Simulation-based bronchoscopy training: Randomized trial comparing worked example to video introduction.

INTRODUCTION: Learning the complex skill of bronchoscopy involves the integration of cognitive domains and motor skills. The development of simulators has opened up new possibilities in bronchoscopy training. This study aimed at evaluating how effective the modeling example methodology is in training this skill and assessed its effect on cognitive load in learning. METHODS: Forty-seven medical students participating in a simulator-based bronchoscopy training program were randomly allocated to a control group, receiving a video lesson, and the modeling example group. They were evaluated by the simulator's metrics at different time points: pre-, posttest, and 15 days and 12 months after training. Cognitive load was assessed with the modified Paas scale. RESULTS: Simulation-based training was effective for both groups, based on simulator metrics (p < .05). The modeling example group outperformed the control group in all measures at posttest and after 15 days (p < .001). After 12 months, there was a decline in skill in both groups, but the modeling example group performed better (p < .001). Simulation-based training reduced cognitive load, more strongly so in the modeling example group (p < .001). CONCLUSION: The modeling example group showed substantial benefits over the control group, both in reducing the cognitive load in learning and in retaining knowledge and skill after 15 days and 12 months.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study.

OBJECTIVE: Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. METHODS: This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. RESULTS: A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. CONCLUSION: This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Correlation between peak nasal inspiratory flow and peak expiratory flow in children and adolescents.

BACKGROUND: PEAK nasal inspiratory flow (PNIF) has been proposed as a simple method to evaluate nasal patency. Asthma and allergic rhinitis are commonly associated, and lower airway assessment can provide information concerning an objective interpretation of nasal function. AIMS: TO determine whether the PNIF is correlated with peak expiratory flow (PEF) in children and adolescents. METHODS AND RESULTS: Cross-sectional study carried out in healthy students randomly chosen in 14 public schools of the city of Belo Horizonte. PNIF and PEF were assessed for each subject as the following characteristics: gender, height, weight and age. We created a linear regression model to explain the PNIF, in which we included all the variables with a p value ≤ 0.25 in a univariate analysis, and to calculate the relationship between the maximum PNIF and maximum PEF by the Spearman correlation coefficient. In total, 297 healthy subjects, aged between six and eighteen years were evaluated. A positive and significant correlation between PNIF and PEF was found. CONCLUSIONS: PEF is predictive of PNIF. However, these measures evaluate two distinct segments of the airways and should be both obtained for a more precise assessment of airflow limitation.

Bronchoscopy simulation training in the post-pandemic world.

Bronchoscopy is an important procedure to examine the airways. It is traditionally taught by having trainees perform it in humans. This carries risks, albeit rarely, and causes stress to trainees. The objective of this study was to review bronchoscopy simulators, as well as their use in and impact on medical education, presenting perspectives on the use of simulators in the post-pandemic world. This review was based on articles published in English in 2000-2021 and retrieved from any of the following databases: MEDLINE (PubMed), Embase, SciELO, and Google Scholar. Bronchoscopy simulators have improved markedly over time, allowing the teaching/learning process to take place in a risk-free environment. Bronchoscopy simulation training is an interesting option for the evaluation of the airways, especially in the coming years, with the COVID-19 pandemic highlighting the need for continuing medical education.

Nasal peak inspiratory flow and clinical score in children and adolescents with allergic rhinitis.

OBJECTIVE: To assess the correlation between nasal inspiratory peak flow (NIPF) and clinical scoring in patients with allergic rhinitis (AR). METHODS: A concurrent cohort study was carried out with 52 randomly selected patients aged six to 16 with moderate and severe persistent allergic rhinitis, and followed up for eight weeks. Measurements of NIPF and clinical score for AR were evaluated in a blinded manner. Correlations between NIPF and clinical scoring were obtained from linear regression using the Pearson's correlation coefficient (r). Significance level was p < 0.05. RESULTS: Moderate but statistically significant correlation between NIPF and clinical scoring was found (r = -0.44; p < or = 0.001) and nasal obstruction alone (r = -0.438; p < or = 0.001) were found. CONCLUSION: Results confirm data from studies conducted with adult patients that found weak correlation between allergic rhinitis symptoms and objective measurements of nasal obstruction as NIPF. NIPF and the clinical scoring are complementary tools to evaluate AR patients.

