A Case of Dedifferentiated Liposarcoma That Contributes to Accompanying Vessels of Various Size.

Dedifferentiated liposarcoma (DDLPS) is a non-lipogenic sarcoma, generally arising from well-differentiated liposarcoma (WDLPS), although it can develop de novo. DDLPS tumors rarely trans-differentiate into non-adipose mesenchymal tissues; however, the latter lack notable variety and mostly show striated muscle or osteogenic/chondrogenic differentiation. Here, we report a case of DDLPS that contained numerous atypical vessels. A man in his sixties presented with a large tumor in his right thigh, and the tumor was surgically resected. Microscopically, most of the tumor was WDLPS, but a minor portion showed DDLPS, consisting of high-grade spindle cells. Remarkably, the DDLPS contained vessels of various sizes with atypical cytoarchitecture, including vessels with seemingly muscular layers. Immunohistochemically, the atypical cells within the vascular wall expressed aSMA, consistent with smooth muscle cells or pericytes, whereas surrounding high-grade spindle cells only focally expressed it, and these aSMA-positive cells within the vessels exhibited MDM2 amplification by immuno-fluorescence in situ hybridization. Our results demonstrate that DDLPS can trans-differentiate into smooth muscle cells of various-sized accompanying vessels, which may support their survival and proliferation.

Poor compliance with clinical practice guidelines in the management of asthma in primary care in the community of Madrid.

INTRODUCTION: Asthma is a common chronic disease in the paediatric age group that requires close follow-up. Clinical practice guidelines offer evidence-based recommendations to achieve adequate control of the disease. OBJECTIVE: To assess the management of childhood asthma in the primary care setting in the Community of Madrid, and the adherence of health care professionals to guideline recommendations. To analyse the association of asthma management with age, the socioeconomic level of the catchment population and the workload of primary care centres. METHODS: retrospective longitudinal study in patients aged 6-14 years newly diagnosed with asthma in primary care centres of the Community of Madrid in 2021. We analysed sociodemographic and clinical variables and the compliance with recommendations at the time of diagnosis and over 1 year of follow-up. The source of data was the electronic health record database of the primary care system. RESULTS: We found a proportion of compliance with the recommendations upon diagnosis of the disease of 5.84%, with differences associated to the socioeconomic level of the catchment population (P = .033), and the pressure of care (P = .006). The proportion of compliance with recommendations during follow-up was 12.73%, with differences based on age (P = .01), socioeconomic level (P = 0.006) and centre workloads (P = .002). CONCLUSIONS: Compliance with the recommendations of the main childhood asthma management guidelines in the primary care setting was low in the Community of Madrid. Strategies need to be implemented to improve the management of this disease and the adherence of professionals to the protocols developed for this purpose.

Unraveling the hepatic stellate cells mediated mechanisms in aging's influence on liver fibrosis.

Aging enhances numerous processes that compromise homeostasis and pathophysiological processes. Among these, activated HSCs play a pivotal role in advancing liver fibrosis. This research delved into how aging impacts liver fibrosis mechanisms. The study involved 32 albino rats categorized into four groups: Group I (young controls), Group II (young with liver fibrosis), Group III (old controls), and Group IV (old with liver fibrosis). Various parameters including serum ALT, adiponectin, leptin, and cholesterol levels were evaluated. Histopathological analysis was performed, alongside assessments of TGF-ß, FOXP3, and CD133 gene expressions. Markers of fibrosis and apoptosis were the highest in group IV. Adiponectin levels significantly decreased in Group IV compared to all other groups except Group II, while cholesterol levels were significantly higher in liver fibrosis groups than their respective control groups. Group III displayed high hepatic expression of desmin, α-SMA, GFAP and TGF- ß and in contrast to Group I. Increased TGF-ß and FOXP3 gene expressions were observed in Group IV relative to Group II, while CD133 gene expression decreased in Group IV compared to Group II. In conclusion, aging modulates immune responses, impairs regenerative capacities via HSC activation, and influences adipokine and cholesterol levels, elevating the susceptibility to liver fibrosis.

YdbH and YnbE form an intermembrane bridge to maintain lipid homeostasis in the outer membrane of Escherichia coli.

The outer membrane (OM) of didermic gram-negative bacteria is essential for growth, maintenance of cellular integrity, and innate resistance to many antimicrobials. Its asymmetric lipid distribution, with phospholipids in the inner leaflet and lipopolysaccharides (LPS) in the outer leaflet, is required for these functions. Lpt proteins form a transenvelope bridge that transports newly synthesized LPS from the inner membrane (IM) to OM, but how the bulk of phospholipids are transported between these membranes is poorly understood. Recently, three members of the AsmA-like protein family, TamB, YhdP, and YdbH, were shown to be functionally redundant and were proposed to transport phospholipids between IM and OM in Escherichia coli. These proteins belong to the repeating ß-groove superfamily, which includes eukaryotic lipid-transfer proteins that mediate phospholipid transport between organelles at contact sites. Here, we show that the IM-anchored YdbH protein interacts with the OM lipoprotein YnbE to form a functional protein bridge between the IM and OM in E. coli. Based on AlphaFold-Multimer predictions, genetic data, and in vivo site-directed cross-linking, we propose that YnbE interacts with YdbH through ß-strand augmentation to extend the continuous hydrophobic ß-groove of YdbH that is thought to shield acyl chains of phospholipids as they travel through the aqueous intermembrane periplasmic compartment. Our data also suggest that the periplasmic protein YdbL prevents extensive amyloid-like multimerization of YnbE in cells. We, therefore, propose that YdbL has a chaperone-like function that prevents uncontrolled runaway multimerization of YnbE to ensure the proper formation of the YdbH-YnbE intermembrane bridge.

