[Analysis of causes or reasons that fragment sleep and sleep disorder in pregnant and non-pregnant women] / Análisis de causas o motivos que fragmentan el sueño y los trastornos del sue-ño, en mujeres embarazadas y no embarazadas.

Introduction: During pregnancy, sleep undergoes important changes. The objective was to assess the causes or reasons that fragment sleep and sleep disorders in different women and trimesters of pregnancy, comparing them with those of non-pregnant women (NPW). Methods: Cross-sectional study. Anonymous surveys were used to evaluate reasons that fragment sleep and specific questionnaires to evaluate sleep disorders. Results: Pregnant Women (PW)= 320. 1st Trimester of pregnancy (T): n = 106, 2nd. T: n = 104, 3rd T: n = 110. MNE: n = 304. Most frequent reasons that fragmented sleep, statistically significant in PW and were: need to urinate, uncomfortable position, not being able to rotate in bed. As sleep disorders we find: nightmares 44 vs 4.9%; snoring with pauses: 31 vs 3%. Conclusion: We found that in the PW studied, most of the causes or reasons analyzed fragmented sleep; they had more sleep disorders such as nightmares, respiratory disorders and periodic leg movements, in that order, compared to the NPW who in turn, presented insomnia, excessive sleepiness and bruxism.

Introducción: Durante la gestación, el sueño sufre cambios importantes. El objetivo fue evaluar causas o motivos que fragmentan el sueño y los trastornos del sueño en diversas mujeres y trimestres de embarazo, comparándolos con los de las mujeres no embarazadas (MNE). Métodos: Estudio de corte transversal. Se utilizó encuestas anónimas, para evaluar motivos que fragmentan el sueño y cuestionarios específicos para evaluar trastornos del sueño. Resultados: Mujeres Embarazadas (ME)= 320. 1er Trimestre de embarazo (T): n = 106, 2do. T: n = 104, 3er T: n = 110. MNE: n = 304. Motivos más frecuentes que fragmentan el sueño, se presentó en ME y fueron: necesidad de orinar, posición incómoda, no poder rotar en la cama. Como trastornos del sueño encontramos: pesadillas 44 vs 4.9%; ronquidos con pausas: 31 vs 3%. Conclusión: En las mujeres embarazadas estudiadas, la mayoría de las causas o motivos analizados fragmentaron el sueño; tuvieron más desórdenes del sueño como pesadillas, trastornos respiratorios y movimientos periódicos de piernas, comparados con las no embarazadas; quienes a su vez, presentaron insomnio, somnolencia excesiva y bruxismo.

Principios básicos de ecografía pulmonar en neonatología / Basic notions of lung ultrasound in neonatology

La ecografía pulmonar (EP) ha ganado terreno en el diagnóstico de la mayoría de las patologías respiratorias presentes desde el nacimiento. Es altamente sensible a las variaciones del contenidode aire y fluidos pulmonares, y constituye un verdadero densitómetro del parénquimapulmonar con una sensibilidad superior a la de los estudios radiológicos. Es no invasiva, rápida, fácil de realizar junto a la cama del paciente y, a diferencia de la radiología convencional, no presenta riesgos de radiación. Además, nosproporciona información dinámica en tiempo real en una variedad de entornos neonatales y, al igual que las evaluaciones del corazón y el cerebro, puede ser realizada por el neonatólogo. El objetivo de esta publicación es mostrarlos principales artefactos e imágenes que sepueden encontrar en la EP neonatal, así como los diferentes patrones de aireación, y destacar su utilidad en el estudio de los trastornosrespiratorios más frecuentes del neonato.

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.

Basic notions of lung ultrasound in neonatology. / Principios básicos de ecografía pulmonar en neonatología.

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.

La ecografía pulmonar (EP) ha ganado terreno en el diagnóstico de la mayoría de las patologías respiratorias presentes desde el nacimiento. Es altamente sensible a las variaciones del contenido de aire y fluidos pulmonares, y constituye un verdadero densitómetro del parénquima pulmonar con una sensibilidad superior a la de los estudios radiológicos. Es no invasiva, rápida, fácil de realizar junto a la cama del paciente y, a diferencia de la radiología convencional, no presenta riesgos de radiación. Además, nos proporciona información dinámica en tiempo real en una variedad de entornos neonatales y, al igual que las evaluaciones del corazón y el cerebro, puede ser realizada por el neonatólogo. El objetivo de esta publicación es mostrar los principales artefactos e imágenes que se pueden encontrar en la EP neonatal, así como los diferentes patrones de aireación, y destacar su utilidad en el estudio de los trastornos respiratorios más frecuentes del neonato.

Estudo retrospectivo dos achados cardiorrespiratórios e laboratoriais de cães atendidos para avaliação pré-operatória em um serviço de cardiologia e doenças respiratórias (2017-2021) / Retrospective study of cardiorespiratory and laboratory findings in dogs treated for preoperative evaluation in a cardiology and respiratory disease service (2017-2021)