Worked example como método de ensino da ausculta cardíaca pediátrica para estudantes de Medicina / Worked example as a method for teaching pediatric cardiac auscultation to Medical students

Resumo: Introdução: A performance e a acurácia da ausculta cardíaca de médicos recém-formados estão aquém do esperado, o que resulta em excesso de encaminhamentos para o cardiologista, solicitação de exames desnecessários e atraso diagnóstico. O desenvolvimento de metodologias de ensino eficazes é necessário para melhorar a ausculta cardíaca e a capacidade diagnóstica dos médicos recém-graduados. Objetivo: Este estudo teve como objetivo verificar a eficácia do uso da metodologia do worked example, comparada ao ensino tradicional de aulas expositivas da semiologia do aparelho cardiovascular. Método: Participaram do estudo 56 alunos do quarto ano da Universidade Federal de Minas Gerais. Trata-se de um estudo experimental que comparou a eficácia do modelo de ensino baseado na metodologia do worked example com a metodologia tradicional de aula expositiva sobre ausculta cardíaca pediátrica. Os alunos foram randomizados em grupo experimental e grupo de controle, e avaliados em fases distintas - pré-teste, pós-teste imediato e pós-teste tardio. Resultado: A partir da Análise de Variância de Medidas Repetidas, houve efeito significativo em ambos os métodos de treinamento quando se considerou a fase do estudo (p < 0,001). Os dois grupos obtiveram desempenhos semelhantes independentemente do método de treinamento (p = 0,863). Conclusão: A metodologia ativa conhecida como worked example pode ser tão eficaz quanto uma metodologia tradicional no ensino e aprendizagem da ausculta cardíaca pediátrica.

Abstract: Introduction: The cardiac auscultation performance of newly graduated physicians is below expectations, which results in excessive referrals to cardiologists, requests for unnecessary tests and delays in diagnosis. The development of effective teaching methodologies is necessary to improve cardiac auscultation and the diagnostic capacity of newly graduated physicians. Methods: 56 students from the 4th year of Federal University of Minas Gerais, Brazil, participated in an experimental study to compare the effectiveness of the pedagogical model based on the worked example methodology when compared to the traditional methodology of lectures on pediatric cardiac auscultation. The students were randomized into an experimental group and a control group and evaluated in different phases - pre-test, immediate post-test and later post-test. Results: From the Analysis of Variance of Repeated Measures, there was a significant effect observed in both training methods when considering the study phase (p < 0.001). Both groups obtained similar performances regardless of the training method (p = 0.863). Conclusion: This study suggests that an active methodology can be as effective as a traditional methodology in teaching and learning Pediatric Cardiac Auscultation.

Factors associated with asthma expression in adolescents.

OBJECTIVE: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. METHODS: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. RESULTS: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). CONCLUSIONS: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

Cleft lip and palate associated hearing loss in Brazilian children.

