[Translated article] Pharmaceutical care in respiratory diseases: Current situation and opportunities for hospital pharmacy in Spain.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training, and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=21), hospitalised patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma, and lung transplant as a priority. 51% considered integration to be adequate and 91% considered it necessary to implement prioritisation criteria. Professional competencies ranged from 6.5 to 6.9 out of 10 points. Only 45% of participants had received specific training in the last 4 years, indicating greater priority for asthma, pulmonary hypertension, and IPF. CONCLUSIONS: Most centers have pharmacists specialised in respiratory diseases. However, there is room for improvement in terms of subspecialisation, participation in multidisciplinary committees, implementation of prioritisation criteria, diversification in pathologies treated, as well as greater specific training in this area.

Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain. / Atención farmacéutica en enfermedades respiratorias: situación y oportunidades de la farmacia hospitalaria en España.

OBJECTIVE: Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases. METHOD: Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction. RESULTS: In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF. CONCLUSIONS: Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center.

Background Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and method This retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH.  Results There were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%. Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. Conclusion Bronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.

A Retrospective Chart Review of Pediatric Complicated Community-Acquired Pneumonia: An Experience in the Al Qassimi Women and Children Hospital.

Background Community-acquired pneumonia (CAP) is one of the most common global health issues. Even though many vaccinations and new diagnostic tools are available, CAP has a higher mortality rate, especially in children less than five years of age. Complicated CAP (CCAP) in a healthy child is a severe disease characterized by a combination of local complications, such as parapneumonic effusion (PPE), empyema (EMP), necrotizing pneumonia (NP), abscess, pneumothorax, and bronchopleural fistula, and systemic complications, such as bacteremia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death. This study describes the demographic features, clinical presentation, management, and outcomes of patients diagnosed with CCAP at the Al Qassimi Women's and Children's Hospital (AQWCH). Methodology This retrospective chart review aims to collect and explore the data of all previously healthy children admitted with CCAP between the ages of one month and 13 years at AQWCH from January 2018 to December 2020. The primary study outcome measure is to provide clinicians with the diagnostics, evaluation, and management required to treat complicated pneumonia. Results A total of 195 patients were diagnosed with CAP, of whom 30 (15.3%) were diagnosed with CCAP. Of these, 14 (46.6%) patients had NP, eight (26.7%) had PPE, and eight (26.7%) had EMP. The median age of patients was 2.5 years, with 13 (43%) males and 17 (57%) females. The median duration of their stay in the hospital was 16 days. All patients were vaccinated with Hib, PCV13, or PCV7, and 57% of the patients received antibiotics before admission. The most common findings were consolidation and pleural effusion. Blood culture was negative in all cases, and pleural culture was positive only in three cases. A total of 17 (57%) patients underwent video-assisted thoracoscopic surgery (VATS), and post-VATS surgical emphysema was found to be the most common complication. Chest X-rays normalized after three months in 65% of patients. On comparing patients who were admitted to the Pediatric Intensive Care Unit (PICU) before any surgical intervention with those who were not, it was found that patients who required PICU admission were young (median = 2 years; interquartile range (IQR) = 1-4.5; p = 0.044) and had higher respiratory rate (mean = 49 breaths/per minute, standard deviation (SD) = 11; p = 0.000). In addition, they had lower median albumin (median = 2 g/L; IQR = 1.8-2.23; p = 0.004). On comparing patients who required VATS and those who did not require VATS, it was found that the former had a higher median respiratory rate (48 per min; range = 42-54; p = 0.01). A cavity in the chest computed tomography (CT) was found in 86% of patients with VATS (p = 0.017), and they had lower median albumin (median = 2 g/L; IQR = 1.92-2.24; p = 0.012), as well as longer median duration of using oral antibiotics (median = 21 days; IQR = 19-26; p = 0.025). Patients with complicated NP had a higher respiratory rate and higher PICU admission, and more cavity in the chest was found in the CT study. Most NP patients also underwent VATS and had longer median days of using oral antibiotics. One patient developed a bronchopleural fistula, and one patient diagnosed with NP died. Conclusions CCAP is a major cause of hospitalization in children. It is important to suspect CCAP in all CAP patients not responding to treatment after 48-72 hours.

Experience of a virtual course of pneumonology for Medical students at the University of Buenos Aires during the COVID-19 pandemic / Experiencia de un curso virtual de la materia neumonología para alumnos de la carrera de Medicina de la Universidad de Buenos Aires durante la pandemia COVID-19

ABSTRACT Experience of a virtual course of pneumonology for Medical students at the University of Buenos Aires during the COVID-19 pandemic The COVID-19 pandemic not only affects people´s health: schools and universities around the world had to forcibly adapt to a distance education modality. Knowing that the epidemiological situation could continue for several months, the teachers of our Unit, in charge of teaching Pneumonology, had to anticipate and devise a contingency plan to ensure training continuity during 2020-21. The virtual courses took place in four weeks. The classes were given in mp4 format and virtual workshops. Once a week a virtual meeting was held to answer questions related to the content. The students had to be divided into groups to solve practical assignments and a final work with their defense at the end of the course. In addition, they conducted a survey to evaluate the course. The final exam was presential for the 2020 course and virtual for the 2021. All the students who took the exam approved. The experience was enriching, different and challenging. It allowed us to reflect and ask ourselves that the traditional way of teaching can and should be complemented with the resources that technology brings us. Although the total reopening of the University may seem uncertain, this is the opportunity to better plan the way out of the crisis and promote internal reflection on the renewal of the teaching and learning model.

