Evidence Based Study of Surasadi Gana on Respiratory Disorders: A Review

Introduction: Collection of medicinal herbs having similar effect are collectively known as Gana (group) in Samhita and Vargas (category) in Nighantu. Surasadi Gana is included in 37 of such groups mentioned in Sushruta Samhita, with 21 Herbs completing the group. This article is made in a view to review the importance and utility of few herbs included in Surasadi Gana indicated for the management of respiratory disorders. Material and Methods: The literature regarding the drugs mentioned in the group, collected from different Ayurveda classics. Research papers are compiled from published sources and discussed in light of therapeutic effects. Observation and Result: Maximum of the herbs in this group are having properties as Katu rasa (pungent) and Ushna veerya (hot potency). Such herbs are predominantly advised in Kapha (phlegm humour) dominant diseases, viz. Kasa (cough), Shwasa (asthma), Pratishyaya (common cold), Kushtha (skin disorders), Krimi (worm infestation) and Vrana (wound). Conclusion: The herbs, despite having several Ayurvedic indications, the respiratory tract is the focus of the specific activity.

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.

A Conceptual Study on the Role of Vasa Bhavit Haridra Churnam in Vataja Kasa (Dry Cough) w.s.r. to Allergic Bronchitis: A Review

In the present era of COVID -19, management of respiratory disorders is becoming a challenge to the world. Ayurveda, the science of life, provides a lot of hope in the present condition by assuring better results in the field of prevention and management of respiratory diseases. Cough carries out an essential protective function for the respiratory tract and lungs. Kasa (cough) is one of the commonest complaints in day-to-day life and it is also a symptom of various diseases of the respiratory system. In Ayurveda, Acharyas have explained Kasa in detail. They have described five types of Kasa. Among the various respiratory diseases, Vataja Kasa (dry cough) has been selected here. In the contemporary science, it can be correlated to Allergic Bronchitis, which is one of the common problems throughout the world. In the present study Vasa Bhavit Haridra Churnam (VBHC) has been selected from Siddh Bhaisajya Manimala and further details regarding the ingredients were collected from various text books, PubMed, research articles, previous works done etc. As per the data collected, Allergic Bronchitis when treated with Vasa Bhavit Haridra Churnam will be effective in relieving the symptoms. Ayurveda has a vital role to play in the field of respiratory ailments.

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.

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.

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.

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.

Development of a New Multi-parameter Sleep Quality Evaluation System / 中国医疗器械杂志

In order to study the effects of sleep-disordered breathing on human physiology and function, and to accurately and objectively evaluate the level of human sleep quality at night, it can help patients with respiratory disorders improve sleep quality. This paper elaborates the development process of a new multi-parameter sleep quality evaluation system from the hardware circuit design, software and algorithm analysis design of the system. The system hardware platform collects the physiological signals of the 11-channel nighttime sleep period, and displays and stores them in real time on the monitoring platform. After collecting the sleep data of the whole night, it can effectively assist the sleep doctor to sleep by combining the judgment of the sleep-time respiratory disorder, the determination of the sleep cardiovascular event, the determination of the sleep-aware response event, and the sleep structure staging. The quality of sleep in patients with disorders was deeply evaluated.

Study of eosinophil count in nasal smear and peripheral blood smear in children with allergic rhinitis

Background: Allergic respiratory disorders are the common cases seen in Pediatrics OPD. With an appropriate history and detailed examination, the diagnosis usually may not be problematic and routine investigations may not contribute much for the final diagnosis but may help in ruling other possibilities. The objectives of this study were done to know the eosinophil counts in nasal and blood smear and to assess the feasibility of nasal cytogram which is simple, economical and reliable investigation in patients of allergic respiratory disorders.Methods: A prospective clinical correlation study conducted in outpatient visiting Mysore Medical College and Research Institute, Cheluvamba hospital Department of Pediatrics and ENT Department KR hospital. 60 children of age group between 2 to 18 years were selected to estimate the eosinophil count in nasal and peripheral smear in allergic rhinitis. All allergic rhinitis cases based on clinical signs and symptoms were selected and investigated for nasal and blood eosinophilia. The nasal and blood eosinophilia were compared with each other and the clinical findings of allergic rhinitis were studied.Results: In this study peak age incidence is between 6-10 years and there is equal gender distribution. Seasonal variation and pollen allergens were the most common risk factors for allergic rhinitis. Running nose and the nasal obstruction were the most common symptoms in children with allergic rhinitis followed by sneezing and itching. One tenth of the children with allergic rhinitis had bronchial asthma. Nasal eosinophilia contributes to the diagnosis of allergic rhinitis as compared blood eosinophilia. Mild intermittent variety of allergic rhinitis was the most common form of allergic rhinitis.Conclusions: Among various risk factors for allergic rhinitis, seasonal variation and pollen allergens have significant association with the severity of allergic rhinitis. Among various symptomology, only itching had a significant relation to the severity of allergic rhinitis.

