clinical manifestations. The prognosis varies widely, with high mortality rates in severe cases. A history of medications related to pulmonary toxicity in patients with new-onset respiratory symptoms should prompt consideration of DILD as a potential underlying cause.

Knowledge, confidence, and clinical experience of physiotherapists and multiprofessional team on pulmonary rehabilitation / Conocimiento, confianza y experiencia clínica de los fisioterapeutas y el equipo multiprofesional sobre la rehabilitación pulmonar / Conhecimento, confiança e experiência clínica dos fisioterapeutas e equipe multiprofissional sobre reabilitação pulmonar

ABSTRACT The knowledge deficit of health professionals has been a barrier to expanding and implementing of pulmonary rehabilitation (PR) services, despite the reported benefits of PR for individuals with Chronic Respiratory Disease (CRD). This study aims to assess the preparedness of health care professionals from two Brazilian cities to perform PR in the public health system. This is survey is part of a larger project to implement PR in the Brazilian public health system. A self-administered questionnaire was used to assess the knowledge (19 questions), training (7 questions), confidence (10 questions), and clinical experience (8 questions) of physical therapists (PT) and the multiprofessional team (MT) before a PR workshop. In total, 44 PT and 231 MT answered the questionnaire. The mean total knowledge score was 10±3 for PT and 6±3 for MT. Few physical therapist reported having "a lot" of experience (25%) and confidence (22.7%) to perform PR, as well as sufficient training to conduct the six-minute walk test (27.3%).Even fewer MT reported having "a lot" of experience (10%) and sufficient training (4.8%) to perform PR, as well as to plan the educational program for patients (10%) and the confidence to refer patients to PR (6.5%). This is the first study to evaluate the preparedness of professionals from the Brazilian public health network to provide PR. Notably, both PT and MT have low preparation to perform PR in the studied cities, reinforcing the need for continuing education.

RESUMEN El déficit de conocimientos entre los profesionales de la salud ha sido una barrera para la expansión e implementación de los servicios de rehabilitación pulmonar (RP) a pesar de sus beneficios comprobados para las personas con enfermedad respiratoria crónica (ERC). Este estudio de encuesta forma parte de un proyecto más amplio para implantar la RP en el sistema público sanitario brasileño mediante la evaluación de la preparación de los profesionales sanitarios de dos municipios brasileños para proporcionarla. Se utilizó un cuestionario autoadministrado para evaluar los conocimientos (19 preguntas), la formación (7 preguntas), la confianza (10 preguntas) y la experiencia clínica (8 preguntas) de los fisioterapeutas (FT) y del equipo multiprofesional (EM), aplicado previamente en un taller sobre RP. La puntuación media de los conocimientos fue de 10±3 para FT y de 6±3 para EM. Menos de un tercio de los FT afirmaron que tenían "mucha" experiencia (25%) y confianza (22,7%) para realizar la RP, así como formación suficiente para realizar la prueba de la marcha de seis minutos (27,3%). Pocos profesionales del EM declararon que tenían "mucha" experiencia (10%) y formación suficiente (4,8%) para realizar la RP, así como para planificar el programa educativo (10%) y tenían confianza para derivar a pacientes para la RP (6,5%). Este es el primer estudio que evalúa la preparación de los profesionales de la red pública de salud en Brasil para proporcionar la RP, y se observa que, en los municipios donde se realizó, tanto los FT como el EM están poco preparados para llevarla a cabo, lo que refuerza la necesidad de una formación continuada.