Carbon footprint of pressurized gas metered dose inhalers (pMDI) in Brazil and Porto Alegre: impacts and alternatives / La huella de carbono de los dispositivos inhaladores dosificados de gas presurizado (pMDI) en Brasil y en Porto Alegre: impactos y alternativas / Pegada de carbono dos dispositivos inalatórios dosimetrados de gás pressurizado (pMDI) no Brasil e em Porto Alegre: impactos e alternativas

Objective: To calculate the carbon footprint of pressurized gas-type metered-dose inhalers for asthma and chronic obstructive pulmonary disease control (COPD) dispensed by the brazilian national health service (SUS) in Brazil and in Porto Alegre (RS) in 2019. Method: Collection and analysis of data on the dispensation of salbutamol and beclomethasone by the SUS network and Farmácia Popular do Brasil in 2019, obtained by request to the Ministry of Health. Dispensations were multiplied by the proportional carbon footprint of each device using data already published in the literature. Results: In 2019, the prescription of pMDIs (pressurized metered-dose inhalers) within the Brazilian Unified Health System (SUS) resulted in the emission of approximately 24,889,141 to 60,878,728 metric tons of CO2 equivalent into the atmosphere across Brazil, which is equivalent to traveling by a typical gasoline-powered car from the northernmost to the southernmost point of the country between 23 to 57 million times. Furthermore, in the specific context of Porto Alegre, the emissions ranged from approximately 459,830 to 1,151,008 metric tons of CO2 equivalent, corresponding to traveling by a typical gasoline-powered car from the northernmost to the southernmost point of Brazil between 433,000 to 1 million times. Conclusion: The national health service in Brazil is responsible for emitting a massive amount of GHGs each year due to pMDI-type inhalation devices.  Switching to DPIs or SMIs in the indicated cases would avoid a great environmental damage, and at the same time would be of clinical benefit to patients, since they are the first choice currently recommended by the clinical guidelines for the treatment of asthma and COPD, promoting public health and, at the same time, planetary health.

Objetivo: Calcular la huella de carbono de los inhaladores de dosis medida de gas presurizado utilizados para el control del asma y la enfermedad pulmonar obstructiva crónica (EPOC) dispensados por el Sistema Único de Salud (SUS) en Brasil y en Porto Alegre (RS) en el año 2019. Método: Recopilación y análisis de datos de dispensación de salbutamol y beclometasona por la red SUS y Farmácia Popular do Brasil en 2019, obtenidos a través de una solicitud al Ministerio de Salud en virtud de la Ley de Acceso a la Información. Las dispensaciones se multiplicaron por la huella de carbono proporcional de cada dispositivo utilizando datos previamente publicados en la literatura. Resultados: La prescripción de los inhaladores de dosis medida de gas presurizado en el SUS en 2019 resultó en la emisión de entre 24,889,141 y 60,878,728 toneladas de CO2-eq en todo Brasil, equivalente a viajar en un automóvil de gasolina común desde el extremo norte hasta el extremo sur del país entre 23 y 57 millones de veces. En el caso de la ciudad de Porto Alegre, las emisiones oscilaron entre 459,830 y 1,151,008 toneladas de CO2-eq, lo que equivale a recorrer la distancia de norte a sur de Brasil entre 433,000 y 1 millón de veces en un automóvil de gasolina común. Conclusión: En el SUS, se emite una enorme cantidad de gases de efecto invernadero (GEE) cada año debido a los dispositivos inhaladores del tipo pMDI. El cambio a DPIs o SMIs en los casos indicados evitaría un gran daño ambiental y, al mismo tiempo, proporcionaría beneficios clínicos a los pacientes, ya que es la primera opción actualmente recomendada por las directrices clínicas para el tratamiento del asma y la EPOC, promoviendo la salud pública y al mismo tiempo la salud del planeta.

Objetivo: Calcular a pegada de carbono dos inaladores do tipo gás pressurizado dosimetrado para controle da asma e doença pulmonar obstrutiva crônica (DPOC) dispensados pelo Sistema Único de Saúde (SUS) no Brasil e em Porto Alegre (RS) no ano de 2019. Método: Coleta e análise de dados de dispensação de salbutamol e beclometasona pela rede SUS e Farmácia Popular do Brasil em 2019, obtidas por solicitação ao Ministério da Saúde através da Lei de Acesso à Informação. As dispensações foram multiplicadas pela pegada de carbono proporcional de cada dispositivo utilizando dados já publicados na literatura. Resultados: A prescrição de pMDI no SUS, em 2019, resultou entre 24.889.141 e 60.878.728 toneladas de CO2-eq liberados na atmosfera em todo o Brasil (equivalente a percorrer 23 a 57 milhões de vezes a distância de norte a sul do Brasil com um carro comum a gasolina); e entre 459.830 e 1.151.008 toneladas de CO2-eq na cidade de Porto Alegre (correspondente a percorrer 433mil a 1 milhão de vezes a distância de norte a sul do Brasil com um carro comum a gasolina). Conclusão: No SUS, emite-se enorme quantidade de GEEs a cada ano devido aos dispositivos inalatórios do tipo pMDI. A troca por DPIs ou SMIs nos casos indicados evitaria um grande dano ambiental, e ao mesmo tempo benefício clínico aos pacientes, pois trata-se da primeira escolha atual preconizada pelas diretrizes clínicas para o tratamento de asma e DPOC, promovendo a saúde pública e ao mesmo tempo a saúde planetária.