Os cães idosos são acometidos com frequência por enfermidades no sistema cardiovascular e respiratório, estando muita das vezes assintomáticos até terem indicação para algum procedimento cirúrgico que requer a avaliação pré-operatória, momento este que muitos achados clínicos poderão ser detectados, ao ponto da necessidade de tratamento prévio à intervenção cirúrgica. Diante disso, o trabalho tem por objetivo detectar as principais manifestações cardiorrespiratórias e sua correlação aos dados encontrados nos exames complementares e informações epidemiológicas de 138 cães atendidos em um serviço especializado em cardiologia e doenças respiratórias, no período de 2017 a 2021, para fins de risco cirúrgico. Foi possível observar maior predominância de animais idosos, de pequeno porte e do sexo feminino. Dentre as doenças cardíacas, a doença degenerativa crônica de mitral foi a mais prevalente, seguida da dirofilariose. Em relação as afecções respiratórias, a bronquite crônica e o colapso de traqueia foram mais diagnosticadas, seguidas da broncopneumonia e da síndrome braquicefálica. Quando da observação do ritmo cardíaco por meio do eletrocardiograma, a arritmia sinusal, ritmo sinusal e sinus arrest foram os principais achados. Quanto aos achados laboratoriais, foi possível observar aumento da média de hematimetria, redução da média do hematócrito e das plaquetas. Entretanto, alguns animais apresentaram azotemia, leucocitose e eosinofilia. Observou-se que pacientes com doenças cardíacas em estágios de congestão possuem redução da pressão arterial, aumento da hematimetria e taquiarritmias, como taquicardia sinusal e/ou complexos atriais prematuros. Pacientes com idade mais avançada tendem a ter redução dos valores de leucometria global e maior probabilidade de manifestação de aumento da pressão arterial. Portadores de dirofilariose cursam com aumento de eosinófilos.

Elderly dogs are frequently affected by diseases in the cardiovascular and respiratory system, being often asymptomatic until they are indicated for a surgical procedure that requires preoperative evaluation, at which point many clinical findings can be detected, to the point of need for treatment prior to surgical intervention. Therefore, the work aims to detect the main cardiorespiratory manifestations and their correlation to data found in complementary exams and demographic information of 138 animals treated at a service specialized in cardiology and respiratory diseases, from 2017 to 2021, for risk purposes surgical. It was possible to observe a greater predominance of elderly, small and female animals. Among heart diseases, chronic degenerative mitral disease was the most prevalent, followed by heartworm disease. Regarding respiratory affections, chronic bronchitis and tracheal collapse were more commonly diagnosed, followed by bronchopneumonia and brachycephalic syndrome. When observing the cardiac rhythm through the electrocardiogram, sinus arrhythmia, sinus rhythm and sinus arrest were the main findings. As for laboratory findings, it was possible to observe an increase in mean hematimetry, a reduction in mean hematocrit and platelets. However, some animals showed azotemia, leukocytosis and eosinophilia. It was observed that patients with cardiac diseases in stages of congestion have reduced blood pressure, increased hematimetry and tachyarrhythmias, such as sinus tachycardia and/or premature atrial complexes. Older patients tend to have reduced global white blood cell values and more likely to manifest increased blood pressure. Heartworm patients have an increase in eosinophils.

Airway and Alveoli Organoids as Valuable Research Tools in COVID-19.

The coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, SARS-CoV-2, affects tissues from different body systems but mostly the respiratory system, and the damage evoked in the lungs may occasionally result in severe respiratory complications and eventually lead to death. Studies of human respiratory infections have been limited by the scarcity of functional models that mimic in vivo physiology and pathophysiology. In the last decades, organoid models have emerged as potential research tools due to the possibility of reproducing in vivo tissue in culture. Despite being studied for over one year, there is still no effective treatment against COVID-19, and investigations using pulmonary tissue and possible therapeutics are still very limited. Thus, human lung organoids can provide robust support to simulate SARS-CoV-2 infection and replication and aid in a better understanding of their effects in human tissue. The present review describes methodological aspects of different protocols to develop airway and alveoli organoids, which have a promising perspective to further investigate COVID-19.

Evaluación de la función respiratoria en pacientes con patologías neuromusculares / Evaluation of Respiratory Function in Patients with Neuromuscular Diseases

Introducción: La Enfermedades Neuromusculares se caracterizan por la pérdida progresiva de la fuerza muscular, la morbi-mortalidad aumenta con la exageración de la debilidad muscular determinando mayor riesgo de complicaciones respiratorias. Es de suma importancia evaluar e interpretar adecuadamente la función pulmonar y ventilatoria para poder realizar intervenciones que pueda prevenir dichas complicaciones. Objetivos: El objetivo del estudio fue reportar el estado funcional respiratorio de un grupo de pacientes con ENM en control ambulatorio y relacionar estos hallazgos con umbrales clínicamente relevantes de complicaciones respiratorias, reforzando intervenciones basadas en opiniones de expertos. Materiales y métodos: Se realizó un estudio Descriptivo-Observacional de corte transversal, donde fueron evaluados en forma ambulatoria, de marzo del 2017 a agosto del 2018, 30 niños y adolescentes con enfermedades neuromusculares. Resultados: El 46% del total de pacientes presenta capacidad tusígena no funcional con alto riesgo de complicaciones. No obstante, sólo el 10% del total de pacientes fueron aptos para realizar adecuadamente estudios de espirometría. Durante las pruebas espirométricas, sólo el 50% de los pacientes logró mantener 6 segundos la espiración. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor.