INTRODUCTION: Cleft lip and palate children have chronic otitis media related to Eustachian Tube dysfunction and associated conductive hearing loss. In this group of children, communicative skill development limitations, in association with orofacial aesthetics and functional disorders, can lead to behavioral, educational and social problems. METHODS: We evaluated the minimum hearing threshold and the air-bone gap (ABG) in a range from 500 to 4000 Hz for 4-14 years old cleft lip and palate children (CLPC). This cross-sectional study took place in a multiprofessional tertiary care center and involved 89 CLPC with bilateral or unilateral postforamen or transforamen malformation, divided into two groups: those aged 4-7 and 8-14 years. The hearing tests of 89 children were evaluated: 53 (group I) aged from 4 to 7 years (67.9% male) and 36 (group II) aged from 8 to 14 years (55.6% female). RESULTS: The minimum hearing threshold 500-4 KHz mean (MHT 500-4 KHz) was 19.4 dB for all children. MHT 500-4 KHz was 21.2 dB and 17.5 dB respectively for the group I and group II. Both groups demonstrated a minimum hearing threshold of up to 70 dB at certain frequencies. The global ABG 500-4 KHz average was 16.6 dB (SD 12.5): 19.7 dB (SD 12.9) in group I and 13.2 dB (SD 11.1) in group II. CONCLUSION: The worst hearing thresholds were found in children of 4-7 years old: 21.2 dB MHT 500-4 KHz and 19.7 ABG 500-4 KHz, what is a disadvantage for them, as the normal hearing thresholds are up to 15 dB. The children of 8-14 years old had MHT 500-4 KHz of 17.5 dB, and ABG 500-4KHZ OF 13.2 with up to 70 dB of hearing loss.

Peak nasal inspiratory flow in children and adolescents with sickle cell disease: a case-control study

SUMMARY OBJECTIVE: Sickle cell disease is the most frequent of the hereditary hemoglobinopathies and it presents multisystemic effects. A manifestation that is commonly found in sickle cell disease is upper airway obstruction, particularly adenotonsillar hypertrophy. This study aims to evaluate the peak nasal inspiratory flow measurements of children and adolescents with sickle cell disease. METHODS: This is a case-control study on children aged between 8 and 15 years who were diagnosed with sickle cell disease. Peak nasal inspiratory flow measurements were obtained from patients. RESULTS: A total of 279 patients were enrolled in this study, with 93 in the case group and 186 in the control group. The case group had an 82.83% chance of having lower peak nasal inspiratory flow values than the control group. In the case group, 75% of the peak nasal inspiratory flow values were in the lower standards, whereas in the control group, only 25% were in the lower standards. CONCLUSION: This study showed a high prevalence of reduced peak nasal inspiratory flow values in children with sickle cell disease and could certainly be incorporated into the day-to-day clinical evaluation of patients as a screening instrument.

Bronchoscopy simulation training in the post-pandemic world / Treinamento com simuladores de broncoscopia no mundo pós-pandemia

ABSTRACT Bronchoscopy is an important procedure to examine the airways. It is traditionally taught by having trainees perform it in humans. This carries risks, albeit rarely, and causes stress to trainees. The objective of this study was to review bronchoscopy simulators, as well as their use in and impact on medical education, presenting perspectives on the use of simulators in the post-pandemic world. This review was based on articles published in English in 2000-2021 and retrieved from any of the following databases: MEDLINE (PubMed), Embase, SciELO, and Google Scholar. Bronchoscopy simulators have improved markedly over time, allowing the teaching/learning process to take place in a risk-free environment. Bronchoscopy simulation training is an interesting option for the evaluation of the airways, especially in the coming years, with the COVID-19 pandemic highlighting the need for continuing medical education.

RESUMO A broncoscopia é um procedimento importante para examinar as vias aéreas. O treinamento tradicional consiste em realizar o procedimento em humanos. Isso traz riscos, embora apenas raramente, e causa estresse nos broncoscopistas em formação. O objetivo deste estudo foi realizar uma revisão da literatura a respeito de simuladores de broncoscopia e seu uso e impacto na educação médica, apresentando perspectivas acerca do uso de simuladores no mundo pós-pandemia. A revisão baseou-se em artigos publicados em inglês em 2000-2021 e recuperados a partir de buscas realizadas nos seguintes bancos de dados: MEDLINE (PubMed), Embase, SciELO e Google Acadêmico. Os simuladores de broncoscopia melhoraram muito ao longo dos anos, permitindo que o processo de ensino e aprendizagem ocorra em um ambiente livre de riscos. O treinamento com simuladores de broncoscopia é uma opção interessante para a avaliação das vias aéreas, principalmente nos próximos anos, já que a pandemia de COVID-19 ressaltou a necessidade de educação médica continuada.