Sulfato de magnesio y aminofilina en el tratamiento de niños, niñas y adolescentes hospitalizados. Perfil de uso y respuesta terapéutica

Introducción: Sulfato de magnesio (MgSO4) y aminofilina son broncodilatadores intravenosos utilizados en el tratamiento de niños con broncoobstrucción (BO). La evidencia disponible para recomendar su uso es escasa. Objetivo: Caracterizar el perfil de uso y la respuesta terapéutica al MgSO4 y aminofilina en el tratamiento de la BO en niños hospitalizados en un centro de referencia de Uruguay. Materiales y métodos: Estudio descriptivo de corte transversal mediante revisión de historias y entrevistas. Se incluyeron a todos los menores de 15 años que utilizaron estos fármacos. Se evaluó la respuesta terapéutica a la administración de ambos fármacos en forma exclusiva y concomitante y la presencia de efectos adversos. Resultados: Se incluyeron 102 niños, mediana de edad 4 años, ≤5 años 62%. Los principales diagnósticos fueron: crisis asmática 56% y neumonía viral 31%. Recibieron ambos fármacos 48%, únicamente aminofilina 28% y exclusiva de MgSO4 24%. Se observó buena respuesta terapéutica a la administración: exclusiva de MgSO4 67%, consecutiva de MgSO4 y aminofilina 45% y exclusiva de aminofilina en 34%. En 38,2% se registró al menos un efecto adverso, 64% eran menores de 5 años, riesgo aumentado en 1,5 veces. Conclusiones: Se registraron variadas indicaciones, la mayoría en niños asmáticos y en un porcentaje menor indicaciones fuera de prospecto. Menos de la mitad presentaron buena respuesta luego de la administración de MgSO4 y/o aminofilina. En un porcentaje no despreciable se registraron efectos adversos, predominaron en menores de 5 años. Son necesarios nuevos estudios para continuar caracterizando el perfil de uso y seguridad de estos fármacos.

Introduction: Magnesium sulfate (MgSO4) and aminophylline are intravenous bronchodilators used in the treatment of children with bronchoobstruction (BO). The evidence available to recommend their use is scarce. Objective: To characterize the use profile and therapeutic response to MgSO4 and aminophylline in the treatment of BO in children hospitalized in a reference center in Uruguay. Materials and methods: This was a descriptive cross-sectional study through review of clinical histories and interviews. All children under 15 years of age who used these drugs were included. The therapeutic response to the administration of both drugs exclusively and concomitantly and the presence of adverse effects were evaluated. Results: 102 children were included, median age was 4 years, 62% were ≤5 years. The main diagnoses were: asthmatic crisis, 56% and viral pneumonia, 31%. 48% received both drugs, 28% only aminophylline and 24% exclusively MgSO4. Good therapeutic response was observed to the administration: MgSO4 exclusively, 67%, MgSO4 followed by aminophylline, 45% and aminophylline exclusively in 34%. At least one adverse effect was recorded in 38.2%, of these, 64% were under 5 years of age, risk increased by 1.5 times. Conclusions: Various indications were recorded, the majority in asthmatic children and a smaller percentage off-label indications. Less than half had a good response after the administration of MgSO4 and/or aminophylline. Adverse effects were recorded in a non-negligible percentage, predominating in children under 5 years of age. New studies are necessary to continue characterizing the use and safety profile of these drugs.

Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Odontopediatría en el paciente con enfermedad sistémica / Pediatric dentistry in patients with systematic disease

Esta revisión ofrece un enfoque sistemático para establecer una prestación de atención dental segura, integral, coordinada y orientada a la familia del niño con complejidades médicas. Sugerimos que adoptar un enfoque individualizado basado en la fortaleza para la evaluación de niños con afecciones médicas complejas ofrece la base más segura para la prestación de atención en pacientes con enfermedad cardiaca y asma. El objetivo de esta revisión es brindar una visión razonada de atención en el paciente comprometido sistémicamente, basados en protocolos internacionales, y una serie de pasos y modificaciones que deben ser consideradas al momento del manejo odontológico. Se realizó la búsqueda científica en bases digitales contemplando información en idiomas inglés y español, acerca del manejo del paciente dependiendo de su diagnóstico médico y sus complicaciones. Concluimos que el tratamiento dental de pacientes pediátricos con enfermedades sistémicas se puede llevar a cabo de manera eficiente en presencia de un equipo dental bien equipado y apoyo de los padres. Un dentista pediátrico juega un papel importante en el alivio de la ansiedad del niño, manteniendo una relación positiva y haciendo que los servicios de atención se conviertan en experiencias cómodas y libres de complicaciones para pacientes infantiles con enfermedades sistémicas de base, como cardiopatías y/o asma (AU)

This review provides a systematic approach to establishing safe, comprehensive, coordinated, and family-oriented dental care delivery for the child with medical complexities. We suggest that adopting an individualized, strength-based approach to evaluating children with complex medical conditions provides the surest basis for delivering care to heart disease and asthma patients. This review aims to provide a reasoned care approach for the patient with a systemic compromise based on international protocols and a series of steps and modifications that should be considered during dental management. A scientific search was conducted in digital databases, including information in English and Spanish, on managing patients according to their medical diagnosis and complications. We conclude that dental treatment of pediatric patients with systemic diseases can be carried out efficiently in the presence of a well-equipped dental team and parental support. A pediatric dentist plays a vital role in relieving the child's anxiety, maintaining a positive relationship, and making care services become comfortable and complication-free experiences for pediatric patients with underlying systemic diseases, such as heart disease and/or asthma (AU)

Guia prático para o uso de imunobiológicos em doenças alérgicas - ASBAI / Practical guide for the use of immunobiologic agents in allergic diseases - ASBAI

Os anticorpos monoclonais são uma nova classe de medicamentos que representa um marco na evolução da terapia de doenças alérgicas graves. Além de possibilitar uma terapia imunológica alvo específico, proporciona maior controle de sintomas, redução de exacerbações, melhoria da qualidade de vida e da segurança. A eficácia e a segurança dos anticorpos monoclonais no tratamento de doenças alérgicas estão bem documentadas nos estudos clínicos pivotais, de extensão e de vida real. No Brasil, estão licenciados atualmente pela Agência Nacional de Vigilância Sanitária (ANVISA) imunobiológicos para asma, dermatite atópica (DA), esofagite eosinofílica (EoE), granulomatose eosinofílica com poliangeíte (GEPA), rinossinusite crônica com pólipo nasal (RSCcPN), síndromes hipereosinofílicas (SHE) e urticária crônica espontânea (UCE). Com a incorporação do uso dessas novas terapias no dia a dia do médico alergologista e imunologista, naturalmente emergem aspectos práticos que exigem orientações práticas perante as evidências científicas mais atuais, a fim de se manter a boa prática médica, com uso criterioso e consciente pelo especialista capacitado. Assim, nesse guia prático, abordaremos os imunobiológicos aprovados até o momento para doenças alérgicas graves, com objetivo de auxiliar o especialista em Alergia e Imunologia na prescrição e manejo dessas medicações, incluindo indicações, contraindicações, monitoramento da eficácia e segurança, notificação de eventos adversos, bem como aspectos associados aos cuidados com vacinas, populações especiais, acesso, transporte, armazenamento e aplicação domiciliar.

