Hybrid model for early identification post-Covid-19 sequelae.

Artificial Intelligence techniques based on Machine Learning algorithms, Neural Networks and Naïve Bayes can optimise the diagnostic process of the SARS-CoV-2 or Covid-19. The most significant help of these techniques is analysing data recorded by health professionals when treating patients with this disease. Health professionals' more specific focus is due to the reduction in the number of observable signs and symptoms, ranging from an acute respiratory condition to severe pneumonia, showing an efficient form of attribute engineering. It is important to note that the clinical diagnosis can vary from asymptomatic to extremely harsh conditions. About 80% of patients with Covid-19 may be asymptomatic or have few symptoms. Approximately 20% of the detected cases require hospital care because they have difficulty breathing, of which about 5% may require ventilatory support in the Intensive Care Unit. Also, the present study proposes a hybrid approach model, structured in the composition of Artificial Intelligence techniques, using Machine Learning algorithms, associated with multicriteria methods of decision support based on the Verbal Decision Analysis methodology, aiming at the discovery of knowledge, as well as exploring the predictive power of specific data in this study, to optimise the diagnostic models of Covid-19. Thus, the model will provide greater accuracy to the diagnosis sought through clinical observation.

Objective measures for functional diagnostic of the upper airways: practical aspects.

OBJECTIVE: To review the main papers published on the main available tests to obtain objective values of nasal patency and to demonstrate aspects of their use in medical practice. METHODOLOGY: We performed a non-systematic review of the MEDLINE and LILACS databases, and the most relevant articles were selected. RESULTS: Objective evaluations are important in epidemiological studies and in monitoring of patients with nasal obstruction. There is a wide variety of objective tests of nasal function; among them acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow (PNIF) are currently the most used tests. CONCLUSION: The choice of the method to evaluate nasal function depends on the conditions of each health service. PNIF has been highlighted as a simple and reliable alternative that provides easy-to-interpret results, and is thus an attractive method for clinical practice.

Application of Peak Nasal Inspiratory Flow reference values in the treatment of allergic rhinitis.

OBJECTIVE: To assess the applicability of the Peak Nasal Inspiratory Flow (PNIF) curves in follow-up of children in the treatment of allergic rhinitis. METHODS: Prospective study of 40 patients with AR, grouped in corticosteroid spray versus physiological saline solution use. Follow up for 10 weeks through clinical score and PNIF percentages in relation to the reference curves, with was-out at week 8. Statistical assessment of the effect of treatment on variation of PNIF and clinical score was calculated by ANOVA model and Multiple Comparison of Means Test - Least Significant Difference. RESULTS: There was a statistically significant influence of the group, time and interaction between time and group on PNIF percentages. Throughout follow up, patients from the treatment group had mean PNIF percentages significantly higher than the placebo group. Clinical score results also demonstrated a statistically significant influence between the groups, time and interaction between time and group. CONCLUSION: Increase in PNIF percentage values observed in children treated with intranasal corticosteroids revealed the applicability of PNIF curves in their follow up.

Reference values for peak nasal inspiratory flow in children and adolescents in Brazil.

STATEMENT OF THE PROBLEM: Allergic rhinitis is a global public health issue. Peak nasal inspiratory flow (PNIF) can help in the assessment of patients with allergic rhinitis. However, reference values in the literature for PNIF in school children and adolescents are limited. THE AIM OF THIS STUDY was to identify reference values of PNIF among children and adolescents. METHODS: We conducted a cross-sectional study to identify reference values of PNIF among healthy school children and adolescents aged from eight to fifteen years old, selected from 14 randomly selected public schools. Participants performed measurements of PNIF using the In-check-inspiratory flow meter (Clement Clarke, Harlow, England). PNIF values were correlated to gender, age, height, weight and body mass index. RESULTS: A total of 526 subjects participated in the study. The final linear regression model for PNIF allowed obtaining the following equation for subjects aged from eight to 15 years old: PNIF (l/m) = height (centimeters) x 0.7 + 11.2, for boys and PNIF (l/m) = height (centimeters) x 0.7, for girls. CONCLUSION: the equations of the final regression model resulted in a simple formula to obtain reference values of PNIF for subjects aged from 8 to 15 years old.

Adherence rate to inhaled corticosteroids and their impact on asthma control.

BACKGROUND: Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control. METHODS: A cohort concurrent study was carried out for 12 months with 122 asthmatic patients, aged 3-12 years, randomly selected in a pediatric pulmonology outpatient clinic, who received BDP free of charge. Adherence rates were verified by pharmacy records. Clinical control was assessed through a scoring system comprised four variables (nocturnal and morning symptoms, limitation of physical activities and exacerbations). Total score was 16 points. Patients whose score was below or equal to two were considered controlled (group 1), and patients whose score was above or equal to three were considered uncontrolled (group 2). For patients able to perform spirometry, we considered as controlled the patients with forced expiratory volume in 1 s (FEV(1)) equal to or above 80% of the predicted value, and as uncontrolled the patients with FEV(1) below 80%. RESULTS: Fewer than half (40.3% maximum) of the 122 patients maintained asthma control. Median adherence rate of groups 1 and 2 were 85.5% and 33.8%, (P < 0.001) in the 4th month, 90.0% and 48.0% (P < 0.001) in the 8th month and 84.4% and 47.0% in the 12th month (P < 0.001), respectively. CONCLUSION: In all periods, there were statistically significant differences in adherence rates for maintaining or not maintaining the asthma control. Optimal asthma control entailed adherence rate higher than 80%. Strategies for reducing asthma morbidity should include a regular monitoring of adherence to inhaled steroids.

Obtaining concomitant control of allergic rhinitis and asthma with a nasally inhaled corticosteroid.

Allergic rhinitis (AR) and asthma coexist frequently and a dual treatment is recommended by prescribing topical nasal plus oral inhaled corticosteroids. The purpose of this study was to assess the efficacy of a nasally inhaled corticosteroid aiming at concomitant control of AR and asthma. A controlled trial was conducted among 60 patients with AR and asthma, aged 6-18 years, who were randomized into two groups. During 8 weeks, the experimental group (30 patients) received exclusively fluticasone propionate hydrofluoroalkane (FP-HFA) inhaled through the nose (mouth closed) using a large volume spacer attached to a face mask. The comparison group (30 patients) received a nasal spray of isotonic saline plus oral inhalation of FP-HFA through a mouthpiece attached to the same spacer. Clinical scores for AR and asthma, nasal inspiratory peak flow (NIPF), and spirometry were assessed by blinded observers. There was a significant improvement in AR scores and NIPF in the experimental group (P or= 0.20). Prebronchodilator FEV(1) (% predicted value) improved by 10% in both groups, comparing values at inclusion with those obtained at the end of follow up. Our results suggest that nasally inhaled FP-HFA through a spacer may control AR and asthma in children and adolescents. This approach is likely to result in higher compliance, lower costs, and fewer side effects.