RESUMO O déficit de conhecimento dos profissionais de saúde tem sido uma barreira para a expansão e implementação dos serviços de reabilitação pulmonar (RP), apesar dos seus benefícios comprovados para indivíduos com doença respiratória crônica (DRC). Objetivo: avaliar o preparo dos profissionais de saúde de dois municípios brasileiros para fornecer a RP no sistema público de saúde. Esse estudo, do tipo survey, foi parte de um projeto maior para implementação da RP no sistema público de saúde brasileiro. Foi utilizado um questionário autoaplicável para avaliar o conhecimento (19 questões), o treinamento (7 questões), a confiança (10 questões) e a experiência clínica (8 questões) dos fisioterapeutas (FT) e da equipe multiprofissional (EM), aplicado antes de um workshop sobre RP. No total, 44 FT e 231 EM responderam o questionário. A pontuação média de conhecimento foi de 10±3 para FT e 6±3 para EM. Poucos FT referiam ter "muita" experiência (25%) e confiança (22,7%) para realizar RP, bem como treinamento suficiente para realizar o teste de caminhada de seis minutos (27,3%). Ainda menos profissionais da EM relataram ter "muita" experiência (10%) e treinamento suficiente (4,8%) para realizar RP, assim como para planejar o programa educacional dos pacientes (10%) e ter confiança para encaminhar pacientes para a RP (6,5%). Este é o primeiro estudo a avaliar o preparo dos profissionais da rede pública de saúde no Brasil para fornecer RP. Notavelmente, tanto FT quanto EM têm baixo preparo para realizar RP nos municípios estudados, reforçando a necessidade de realização de educação continuada.

"Interstitial lung abnormalities": translation to and use in Portuguese / Anormalidades pulmonares intersticiais: tradução e uso na língua portuguesa

Abstract Objective: To conduct a survey on the use of the term "interstitial lung abnormalities" in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic. Materials and Methods: A survey was sent via electronic message to various radiologists in Brazil, asking about their familiarity with the term, which translation of the term they use in Portuguese, and whether they use the criteria proposed by the Fleischner Society. Results: A total of 163 responses were received, from all regions of Brazil. Although the vast majority (88%) of the respondents stated that they were familiar with the term "interstitial lung abnormalities", there was considerable variation regarding the equivalent term they used in Portuguese. Conclusion: We suggest that the term "anormalidades pulmonares intersticiais" be used in order to standardize radiology reports and disseminate knowledge of these findings in Brazil.

Resumo Objetivo: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema. Materiais e Métodos: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a familiarização com o termo, qual tradução em português utilizam e se usam os critérios propostos pela diretriz da Sociedade Fleischner. Resultados: Foram recebidas 163 respostas de todas as regiões do Brasil e a grande maioria dos radiologistas respondeu estar familiarizado com o termo interstitial lung abnormalities (88%), mas houve grande variação em relação ao termo utilizado como tradução para o português. Conclusão: Sugerimos a padronização do termo "anormalidades pulmonares intersticiais", a fim de uniformizar os relatórios radiológicos e difundir esta entidade no País.

Recuperación de la frecuencia cardíaca en pacientes con enfermedad pulmonar intersticial difusa

Introducción: La enfermedad pulmonar intersticial difusa no soporta el ejercicio, debido a la sensación de disnea y fatiga durante el esfuerzo de baja intensidad. La recuperación de la frecuencia cardíaca se relaciona con el desempeño en el test de caminata de los seis minutos. Objetivo: Determinar las diferencias sociodemográficas de la función y la capacidad pulmonar en pacientes con enfermedad intersticial difusa, a partir de la recuperación de la frecuencia cardíaca durante el test de caminata de los seis minutos. Métodos: Se realizó un estudio descriptivo de corte transversal. Se calculó la recuperación de la frecuencia cardíaca a partir de la diferencia entre el final del test y los cinco minutos de la prueba. Se conformaron dos grupos de comparación, anormal versus normal, en variables sociodemográficas de la función pulmonar y la capacidad funcional. Resultados: Se vincularon 38 pacientes en el grupo normal y en el anormal 26. En el primero predominaron la edad de 62,26 ± 15,82 y los hombres (52,6 %); mientras que en el grupo anormal los años promediaron entre 58,77 ± 13,23 y sobresalieron las mujeres (61,5 %). Se presentó un valor p < 0,05 del grupo recuperación de la frecuencia anormal en la distancia recorrida, disnea y fatiga al final, un minuto y a los cinco minutos de culminar el test. Conclusiones: Los pacientes con enfermedad pulmonar intersticial difusa con una recuperación de la frecuencia cardíaca anormal presentaron peores resultados en la distancia recorrida, volumen de oxígeno, los equivalentes metabólicos, disnea y fatiga de los miembros inferiores.