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)

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...

Surfactant Replacement Therapy Beyond Respiratory Distress Syndrome in Neonates.

Background: Surfactant replacement therapy is an established modality of treatment in preterm neonates with respiratory distress syndrome. In addition, there are various neonatal respiratory disorders which are characterized by surfactant deficiency in which surfactant therapy can be a feasible and safe option. Objective: To collate the literature on the use of surfactant replacement therapy in neonates beyond respiratory distress syndrome and examine the evidence and newer developments. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, and EMBASE up to June 2015; and previous reviews, including cross-references, abstracts, and conference proceedings. Results: Evidence supports surfactant administration via bolus route in neonates with meconium aspiration syndrome, but additional robust evidence is required before its adoption in clinical practice. There is limited evidence to support surfactant therapy in neonates with pneumonia, pulmonary hemorrhage and bronchopulmonary dysplasia. Large multicenter randomized trials are needed to cement or refute the role of surfactant therapy in these disorders.

Relationship between Prader-Willi syndrome and sleep related breathing disorders / 国际儿科学杂志

Prader-Willi syndrome( PWS) is a type of genetic disease,which is associated with low mus-cle tone,growth and development,progressive fatal obesity and sleep related respiratory disorders(SRBD). Ob-structive sleep apnea hypopnea syndrome( OSAHS) is the most common type of SRBD. The cause,influencing factors and treatment of OSAHS in patients with PWS are described in this paper. To understand the degree of OSAHS in children with PWS,the polysomnography is recommended.

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).

Monitoring results and correlation analysis of polysomnography in 110 cases of elderly patients with obstructive sleep apnea-hypopnea syndrome / 中华老年医学杂志

Objective To improve the understanding of the characteristics of obstructive sleep apnea-hypopnea syndrome (OSAHS) in the elderly patients, and to improve the diagnosis and treatment level. Methods Monitoring results of polysomnography (PSG) from 110 elderly OSAHS patients were analyzed retrospectively. The general conditions, sleep architecture, apnea and hypopnea events, oxygen reduction as well as possible correlations between various indicators were analyzed using SPSS18.0 statistical software. Results The median rapid eye movement (REM) and non-REM (NREM) sleep time of elderly patients with OSAHS accounted for 2. 17% and 76.73%,respectively. The median arousal index was 45.6 times/h. The longest time of sleep apnea was (51.94±22.06) s, the median of average sleep apnea time was 22.50 s, the longest time of hypopnea was (47.06±12.52) s and the average hypopnca time was (21.50±4.63) s. The median respiratory disturbance index (RDI) of all patients was 21.50, the patients with RDI between 5 and 20 accounted for 46.40%, with RDI between 20 and 40 accounted for 31.80% and with RDI over 40 accounted for 21.8%. The average oxygen saturation accounted for (93.45% ± 2.81%), the lowest oxygen saturation accounted for (76.3%± 10. 5%) and the median oxygen desaturation index was 31.6;times/h. BMI was negatively correlated with lowest oxygen saturation (r=-0. 378, P＜0.01) and average oxygen saturation ( r = - 0. 355, P ＜ 0. 01 ), while was positively correlated with oxygen desaturation index (r=0. 338, P＜0. 01 ). The lowest oxygen saturation was negatively correlated with the longest time of obstructive apnea (r= -0. 47, P＜0. 01 ), the average time of obstructive apnea (r=-0.316, P＜0.01), the longest time of hypopnea (r=-0.293, P＜0.01) and the average time of hypopnea (r=-0. 277, P＜0.01). The median time intervals of oxygen desaturation during supine, left side and right side position were 2.36 min, 11.54 min and 12.45 min,respectively. The median time intervals of oxygen desaturation during left side and right side position were both longer than that of supine position (Z= -6.12 and -7. 10 respectively, both P＜0.01).Conclusions Elderly patients with OSAHS manifest obvious disorder of sleep structural and sleep fragmentation. According to RDI, the majority of the patients are classified as mild to moderate in severity. However, elderly patients with OSAHS are severe regarding to hypoxia relatively. The severity of hypoxia is related with BMI and the lasting time of sleep-disordered breathing events, and hypoxia are less severe when sleeping on left side or on right side.

Recurrent haemoptysis following sildenafil administration.

Sildenafil is widely used in the treatment of male erectile disorder and is generally well-tolerated. Its adverse effects are reported to be mild and include flushing, headache, dyspepsia and visual disturbances. We document a case of recurrent haemoptysis observed soon after self administration of sildenafil in a 38-year-old male with no other causative factors. The episodes of haemoptysis stopped following stoppage of sildenafil.