Monoclonal antibodies are a new class of drugs that represent a milestone in the evolution of therapy for severe allergic diseases. In addition to allowing targeted immunologic therapy, they can improve symptom control, reduce exacerbations, and increase quality of life and safety. The efficacy and safety of monoclonal antibodies in the treatment of allergic diseases are well documented in pivotal, extension, and real-life clinical studies. In Brazil, immunobiologic agents are currently licensed by the National Health Surveillance Agency (ANVISA) for use in asthma, atopic dermatitis (AD), eosinophilic esophagitis (EoE), eosinophilic granulomatosis with polyangiitis (EGPA), chronic rhinosinusitis with nasal polyps (CRSwNP), hypereosinophilic syndrome (HES), and chronic spontaneous urticaria (CSU). With the incorporation of these new therapies into the daily practice of the allergist and immunologist, practical aspects will naturally emerge and require practical guidelines in light of the most current scientific evidence in order to maintain good medical practice, with judicious and conscious use by a qualified specialist. Therefore, in this practical guide, we will address the immunobiologic agents currently approved for severe allergic diseases, aiming to assist allergy and immunology specialists in the prescription and practical management of these medications, including indications, contraindications, efficacy and safety monitoring, adverse event reporting, as well as health care factors associated with vaccination, special populations, access, transport, storage, and home use.

Perfil etiológico, sociodemográfico e desfechos dos pacientes com asma internados por síndrome respiratória aguda grave (SRAG) no Brasil de 2020 a 2022: uma análise de 83.452 internações / Etiology, sociodemographic profile, and outcomes of patients with asthma hospitalized for severe acute respiratory illness (SARI) in Brazil from 2020 to 2022: an analysis of 83,452 hospitalizations Braian

Introdução: A asma é uma das doenças crônicas mais frequentes na população brasileira. O objetivo deste estudo foi determinar as etiologias, o perfil sociodemográfico e os fatores de risco para óbito entre pacientes com asma internados por síndrome respiratória aguda grave (SRAG) no Brasil entre 2020 e 2022. Métodos: A partir do banco de dados SIVEP-Gripe, incluímos todos os pacientes com idade maior que 5 anos registrados no banco de 01/01/2020 até 21/07/2022, hospitalizados por SRAG, com antecedente de asma e com desfechos conhecidos. Como exposições, foram estudadas a idade, sexo, região de moradia, etnia e agentes etiológicos virais isolados. Os desfechos foram internação em unidade de terapia intensiva, necessidade de ventilação mecânica e óbito. Para calcular a razão de chances entre exposição e desfechos, utilizamos modelos lineares generalizados mistos multinível. Resultados: Foram incluídas na análise 83.452 internações, sendo 14.062 crianças e adolescentes, e 69.390 adultos. A mortalidade aumentou com a idade, indo de 0,6% entre 5-10 anos para 33% nos maiores que 60 anos. Na população pediátrica, morar na região Norte e Nordeste e ter entre 10-20 anos foram associados a maior mortalidade (OR 2,14 IC95% 1,41- 3,24 e OR 3,73 IC95% 2,65-5,26 respectivamente). Quanto aos agentes etiológicos, apenas o SARS-CoV-2 conferiu maior risco de óbito (OR 5,18 IC95% 3,62-7,42). Entre adultos, sexo feminino e etnias não brancas foram protetoras (OR 0,87 IC95% 0,83-0,9 e OR 0,90; IC95% 0,85-0,94 respectivamente) para óbito. Faixas etárias mais avançadas, morar nas regiões Norte e Nordeste e o diagnóstico de COVID-19 foram associados a maior mortalidade. Conclusões: Há importantes vulnerabilidades sociodemográficas nos desfechos das internações de pacientes com asma por SRAG, com maior mortalidade nas regiões Norte-Nordeste, entre adolescentes na faixa etária pediátrica e entre idosos nos adultos. Além disso, destaca-se o protagonismo da COVID-19 entre as infecções associadas a maior mortalidade.

Introduction: Asthma is one of the most common chronic diseases affecting the Brazilian population. We aimed to determine the etiology, sociodemographic profile, and risk factors for death in patients with asthma hospitalized for severe acute respiratory illness (SARI) in Brazil from 2020 to 2022. Methods: We included all patients over 5 years of age registered in the Influenza Epidemiological Surveillance Information System (SIVEP Gripe) database of the Brazilian Ministry of Health from January 1, 2020 to July 21, 2022 hospitalized for SARI. Patients had to have a history of asthma and known outcomes. As exposures, age, sex, region of residence, ethnicity, and viral etiological agent were evaluated. The outcomes measured were admission to an intensive care unit, need for mechanical ventilation, and death. We used multilevel generalized linear mixed models to calculate the odds ratio between exposure and outcomes. Results: A total of 83,452 hospitalizations were included, of which 14,062 were children and adolescents and 69,390 were adults. Mortality increased with age, ranging from 0.6% in those aged 5-10 years to 33% in those over 60 years. In the pediatric population, living in the north and northeast regions (OR 2.14, 95%CI 1.41-3.24) and having between 10-20 years (OR 3.73, 95%CI 2.65-5.26) were associated with higher mortality. As for etiologic agents, only SARS-CoV-2 was associated with a higher risk of death (OR 5.18, 95%CI 3.62-7.42). Among adults, female sex (OR 0.87, 95%CI 0.83-0.9) and non-White ethnicities (OR 0.90, 95%CI 0.85-0.94) were protective factors against death. Older age groups, living in the north and northeast regions, and a diagnosis of COVID-19 were associated with higher mortality. Conclusions: There are important sociodemographic vulnerabilities in the outcomes of patients with asthma hospitalized for SARI, with higher mortality rates in the north and northeast regions, among adolescents in the pediatric age group, and among older adults. Furthermore, COVID-19 was one of the main infections associated with higher mortality.