Introduction: Diffuse interstitial lung disease does not tolerate exercise, due to the sensation of dyspnea and fatigue during low-intensity exertion. Heart rate recovery is related to performance in the six-minute walk test. Objective: To determine sociodemographic differences in lung function and capacity in patients with diffuse interstitial lung disease, based on heart rate recovery during the 6-minute walk test. Methods: A descriptive cross-sectional study was performed. Heart rate recovery was calculated from the difference between the end of the test and the five minutes of the test. Two comparison groups were formed, abnormal versus normal, in sociodemographic variables of pulmonary function and functional capacity. Results: 38 patients were included in the normal group and 26 in the abnormal group. In the normal group, age was 62.26 ± 15.82 and men were predominant (52.6 %); while in the abnormal group, age averaged 58.77 ± 13.23 and women were predominant (61.5 %). A p-value < 0.05 of the abnormal frequency recovery group was presented in the distance run, dyspnea at the end, fatigue at the end, 1 minute and at 5 minutes after the culmination of the test. Conclusions: Patients with diffuse interstitial lung disease with abnormal heart rate recovery had worse results in distance run, oxygen volume, metabolic equivalents, dyspnea and lower limb fatigue.

Relative incidence of interstitial lung diseases in Brazil / Incidência relativa de doenças pulmonares intersticiais no Brasil

ABSTRACT Objective: To assess the relative frequency of incident cases of interstitial lung diseases (ILDs) in Brazil. Methods: This was a retrospective survey of new cases of ILD in six referral centers between January of 2013 and January of 2020. The diagnosis of ILD followed the criteria suggested by international bodies or was made through multidisciplinary discussion (MDD). The condition was characterized as unclassifiable ILD when there was no specific final diagnosis following MDD or when there was disagreement between clinical, radiological, or histological data. Results: The sample comprised 1,406 patients (mean age = 61 ± 14 years), and 764 (54%) were female. Of the 747 cases exposed to hypersensitivity pneumonitis (HP)-related antigens, 327 (44%) had a final diagnosis of HP. A family history of ILD was reported in 8% of cases. HRCT findings were indicative of fibrosis in 74% of cases, including honeycombing, in 21%. Relevant autoantibodies were detected in 33% of cases. Transbronchial biopsy was performed in 23% of patients, and surgical lung biopsy, in 17%. The final diagnoses were: connective tissue disease-associated ILD (in 27%), HP (in 23%), idiopathic pulmonary fibrosis (in 14%), unclassifiable ILD (in 10%), and sarcoidosis (in 6%). Diagnoses varied significantly among centers (c2 = 312.4; p < 0.001). Conclusions: Our findings show that connective tissue disease-associated ILD is the most common ILD in Brazil, followed by HP. These results highlight the need for close collaboration between pulmonologists and rheumatologists, the importance of detailed questioning of patients in regard with potential exposure to antigens, and the need for public health campaigns to stress the importance of avoiding such exposure.

