Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago / Riesgo de déficit de vitamina D en niños asmáticos hospitalizados en el área norte de Santiago

Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization. (AU)

Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización. (AU)

Risk of vitamin D deficit in asthmatic children hospitalized in the north area of Santiago.

Introduction: Introduction: in recent years asthma hospitalization rate in Chilean children has doubled. Numerous studies have shown an association between hypovitaminosis D and frequent, severe asthmatic exacerbations in children. Objective: to estimate the risk of vitamin D (vitD) deficiency and insufficiency in hospitalized asthmatic children compared with patients who are monitored on an outpatient basis and do not have records of hospitalization in one year. Material and methods: an observational, analytic, and case-control study carried out in one calendar year including asthmatic children between 5 and 15 years of age. This study registered: sociodemographic and clinical data, asthma control test, severity score of hospitalization and measurements of vitD blood levels. Associations between variables were analyzed using the t-test and chi-squared test. The risk for hypovitaminosis D and deficiency was calculated through logistic regression. The data was fed into the Stata 14 software. Results: a total of 117 patients, 9 ± 2.7 years old, were admitted, 64 % were male and 51 % presented with malnutrition by excess. Six out of ten children presented moderate asthma and 55 % had a poor control of their pathology; 73.5 % presented hypovitaminosis D (insufficiency and deficiency), hospitalized patients had 2.8 times more risk of presenting vitD deficiency, adjusted according to seasonality and age (95 %CI, 1.07-7.5, p < 0.05) without being associated with a higher severity score of hospitalization. Conclusion: Most of the asthmatic children in the sample presented with hypovitaminosis D, with a higher percentage of deficiency in hospitalized patients, which is not associated with greater severity of hospitalization.

Introducción: Introducción: la tasa de hospitalización por asma se ha duplicado en los últimos años en Chile. Numerosos estudios demuestran una asociación entre la hipovitaminosis D y la presencia de exacerbaciones frecuentes y severas. Objetivo: comparar el riesgo de déficit e insuficiencia de vitamina D (vitD) en niños asmáticos que se hospitalizan en relación con los que se tratan ambulatoriamente. Material y métodos: estudio observacional, analítico, de casos y controles realizado durante 1 año calendario. Se incluyó a pacientes asmáticos de 5 a 15 años. Se registraron datos sociodemográficos, clínicos, nivel de control de asma, puntaje de severidad de hospitalización y se midió la concentración sanguínea de vitD. Se analizó la asociación entre las variables mediante la prueba de la t y la del chi cuadrado. Mediante regresión logística se calculó el riesgo de hipovitaminosis D y déficit de vitD en los sujetos. Los datos se analizaron con el software Stata 14. Resultados: se enrolaron 117 pacientes de 9 ± 2,7 años, 64 % de varones y 51 % con malnutrición por exceso. Seis de cada diez niños presentaban asma moderada y el 55 % tenían mal control de su enfermedad. El 73,5 % de los sujetos presentaban hipovitaminosis D (déficit o insuficiencia). Los hospitalizados tuvieron 2,8 veces más riesgo de presentar déficit de vitD (IC 95 %: 1,07-7,5), ajustado según estacionalidad y edad, sin asociarse a mayor puntaje de severidad de la hospitalización. Conclusión: la mayoría de los niños asmáticos de la muestra presentan hipovitaminosis D, siendo mayor el porcentaje de déficit en los hospitalizados, lo que no se asocia a mayor severidad de la hospitalización.

[Wheezing and asthma epidemiology in infants and preschoolers]. / Situación epidemiológica de la bronquitis obstructiva y asma en lactantes y preescolares.

In Chile, there is a lack of information about wheezing and asthma epidemiology in children under 5 years of age. OBJECTIVE: To determine at the national level the hospitalization and mortality rates in children aged under 5 years with diagnosis of acute bronchitis and asthma. PATIENTS AND METHOD: Hospitalization rates were made using discharge data provided by the Department of Health Statis tics and Information, selecting only those corresponding to the ICD10 codes for asthma and acute bronchitis. Population sizes of those at risk of hospitalization were obtained from projections of the National Institute of Statistics. The mortality rate was obtained by calculating the quotient between the number of deaths due to acute bronchitis and asthma in children under 5 years of age and the exposed population. The evolution of the global and regional hospitalization rates from 2002 to 2017 was studied. RESULTS: Most of the patients who were hospitalized had a diagnosis of acute bronchitis (93,6%), were under two years old, were male, and were hospitalized in winter. During the analyzed period, the acute bronchitis hospitalization rate dropped from 79.7 to 56.1 per 10,000 inhabitants, meanwhile, the asthma hospitalization rate increased from 2.4 to 7.6 per 10,000 inhabitants. The mortality rate in patients with acute bronchitis was 0.52 per 100,000 inhabitants. No mortality was observed in patients diagnosed with asthma. CONCLUSIONS: During the analyzed period, a significant reduction in hospitalization rate due to acute bronchitis was observed in children aged under 5 years, with a low mortality rate.