Parapneumonic pleural effusion: early versus late thoracoscopy.

OBJECTIVE: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. METHODS: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. RESULTS: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. CONCLUSIONS: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

A aula tradicional pode ser substituída pelo Worked Example no ensino da radiologia? / Can the traditional class be replaced by the Worked Example in the teaching of Radiology?

Resumo: Introdução: Durante a última década, o modelo tradicional de ensino médico foi amplamente debatido, e, há pouco tempo, a pandemia da Covid-19 impôs novamente mudanças, iniciadas em caráter de urgência em todo o mundo, trazendo novos desafios à formação médica no que concerne ao ensino e à aprendizagem. A estratégia de ensino conhecida como Worked Example é uma ferramenta instrucional na qual um especialista mostra a solução de um determinado problema para um aprendiz de forma pormenorizada. Objetivo: Este estudo teve como objetivo comparar as aulas expositivas em vídeo com a técnica Worked Example para ensino de tomografia de tórax. Método: Trata-se de um estudo experimental realizado, por meio de uma intervenção educacional, com alunos do curso de Medicina em fases iniciais e finais da prática clínica. Resultado: A análise de variância de medidas repetidas (ANOVA) foi usada na análise estatística. Houve diferença significativa entre as notas antes e depois do treinamento (F1; 74 = 46,008; p < 0,001) e entre as fases do curso (F2; 148 = 19,452; p < 0,001). Não houve diferença estatisticamente significativa entre os grupos (F2; 74 = 1,401; p = 0,240). Não houve diferença significativa no esforço mental referido na comparação entre grupos (F1; 69 = 0,092; p = 0,762), porém os alunos do segundo ano apresentaram um escore de esforço significativamente maior. Conclusão: O Worked Example, uma técnica com boa aplicabilidade para estudantes da graduação e adequada para formatos digitais, mostrou-se igualmente eficaz a aula expositiva, técnica consagrada no ensino de radiologia.

Abstract: Introduction: During the last decade, the traditional model of medical education was widely debated, and recently, the Covid-19 pandemic added new challenges in teaching and learning in medical education. The Worked Example is an instructional tool in which an expert shows a detailed problem solution for a learner. Objective: This study aimed to compare, in an experimental study with medical students, lectures in online format with Worked Example for teaching chest tomography. Method: Experimental study through an educational intervention with medical students in the initial and final stages of clinical practice. Result: Analysis of variance of repeated measures (ANOVA) was used in the statistical analysis. There was a significant difference between the grades before and after training (F1; 74 = 46.008; p < 0.001) and between the course phases studied (F2; 148 = 19.452; p < 0.001). There was no statistically significant difference between the groups (F2; 74 = 1.401; p = 0.240). There was no significant difference in mental effort reported in the comparison between groups (F1; 69 = 0.092; p = 0.762), but students in the 2th year had a significantly higher effort score. Conclusion: Worked Example, which is a good technique for students and suitable for digital formats, was equally effective as lecture, a well-known instructional method for teaching radiology.

Epidemiological trends of allergic diseases in adolescents.

OBJECTIVE: To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here. METHODS: This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002. RESULTS: The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002). CONCLUSIONS: The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.

Does the Airmax® internal nasal dilator increase peak nasal inspiratory flow (PNIF) in adolescent athletes?