RESUMO Objetivo: Avaliar a frequência relativa de casos incidentes de doenças pulmonares intersticiais (DPI) no Brasil. Métodos: Levantamento retrospectivo de casos novos de DPI em seis centros de referência entre janeiro de 2013 e janeiro de 2020. O diagnóstico de DPI seguiu os critérios sugeridos por órgãos internacionais ou foi feito por meio de discussão multidisciplinar (DMD). A condição foi caracterizada como DPI não classificável quando não houve um diagnóstico final específico após a DMD ou houve discordância entre dados clínicos, radiológicos ou histológicos. Resultados: A amostra foi composta por 1.406 pacientes (média de idade = 61 ± 14 anos), sendo 764 (54%) do sexo feminino. Dos 747 casos expostos a antígenos para pneumonite de hipersensibilidade (PH), 327 (44%) tiveram diagnóstico final de PH. Houve relato de história familiar de DPI em 8% dos casos. Os achados de TCAR foram indicativos de fibrose em 74% dos casos, incluindo faveolamento, em 21%. Autoanticorpos relevantes foram detectados em 33% dos casos. Biópsia transbrônquica foi realizada em 23% dos pacientes, e biópsia pulmonar cirúrgica, em 17%. Os diagnósticos finais foram: DPI associada à doença do tecido conjuntivo (em 27%), PH (em 23%), fibrose pulmonar idiopática (em 14%), DPI não classificável (em 10%) e sarcoidose (em 6%). Os diagnósticos variaram significativamente entre os centros (c2 = 312,4; p < 0,001). Conclusões: Nossos achados mostram que DPI associada à doença do tecido conjuntivo é a DPI mais comum no Brasil, seguida pela PH. Esses resultados destacam a necessidade de uma estreita colaboração entre pneumologistas e reumatologistas, a importância de fazer perguntas detalhadas aos pacientes a respeito da potencial exposição a antígenos e a necessidade de campanhas de saúde pública destinadas a enfatizar a importância de evitar essa exposição.

Connective tissue disease-associated interstitial lung disease / Doença pulmonar intersticial associada a doença do tecido conjuntivo

ABSTRACT Connective tissue disease-associated interstitial lung disease (CTD-ILD) represents a group of systemic autoimmune disorders characterized by immune-mediated organ dysfunction. Systemic sclerosis, rheumatoid arthritis, idiopathic inflammatory myositis, and Sjögren's syndrome are the most common CTDs that present with pulmonary involvement, as well as with interstitial pneumonia with autoimmune features. The frequency of CTD-ILD varies according to the type of CTD, but the overall incidence is 15%, causing an important impact on morbidity and mortality. The decision of which CTD patient should be investigated for ILD is unclear for many CTDs. Besides that, the clinical spectrum can range from asymptomatic findings on imaging to respiratory failure and death. A significant proportion of patients will present with a more severe and progressive disease, and, for those, immunosuppression with corticosteroids and cytotoxic medications are the mainstay of pharmacological treatment. In this review, we summarized the approach to diagnosis and treatment of CTD-ILD, highlighting recent advances in therapeutics for the various forms of CTD.

RESUMO Doença pulmonar intersticial associada à doença do tecido conjuntivo (DPI-DTC) representa um grupo de distúrbios autoimunes sistêmicos caracterizados por disfunção de órgãos imunomediada. Esclerose sistêmica, artrite reumatoide, miosite inflamatória idiopática e síndrome de Sjögren são as DTC mais comuns que apresentam acometimento pulmonar, bem como pneumonia intersticial com achados autoimunes. A frequência de DPI-DTC varia de acordo com o tipo de DTC, mas a incidência total é de 15%, causando um impacto importante na morbidade e mortalidade. A decisão sobre qual paciente com DTC deve ser investigado para DPI não é clara para muitas DTC. Além disso, o espectro clínico pode variar desde achados assintomáticos em exames de imagem até insuficiência respiratória e morte. Parte significativa dos pacientes apresentará doença mais grave e progressiva, e, para esses pacientes, imunossupressão com corticosteroides e medicamentos citotóxicos são a base do tratamento farmacológico. Nesta revisão, resumimos a abordagem do diagnóstico e tratamento de DPI-DTC, destacando os recentes avanços na terapêutica para as diversas formas de DTC.