Introduction: Neuromuscular Diseases are characterized by the progressive loss of muscle mass, morbidity and mortality increases with the progress of muscle weakness due to the increased risk of respiratory complications, so it is very important to properly evaluate and interpret the measurements of lung functions and ventilation to be able to carry out a specific treatment that can reduce respiratory complications. Objectives: The purpose of this work is to present the results of the measurements of flows, volumes, respiratory capacities and spirometric patterns in outpatients with neuromuscular diseases and to verify their usefulness to detect vital risks. Materials and methods: A cross-sectional Descriptive-Observational study was carried out, where 30 children and adolescents with neuromuscular diseases were evaluated on an outpatient basis, from March 2017 to August 2018. Results: 46% of all patients presented a non-functional cough with a high risk of complications and only 10% of all patients were eligible for spirometry studies. During the spirometric tests, 50% of the patients managed to maintain expiration for 6 seconds. In 70% of the patients, abnormalities in the Flow-Volume curve could be detected. Conclusion: Although spirometry is the main pulmonary function test, its usefulness and efficacy in neuromuscular diseases depends on the findings of specific alterations in the morphology of the flow-volume curve, which in many cases are not possible to distinguish.

Sensitivity and specificity of four screening sleep-disordered breathing tests in patients with and without cardiovascular disease.

OBJECTIVES: Polysomnogram is the gold standard for the diagnosis of sleep-disordered breathing (SDB); a sensitive and specific alternative strategy would be ideal, due to its low availability, and screening patients at high risk of OSA is very important. This study aimed to determine the operating characteristics of screening tests in patients with and without cardiovascular disease (CVD). MATERIAL AND METHODS: Epworth sleepiness scale (ESS), Berlin, STOP-bang and Pittsburgh sleep quality index (PSQI) were applied in adults with and without cardiovascular disease in three Colombian cities, as well as anthropometric measurements and a polysomnogram. Operating characteristics were calculated for each test and the best cut-off values in patients with and without CVD were obtained. RESULTS: 964 patients (median age: 58), 662 with and 302 without CVD were included. The prevalence for SDB (AHI =5) were 43.4 % (OSA), 16.2% (central apnea), and 12.4 % (other). In patients without CVD, the highest sensitivity for OSA and central apnea was for PSQI (80-85%). The highest specificity was for STOP-bang (68%) and Berlin (78.6%). In CVD the best sensitivity was for PSQI (81.9%) followed by Berlin (71.9%) and the best specificity for STOP-bang (82.1%). No isolated questionnaire showed good diagnostic performance (AUC=0.6) and the cut-off values had no variations except for ESS. CONCLUSION: Screening tests showed low operating characteristics for the diagnosis to SDB, but better performance in patients with CVD. They are not recommended as the only diagnostic test, but they can be useful to guide the initial diagnostic process.

Tradução de diretrizes para enfermeiras da Atenção Básica sobre transtornos respiratórios infantis nas emergências climáticas florestais / Translation of guidelines for primary health care nurses on childhood respiratory disorders during forest climate emergencies

Objetivo Geral: desenvolver com a participação de um grupo de interesse, diretrizes baseadas em evidências, de abordagem à criança vulnerável aos transtornos respiratórios relacionados às queimadas sazonais na Amazônia, para utilização da enfermagem na rede de atenção básica. Método: adotou-se o modelo conceitual do conhecimento à ação de tradução do conhecimento integrado. Desse modelo, aplicou-se o ciclo da criação em três etapas: investigação do conhecimento na pesquisa de campo; síntese do conhecimento na revisão de melhores evidências e a elaboração de uma ferramenta (livro de casos) com narrativas reais de famílias e enfermeiros com diretrizes de boas práticas nos transtornos respiratórios nas emergências climáticas, construído de maneira participativa e avaliada por enfermeiros e gestores em saúde a partir da ferramenta AGREE-HS. O grupo de interesse foi composto por 25 participantes: 15 familiares de crianças na primeira infância, 04 enfermeiros (as) da atenção básica e 06 gestores (as) em saúde em 08 encontros grupais cuja dinâmica 'árvore do conhecimento' foi aplicada separadamente. Resultados: os incêndios florestais amazônicos sazonais, determinam emergências climática e ambiental que pressionam a demanda de atendimento com barreiras para a coordenação do cuidado na unidade básica de saúde. Mas, o manejo dos transtornos respiratórios infantis pela equipe de saúde da família da rede de atenção básica se fundamenta mais em princípios biomédicos da atenção primária do que os princípios da integralidade da Estratégia Saúde da Família. Na ressignificação dos interdiscursos, os participantes revelam formações ideológicas acríticas sobre os efeitos do fogo como desencadeadores de incêndios como capazes de gerar transtornos respiratórios na primeira infância. Portanto, essa visão acrítica sobre os determinantes ambiental, social e biológicos agravam as vulnerabilidades individuais, coletivas e programática da saúde infantil com limites para a resolutividade na interface de dois modelos assistenciais (biomédico e integralidade) em constante tensão. A vulnerabilidade infantil à exposição ambiental é uma problemática de saúde planetária e a ferramenta proposta 'Livro de Casos' para a enfermagem, traduz conhecimentos resolutivos, por contribuir para o aumento da eficiência dos sistemas de saúde e a satisfação dos usuários com a qualidade dos serviços. O desafio desta tradução está em preencher a lacuna da evidência, com políticas e práticas profissionais. Considerações finais: é imperativo desenvolver uma consciência de saúde planetária no enfrentamento de iniquidades em saúde e a resiliência dos sistemas de saúde e populações sobre a saúde ambiental em emergências climáticas. Há potencial na estratégia de saúde da família para a minimização de internações por causas sensíveis à atenção primária e o enfermeiro, como essencial para a construção do vínculo na primeira infância de modo autônomo e seguro. Espera-se que a ferramenta contribua com o fortalecimento da atenção básica e o enfrentamento das internações por doenças sensíveis a atenção primária, a partir do momento em que podem ser desenvolvidas habilidades e estratégias que previnam a ocorrência, complicações e mortes por transtornos respiratórios sazonais.