OBJECTIVES: Nasal dilators are being developed for the purpose of increasing air flow in the nasal valve. The aim of this study is to evaluate the use of the internal nasal dilator (IND) by adolescent athletes. METHODS: A double-blind, crossover clinical trial in which we evaluated 54 adolescents using experimental and placebo INDs, submitted to a cardio-respiratory test in randomized order. The predicted values for the peak nasal inspiratory flow (PNIF) were obtained and the intensity of dyspnea was evaluated using the visual analog scale method after the race. RESULTS: In relation to PNIF (% predicted), when participants used the experimental IND, significantly higher means were found in comparison with the placebo (104.27±24.67L/min and 97.73±25.61L/min, respectively) (p=0.010). There were no significant differences observed in terms of heart rate (HR), pulse oximetry (SpO2) and maximal oxygen uptake (VO2max), before and after the cardio-respiratory test. There was also no significant difference (p>0.05) between the use of experimental and placebo INDs on dyspnea scale measurements after completion of the cardio-respiratory test. CONCLUSION: Results suggested that the Airmax® IND improves nasal patency, as measured by PNIF, in healthy adolescent athletes. There was no statistically significant difference in the values for heart rate and SpO2. There was also no difference between the conditions tested for the mean VO2max. Further studies should be conducted to evaluate the effect of IND in adolescent athletes with chronic diseases, such as asthma and allergic rhinitis, and also using other cardio-respiratory assessment methods.

Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

OBJECTIVE:: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. METHODS:: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. RESULTS:: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. CONCLUSIONS:: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter. OBJETIVO:: Avaliar a função pulmonar e a capacidade funcional em crianças e adolescentes com doença falciforme. MÉTODOS:: Estudo transversal com 70 crianças e adolescentes com doença falciforme (8-15 anos), submetidos a testes de função respiratória (espirometria) e de capacidade funcional (teste de caminhada de seis minutos). Os resultados da avaliação da função pulmonar foram comparados com variáveis relacionadas à gravidade da doença falciforme e à presença de história de asma e de síndrome torácica aguda. RESULTADOS:: Dos 64 pacientes submetidos à espirometria, 15 (23,4%) apresentaram resultados alterados: distúrbio ventilatório restritivo, em 8; (12,5%) e distúrbio respiratório obstrutivo, em 7 (10,9%). Dos 69 pacientes submetidos ao teste de caminhada de seis minutos, 18 (26,1%) apresentaram resultados alterados na distância em % do previsto para a idade, e houve uma queda ≥ 3% na SpO2 em 36 (52,2%) dos pacientes. Não houve associações significativas entre função pulmonar alterada e as outras variáveis analisadas, exceto para hipoxemia e distúrbio ventilatório restritivo. CONCLUSÕES:: Observou-se uma significativa prevalência de alterações na função pulmonar nesta amostra de crianças e adolescentes com doença falciforme. A elevada prevalência de distúrbios ventilatórios sugere a necessidade de um olhar mais atento à função pulmonar desde a infância nessa população.

Prevalence of self-reported smoking experimentation in adolescents with asthma or allergic rhinitis.

OBJECTIVE: To determine the prevalence of smoking experimentation among adolescents with asthma or allergic rhinitis. METHODS: This was a cross-sectional study involving adolescent students (13-14 years of age) in the city of Belo Horizonte, Brazil. The participants completed the Centers for Disease Control and Prevention and International Study of Asthma and Allergies in Childhood questionnaires, both of which have been validated for use in Brazil. We calculated the prevalence of smoking experimentation in the sample as a whole, among the students with asthma symptoms, and among the students with allergic rhinitis symptoms, as well as in subgroups according to gender and age at smoking experimentation. RESULTS: The sample comprised 3,325 adolescent students. No statistically significant differences were found regarding gender or age. In the sample as a whole, the prevalence of smoking experimentation was 9.6%. The mean age for smoking experimentation for the first time was 11.1 years of age (range, 5-14 years). Among the adolescents with asthma symptoms and among those with allergic rhinitis symptoms, the prevalence of self-reported smoking experimentation was 13.5% and 10.6%, respectively. CONCLUSIONS: The proportion of adolescents with symptoms of asthma or allergic rhinitis who reported smoking experimentation is a cause for concern, because there is strong evidence that active smoking is a risk factor for the occurrence and increased severity of allergic diseases.

External nasal dilators: definition, background, and current uses.