Relación de la enfermedad periodontal inflamatoria crónica con enfermedades sistémicas / Relationship of chronic inflammatory periodontal disease with systemic diseases

Introducción: La enfermedad periodontal es una infección inmunoinflamatoria crónica de origen multifactorial. Puede avanzar a nivel sistémico por el paso de bacterias y sus productos al torrente sanguíneo, lo cual constituye un factor de riesgo para alteraciones sistémicas. La revisión bibliográfica se realizó de julio 2022 hasta febrero 2023. Se utilizaron las bases de datos PubMed, SciELO y Elsevier y el motor de búsqueda Google Académico. Objetivos: Describir la relación de la enfermedad periodontal inflamatoria crónica con enfermedades sistémicas. Desarrollo: La medicina periodontal estudia la relación que existe entre las periodontopatías y enfermedades sistémicas, como las cardiovasculares, cerebrovasculares, pulmonares, la renal crónica, la artritis reumatoide y el Alzheimer. Las bacterias provenientes de las bolsas periodontales pasan hacia la circulación sanguínea, producen infección metastásica y daño metastásico, mediante la producción de endotoxinas, lipopolisacáridos e inflamación metastásica. Conclusiones: La enfermedad periodontal crónica constituye un factor de riesgo para el desarrollo de enfermedades cardiovasculares, pulmonares, renales, trastornos cerebrovasculares, artritis reumatoide y el Alzheimer debido a reacciones inflamatorias producidas por microorganismos patogénicos; se establece una relación bidireccional entre estas enfermedades y las periodontopatías(AU)

Introduction: Periodontal disease is a chronic immunoinflammatory infection of multifactorial origin. It can advance at a systemic level due to the passage of bacteria and their products into the bloodstream, which constitutes a risk factor for systemic alterations. The bibliographic review was carried out from July 2022 to February 2023. The PubMed, SciELO and Elsevier databases and the Google Scholar search engine were used. Objectives: Describe the relationship of chronic inflammatory periodontal disease with systemic diseases. Development: Periodontal medicine studies the relationship between periodontopathies and systemic diseases, such as cardiovascular, cerebrovascular, pulmonary, chronic kidney disease, rheumatoid arthritis and Alzheimer's. Bacteria from periodontal pockets pass into the blood circulation, producing metastatic infection and metastatic damage, through the production of endotoxins, lipopolysaccharides and metastatic inflammation. Conclusions: Chronic periodontal disease constitutes a risk factor for the development of cardiovascular, pulmonary, renal diseases, cerebrovascular disorders, rheumatoid arthritis and Alzheimer's due to inflammatory reactions produced by pathogenic microorganisms; A bidirectional relationship is established between these diseases and periodontopathies. The analysis of this relationship and the mechanisms by which it occurs guarantees the development of a more integrative care practice(AU)

Paracoccidoidomicosis: Reporte de 4 casos

La paracoccidioidomicosis (PCM) es una infección causada por hongos patógenos humanos del género Paracoccidioides. Es una micosis sistémica que puede afectar cualquier órgano. Se describen con este reporte cuatro casos de paracoccidioidomicosis con diferentes presentaciones clínicas, tiempo de evolución, con afectación mucocutánea, pulmonar, glándulas suprarrenales, sistema nervioso entre otros, principalmente en adultos varones de diferentes edades y profesiones, tanto inmunosuprimidos como inmunocompetentes, teniendo en común el contacto con el suelo. Se demuestra de esta manera la importancia de considerar esta patología ante una sospecha clínica de micosis sistémica para así realizar una confirmación temprana y tratamiento oportuno ya que presenta buena respuesta terapéutica antimicótica y mejoría clínica.

Paracoccidioidomycosis (PCM) is an infection caused by human pathogenic fungi of the genus Paracoccidioides. This report describes: 4 cases of paracoccidioidomycosis diagnosed with different clinical presentations, different times of evolution, with mucocutaneous, pulmonary, adrenal gland, and nervous system involvement, among others, mainly in male adults of different ages and professions, both immunosuppressed and immunocompetent, having in common contact with the ground. In this way, PCM is a systemic mycosis that can affect any organ and therefore the importance of considering this pathology when a diagnostic suspicion of systemic mycosis is presented in order to make an early diagnosis and timely treatment since it presents a good therapeutic response, antifungal and clinical improvement.