RESUMEN La pandemia por COVID-19 no solo afecta la salud de las personas: escuelas y universidades de todo el mundo debieron adaptarse de forma forzosa a la modalidad de educación a distancia. Sabiendo que la situación epidemiológica de la pandemia podía continuar por varios meses, los docentes de nuestra Unidad, encargada de dictar la asignatura Neumonología, debimos anticiparnos e idear un plan de contingencia para asegurar la continuidad formativa durante el período 2020-21. Los cursos virtuales se llevaron a cabo en cuatro semanas. Se dictaron clases en formato mp4 y talleres virtuales. Una vez por semana se realizaba una reunión virtual para responder preguntas relacionadas con el contenido. Los alumnos debieron dividirse en grupos para resolver trabajos prácticos y un trabajo final con su defensa al completar el curso. Además, realizaron una encuesta para evaluar el curso. El examen final oral fue presencial para el curso 2020 y virtual para el de 2021, y aprobaron todos los alumnos que se presentaron. La experiencia fue enriquecedora, diferente y desafiante. Nos permitió reflexionar y plantearnos que la forma de enseñanza tradicional puede y debe complementarse con los recursos que la tecnología nos acerca. Aunque el momento de la reapertura total de la Universidad pueda parecer incierto, esta es la oportunidad para planificar mejor la salida de la crisis y promover la reflexión interna sobre la renovación del modelo de enseñanza y aprendizaje.

Experiencia de un curso virtual de la materia neumonología para alumnos de la carrera de Medicina de la Universidad de Buenos Aires durante la pandemia COVID-19 / Experience of a Virtual Course of Pneumonology For Medical Students At The University of Buenos Aires During The COVID-19 Pandemic

La pandemia por COVID-19 no solo afecta la salud de las personas: escuelas y universidades de todo el mundo debieron adaptarse de forma forzosa a la modalidad de educación a distancia. Sabiendo que la situación epidemiológica de la pandemia podía continuar por varios meses, los docentes de nuestra Unidad, encargada de dictar la asignatura Neumonología, debimos anticiparnos e idear un plan de contingencia para asegurar la continuidad formativa durante el período 2020-21. Los cursos virtuales se llevaron a cabo en cuatro semanas. Se dictaron clases en formato mp4 y talleres virtuales. Una vez por semana se realizaba una reunión virtual para responder preguntas relacionadas con el contenido. Los alumnos debieron dividirse en grupos para resolver trabajos prácticos y un trabajo final con su defensa al completar el curso. Además, realizaron una encuesta para evaluar el curso. El examen final oral fue presencial para el curso 2020 y virtual para el de 2021, y aprobaron todos los alumnos que se presentaron. La experiencia fue enriquecedora, diferente y desafiante. Nos permitió reflexionar y plantearnos que la forma de enseñanza tradicional puede y debe complementarse con los recursos que la tecnología nos acerca. Aunque el momento de la reapertura total de la Universidad pueda parecer incierto, esta es la oportunidad para planificar mejor la salida de la crisis y promover la reflexión interna sobre la renovación del modelo de enseñanza y aprendizaje.

Experience of a virtual course of pneumonology for Medical students at the University of Buenos Aires during the COVID-19 pandemic The COVID-19 pandemic not only affects people´s health: schools and universities around the world had to forcibly adapt to a distance education modality. Knowing that the epidemiological situation could continue for several months, the teachers of our Unit, in charge of teaching Pneumonology, had to anticipate and devise a contingency plan to ensure training continuity during 2020-21. The virtual courses took place in four weeks. The classes were given in mp4 format and virtual workshops. Once a week a virtual meeting was held to answer questions related to the content. The students had to be divided into groups to solve practical assignments and a final work with their defense at the end of the course. In addition, they conducted a survey to evaluate the course. The final exam was presential for the 2020 course and virtual for the 2021. All the students who took the exam approved. The experience was enriching, different and challeng ing. It allowed us to reflect and ask ourselves that the traditional way of teaching can and should be complemented with the resources that technology brings us. Although the total reopening of the University may seem uncertain, this is the opportunity to bet ter plan the way out of the crisis and promote internal reflection on the renewal of the teaching and learning model.

Update on COVID-19: A teleconference with the Paediatric Virology Study Group (Review).

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans mainly via contact and droplet transmission and its entry into cells is mediated by the efficient binding of the spike (S) viral protein with the angiotensin converting enzyme-2 (ACE2) receptors. Although acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 fulfills the criteria of the Berlin definition, in a considerable proportion of patients with COVID-19, there is a dissociation between their relatively well-preserved lung mechanics and the severity of hypoxaemia. The extent of pneumococcal related morbidity and mortality is largely unknown. Respiratory comorbidities that increase the risk of severe disease and mortality due to SARS-CoV-2 include chronic obstructive pulmonary disease, asthma, bronchiectasis and fibrotic interstitial lung diseases, regardless of aetiology. Pneumococcal and seasonal influenza vaccinations are useful in preventing a substantial burden of mortality in high-risk populations, while general quarantine and social distancing can reduce the infiltration of the virus within the community. To date, several therapeutic agents have been studied or are currently examined, such as hydroxychloroquine, chloroquine, ritonavir/lopinavir, remdesivir, colchicines and interleukin-6 inhibitors. However, the usage of most of these into clinical practice was not based on randomised clinical trials and their results should be viewed with extreme caution; remdesivir seems to be the more promising option. Rigorous efforts are under way for the development of a safe and successful vaccine against SARS-CoV-2.