General Objective: To develop, with the participation of an interest group, evidence-based guidelines for approaching children vulnerable to respiratory disorders related to seasonal fires in the Amazon for the use of nursing in primary care. Method: The conceptual model of knowledge-to-action of integrated knowledge translation was adopted. From this model, the creation cycle was applied in three stages: knowledge inquiry in field research; knowledge synthesis of the state-of-art review searching for the best evidence; and, knowledge tool, the elaboration of a case book. That tool tailored family members' and nurses' narratives with the best evidence available in a format of guidelines to intervene in respiratory disorders during climatic emergencies. The entire process was conducted through a participatory approach and evaluated by nurses and health managers by the AGREE-HS tool. The stakeholders consisted of 25 participants, including 15 family members, four primary healthcare nurses, and six health managers. The participants of knowledge inquiry fieldwork were organized into eight groups that attended to the creative, sensitive dynamic named 'tree of " knowledge." Results: seasonal Amazonian forest fires determine climatic and environmental emergencies that pressure the demand for care with barriers to care coordination in the primary health unit. However, the management of children's respiratory disorders by the family health team of the primary care network is based more on biomedical principles of primary care than on the principles of the integrality of the Family Health Strategy. The interdiscourses meaning that the participants reveal uncritical ideological formations about the effects of fire as fire triggers capable of generating respiratory disorders in early childhood. Therefore, their uncritical vision of the environmental, social, and biological determinants of health aggravates children of health vulnerabilities individual, collective and programmatic. Consequently, it limits resolution at the interface of two care models (biomedical and comprehensiveness) in constant tension. Child vulnerability to environmental exposure is a planetary health problem. The proposed tool 'Case Book' for nursing translates problem-solving knowledge. It contributes to increasing the efficiency of health systems and users' satisfaction with the quality of services. The challenge remains in applying knowledge translated to fill the gap between evidence, professional policies, and practices. Final considerations: The awareness of planetary health in the face of health inequities and the resilience of health systems and populations on environmental health issues in climatic emergencies are considered imperative. There is potential in the family health strategy to minimize hospitalizations for causes sensitive to primary care and the nurse, as essential for building the bond in early childhood autonomously and safely. It is expected that the Case Book guidelines can contribute to strengthening primary healthcare services and confronting hospitalizations for diseases that are sensitive to primary healthcare intervention. During the seasonal increase of respiratory disorders among children, strategies recommended by the guideline can be developed to prevent or reduce the occurrence, complications, and deaths.

Impacto de la contaminación aérea por incendios forestales en la morbimortalidad de la población expuesta / Impact of air pollution by forest fires and the morbidity of the exposed population

La exposición a las emanaciones de incendios forestales es un importante problema de salud pública nacional e internacional. El cambio climático que conlleva sequía y aumento de la temperatura estival aumenta el riesgo y magnitud de los episodios de incendios forestales, generándose grandes incendios cuyas emanaciones pueden afectar a poblaciones distanciadas del epicentro. La asociación entre la exposición a las emanaciones de los incendios forestales, el aumento de las concentraciones de material particulado aéreo y la morbilidad respiratoria (exacerbación de asma y enfermedades respiratorias crónicas) ha sido evidenciada en diversos estudios. Sin embargo, es difícil realizar un metaanálisis de ellos, ya que la metodología empleada es muy disímil. Entre los principales mecanismos de morbilidad se encontrarían: la producción de citoquinas proinflamatorias, la activación endotelial y la disfunción del sistema nervioso autónomo. Ante la exposición al humo de incendios forestales, se produce daño tisular, aumento de los mecanismos protrombóticos, aumento de la presión arterial y cambios en el ritmo cardiaco, que explicaría los efectos cardiovasculares. Los sujetos con patología cardiovascular preexistente podrían tener mayor riesgo cardiovascular; sin embargo, existen factores confundentes en esta asociación. Por otra parte, el posible riesgo cancerígeno con la exposición a estas emanaciones requiere mayores estudios poblacionales.

Exposure to forest fire fumes is a major national and international public health issue. Climate change that leads to drought and increased summer temperature increases the risk and magnitude of wildfires episodes, generating mega-fires whose fumes not only affect the boundary population, but they may become transcontinental. Association between exposure to forest fire fumes, mainly increased concentrations of air born particulate matter and respiratory morbidity (exacerbation of asthma and chronic respiratory diseases) has been evidenced by diverse studies. However, it is difficult to carry out meta-analysis with them since the methodology used is dissimilar. Among the main causes of morbidity have been postulated the production of pro-inflammatory cytokines, endothelial activation and dysfunction of the autonomic nervous system. Occurrence of tissue damage, increased prothrombotic mechanisms, increased blood pressure and changes in heart rate, would explain the cardiovascular effects associated with exposure to smoke from these fires. However, epidemiological outcomes have not been entirely consistent, as the association between cardiovascular morbidity and exposure to wildfire fumes may be mixed with confounding factors. Despite this, patients with pre-existing cardiovascular pathology may be at increased risk. Finally, the potential risk of carcinogen with exposure to these fumes requires further population studies.

Prevalence of urinary cotinine levels in children under 5 years of age during consultations for acute respiratory disease at the emergency department of the Universidad de La Sabana clinic.