Estudo de incidência de acometimentos cardiovasculares e pulmonares causados pelo cigarro eletrônico: uma revisão de escopo / Incidence study of cardiovascular and pulmonary disorders caused by electronic cigarettes: a scope review

Introdução: O uso de cigarros eletrônicos (CE) tem aumentado, mas sem um estudo aprofundado sobre seus efeitos na saúde cardiovascular e pulmonar. Uma pergunta norteadora foi elaborada: Os cigarros eletrônicos causam acometimentos cardiovasculares e pulmonares? Esta revisão de escopo pontua a existência dos acometimentos cardiovasculares e pulmonares causados pelo uso de cigarros eletrônicos. Metodologia: Bancos de dados: MEDLINE-Pubmed, LILACS e Web of Science. Descritores: "Electronic Nicotine Delivery System", "E-Cigarette Vapor", "COPD", "Lung Neoplasms", "Myocardial Infarction" e "Pneumonia". Primeira busca: 28 artigos. Critérios de Exclusão: artigos que não se encaixam na classificação de estudos primários e estudos duplicados. Busca final: 6 artigos, descritos na íntegra. Resultados: Dos artigos encontrados: 83,3% (EUA); 16,7% (Coreia do Sul); 16,7% estudo transversal; 16,7% estudo longitudinal; 33,3% ensaio clínico randomizado com pessoas; 33,3% estudos de coorte. Discussão: Os artigos demonstraram que o CE pode estar associado a acometimentos cardiovasculares, como infarto e acidente vascular, apesar de não ser tão influente quando comparado ao cigarro tradicional. Quanto aos acometimentos pulmonares, não houve consenso entre os dados dos artigos pesquisados. Conclusão: Faz-se necessária a realização de mais pesquisas sobre o tema, devido a divergência entre os dados presentes na literatura.

Introduction: The use of electronic cigarettes (EC) has increased, but without an in-depth study on their effects on cardiovascular and pulmonary health. A guiding question was formulated: Do electronic cigarettes cause cardiovascular and pulmonary disorders? This scoping review points out the existence of cardiovascular and pulmonary disorders caused by the use of electronic cigarettes. Methodology: Databases: MEDLINE-Pubmed, LILACS and Web of Science. Descriptors: "Electronic Nicotine Delivery System", "E-Cigarette Vapor", "COPD", "Lung Neoplasms", "Myocardial Infarction" and "Pneumonia". First search: 28 articles. Exclusion Criteria: articles that do not fit into the classification of primary studies and duplicated studies. Final search: 6 articles, described in full. Results: Of the articles found: 83.3% (USA); 16.7% (South Korea); 16.7% cross-sectional study; 16.7% longitudinal study; 33.3% randomized clinical trial with people; 33.3% cohort studies. Discussion: The articles showed that the EC may be associated with cardiovascular disorders, such as infarction and stroke, although it is not as influential when compared to traditional cigarettes. As for pulmonary disorders, there was no consensus among the data from the researched articles. Conclusion: More research on the topic is necessary, due to the divergence between the presented data in the literature.

La fibrosis quística en niños en el Ecuador / Cystic fibrosis in children in Ecuador

Objetivo: analizar la fibrosis quística en niños en el Ecuador. Metodología: Revisión sistemática de 21 publicaciones relacionadas al tema, específicamente 13 articulos de investigación en contexto ecuatoriano. Resultados y conclusión: En el Ecuador la incidencia de la enfermedad es de 1 por cada 11.110 habitantes y cada año nacen aproximadamente 23 niños con esta afección, teniéndose en cuenta las mutaciones en el CFTR, entorpecen el diagnóstico molecular, así como se ha estudiado un caso pediátrico de FQ con complicaciones en pancreatitis, siendo esto inusual en la población infantil, siendo considerable proseguir con investigaciones conducentes a tener una mejor referencia científica de la FQ en el Ecuador.