Our goal was to revise the literature about external nasal dilators (ENDs) as to their definition, history, and current uses. We reviewed journals in the PubMed and MEDLINE databases. The current uses hereby presented and discussed are physical exercise, nasal congestion and sleep, snoring, pregnancy, cancer, and healthy individuals. Numerous studies have shown that ENDs increase the cross-sectional area of the nasal valve, reducing nasal resistance and transnasal inspiratory pressure and stabilizing the lateral nasal vestibule, avoiding its collapse during final inspiration. These effects also facilitate breathing and are beneficial to patients with nasal obstruction. Furthermore, END use is simple, noninvasive, painless, affordable, and bears minimum risk to the user. Most studies have limited sample size and are mainly focused on physical exercise. In conclusion, ENDs seem useful, so further studies involving potential effects on the performance of physical tests and improvements in sleep quality are necessary, especially in children and teenagers.

Correlation between Bhalla score and spirometry in children and adolescents with cystic fibrosis.

OBJECTIVE: To correlate the findings of high resolution computed tomography of the chest based on the Bhalla score with the clinical data and spirometry in children and adolescents with cystic fibrosis, and to study the concordance between two radiologists for the Bhalla score and its categories. METHODS: We evaluated the medical records of 23 patients from the outpatient clinic. The items evaluated included age, weight, height, height/age Z-score, weight/age Z-score, body mass index (BMI), O2 saturation, spirometry and Bhalla score. RESULTS: The patients had a mean age of 17.4 years ± 5.7 years, with fifteen females and eight males. There was good correlation between Bhalla score and spirometry (FVC-r =0.718, p<0.001; FEV1-r=0.830, p<0.001; FEF25-75%-r =0.786, p<0.001; FEV1/FVC-r=0.714, p<0.001). It was also noted that some patients with FEF25-75%> 70% already had changes in their final Bhalla score. In the analysis of the concordance between the examiners a Kappa coefficient of 0.81 (p <0.001) was found, and an intraclass correlation coefficient of 0.98. CONCLUSION: A good correlation between Bhalla scores with spirometry confirmed its usefulness in evaluating and monitoring patients with cystic fibrosis, given it can be used both in patients who are unable to perform spirometry as well as for a pooled analysis of the two examinations since the HRCT scans show early changes in patients with normal function tests.

Asma grave em pacientes adultos e pediátricos: Protocolo da Sociedade Mineira de Pneumologia e Cirurgia Torácica (SMPCT) - 2019 / Severe asthma in adult and pediatric patients: Protocol of the Sociedade Mineira de Pneumologia e Cirurgia Torácica (SMPCT) - 2019

Este documento é uma revisão do protocolo de asma grave da SMPCT de 2015, que se fez necessária devido à atualização de avanços em pesquisas, principalmente em fenotipagem/genotipagem e terapêutica da asma grave, além de asma grave na pediatria. A maioria da publicações relata que 5% a 10% dos asmáticos podem apresentar asma grave. Porém, levantamento na Holanda encontrou uma prevalência menor, de 3,6% ou 10,4/10000 habitantes, que parece ser mais próximo da realidade. Este protocolo tem como população alvo os pacientes com asma grave, adultos e pediátricos, conforme definições de asma grave da"International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma" de 2014 e GINA 2018.1,3 Seus potenciais utilizadores são especialistas em doenças respiratórias que lidam com asma grave, e que devem ser os responsáveis pela aplicação do protocolo, e também clínicos gerais, pediatras, médicos de cuidados primários, enfermeiros, fisioterapeutas e outros profissionais da saúde. É aconselhável consulta com um especialista em asma nos seguintes casos: asma de difícil diagnóstico, suspeita de asma ocupacional, asma persistente não controlada com exacerbações frequentes, asma com risco de morte, eventos adversos significativos ou suspeita de subtipos de asma grave.4 Este documento não tem a intenção de instituir um tratamento padronizado, mas estabelecer bases racionais para decisões em pacientes com asma grave, pois as recomendações não conseguem abranger toda a complexidade do julgamento clínico em casos individuais. Os autores recomendam sua revisão e atualização no período máximo de 3 anos, ou, se necessário, em tempo menor.