Impacto pronóstico de la enfermedad pulmonar obstructiva crónica y el asma bronquial en pacientes con insuficiencia cardiaca / Prognostic impact of chronic obstructive pulmonary disease and bronchial asthma in patients with heart failure

Propósito Analizar el impacto de la enfermedad pulmonar obstructiva crónica (EPOC) y el asma bronquial sobre el manejo terapéutico y el pronóstico de los pacientes con insuficiencia cardiaca (IC). Métodos Análisis de la información contenida en un registro clínico de pacientes remitidos a una unidad especializada de IC entre enero de 2010 y junio de 2022. Se compararon su perfil clínico, el tratamiento y el pronóstico en base a la presencia de EPOC o asma bronquial. El análisis de supervivencia se realizó mediante los métodos de Kaplan-Meier y Cox. La mediana de seguimiento fue de 1.493 días. Resultados Se estudiaron 2.577 pacientes, de los cuales 251 (9,7%) presentaban EPOC y 96 (3,7%), asma bronquial. Observamos diferencias significativas entre los tres grupos con respecto a la prescripción de betabloqueantes (EPOC=89,6%; asma=87,5%; no broncopatía=94,1%; p=0,002) e inhibidores del cotransportador de sodio-glucosa tipo2 (EPOC=35,1%; asma=50%; no broncopatía=38,3%; p=0,036). Además, los pacientes con patología bronquial recibieron con menor frecuencia un desfibrilador (EPOC=20,3%; asma=20,8%; no broncopatía=29%; p=0,004). La presencia de EPOC se asoció de forma independiente con mayor riesgo de muerte por cualquier causa (HR=1,64; IC95%: 1,33-2,02), muerte u hospitalización por IC (HR=1,47; IC95%: 1,22-1,76) y muerte cardiovascular o trasplante cardiaco (HR=1,39; IC95%: 1,08-1,79) en comparación con la ausencia de broncopatía. La presencia de asma bronquial no se asoció a un impacto significativo sobre los desenlaces analizados. Conclusiones La EPOC, pero no el asma bronquial, es un factor pronóstico adverso e independiente en pacientes con IC. (AU)

Purpose To analyze the impact of chronic obstructive pulmonary disease (COPD) and bronchial asthma on therapeutic management and prognosis of patients with heart failure (HF). Methods Analysis of the information collected in a clinical registry of patients referred to a specialized HF unit from January-2010 to June-2012. Clinical profile, treatment and prognosis of patients was evaluated, according to the presence of COPD or asthma. Survival analyses were conducted by means of Kaplan-Meier and Cox's methods. Median follow-up was 1493 days. Results We studied 2577 patients, of which 251 (9.7%) presented COPD and 96 (3.7%) bronchial asthma. Significant differences among study groups were observed regarding to the prescription of beta-blockers (COPD=89.6%; asthma=87.5%; no bronchopathy=94.1%; P=.002) and SGLT2 inhibitors (COPD=35.1%; asthma=50%; no bronchopathy=38.3%; P=.036). Also, patients with bronchial disease received less frequently a defibrillator (COPD=20.3%; asthma=20.8%; no broncopathy=29%; P=.004). COPD was independently associated with increased risk of all-cause mortality (HR=1.64; 95%CI: 1.33-2.02), all-cause death or HF admission (HR=1.47; 95%CI: 1.22-1.76) and cardiovascular death or heart transplantation (HR=1.39; 95%CI: 1.08-1.79) as compared with patients with no bronchopathy. Bronchial asthma was not significantly associated with increased risk of adverse outcomes. Conclusions COPD, but not asthma, is an adverse independent prognostic factor in patients with HF. (AU)

[Assessment of blood eosinophil count in respiratory disease from primary care]. / Valoración del recuento sanguíneo de eosinófilos en la patología respiratoria desde atención primaria.

Most physicians in general, and family physicians in particular, are familiar with certain parameters when ordering a hematological study, such as hemoglobin (including hematocrit and its features), leukocytes (including lymphocytes) and platelets. Nevertheless, there are two values that we use to overlook which are eosinophils and basophils. Specifically, eosinophils have a tendency to increase with allergic pathology. This article focuses on this type of cells, helping to interpret the values obtained and highlighting their importance in two of the most frequent respiratory pathologies in primary care: asthma and COPD. In addition to observing how the increase or normality of these parameters condition the diagnosis, phenotype and even the treatment.

Paciente varón de tres años con sibilancias y tos crónica / Three-Year-Old Male with Wheezing and Chronic Cough

Se presenta el caso de un niño de 3 años con diagnóstico de asma, rinitis alérgica, características craneofaciales dismórficas e infecciones respiratorias altas y bajas recurrentes, manejado como asma desde un inicio. Como parte del estudio de comorbilidades, se decide realizar una prueba del sudor que sale en rango intermedio y más tarde se encuentra una mutación, donde se obtiene un resultado positivo para una copia que se asocia a fibrosis quística. Se revisará el caso, así como el diagnóstico, clínica y tratamiento del síndrome metabólico relacionado con el regulador de conductancia transmembrana de fibrosis quística (CRMS).