Objective: to analyze cystic fibrosis in children in Ecuador. Methodology: Systematic review of 21 publications related to the subject, specifically 13 research articles in the Ecuadorian context. Results and conclusion: In Ecuador the incidence of the disease is 1 for every 11,110 inhabitants and each year approximately 23 children are born with this condition, taking into account CFTR mutations, which hinder molecular diagnosis, as well as a study pediatric case of CF with complications in pancreatitis, this being unusual in the child population, it is important to continue with research leading to a better scientific reference of CF in Ecuador.

Paraccocidiomicosis sistémica en consumidor crónico de corticoides

La Paracoccidiomicosis es una infección endémica. Junto con la histoplasmosis, son las infecciones micóticas más frecuentes en Latinoamérica. Esta micosis puede ser de afección local o sistémica, con un marcado trofismo por los pulmones, órganos linfoides, hígado, glándulas suprarrenales, piel y mucosa. Presentamos el caso de un varón adulto, consumidor crónico de corticoides, que desarrolla una paracoccidiomicosis sistémica con afección pulmonar y de glándulas suprarrenales con buena repuesta a la terapéutica antifúngica.

Paracoccidiomycosis is an endemic infection, together with histoplasmosis, they are the most frequent fungal infections in Latin America. This mycosis can be of local or systemic affection, with a marked trophism by the lungs, lymphoid organs, liver, adrenal glands, skin and mucosa. We present the case of an adult male, chronic steroid user, who develops systemic paracoccidiomycosis with pulmonary and adrenal gland involvement with good response to antifungal therapy.

Perfil de pacientes evaluados con el Test de Capacidad de Difusión de Monóxido de Carbono: Una experiencia chilena / Profile of patients evaluated with the Carbon Monoxide Diffusion Capacity Test: A Chilean experience

ANTECEDENTES: La prueba de capacidad de difusión de monóxido de carbono (DLCO) es una evaluación de función pulmonar rutinaria y no invasiva clínicamente útil para determinar el estado de la función pulmonar en pacientes con trastornos crónicos como la enfermedad pulmonar intersticial difusa (EPID). OBJETIVO: Describir el perfil sociodemográfico y clínico de usuarios de la prueba DLCO en Valdivia, Chile. Materiales y Métodos: Estudio observacional, retrospectivo, de base documental. A partir de registros de 490 pacientes que se realizaron la prueba DLCO entre 2017 y 2019, se describen características sociodemográficas, clínicas y reporte de consumo de cigarrillo como cigarrillos/d e índice paquetes/año (IPA), comparando por sexo. RESULTADOS: La mayor proporción de evaluados fueron mujeres (61%), con una edad mediana de 65 años, mayor en mujeres (66 vs 64 años; p = 0,0361). La mayoría consultaron por EPID (54,5%). Según estado nutricional, 38% presentó preobesidad y 24,7% obesidad I (24,7%), destacando que 40,5% de las mujeres y 33% de los hombres se encontraron en alguna categoría de obesidad. Entre quienes reportaron información de consumo de cigarrillos (n = 346, 70,6%), 14,7% (n = 51) eran consumidores actuales, con un consumo mediano de 10 cigarrillos/d, sin diferencias por sexo. Entre exfumadores (n = 144; 50% hombres/mujeres) hubo significativamente menor consumo diario (5 vs 15; p = 0,0300) y de IPA (7 vs 18; p = 0,0083) en mujeres. CONCLUSIONES: En usuarios de DLCO el principal diagnóstico de consulta fue EPID. Destacó alta frecuencia de obesidad y tabaquismo, sin diferencia de consumo por sexo en fumadores actuales, pero sí en exfumadores.

