[Updated recommendations for vaccination in adults with respiratory diseases. Argentine Association of Respiratory Medicine, 2023]. / Recomendaciones actualizadas para la vacunación de adultos con enfermedades respiratorias. Asociación Argentina de Medicina Respiratoria, 2023.

Adult smokers, those with comorbidities, and the elderly, are at greater risk of contracting infections and their complications. Community acquired respiratory infections due to viruses, pneumococcus and other bacteria, affect both healthy and sick adults. There are vaccines that the pulmonologist must know and prescribe. The target strains of the influenza vaccine are defined by the WHO for the Southern hemisphere considering those involved in the previous influenza season in the Northern hemisphere. Its effectiveness depends on virulence, concordance between circulating and vaccine strains, and population coverage. The anti-pneumococcal polysaccharide vaccine available since 1983 is being replaced by more effective conjugate vaccines to prevent infections related to serotypes present in them. Immunization against SARS-CoV-2 reduced the contagion, severity, and lethality of COVID-19. The acellular vaccine against Bordetella pertussis for adults is present for specific situations in the adult calendar; vaccinating them strengthens the control of childhood contagion. The double (diphtheria + tetanus), and triple (double + pertussis) bacterial vaccines, and the vaccines against measles, chickenpox, rubella, human papillomavirus, Haemophilus influenzae, meningococcus, herpes zoster, Argentine hemorrhagic fever and yellow fever, are of a more limited use. Soon we will have new vaccines such as the one recently approved by the FDA against respiratory syncytial virus. Through a consensus of experts in respiratory infections, we review the new evidence regarding the immunization of adults who consult a pulmonologist, and thus update the recommendations on vaccination made eight years ago.

Los adultos fumadores con comorbilidades, y los ancianos, corren mayor riesgo de contraer infecciones y sus complicaciones. Las infecciones respiratorias comunitarias por virus, neumococo y otras bacterias afectan tanto a adultos sanos como enfermos. Existen vacunas que el neumonólogo debe conocer y prescribir. Las cepas blanco de la vacuna contra influenza son definidas por la OMS para el hemisferio sur considerando a las implicadas en la temporada precedente de influenza en el hemisferio norte. Su efectividad depende de la virulencia, la concordancia entre las cepas circulantes y las vacunales y la cobertura de la población. La vacuna anti-neumocócica polisacárida disponible desde 1983 está siendo reemplazada por vacunas conjugadas más eficaces para prevenir infecciones relacionadas a serotipos presentes en las mismas. La inmunización contra SARS-CoV-2 redujo el contagio, la gravedad y la letalidad de COVID-19. La vacuna acelular contra Bordetella pertussis para adultos está presente para situaciones puntuales en el calendario para adultos, vacunarlos fortalece el control del contagio infantil. Las vacunas doble bacteriana (difteria + tétanos), y triple (doble + pertussis), y contra sarampión, varicela, rubeola, virus del papiloma humano, Haemophylus influenzae, meningococo, herpes zóster, fiebre hemorrágica argentina y fiebre amarilla, son de uso más limitado. Pronto contaremos con nuevas vacunas, como la recientemente aprobada por la FDA contra el virus sincicial respiratorio. Revisamos a través de un consenso de expertos en infecciones respiratorias las nuevas evidencias acerca de la inmunización de adultos que consultan al neumonólogo, y actualizamos así las recomendaciones sobre vacunación realizadas ocho años atrás.

Prevalencia y características clínicas del asma en adultos jóvenes en zonas urbanas de Argentina / Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina

Objetivo: Estimar la carga del asma en la población adulta joven en zonas urbanas de Argentina. Diseño: Se realizó una encuesta telefónica a nivel nacional en sujetos de 20 a 44 años en áreas urbanas de Argentina. Se utilizó el cuestionario de la European Community Respiratory Health Survey. El asma se definió como ataque en el último año o uso de medicamentos para el asma. Resultados: Mil quinientos veintiún sujetos fueron encuestados (62,4% mujeres, edad media 33 años). Noventa y uno fueron clasificados como asmáticos (5,9%, IC 95% 4,7-7,1). La prevalencia ajustada por edad, sexo y nivel educativo fue de 6,4% (IC 95% 5,1-7,7). El porcentaje de sibilancia fue de un 13,9% (IC 95% 15,6-12,2) y el de diagnóstico médico de asma, de un 9,5% (IC 95% 8,0-11,0). Entre los diagnósticos (n = 154), el 71,3% realizó una espirometría y el 51,9% de los tratados (n = 77) utilizaba medicamentos diariamente y un 46,8% como rescate. De los que reportaron algún ataque en el último año (n = 60), un 55% tuvieron una visita a Urgencias y un 23,3% fueron hospitalizados. El asma se asoció con rinitis (OR 11,1; IC 95% 6,2-19,9) e historia familiar (OR 3,6; IC 95% 2,3-5,5). Conclusión: La prevalencia de asma en adultos jóvenes en Argentina es similar a la de Europa. Aunque los ataques y las admisiones fueron comunes, el uso regular de los medicamentos fue informado por la mitad de los tratados. Los resultados pueden ser útiles para otros países de América Latina (AU)

Objective: To investigate the burden of asthma in a young adult population in urban areas of Argentina. Design: A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. Results: In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5). Conclusion: Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries (AU)

Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina. / Prevalencia y características clínicas del asma en adultos jóvenes en zonas urbanas de Argentina.

OBJECTIVE: To investigate the burden of asthma in a young adult population in urban areas of Argentina. DESIGN: A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications. RESULTS: In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5). CONCLUSION: Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.

Efecto de las campañas y de las advertencias sanitarias de cigarrillos en la línea de atención al fumador en Argentina / Effect of Mass Media Campaigns and Health Warnings on Cigarette Packs on Smokers' Quitline in Argentina

Las líneas telefónicas de ayuda al fumador son un medio eficaz para promover la cesación. La incorporación de imágenes y frases como advertencias sanitarias junto al número de la línea en el paquete de cigarrillos se asoció a un incremento sustancial de llamadas, comparable al logrado por fuertes campañas en medios masivos.

Association Between Cigarette Smoking Prevalence and Income Level: A Systematic Review and Meta-Analysis.

INTRODUCTION: Previous evidence linked low socioeconomic status with higher smoking prevalence. Our objective was to assess the strength of this association in the world population, updating a previous work. METHODS: Systematic review and meta-analysis of observational studies. Subgroup analyses included continents, WHO regions, country mortality levels, gender, age, risk of bias, and study publication date. Independent reviewers selected studies, assessed potential bias and extracted data. We searched MEDLINE, EMBASE, CENTRAL, SOCINDEX, AFRICAN INDEX MEDICUS, and LILACS, and other sources from 1989 to 2013 reporting direct measurements of income and current cigarette smoking. RESULTS: We retrieved 13,583 articles and included 93 for meta-analysis. Median smoking prevalence was 17.8% (range 3-70%). Lower income was consistently associated with higher smoking prevalence (odds ratio [OR]: 1.45; 95% confidence interval [CI]: 1.35-1.56). This association was statistically significant in the subgroup analysis by WHO regions for the Americas (OR: 1.54; 95% CI: 1.42-1.68), South East Asia (OR: 1.53; 95% CI: 1.10-2.00), Europe (OR: 1.45; 95% CI: 1.29-1.63), and Western Pacific (OR: 1.32; 95% CI: 1.02-1.72), and in studies conducted during 1990s (OR: 1.42; 95% CI: 1.24-1.62) and 2000s (OR: 1.48; 95%CI: 1.30-1.64). Likewise, it was noted in low-mortality countries (OR: 1.48; 95% CI: 1.37-1.60) and for both genders. Prevalence was highest in the lowest income levels compared to the middle (OR: 1.69; 95% CI: 1.49-1.92), followed by the middle level compared to the highest (OR: 1.31; 95% CI: 1.20-1.43). CONCLUSIONS: Our results show that current cigarette smoking was significantly associated with lower income worldwide and across subgroups, suggesting a dose-response relationship. IMPLICATIONS: This unique updated systematic review shows a consistent inverse dose-response relationship between cigarette smoking and income level, present among most geographical areas and country characteristics. Public health measures should take into account this potential inequity and consider special efforts directed to disadvantaged populations.