BACKGROUND: Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease. METHODS: A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016. RESULTS: We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P <  0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627. CONCLUSIONS: A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke.

Disfunções respiratórias em portadores de doença de Parkinson: revisão sistemática / Respiratory Dysfunction in patients with Parkinson's disease: systematic review

A Doença de Parkinson (DP) é uma patologia neurodegenerativa, lentamente progressiva. As alterações posturais típicas da DP, associado à rigidez dos músculos intercostais, comprometem a mobilidade da caixa torácica, repercutindo na diminuição da expansibilidade pulmonar na inspiração e da depressão torácica na expiração. A dinâmica respiratória é afetada pela diminuição da força dos músculos respiratórios, a qual leva a atelectasia, hipoxemia e insuficiência ventilatória. OBJETIVO: Identificar através de revisão sistemática quais as disfunções respiratórias na doença de Parkinson. MATERIAS e MÉTODOS: trata-se de um estudo de Revisão Sistemática, sobre as disfunções respiratórias na doença de Parkinson. Foram realizadas buscas nas bases de dados, Medline, PubMED, Lilacs, SciELO, Scopus não foi imposta restrição de idiomas para pesquisa. Para critério de inclusão foram selecionados estudos que relataram as disfunções respiratórias na DP, desenvolvidos nos últimos 10 anos. A qualidade metodológica dos estudos foi analisada utilizando a escala de PEDro. RESULTADOS: Na buscar iniciada no período de 2009 a outubro de 2019, foram incluídos 10 artigos nesta revisão sistemática que demostraram as disfunções respiratórias na doença de Parkinson. CONCLUSÃO: Os estudos demostraram que a doença de Parkinson apresenta diminuição do volume expiratório forçado no primeiro segundo, diminuição da capacidade vital forçada, aumento do volume residual e resistências das vias aéreas.

Parkinson's disease (PD) is a slowly progressive neurodegenerative disorder, being the characteristic neurological sign of the loss of dopaminergic neurons in the compact part of substantia nigra, causing and unknown and affecting elderly people over 65 years. The clinical features published in PD are used for signs and symptoms such as tremor at rest, bradykinesia, hypokinesia, postural alteration, loss of postural reflexes and freezing phenomenon. Because typical postural changes in PD, associated with intercostal muscle stiffness, compromise rib cage mobility, decrease the impact on pulmonary expansion on inspiration, and thoracic changes in respiration, respiratory respiration is affected by respiratory muscle strength, occasionally respiratory muscle strength intercostal muscles stiffness and bradykinesia leading to atelectasis, hypoxemia and ventilatory insufficiency. OBJECTIVE: Identify, through systematic review, what are the respiratory dysfunctions in Parkinson's disease. MATERIALS AND METHODS: This is a systematic review study on respiratory dysfunction in Parkinson's disease. Searches were performed in the databases Medline, Pubmed, Lilacs, Scielo, and no language restrictions were imposed for research. For inclusion criteria, studies related to respiratory dysfunction in PD lasting 10 years were selected. The methodological quality of the studies was analyzed using a PEDro scale. RESULT: In the research initiated between 2009 and October 2019, 10 articles were included in this systematic review that demonstrated respiratory dysfunction in Parkinson's disease. CONCLUSION: Studies of Parkinson's disease showed decreased forced expiratory volume in one second, decreased forced vital capacity, increased residual volume and airway resistance.

Síndrome de apnea obstructiva del sueño en pediatría / Pediatric Obstructive Sleep Apnea Syndrome

El síndrome de apnea/hipopnea obstructiva (SAHOS) se caracteriza por un aumento de la resistencia de la vía aérea superior asociado a una estrechez y colapso intermitente de la faringe produciendo roncopatía y periodos de apneas e hipopneas (1,2,3). Es una patología frecuente que puede ocasionar complicaciones importantes si no se diagnostica y trata adecuadamente. La clínica en niños es distinta que en adultos, ya que la somnolencia se manifiesta de forma paradójica, con alteraciones de la conducta y emocionales. Si no se trata puede ocasionar morbilidad importante que afecta a los sistemas nerviosos central, cardiovascular y endocrino. La identificación de factores de riesgo permite un diagnóstico y un tratamiento precoz. La Polisomnografía nocturna (PSG), es el método diagnóstico de elección. Registros más simplificados son útiles solo cuando los resultados son positivos. El tratamiento más frecuente es la adenoamigdalectomía, con ella se obtiene un porcentaje elevado de curación. En otros pacientes va a depender de la causa o factores predisponentes como puede ser la baja de peso en los niños obesos. En algunos casos van a requerir de CPAP/BiPAP-nasal, dispositivos intraorales, distracción maxilomandibular o tratamiento tópico antiinflamatorio.

Abstract. Obstructive sleep apnea/hypopnea syndrome (OSAS) is characterized by an increased resistance in the upper airway, associated with a narrow and intermittent collapse of the pharynx causing snoring and periods of apneas and hypopneas (1,2,3). It is a highly prevalent pathology that can cause major complications when it is not diagnosed and treated properly. The presentation is different in children than in adults, since sleepiness can be manifested in a paradoxical way, with behavioral and emotional symptoms. If left untreated, it can cause significant morbidity affecting the cardiovascular, endocrine and central nervous systems. The identification of risk factors allows making a diagnosis and establishing treatment earlier. Nocturnal polysomnography (PSG) is the diagnostic method of choice. Simpler recordings are useful only when the results are positive. The most common treatment is tonsillectomy, which is a highly successful treatment. In other patients, the treatment will depend on the cause or risk factors, such as weight loss in obese children. In some cases, children might require the use of a nasal CPAP/BiPAP, intraoral devices, maxillomandibular advancement or anti-inflammatory topical treatment.