BACKGROUND: The carbon monoxide diffusion capacity test (DLCO) is a clinically useful, routine, non-invasive lung function assessment to determine the status of lung function in patients with chronic disorders such as interstitial lung disease (ILD). AIM: To describe the sociodemographic and clinical profile of users of the DLCO test in Valdivia, Chile. MATERIALS AND METHODS: Observational, retrospective, documentary-based study. From the records of 490 patients who underwent the DLCO test between 2017 and 2019, sociodemographic and clinical characteristics and reports of cigarette consumption are described, such as cigarettes/d and pack-year index (PYI), comparing by sex. Results: The highest proportion of those evaluated were women (61%), with a median age of 65 years, higher in women (66 vs. 64 years; p = 0.0361). The majority consulted for ILD (54.5%). According to nutritional status, 38% presented pre-obesity and 24.7% obesity I (24.7%), highlighting that 40.5% of women and 33% of men were in some category of obesity. Among those who reported information on cigarette consumption (n = 346, 70.6%), 14.7% (n = 51) were current consumers, with a median consumption of 10 cigarettes/d, without differences by sex. Among exsmokers (n = 144; 50% men/women) there was significantly less daily (5 vs 15; p = 0.0300) and IPA (7 vs 18; p = 0.0083) consumption in women. CONCLUSIONS: In DLCO users, the main consultation diagnosis was ILD. High frequency of obesity and smoking stood out, with no difference in consumption by sex in current smokers, but yes in ex-smokers.

Ecografía pulmonar en la evaluación del paciente crítico / Lung ultrasound in the evaluation of critically ill patients

Introducción: La ecografía es una técnica de imagen no invasiva que permite explorar diferentes órganos de manera inmediata, constituye un instrumento de alto valor diagnóstico al alcance del profesional de la salud, y es utilizada en todas las especialidades médicas. En los últimos años, la evolución tecnológica ha permitido que los aparatos de ecografía sean más pequeños, portátiles, y con una alta resolución, tal es el caso de la ecografía clínica o ecografía a pie de cama. La ecografía del paciente crítico ha cambiado la práctica médica; específicamente la ecografía pulmonar se debe realizar en todos los pacientes con enfermedad pulmonar aguda. Objetivo: Aportar el conocimiento teórico necesario para promover el uso de la ecografía pulmonar en la evaluación del paciente crítico, y contribuir, mediante su aplicación, a la disminución del riesgo de exposición a las radiografías. Métodos: Se efectuó una revisión de la literatura médica actualizada sobre el papel de la ecografía pulmonar en la evaluación del paciente crítico, en el período de julio a diciembre de 2021. Se utilizaron los siguientes motores de búsqueda: SciELO, Medigraphic y Google Académico. Conclusiones: En el contexto actual, la ecografía pulmonar ha adquirido un papel protagónico, pues su uso facilita una evaluación frecuente y no invasiva del paciente crítico con afección pleuropulmonar. Su aplicación garantiza la disminución del riesgo de exposición a las radiografías.

Introduction: ultrasound is a non-invasive imaging technique that allows us to explore different organs immediately; it constitutes an instrument of high diagnostic value within the reach of health professionals and used in all medical specialties. In recent years, technological evolution has allowed ultrasound devices to be smaller, portable and with high resolution, such is the case of clinical ultrasound or bedside ultrasound. Bedside ultrasound in critically ill patients has changed medical practice; specifically, lung ultrasound should be performed in all patients with acute lung disease. Objective: to provide the necessary theoretical knowledge in order to promote the use of lung ultrasound in the evaluation of critically ill patients, as well as to contribute, through its application, to reduce the risk of exposure to radiographs. Methods: a review of the updated medical literature on the role of lung ultrasound in the evaluation of the critically ill patients was performed from July to December 2021. SciELO, Medigraphic and Google Scholar were the search engines used. Conclusions: lung ultrasound has acquired a leading role in the current context, since its use facilitates a non-invasive and common evaluation of the criticall ill patients with pleuropulmonary disease. Its application guarantees the reduction of the risk of exposure to X-rays.