A multi-step pathway connecting short sleep duration to daytime somnolence, reduced attention, and poor academic performance: an exploratory cross-sectional study in teenagers.

BACKGROUND: A multi-step causality pathway connecting short sleep duration to daytime somnolence and sleepiness leading to reduced attention and poor academic performance as the final result can be envisaged. However this hypothesis has never been explored. OBJECTIVE: To explore consecutive correlations between sleep duration, daytime somnolence, attention levels, and academic performance in a sample of school-aged teenagers. METHODS: We carried out a survey assessing sleep duration and daytime somnolence using the Pediatric Daytime Sleepiness Scale (PDSS). Sleep duration variables included week-days' total sleep time, usual bedtimes, and absolute weekday to-weekend sleep time difference. Attention was assessed by d2 test and by the coding subtest from the WISC-IV scale. Academic performance was obtained from literature and math grades. Structural equation modeling was used to assess the independent relationships between these variables, while controlling for confounding effects of other variables, in one single model. Standardized regression weights (SWR) for relationships between these variables are reported. RESULTS: Study sample included 1,194 teenagers (mean age: 15 years; range: 13-17 y). Sleep duration was inversely associated with daytime somnolence (SWR = -0.36, p < 0.01) while sleepiness was negatively associated with attention (SWR = -0.13, p < 0.01). Attention scores correlated positively with academic results (SWR = 0.18, p < 0.01). Daytime somnolence correlated negatively with academic achievements (SWR = -0.16, p < 0.01). The model offered an acceptable fit according to usual measures (RMSEA = 0.0548, CFI = 0.874, NFI = 0.838). A Sobel test confirmed that short sleep duration influenced attention through daytime somnolence (p < 0.02), which in turn influenced academic achievements through reduced attention (p < 0.002). CONCLUSIONS: Poor academic achievements correlated with reduced attention, which in turn was related to daytime somnolence. Somnolence correlated with short sleep duration.

Heart rate nonlinear dynamics during sudden hypoxia at 8230 m simulated altitude.

OBJECTIVE: Acute hypobaric hypoxia is associated with autonomic changes that bring a global reduction of linear heart rate variability (HRV). Although changes in nonlinear HRV can be associated with physiologic stress and are relevant predictors of fatal arrhythmias in ischemic heart disease, to what extent these components vary in sudden hypobaric hypoxia is not known. METHODS: Twelve military pilots were supplemented with increasing concentrations of oxygen during decompression to 8230 m in a hypobaric chamber. Linear and nonlinear HRV was evaluated at 8230 m altitude before, during, and after oxygen flow deprivation. Linear HRV was assessed through traditional time-domain and frequency-domain analysis. Nonlinear HRV was quantified through the short-term fractal correlation exponent alpha (alphas) and the Sample Entropy index (SampEn). RESULTS: Hypoxia was related to a decrease in linear HRV indexes at all frequency levels. A non-significant decrease in alphas (basal, 1.39 +/- 0.07; hypoxia, 1.11 +/- 0.13; recovery, 1.41 +/- 0.05; P = .054) and a significant increase in SampEn (basal, 1.07 +/- 0.11; hypoxia, 1.45 +/- 0.12; recovery, 1.43 +/- 0.09; P = .018) were detected. CONCLUSIONS: The observed pattern of diminished linear HRV and increased nonlinear HRV is similar to that seen in subjects undergoing heavy exercise or in patients with ischemic heart disease at high risk for ventricular fibrillation.

Brief review: diurnal rhythms, obesity and educational achievement in South american cultures.

Obesity causes or exacerbates a host of medical conditions, including cardiovascular, pulmonary, and endocrine diseases. In addition, there is growing evidence that obesity and sleep problems are linked in adolescents and that they are significant obstacles for learning, having a negative impact on behavior, and attainment of social competence and quality of life. The theoretical basis of this relationship is discussed. Several studies investigating the relationships between obesity, sleep disturbance, and a number of important negative outcomes are reviewed.

Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: Resultados del estudio capo en Argentina / Adherence with National Guidelines in hospitalized patients with community-acquired pneumonia: Results of CAPO study in Argentina

Un comité de seis sociedades científicas en Argentina desarrolló guías para la atención de pacientes con neumonía adquirida en la comunidad (NAC). El objetivo de este estudio fue evaluar el nivel de cumplimiento con el cuidado recomendado en las guías nacionales en pacientes hospitalizados con NAC en Argentina. Usando indicadores de calidad, la atención de 436 pacientes hospitalizados en 12 centros de Argentina fue evaluada en las áreas de hospitalización, oxigenoterapia, terapia antibiótica empírica, terapia switch, alta hospitalaria y prevención. El nivel de cumplimiento fue clasificado como óptimo (>90%), intermedio (60% a 90%), y bajo (<60%). La selección de antibióticos empíricos y la administración dentro de las primeras ocho horas de admisión tuvieron una adherencia superior al 80%. Se identificó un nivel de cumplimiento bajo en las áreas del pasaje de antibióticos de la vía endovenosa a la vía oral (53%), la prevención con vacunación antineumocóccica (51%) y el ofrecimiento para dejar de fumar (29%). Usando indicadores de calidad se pueden identificar áreas específicas de atención en pacientes con NAC con un bajo nivel de cumplimiento con las guías nacionales. En Argentina se deben desarrollar inicialmente intervenciones enfocadas a mejorar el manejo del pasaje de antibióticos de la vía endovenosa a la vía oral y prevención de la NAC.

A committee of six scientific organizations from Argentina developed guidelines for the management of patients with community-acquired pneumonia (CAP).The objective of this study was to evaluate the level of adherence with the recommended care suggested by the guidelines in patients hospitalized with CAP in Argentina. Using quality indicators the management of 436 patients who were hospitalized in 12 Argentinean institutions was evaluated. The care given among the following areas was reviewed: need for hospitalization, need for oxygen therapy, empiric antibiotic therapy, switch therapy, hospital discharge, and prevention. The level of adherence was classified as optimal (>90%), intermediate (60% to 90%), and low (<60%).The selection of the empiric antibiotic therapy and the administration of antibiotics between the first 8 hours after arrival had an adherence greater to 80%. A low level of adherence was found in the areas of switch therapy (53%), prevention of CAP with pneumococcal vaccine (51%) and smoking cessation offered (29%). Using quality indicators it is possible to identify specific areas of management in patients with CAP to a low level of adherence with national guidelines. In Argentina interventions to improve switch therapy and prevention of CAP should be developed.

Snoring, witnessed sleep apnoeas and pregnancy-induced hypertension.

BACKGROUND: Snoring is common in pregnancy, but there are only a few studies that have investigated the relationship of snoring and pregnancy complications. We aimed to investigate the relationship of snoring and witnessed sleep apnoeas with pregnancy-induced hypertension. METHODS: A questionnaire was administered on the day of delivery to 456 women at the Department of Obstetrics, Hospital Donación F. Santojanni, Buenos Aires, Argentina. Pregnancy complications and blood pressure measurements were recorded from each woman's medical chart. RESULTS: Some 156 (35%) of 447 women with singleton pregnancies who answered the questionnaire, snored at some time during their pregnancy. Snoring was related to pregnancy-induced hypertension and pre-eclampsia combined, with an adjusted odds ratio of 1.82 (95% CI: 1.16-2.84; p <0.01), independent of body mass index before pregnancy, weight gain during pregnancy, neck circumference, smoking, alcohol and age. Witnessed sleep apnoeas were also related to pregnancy-induced hypertensive disease, with an adjusted odds ratio of 8.00 (95% CI: 2.71-23.55; p <0.001). Daytime sleepiness was more prevalent in snoring women. CONCLUSIONS: Snoring and witnessed sleep apnoeas are independently related to pregnancy-induced hypertensive disease.

[Adherence with national guidelines in hospitalized patients with community-acquired pneumonia. Results of CAPO study in Argentina]. / Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad. Resultados del estudio CAPO en Argentina.