Participación del odontólogo en la asistencia de pacientes con trastornos respiratorios relacionados con el sueño / The dentist´s role in attending patients with sleep-related respiratory disorders

En esta revisión se mencionan, en primer lugar, algunas alteraciones odontológicas y oro-cráneo-faciales que son observadas con cierta frecuencia en pacientes que concurren a la consulta odontológica. Luego se realiza una descripción del rol del odontólogo en la evaluación de pacientes que pudieran presentar trastornos respiratorios relacionados con el sueño (TRRS). A continuación, se describen brevemente dos de los más frecuentes TRRS: el ronquido y la apnea obstructiva del sueño. Finalmente, se mencionan algunos recursos terapéuticos de utilidad en los TRRS, particularmente los beneficios de la implementación de la aparatología oral (AO) en estos pacientes (AU)

In this review, we first mention some odontological and oro-cranial-facial alterations that are frequently observe in patients who attend the dental office. After that, a description of the role of the dentist in the evaluation of patients who could present RDRS will be made. Besides two of the most frequent RDRS are briefly describe: snoring and obstructive sleep apnea. Finally, some useful therapeutic resources for the RDRS treatment will be comment, particularly the benefits of the implementation of oral appliances (OA) -in these patients (AU)

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate.

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

Cardiac diastolic and autonomic dysfunction are aggravated by central chemoreflex activation in heart failure with preserved ejection fraction rats.

KEY POINTS: Heart failure with preserved ejection fraction (HFpEF) is associated with disordered breathing patterns, and sympatho-vagal imbalance. Although it is well accepted that altered peripheral chemoreflex control plays a role in the progression of heart failure with reduced ejection fraction (HFrEF), the pathophysiological mechanisms underlying deterioration of cardiac function in HFpEF are poorly understood. We found that central chemoreflex is enhanced in HFpEF and neuronal activation is increased in pre-sympathetic regions of the brainstem. Our data showed that activation of the central chemoreflex pathway in HFpEF exacerbates diastolic dysfunction, worsens sympatho-vagal imbalance and markedly increases the incidence of cardiac arrhythmias in rats with HFpEF. ABSTRACT: Heart failure (HF) patients with preserved ejection fraction (HFpEF) display irregular breathing, sympatho-vagal imbalance, arrhythmias and diastolic dysfunction. It has been shown that tonic activation of the central and peripheral chemoreflex pathway plays a pivotal role in the pathophysiology of HF with reduced ejection fraction. In contrast, no studies to date have addressed chemoreflex function or its effect on cardiac function in HFpEF. Therefore, we tested whether peripheral and central chemoreflexes are hyperactive in HFpEF and if chemoreflex activation exacerbates cardiac dysfunction and autonomic imbalance. Sprague-Dawley rats (n = 32) were subjected to sham or volume overload to induce HFpEF. Resting breathing variability, chemoreflex gain, cardiac function and sympatho-vagal balance, and arrhythmia incidence were studied. HFpEF rats displayed [mean ± SD; chronic heart failure (CHF) vs. Sham, respectively] a marked increase in the incidence of apnoeas/hypopnoeas (20.2 ± 4.0 vs. 9.7 ± 2.6 events h-1 ), autonomic imbalance [0.6 ± 0.2 vs. 0.2 ± 0.1 low/high frequency heart rate variability (LF/HFHRV )] and cardiac arrhythmias (196.0 ± 239.9 vs. 19.8 ± 21.7 events h-1 ). Furthermore, HFpEF rats showed increase central chemoreflex sensitivity but not peripheral chemosensitivity. Accordingly, hypercapnic stimulation in HFpEF rats exacerbated increases in sympathetic outflow to the heart (229.6 ± 43.2% vs. 296.0 ± 43.9% LF/HFHRV , normoxia vs. hypercapnia, respectively), incidence of cardiac arrhythmias (196.0 ± 239.9 vs. 576.7 ± 472.9 events h-1 ) and diastolic dysfunction (0.008 ± 0.004 vs. 0.027 ± 0.027 mmHg µl-1 ). Importantly, the cardiovascular consequences of central chemoreflex activation were related to sympathoexcitation since these effects were abolished by propranolol. The present results show that the central chemoreflex is enhanced in HFpEF and that acute activation of central chemoreceptors leads to increases of cardiac sympathetic outflow, cardiac arrhythmogenesis and impairment in cardiac function in rats with HFpEF.

Plumbemia, estrés oxidativo y alteraciones respiratorias en población expuesta a contaminación ambiental en Lima Metropolitana / Blood lead, oxidative stress and respiratory anomalies post exposition to enviromental contamination at Metropolitan Lima

Objective: Evaluar la relación entre plumblemia, estrés oxidativo y alteraciones respiratorias en las policías de tránsito de la zonas más contaminadas del Centro de Lima...

Objective: To evaluate the relationship between blood leal, oxidative stress and respiratory disorders in the traffic police of the most polluted areas of Lima Metropolitana...