Tasas regionales de hospitalización y mortalidad por asma infantil en Chile / Regional asthma hospitalization rates and global asthma mortality rate in Chilean children

INTRODUCCIÓN: En los últimos años se ha observado un aumento significativo de la tasa de hospitalización por asma en niños. En la actualidad se desconocen las tasas regionales y la tasa de mortalidad. OBJETIVO: Conocer las tasas regionales de hospitalización por asma en niños y determinar la mortalidad en este grupo etario. PACIENTES Y MÉTODO: Se calculó la tasa de hospitalización por asma en las 15 regiones del país existentes al momento de realizar el estudio, entre el año 2008 y 2014, en base al número de egresos hospitalarios por región y de las poblaciones expuestas al riesgo de hospitalización. La tasa de mor talidad se obtuvo calculando el cociente entre el número de defunciones por asma en niños de 5 a 15 años y la población expuesta. RESULTADOS: La tasa más alta de hospitalización la presentó la V región con 7,6 por 10.000 habitantes. La tasa media de hospitalización en las distintas regiones fue similar a la de la Región Metropolitana, con la excepción de 4 regiones. La tasa global de mortalidad por asma en niños de 5 a 15 años para el periodo analizado es de 0,37 por 100.000 habitantes. CONCLUSIONES: La mayoría de las regiones del país presentan tasas de hospitalización similares a la Región Metropolitana. La V Región presenta la tasa más alta de hospitalización. La tasa global de mortalidad por asma en niños de 5 a 15 años es de 0,37 por 100.000 habitantes.

INTRODUCTION: In recent years, there has been a significant increase in asthma hospitalization rates in children, however, regional and mortality rates are yet unknown. OBJECTIVE: To determine regional asth ma hospitalization rates in children and the global mortality rate in this age group. PATIENTS AND METHOD: We determined asthma hospitalization rates in the 15 regions of the country existing at the time of the study, between 2008 and 2014, based on the number of hospital discharges in each region and the population at risk of hospitalization. The mortality rate was obtained using the ratio between deaths due to asthma in children aged 5 to 15 and the exposed population. RESULTS: the 5th region presented the highest hospitalization rate (7.6 per 10,000 inhabitants). Except for 4 regions, the median hospitalization rates of the different regions were similar to those found in the Metropolitan Region. The overall mortality rate due to asthma in 5 to 15-year-old children was 0.37 per 100,000 inhabitants in the analyzed period. CONCLUSIONS: most regions of the country have similar hospitalization rates to the Metropolitan Region and the 5th region presents the highest hospitali zation rate due to asthma. The global mortality rate in children between 5 and 15 years old is 0.37 per 100,000 inhabitants.

Regional asthma hospitalization rates and global asthma mortality rate in Chilean children. / Tasas Regionales de hospitalización y mortalidad por asma infantil en Chile.

INTRODUCTION: In recent years, there has been a significant increase in asthma hospitalization rates in children, however, regional and mortality rates are yet unknown. OBJECTIVE: To determine regional asth ma hospitalization rates in children and the global mortality rate in this age group. PATIENTS AND METHOD: We determined asthma hospitalization rates in the 15 regions of the country existing at the time of the study, between 2008 and 2014, based on the number of hospital discharges in each region and the population at risk of hospitalization. The mortality rate was obtained using the ratio between deaths due to asthma in children aged 5 to 15 and the exposed population. RESULTS: the 5th region presented the highest hospitalization rate (7.6 per 10,000 inhabitants). Except for 4 regions, the median hospitalization rates of the different regions were similar to those found in the Metro politan Region. The overall mortality rate due to asthma in 5 to 15-year-old children was 0.37 per 100,000 inhabitants in the analyzed period. CONCLUSIONS: most regions of the country have similar hospitalization rates to the Metropolitan Region and the 5th region presents the highest hospitali zation rate due to asthma. The global mortality rate in children between 5 and 15 years old is 0.37 per 100,000 inhabitants.

Diagnóstico de la discinecia ciliar primaria / Diagnosis of the primary ciliary dyskinesia

Primary ciliary dyskinesia is a congenital disorder due to abnormal motile ciliary function, especially in the airway epithelium. The mucociliary clearance is impaired, producing reoccurring respiratory tract infections, usually resulting in bronchiectasis as an adult. Patients also have frequent ear and sinus infections and almost 50% of them have situs inversus. Diagnosis of primary ciliary dyskinesia is difficult because there is not a single gold standard test, resulting in the need of a multi-test approach. Until recently in our country we only had transmission electron microscopy, but nasal nitric oxide and high speed video microscopy are now available. In this article we will detail the most important clinical characteristics that make us suspect the presence of primary ciliary dyskinesia at different ages and the methods available for its diagnosis.

La discinesia ciliar primaria es una enfermedad congénita debida a una alteración del movimiento normal de los cilios, especialmente a nivel del epitelio respiratorio. Esto se traduce en una alteración del clearance mucociliar lo que predispone al paciente a tener infecciones respiratorias repetidas, terminando en la aparición de bronquiectasias en la edad adulta. También son frecuentes las infecciones repetidas de oídos y cavidades perinasales. La presencia de situs inverso puede verse en hasta en 50% de los pacientes con esta enfermedad. El diagnóstico de discinesia ciliar primaria es difícil ya que no existe un examen que sea considerado patrón de oro, por lo que se requiere la realización de distintos exámenes. En nuestro país hasta hace poco tiempo solo contábamos con la microscopía electrónica, pero recientemente se ha sumado la medición de óxido nítrico nasal y la videomicroscopía de alta velocidad. En el presente artículo se detallarán las características clínicas más importantes que hacen sospechar la presencia de DCP en las distintas edades y los métodos disponibles para su diagnóstico.