A committee of six scientific organizations from Argentina developed guidelines for the management of patients with community-acquired pneumonia (CAP).The objective of this study was to evaluate the level of adherence with the recommended care suggested by the guidelines in patients hospitalized with CAP in Argentina. Using quality indicators the management of 436 patients who were hospitalized in 12 Argentinean institutions was evaluated. The care given among the following areas was reviewed: need for hospitalization, need for oxygen therapy, empiric antibiotic therapy, switch therapy, hospital discharge, and prevention. The level of adherence was classified as optimal (>90%), intermediate (60% to 90%), and low (<60%).The selection of the empiric antibiotic therapy and the administration of antibiotics between the first 8 hours after arrival had an adherence greater to 80%. A low level of adherence was found in the areas of switch therapy (53%), prevention of CAP with pneumococcal vaccine (51%) and smoking cessation offered (29%). Using quality indicators it is possible to identify specific areas of management in patients with CAP to a low level of adherence with national guidelines. In Argentina interventions to improve switch therapy and prevention of CAP should be developed.

Sleep disordered breathing and daytime sleepiness are associated with poor academic performance in teenagers. A study using the Pediatric Daytime Sleepiness Scale (PDSS).

STUDY OBJECTIVES: Inadequate sleep and sleep disordered breathing (SDB) can impair learning skills. Questionnaires used to evaluate sleepiness in adults are usually inadequate for adolescents. We conducted a study to evaluate the performance of a Spanish version of the Pediatric Daytime Sleepiness Scale (PDSS) and to assess the impact of sleepiness and SDB on academic performance. DESIGN: A cross-sectional survey of students from 7 schools in 4 cities of Argentina. MEASUREMENTS: A questionnaire with a Spanish version of the PDSS was used. Questions on the occurrence of snoring and witnessed apneas were answered by the parents. Mathematics and language grades were used as indicators of academic performance. PARTICIPANTS: The sample included 2,884 students (50% males; age: 13.3 +/- 1.5 years) RESULTS: Response rate was 85%; 678 cases were excluded due to missing data. Half the students slept <9 h per night on weekdays. The mean PDSS value was 15.74 +/- 5.93. Parental reporting of snoring occurred in 511 subjects (23%); snoring was occasional in 14% and frequent in 9%. Apneas were witnessed in 237 cases (11%), being frequent in 4% and occasional in 7%. Frequent snorers had higher mean PDSS scores than occasional or nonsnorers (18 +/- 5, 15.7 +/- 6 and 15.5 +/- 6, respectively; P < 0.001). Reported snoring or apneas and the PDSS were significant univariate predictors of failure and remained significant in multivariate logistic regression analysis after adjusting for age, sex, body mass index, specific school attended, and sleep habits. CONCLUSIONS: Insufficient hours of sleep were prevalent in this population. The Spanish version of the PDSS was a reliable tool in middle-school-aged children. Reports of snoring or witnessed apneas and daytime sleepiness as measured by PDSS were independent predictors of poor academic performance.

Sleep habits and accident risk among truck drivers: a cross-sectional study in Argentina.

Road accidents are a major cause of death, and sleep deprivation affects driving skills. We conducted a cross-sectional study to evaluate sleep habits and accident risk in long-haul truck drivers in Buenos Aires, Argentina. Questionnaires regarding sleep habits, snoring, and daytime sleepiness were administered, and a limited physical examination was performed. We obtained 738 complete answers (response rate 85%). Mean sleep hours during working days was 3.76 (SD 2.40). Mean driving hours was 15.9 (SD 5.60) per day. Frequent sleepiness while driving was reported by 43.7% of responders. Sleepiness while driving was associated with Epworth Sleepiness Scale values >10 (odds ratio 1.85, 95% confidence interval = 1.20-2.85). Snoring was reportea by 71% of drivers and was frequent in 43.8%. Snoring more than 3 times a week (odds ratio 1.73, 95% confidence interval = 1.23-2.44), sleepiness while driving (OR 1.92, 95% confidence interval = 1.08-1.96), and Epworth Sleepiness Scale score > 10 (odds ratio 2.53, 95% confidence interval = 1.61-3.97) were independently associated with reporting of accidents or near accidents. Sleep deprivation and long driving shifts were prevalent in our study. Accident risk was associated with frequent snoring, daytime sleepiness, and reporting of sleepiness at the wheel. This study highlights the need of improving working conditions in this highly exposed population.