Condição periodontal de indivíduos internados em unidade de terapia intensiva: aspectos clínicos, epidemiológicos e microbiológicos / Periodontal condition of individuals hospitalized in the intensive care unit: clinical, epidemiological and microbiological perspective

A periodontite é uma doença de caráter inflamatório dos tecidos periodontais, com perda progressiva da inserção periodontal, resultante da infecção e interação de espécies bacterianas específicas com os componentes de resposta do hospedeiro em indivíduos susceptíveis. Em adição, infecções periodontais podem ser ainda um provável fator de risco para várias doenças sistêmicas crônicas. Este estudo observacional transversal avaliou a condição periodontal sob uma perspectiva clínica, epidemiológica e microbiológica de indivíduos hospitalizados em Unidade de Terapia Intensiva (UTI) do Hospital São Francisco de Assis, em Belo Horizonte, Minas Gerais, Brasil. O estudo objetivou: (1) determinar o índice de placa, a condição periodontal [através dos parâmetros parâmetros clínicos periodontais de sangramento à sondagem (SS), profundidade de sondagem (PS) e nível clínico de inserção (NIC)] e prevalência de periodontite em indivíduos hospitalizados em UTI. (2) identificar variáveis de risco associadas à presença de periodontite e (3) quantificar por meio de qPCR os periodontopatógenos: Porphyromonas gingivalis (P.gingivalis), Treponema denticola (T. denticola), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Actinomyces naeslundii (A. naeslundii), Streptococcus oralis (S. oralis). De uma população inicial de 284 indivíduos hospitalizados em UTI, uma amostra final de 94 participantes, de ambos os gêneros, idade entre 30 a 81 anos, média de números de dentes 15,2 (± 6,9), foram submetidos a exame periodontal completo e microbiológico. Foi reportado uma taxa de prevalência de periodontite de 71,3%, sendo a maioria na forma crônica moderada e localizada. Indivíduos hospitalizados em UTI apresentaram alto índice de placa (escore 2 e 3, respectivamente em 46,8% e 39,4%). A contagem bacteriana de T. denticola isoladamente e associada à P. gingivalis foi significativamente superior no grupo com periodontite...

Periodontitis is an inflammatory chronic disease of periodontal tissues, with progressive loss of periodontal attachment resulting from infection and interaction of specific bacterial species with the components of the host response in susceptible individuals. In addition, periodontal infections can be a potential risk factor for several chronic systemic diseases. This cross-sectional observational study evaluated the periodontal condition of individuals hospitalized in the Intensive Care Unit (ICU) of the Hospital São Francisco de Assis in Belo Horizonte, Minas Gerais, Brazil, under a clinical, epidemiological, and microbiological perspective. The study aimed to: (1) determine the periodontal condition [through clinical periodontal parameters of bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and plaque index] and prevalence of periodontitis of ICU hospitalized individuals; (2) identify the risk variables associated with the presence of periodontitis; (3) quantify, by means qPCR, the periodontopathogens Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Actinomyces naeslundii (A. naeslundii), Streptococcus oralis (S. oralis). From an initial population of 284 individuals hospitalized in the ICU, a final sample of 94 individuals of both genders, aged 30-81 years, mean number of tooth 15.2 (± 6.9) underwent a complete periodontal and microbiological examination. A prevalence rate of periodontitis of 71.3%, mostly in the moderate chronic and localized form, was observed. Individuals hospitalized in ICU showed high plaque index (score 2 and 3 respectively in 46.8% and 39.4% of the sample). Bacterial ...

Intervenções de enfermagem para o diagnóstico padrão respiratório ineficaz em idosos / Nursing intervention for inefficient breathing pattern diagnosis in the elderly / Intervenciones de enfermería para el diagnóstico patrón respiratorio ineficaz en ancianos

Objetivou-se identificar os cuidados relatados pela equipe de enfermagem frente ao diagnóstico padrão respiratório ineficaz relacionado à fadiga em idosos e mapear as intervenções. Trata-se de um estudo descritivo realizado na clínica médica de um hospital universitário, no ano de 2008, no município de Goiânia, Goiás. A amostra foi constituída por 43 profissionais da equipe de enfermagem. Aplicou-se um questionário fundamentado na classificação da North American Nursing Diagnosis Association– International e da Nursing Intervention Classification (NIC). Os dados revelaram 125 atividades de enfermagem que convergiram para 16 intervenções propostas pela NIC. As intervenções reportadas em maior proporção foram: posicionamento (24,0%), oxigenoterapia (15,2%), controle de energia (9,6%), sendo as duas primeiras intervenções adicionais optativas e a última, uma intervenção sugerida. Observou-se que os profissionais de enfermagem conhecem atividades para o manejo do diagnóstico em foco, contudo tendem a priorizar cuidados menos resolutivos.

This study aimed at [1] identifying the care reported by nursing staff upon a diagnosis for fatigue-related ineffective breathing pattern in elderly and [2] mapping out interventions. This is a descriptive study conducted at the clinic of the University Hospital, in 2008, in Goiania, GO, Brazil. The sample consisted of 43 nursing staff professionals. A NANDA-I (North American Nursing Diagnosis Association – International) and NIC (Nursing Intervention Classification) classification-based questionnaire was applied. Data showed 125 nursing activities converging to 16 interventions proposed by the NIC. Interventions rates reported were as follows: positioning (24.0%), oxygen (15.2%), energy control (9.6%), the first two being optional additional interventions and the other a suggested intervention. Nurses were found to have command of activities for management of diagnostic focus; however, they tend to prioritize less specific care.