We present the case of a 3-year-old boy with a diagnosis of asthma, allergic rhinitis, dysmorphic craniofacial characteristics and recurrent upper and lower respiratory infections, managed as asthma from the beginning. As part of the study of comorbidi-ties, it was decided to carry out a sweat test that came out in the intermediate range and later one mutation was found, where a positive result was obtained for a copy that is associated with cystic fibrosis. The case will be reviewed, as well as the diagnosis, symptoms and treatment of the metabolic syndrome related to the cystic fibrosis trans-membrane conductance regulator (CRMS).

Cuidando do ambiente ­ Logística reversa e dispositivos inalatórios / Caring for the environment: reverse logistics and inhalation devices

A asma é uma das doenças crônicas mais prevalentes e representa um problema de saúde pública global que afeta mais de 300 milhões de pessoas em todo o mundo, com um aumento adicional estimado de 100 milhões até 2025. A asma é uma doença típica de origem ambiental com exposição a infeções, alérgenos, poluentes e outros fatores estressores implicados na sua patogênese. O impacto ambiental causado pelos dispositivos inalatórios é cada vez mais importante, e pouco abordado ou valorizado. Até 88% dos profissionais de saúde não têm conhecimento que os dispositivos de aerossol dosimetrado contêm gás propelente que afeta a camada de ozônio e causa aquecimento global. São necessárias estratégias alternativas de tratamento se quisermos evitar a piora das alterações climáticas. Portanto, diante desse cenário existem oportunidades de ouro para tornar o tratamento da asma mais eficaz, moderno, seguro e ecológico.

Asthma is one of the most prevalent chronic diseases and represents a global public health problem, affecting more than 300 million people worldwide, with an estimated additional increase of 100 million cases by 2025. Asthma is a textbook disease of environmental origin, with exposure to infections, allergens, pollutants, and other environmental stressors implicated in its pathogenesis. The environmental impact of inhalation devices is increasingly important and has been rarely addressed and undervalued. Up to 88% of healthcare professionals are unaware that metered-dose aerosol devices contain a propellant gas that affects the ozone layer and causes global warming. Alternative treatment strategies are needed if we are to avoid worsening climate change. Given this scenario, there are excellent opportunities to make asthma treatment more effective, modern, safe, and eco-friendly.

Influência da exposição ambiental na percepção do estado de saúde de indivíduos de cinco países latino-americanos / Effect of environmental exposure on the perceived health status of individuals from five Latin American countries

OBJETIVO: A relação entre exposição ambiental e risco à saúde é amplamente reconhecida e a avaliamos em cinco países da América Latina com condições culturais distintas, mas com Índices de Desenvolvimento Humano semelhantes. MÉTODOS: Estudo transversal envolvendo 3.016 indivíduos (18 a 75 anos) oriundos de: Argentina (n = 878), Brasil (n = 1.030), México (n = 272), Paraguai (n = 508) e Peru (n = 328). A seleção foi aleatória e todos responderam questionário padronizado (fatores sociodemográficos, fatores ambientais e hábitos de vida) derivado do Clinical Screening Tool for Air Pollution Risk. Segundo o estado atual de saúde, foram categorizados em: saúde regular/má/péssima ou excelente/boa. Tendo-a como desfecho, realizou-se análise multivariada.Os dados foram apresentados como razão de verossimilhança (RV) e intervalos de confiança de 95% (IC 95%), tendo-se 5% o nível de significância. RESULTADOS: Foram significantemente associados a pior percepção de situação de saúde: morar em qualquer um dos países, ter umidade na residência (OR = 1,68; IC 95%: 1,33-2,12), dirigir automóvel com janelas abertas (OR = 1,31; IC 95%: 1,03-1,65), ter baixa renda familiar (OR = 1,59; IC 95%: 1,26-2,01), nível educacional incompleto (OR = 1,54; IC 95%: 1,22-1,94), histórico pessoal/familiar de hipertensão arterial (OR = 2,25; IC 95%: 01,64-3,09), doença pulmonar obstrutiva crônica/asma (OR = 1,74; IC 95%: 1,28-2,36), diabete melito (OR = 3,74; IC 95%: 2,23-6,29), obesidade (OR = 1,84; IC 95%: 1,84-3,19) ou comorbidades oftalmológicas (OR = 1,89; IC 95%: 1,55-2,30); realizar exercícios ao ar livre (OR = 1,60; IC 95%: 1,31-1,96). CONCLUSÕES: Apesar das diferentes exposições a que foram submetidos, alguns fatores permanecem muito significativos, e ter baixa renda familiar, expor-se à poluição e ter antecedentes de doenças crônicas foram associados à percepção de condição ruim de saúde.

OBJECTIVE: The relationship between environmental exposure and health outcomes is well known.We investigated this relationship in five Latin American countries with different cultural backgrounds but similar Human Development Indexes. METHODS: This was a cross-sectional study involving 3,016 individuals (18 to 75 years old) from Argentina (n=878), Brazil (n=1030), Mexico (n=272), Paraguay (n=508), and Peru (n=328). Participants were randomly selected and responded to a standardized questionnaire (including sociodemographic and environmental factors and lifestyle habits) derived from a clinical screening tool for air pollution risk. Based on their current health status, participants were categorized as having regular/bad/very bad or excellent/good health. Multivariate analysis was conducted, and data were presented as likelihood ratios and 95% confidence intervals (95%CI).The significance level was set at 5%. RESULTS: Living in any of the study countries; indoor humidity (OR=1.68; 95%CI: 1.33-2.12); driving with the windows open (OR=1.31; 95%CI: 1.03-1.65); low family income (OR=1.59; 95%CI: 1.26-2.01); incomplete education (OR=1.54; 95%CI: 1.22-1.94); personal/family history of hypertension (OR=2.25; 95%CI: 01.643.09), chronic obstructive pulmonary disease/asthma (OR=1.74; 95%:CI: 1.28-2.36), diabetes (OR=3.74; 95%CI:2.23-6.29), obesity (OR=1.84; 95%CI: 1.84-3.19), or ocular comorbidities (OR=1.89; 95%CI: 1.55-2.30); and exercising outdoors (OR=1.60; 95%CI: 1.31-1.96) were significantly associated with a worse perceived health status. CONCLUSIONS: Despite the different exposures to which participants were subjected, some factors remain very significant. Low family income, exposure to pollution, and a history of chronic diseases were associated with the perception of a poor health condition.

