Beneficios que reciben los pacientes asmáticos tras la aplicación de un tratamiento fisioterapéutico y rehabilitador

El asma bronquial sigue siendo la enfermedad crónica más frecuente en la infancia. Su prevalencia continúa aumentando a pesar de que en la actualidad se disponen de eficaces manuales terapéuticos para el correcto manejo de los principales síntomas de la enfermedad. El tratamiento no farmacológico de este padecimiento se fundamenta en tres pilares esenciales: la educación sobre la enfermedad, las guías para profesionales y pacientes y la fisioterapia respiratoria. Los pacientes que tienen un tratamiento fisioterapéutico y rehabilitador de manera habitual, tienen una mejoría significativa en el control del asma, especialmente si estos se practican bajo la supervisión de un fisioterapeuta. Los beneficios que los pacientes asmáticos logran con la fisioterapia y la rehabilitación son numerosos y uno de los efectos más importante es el impacto positivo sobre la calidad de vida.

Bronchial asthma continues to be the most common chronic disease in childhood. Its prevalence continues to increase despite the fact that effective therapeutic manuals are currently available for the correct management of the main symptoms of the disease. The non-pharmacological treatment of this condition is based on three pillars: education about the disease, guides for professionals and patients, and respiratory physiotherapy. Patients who have regular physiotherapy and rehabilitation treatment have a significant improvement in asthma control, especially if these are practiced under the supervision of a physiotherapist. The benefits that asthmatic patients achieve with physiotherapy and rehabilitation are numerous and one of the most important effects is the positive impact on quality of life.

Epidemiología de las infecciones espiratorias agudas antes y en pandemia de Coronavirus en República Dominicana / Epidemiology of Acute Respiratory Infections before and during the Coronavirus pandemic in the Dominican Republic

Resumen Objetivo: El síndrome respiratorio severo por coronavirus del Síndrome Respiratorio Agudo Severo tipo 2 es el microorganismo responsable de causar el COVID-19, una patología con afectación predominantemente respiratoria que posee un comportamiento similar a los procesos virales respiratorios más comunes. El incremento de número de casos de Síndrome Respiratorio Agudo Severo tipo 2 reportados en cada país ha causado un desplazamiento de las infecciones respiratorias agudas (IRAs) causadas por otros patógenos hasta un 70% el número de casos reportado durante la pandemia. Material y métodos: Se realizó un estudio descriptivo y transversal, con recolección de datos retrospectiva de fuente secundaria utilizando como fuente de información los boletines epidemiológicos semanales desde la semana 1 del mes de Enero 2019 a la semana 53 del mes de Diciembre del 2020 del Sistema nacional de vigilancia Epidemiológica del Ministerio de Salud Pública a través de la Dirección General de Epidemiología. Resultados: Se observa disminución de los casos de infección respiratoria aguda con un incremento respectivo en los casos de COVID-19 al comparar los años 2019 y 2020. La provincia con mayor número de casos fue el Distrito Nacional. Conclusión: Es necesario evaluar el comportamiento del Síndrome Respiratorio Agudo Severo tipo 2 con relación a otros patógenos para identificar si las infecciones respiratorias agudas retornarán a un estado previo a la pandemia, cuando el uso de mascarillas ya no sea necesario, Síndrome Respiratorio Agudo Severo tipo 2 será el patógeno prevalente.

Abstract Objective: Severe respiratory syndrome due to coronavirus type 2 is the microorganism responsible for causing COVID-19, a pathology with predominantly respiratory involvement that has a similar behavior to the most common respiratory viral processes. The increase in the number of severe acute respiratory syndrome type 2 cases reported in each country has caused a displacement of acute respiratory infections (ARIs) caused by other pathogens up to 70% of the number of cases reported during the pandemic. Material and methods: This study is descriptive and cross-sectional with retrospective data collection from secondary sources using as a source of information the weekly epidemiological bulletins from week 1 of January 2019 to week 53 of December 2020 of the National Epidemiological Surveillance System of the Ministry of Public Health through the General Directorate of Epidemiology. Results: A decrease in cases of acute respiratory infection with a respective increase in cases of COVID-19 was observed when comparing the years 2019 and 2020. The province with the highest number of cases was the National District. Conclusion: The behavior of severe acute respiratory syndrome type 2 relative to other pathogens needs to be evaluated to identify whether acute respiratory infections will return to a pre-pandemic state when facemask use is no longer necessary severe acute respiratory syndrome type 2 will be the prevalent pathogen.

Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2 / no

La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extra articular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.

Rheumatoid arthritis (RA) is one of the most frequent chronic autoimmune pathologies. It's prevalence varies from 0.5 to 1%, with a primary involvement at the joint, generating disability due to deformities secondary to persistent inflammation. Considering the high impact on the quality of life of those who suffer it, added to the high cost of therapeutic interventions, it becomes imperative for health personnel to join forces to promote early diagnosis and recognize potential complications, in order to impact positively on clinical outcomes. Around 50% of patients with RA may have extra-articular involvement, the lung being one of the most affected organs. In times of SARS-CoV-2 pandemic, it's necessary to remember the types of lung involvement in patients with RA and take into account the susceptibility of these patients to infectious conditions that can generate great morbidity and mortality.

Relación entre competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en niños con tratamiento oncológico en el contexto de la pandemia por COVID-19 / Relationship between competence for home care and the presence of respiratory infections in children with cancer treatment in the context of the COVID-19 pandemic / Relação entre a proficiência para dar os cuidados em casa e a presença de infecções respiratórias em crianças sob tratamento oncológico no contexto da pandemia de COVID-19

Introducción: Los cuidados domiciliarios para los niños con enfermedades neoplásicas, representan costos sociales y económicos, además de posibles riesgos de infección. Por lo que, la importancia del cuidado de los menores ante las infecciones respiratorias virales durante la infancia radica en asegurar las correctas medidas de prevención del contagio. El objetivo de este estudio fue determinar la relación existente entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico. Método: Estudio de enfoque cuantitativo, diseño correlacional, de corte transversal y descriptivo. La muestra se compone de 75 díadas. La competencia del cuidado domiciliario se midió con el instrumento CUIDAR. El análisis estadístico se realizó con el programa estadístico SPSS versión 25, utilizando estadística descriptiva y estadística inferencial no paramétrica. Resultados: La prevalencia de infecciones respiratorias fue del 4% para los menores con cuidadores con un nivel alto de competencia para el cuidado domiciliario, 12% para el nivel medio y 21.3%para el nivel bajo, mostrando dependencia entre las variables de estudio(X2=14.4, gl= 2, p=0.001). Además, se determinó una asociación (r=-.439, p<.001)entre las mismas. Discusión: La competencia con un nivel alto en los cuidados domiciliarios, supone un adecuado desempeño del rol como cuidador familiar con efecto en calidad de vida de la díada cuidador familiar-persona con cáncer. Conclusiones: A mayor competencia para el cuidado, menor la prevalencia de infecciones respiratorias; existiendo una relación entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico.

Introduction: Home care for children with neoplastic diseases represents social and economic costs, as well as possible risks of infection. Therefore, the importance of caring for minors in the face of viral respiratory infections during childhood lies in ensuring the correct measures to prevent contagion. The objectiveof this study was to determine the relationship between competence for home care and the presence of respiratory infections in children undergoing cancer treatment. Method: Study of quantitative approach, correlational, cross-sectional and descriptive design. The sample consists of 75 dyads. Home care competence was measured with the CARE instrument. Statistical analysis was performed with the statistical program SPSS version 25.0, using descriptive statistics and non-parametric inferential statistics. Results: The prevalence of respiratory infections was 4% for children with caregivers with a high level of home care competence, 12% for the medium level and 21.3% for the low level, showing dependence between the study variables (X2=14.4, gl= 2, p=0.001). In addition, an association (r=-.439, p<.001) was determined between them. Discussion: The competence with a high level in home care supposes an adequate performance of the role as family caregiver with effect on quality of life of the family caregiver-person with a cancer dyad. Conclusions:The higher the caregiving competence, the lower the prevalence of respiratory infections; there is a relationship between home caregiving competence and the presence of respiratory infections in children undergoing cancer treatment.