Este estudio tuvo como objetivo identificar el cuidado informado por el personal de enfermería delante deldiagnóstico patrón respiratorio ineficaz relacionado con la fatiga en ancianos y mapear las intervenciones. Se trata de un estudio descriptivo realizado en la clínica médica de un hospital universitario, en 2008, en Goiânia, Goiás-Brasil. La muestra estuvo conformada por 43 profesionales del equipo de enfermería. Se aplicó un cuestionario basado en la clasificación de la North American Nursing Diagnosis Association– International y de la Nursing Intervention Classification (NIC). Los datos revelaron 125 actividades de enfermería que convergieron para 16 intervenciones propuestas por la NIC. Las intervenciones informadas en mayor proporción fueron: posicionamiento (24,0%), oxígenoterapia (15,2%), control de energía (9,6%), siendo las dos primeras intervenciones adicionales opcionales y la última una intervención sugerida. Se observó que los profesionales de enfermería conocen actividades para la gestión del diagnóstico en foco, sin embargo, tienden a priorizar la atención menos resolutiva.

Comparação das variáveis fisiológicas no teste de caminhada de seis minutos e no teste da escada em portadores de doença pulmonar obstrutiva crônica / Comparison of the physiological variables in the six-minute walk test and stair-climbing test in patients with chronic obstructive pulmonary disease

INTRODUÇÃO: A intolerância ao exercício prejudica a realização das atividades de vida diária em portadores de doença pulmonar obstrutiva crônica (DPOC) e a avaliação dessa limitação é fundamental. Objetivo: Comparar o teste de caminhada dos seis minutos (TC6') com o teste da escada (TE) em portadores de DPOC. MÉTODOS: Prospectivo composto por 21 pacientes portadores de DPOC avaliados para um programa de reabilitação pulmonar que realizaram o TC6' e o TE. As variáveis fisiológicas frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2), além da escala de Borg modificada, foram aferidas antes e após cada teste. A distância percorrida era medida ao término de ambos os testes. RESULTADOS: Comparando os momentos (inicial versus final) das variáveis fisiológicas de ambos os testes, foi observado no TC6' (FC 81,1 ± 2,6 versus 98,4 ± 4,4; SpO2 94,9 ± 2,2 versus 90,4 ± 5,0; PSE Borg 0,5 ± 0,8 versus 3,6 ± 2,5) e no TE (FC 86,9 ± 18,8 versus 119,3 ± 14,5; SpO2 94,7 ± 2,5 versus 90,1 ± 4,5; PSE Borg 0,2 ± 0,4 versus 7,0 ± 2,3), sendo que todas as variações foram estatisticamente significativas (p < 0,001) em ambos os testes. Quando avaliada a alteração das variáveis em ambos os testes, verificou-se que a SpO2 obteve redução semelhante (p = 0,912), a FC aumentou significativamente mais no TE (p = 0,006), bem como a PSE Borg (p < 0,001). Em relação à distância percorrida, o TC6' permitiu que os participantes percorressem uma distância significativamente maior do que o TE (404m versus 153m; p < 0,001) CONCLUSÃO: Ambos os testes promoveram alterações fisiológicas significativas. Apesar de o TE representar uma distância significativamente menor, a sobrecarga, bem como a percepção de trabalho, foi significativamente maior.

INTRODUCTION: Exercise intolerance interposes daily life activities in chronic obstructive pulmonary diseases (COPD); hence, the evaluation of this functional limitation becomes fundamental. Objective: To compare the six-minute walk test (HR6peak) with the stair-climbing test (SCT) in patients with COPD. METHODS: prospective analysis of twenty-one patients with COPD who were part of the - Pulmonary Rehabilitation Program - (PRP). Patients were evaluated from July to October, 2008 when they performed the HR6peak and ET, analyzing the variables physiological (HR, PSO2), and the modified Borg scale before and after each test. The distance was measured at the end of the tests. RESULTS: Comparing the timing (early versus late) of physiological and subjective perception of exertion (RPE) from Borg, we can observe that all changes were statistically significant (p <0.001) tests. However, when the physiological changes were compared, the PSO2 obtained presented similar reduction (p = 0.912) in both tests, the HR increased significantly in ET (p = 0.006) and on Borg RPE (p <0.001). Regarding the walking distance performed, the HR6peak (p <0.001), allowed participants to advance to a distance significantly longer than the ET. CONCLUSION: the tests expressed important physiological and subjective perception of effort (RPE) from Borg (p <0.001).

Aerosol therapy of equine respiratory disorders / Aerossolterapia nas doenças respiratórias em eqüinos

Respiratory problems are frequently implicated in horses as a cause of poor sportive performances. The most frequently occurring lower respiratory tract disorders are chronic obstructive pulmonary disease (COPD), inflammatory airway disease and exercise-induced pulmonary haemorrhage (EIPH). Classically, their treatment includes systemic administration of drugs, but aerosol therapy is now known to be a more specific way to treat these disorders. This article describes the equipment and drugs currently available for aerosol therapy in horses.

Affecções respiratórias na espécie eqüina são freqüentemente implicadas como uma das causas de fraco desempenho esportivo. A maior freqüência ocorre nas doenças do sistema respiratório inferior, como a doença pulmonar crônica obstrutiva (COPD), doenças inflamatórias das vias aéreas e hemorragia pulmonar induzida pelo exercício (HPIE). Classicamente, os tratamentos dessas enfermidades incluem as drogas de administração sistêmica, porém, a aerossolterapia é hoje conhecida por ser especificamente um dos melhores tratamentos dessas doenças. A finalidade deste trabalho é de descrever o equipamento e as drogas normalmente utilizadas na aerossolterapia em eqüinos.