Análise do perfil clínico e epidemiológico das internações por asma no período de 2020 a 2021 em um hospital do sul de Santa Catarina / Analysis of the clinical and epidemiological profile of hospitalizations due to asthma in the period 2020­2021 in a hospital in southern Santa Catarina, Brazil

INTRODUÇÃO: A asma brônquica é uma doença crônica inflamatória de alta frequência mundialmente, e em especial no Brasil, onde ocorreram mais de 100.000 internações por ano, segundo dados do DATASUS. Identificar pacientes em admissão hospitalar que poderão necessitar de leito em UTI ou uso de ventilação mecânica por conta de crises asmáticas é um desafio ao profissional de saúde, portanto, faz-se importante analisar variáveis clínicas que possam predispor agravos e avaliar pacientes mais vulneráveis, para que as condutas realizadas sejam efetivas e rápidas. OBJETIVO: Analisar o perfil clínico e epidemiológico de pacientes internados em um hospital do sul do Brasil e avaliar os preditores relacionados ao maior tempo de internação. MÉTODOS: Estudo epidemiológico observacional, do tipo transversal, que utilizou como fonte de informação dados secundários, os quais foram obtidos através de prontuários de pacientes internados em um hospital do sul do Brasil. RESULTADOS: Foram analisados 261 prontuários. Verificou-se que a população menor de 40 anos de idade teve maior prevalência, representando 57% das internações. Além disso, em relação a gênero e etnia, mulheres e caucasianos foram as populações com maiores taxas de hospitalização, sendo 63% e 87% das admissões hospitalares, respectivamente.A necessidade de internação em UTI foi encontrada em 1,1% dos casos (3 pacientes), cerca de 6,9% tiveram internações prolongadas (maiores de 3 dias), e 0,8% vieram à óbito (2 pacientes). Identificou-se que a baixa saturação de oxigênio e a alta frequência cardíaca tiveram relação significativa com internação prolongada. CONCLUSÃO: É importante analisar sinais vitais no momento das admissões hospitalares e o perfil epidemiológico dos pacientes para que as populações mais prevalentes e os fatores preditivos de desfechos mais graves possam ser acompanhados e a conduta a ser tomada seja adequada e efetiva.

INTRODUCTION: Bronchial asthma is a chronic inflammatory disease with a high worldwide frequency, especially in Brazil, where more than 100,000 asthma-related hospitalizations occur annually according to DATASUS data. Identifying patients upon hospital admission who may require an ICU bed or mechanical ventilation due to an asthma attack is a challenge for healthcare professionals. It is important to analyze clinical variables that may predispose to deterioration and evaluate more vulnerable patients to ensure that effective interventions are instituted promptly. OBJECTIVE: To analyze the clinical and epidemiological profile of patients admitted due to asthma in a hospital in southern Brazil and evaluate predictors of longer hospital stay. METHODS: Observational epidemiological study with a cross-sectional design.The source of information were secondary data obtained from medical records of patients admitted to a hospital in southern Brazil. RESULTS: Overall, 261 medical records were analyzed.Patients were predominantly under the age of 40, representing 57% of hospitalizations. In terms of gender and ethnicity, most patients were female (63%) and white (87%).Three patients (1.1%) required ICU admission, approximately 6.9% had prolonged hospitalizations (>3 days), and 2 (0.8%) died. Low oxygen saturation and elevated heart rate correlated significantly with prolonged hospitalization. CONCLUSION: Vital signs at the time of hospital admission and the epidemiological profile of patients should be analyzed, so that the most prevalent populations and predictors of severe outcomes can be monitored, and appropriate and effective measures can be taken.

Asma ocupacional: a propósito de un caso / Work-related Asthma: a case report / Asma ocupacional: relato de caso

Se presenta el caso de un trabajador de 31 años que desempeña tareas en un molino de granos desde hace 12 años y que ha desarrollado asma ocupacional. El objetivo del artículo es presentar los fundamentos utilizados para sostener el origen profesional del asma adquirido. Se describen las tareas laborales que desarrolla, materiales y medios de trabajo que utiliza. Se analiza en particular la exposición laboral a polvo orgánico y su vinculación temporal con la sintomatología respiratoria. Esta información permite comprender la importancia de las condiciones en las que realiza el trabajo y la exposición a un factor de riesgo, el polvo orgánico, para el desarrollo de la patología respiratoria laboral. Se realizaron mediciones de volumen máximo espiratorio pulmonar, con técnica de pico flujo, durante la jornada laboral y fuera de ésta. Se observaron variaciones del flujo espiratorio mayores a 20%, tanto durante la jornada laboral como fuera de ella, con similar patrón sintomático, según relata el trabajador. Se concluyó que existe evidencia del nexo causal entre el asma y el trabajo, por lo que se plantea el diagnóstico de asma ocupacional. Se destaca la importancia de evaluar los riesgos laborales en cada actividad para implementar planes de vigilancia de la salud, tanto del operario como del ambiente de trabajo, para prevenir la aparición como la evolución de esta u otras patologías que en muchos casos generan incapacidad para la tarea y deterioro de la calidad de vida de los trabajadores.

We present the case of a 31-year-old worker who has been working in a grain mill for 12 years and has developed work-related asthma. The objective of this article is to present the foundations used to support the occupational origin of the acquired asthma. The study describe the work tasks performed, the materials used, and the working methods. The work-related exposure to organic dust and its temporal relationship with respiratory symptoms is particularly analyzed. This information allows us to understand the importance of working conditions and exposure to organic dust, a risk factor, for the development of this work-related respiratory pathology. Measurements of maximum expiratory lung volume were made using the peak flow technique during and outside of the workday. Expiratory flow variations greater than 20% were observed, both during and outside of the workday, which followed a similar symptomatic pattern as reported by the worker. The study concluded that there is evidence of a causal link between asthma and work, thus suggesting the diagnosis of work-related asthma. The importance of assessing occupational risks in each activity to implement health surveillance plans for both workers and the work environment is highlighted, aiming to prevent the onset and progression of this and other pathologies that often result in work incapacity and deterioration of workers' quality of life.

Apresentamos o caso de um paciente de 31 anos de idade que trabalha em um moinho de grãos há 12 anos e desenvolveu asma ocupacional. O objetivo do artigo é apresentar a justificativa da origem ocupacional da asma adquirida. Descrevemos as tarefas realizadas, os materiais e os meios de trabalho utilizados. Analisamos especialmente a exposição ocupacional à poeira orgânica e sua conexão temporal com a sintomatologia respiratória. Essas informações nos permitem entender a importância das condições em que o trabalho é realizado e a exposição a um fator de risco, a poeira orgânica, para o desenvolvimento da patologia respiratória ocupacional. As medições do volume pulmonar expiratório máximo foram realizadas com a técnica de pico de fluxo durante e fora da jornada de trabalho. Observamos variações no fluxo expiratório superiores a 20%, tanto durante quanto fora do horário de trabalho, com um padrão sintomático semelhante ao relatado pelo trabalhador. Concluímos que há evidências de um nexo causal entre asma e trabalho e, portanto, propomos o diagnóstico de asma ocupacional. Destacamos a importância de avaliar os riscos ocupacionais em cada atividade para implementar planos de vigilância da saúde tanto do trabalhador quanto do ambiente de trabalho, a fim de evitar o surgimento e a evolução dessa ou de outras patologias que, em muitos casos, geram incapacidade para a tarefa e deterioração da qualidade de vida dos trabalhadores.

Medicaciones inhaladas y cámaras de inhalación para el asma infantil. Red española de grupos de trabajo sobre asma en pediatría (REGAP) / Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP)

El asma, la enfermedad crónica más prevalente en la edad pediátrica, continúa planteando desafíos en su manejo y tratamiento1. Guías nacionales e internacionales destacan la importancia de la educación terapéutica (ET) para lograr el control de esta enfermedad2,3. Esta educación implica la transmisión de conocimientos y habilidades al paciente y su familia, mejorando la adherencia a la medicación, corrigiendo errores en la técnica de inhalación y ajustando el tratamiento según las características individuales de cada paciente4,5. Es esencial que la ET sea progresiva, gradual e individualizada, y que esté presente en todos los niveles asistenciales. La formación en ET de profesionales sanitarios es crucial, especialmente para los pediatras, quienes además deben conocer la extensa variabilidad de medicamentos e inhaladores disponibles y sus indicaciones para cada edad6. Para abordar esta necesidad, el Grupo red española de grupos de trabajo sobre asma en pediatría (REGAP) ha revisado exhaustivamente los inhaladores actualmente disponibles en España para el tratamiento del asma en la edad pediátrica. La revisión incluye una revisión de los distintos sistemas de inhalación y los distintos fármacos inhalados, utilizados para el tratamiento del asma en la edad pediátrica. Esta revisión se actualizará anualmente, incluyendo información sobre fármacos, dispositivos, cámaras de inhalación, indicaciones y financiación. El Grupo REGAP espera que estas tablas sean una valiosa ayuda para los pediatras en su práctica clínica diaria y constituyen una eficaz herramienta de ET.(AU)

Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.(AU)

mSphere of Influence: The discovery of a missing link in bacterial cell envelope biogenesis.

Gregory Harrison is a bacteriologist researching essential pathways in bacteria as potential therapeutic targets. In this mSphere of Influence article, he reflects on a series of studies that employ complementary genetic approaches to define the crucial role of AsmA-family proteins in transporting phospholipids between the inner and outer membranes of Gram-negative bacteria. The authors of these three studies identify this family of lipid transporters through the means of bacterial genetics, answering a long-standing question in bacterial physiology, and serving as a reminder that a well-designed genetic strategy can go a long way in uncovering new biology.

Prognostic impact of chronic obstructive pulmonary disease and bronchial asthma in patients with heart failure.

PURPOSE: To analyze the impact of chronic obstructive pulmonary disease (COPD) and bronchial asthma on therapeutic management and prognosis of patients with heart failure (HF). METHODS: Analysis of the information collected in a clinical registry of patients referred to a specialized HF unit from January-2010 to June-2012. Clinical profile, treatment and prognosis of patients was evaluated, according to the presence of COPD or asthma. Survival analyses were conducted by means of Kaplan-Meier and Cox's methods. Median follow-up was 1493 days. RESULTS: We studied 2577 patients, of which 251 (9.7%) presented COPD and 96 (3.7%) bronchial asthma. Significant differences among study groups were observed regarding to the prescription of beta-blockers (COPD=89.6%; asthma=87.5%; no bronchopathy=94.1%; p=0.002) and SGLT2 inhibitors (COPD=35.1%; asthma=50%; no bronchopathy=38.3%; p=0.036). Also, patients with bronchial disease received less frequently a defibrillator (COPD=20.3%; asthma=20.8%; no broncopathy=29%; p=0.004). COPD was independently associated with increased risk of all-cause mortality (HR=1.64; 95% CI 1.33-2.02), all-cause death or HF admission (HR=1.47; 95% CI 1.22-1.76) and cardiovascular death or heart transplantation (HR=1.39; 95% CI 1.08-1.79) as compared with patients with no bronchopathy. Bronchial asthma was not significantly associated with increased risk of adverse outcomes. CONCLUSIONS: COPD, but not asthma, is an adverse independent prognostic factor in patients with HF.