Introdução: Os cuidados domiciliares para as crianças com doenças neoplásicas representam custos sociais e econômicos, além dos possíveis riscos de infecção. Por isso, a importância de tomar conta delas no que diz respeito às infecções respiratórias virais durante sua meninice radica em segurar as medidas adequadas para prevenir o contágio. O objetivo deste estúdio foi determinar a relação entre as infecções respiratórias nas crianças sob tratamento contra o cancro e a habilitação para lhes fornecer os cuidados em casa. Método: Estúdio da abordagem quantitativa, desenho correlacional, de corte transversal e descritivo. A amostra se compõe de 75 díades. A habilitação dos cuidados em casa foi medida com o instrumento TOMAR CONTA. A análise estatística se realizou com o programa estatístico SPSS, versão 25. Foi utilizada a estatística descritiva e a estatística inferencial não paramétrica. Resultados: A prevalência de infecções respiratórias foi de 4% para as crianças que receberam os cuidados em casa com um alto nível de efetividade; 12%, quando a efetividade dos cuidados foi intermediária; e para a baixa chegou até 21,3%. Isto demonstra a correlação entre as variáveis de estudo (X2= 14,4; gl= 2; p= 0,001). Além disso, se determinou uma associação (r= -,439; p<,001) entre elas. Discussão:A aptidão adequada para fornecer os cuidados em casa aponta que o responsável pela família desempenhou bem seu papel, o que fez com que houvesse repercussões positivas na qualidade de vida da díade "cuidador familiar-pessoa com câncer". Conclusões: Quanto maior é a proficiência para dar os cuidados, menor é o impacto das infecções respiratórias. Existe uma relação entre a habilitação para os cuidados em casa e a presença de infecções respiratórias nas crianças que recebem tratamentos oncológicos

Vigilancia de virus sincicial respiratorio e influenza en niños escolarizados asistidos en un hospital pediátrico durante 2 meses del segundo semestre de 2021 / Respiratory syncytial virus and influenza surveillance in schoolchildren seen at a children's hospital over 2 months of the second semester of 2021

Introducción. Durante la pandemia de COVID-19, disminuyeron las notificaciones de infecciones respiratorias. El objetivo fue estimar la prevalencia de virus sincicial respiratorio (VSR) e influenza en niños escolarizados asistidos en un hospital pediátrico durante el retorno a la presencialidad. Métodos. Estudio transversal de casos sospechosos de COVID-19, de 3-18 años, con prueba negativa para SARSCoV-2, entre agosto y octubre de 2021. Se estratificó por nivel educativo. Se utilizó PCR para detectar VSR e influenza. Resultados. Se incluyeron 619 niños: 234 del nivel inicial, 224 del primario y 161 del secundario; 25,5 % (158) fueron positivos para VSR (36,3 % del nivel inicial versus 21 % del primario y 16 % del secundario); en adolescentes se asoció la infección al contacto escolar con caso sintomático (OR 2,5; IC95%: 1-6,80; p = 0,04). No se aisló virus influenza. Conclusión. VSR se aisló en un cuarto de la población estudiada, con mayor frecuencia en el nivel inicial; en adolescentes, se asoció con contacto escolar sintomático. No se detectaron casos de influenza

Introduction. Reporting of respiratory infections reduced during the COVID-19 pandemic. The objective was to estimate the prevalence of respiratory syncytial virus (RSV) and influenza in schoolchildren seen at a children's hospital during the return to school. Methods. Cross-sectional study of patients aged 3­18 years suspected of COVID-19 with a negative test for SARS-CoV-2 between August and October 2021. Participants were stratified by level of education. PCR was used to detect RSV and influenza. Results. A total of 619 children were included: 234 in preschool, 224 in primary and 161 in secondary school; 25.5% (158) tested positive for RS (36.3% in the pre-school level versus 21% in primary and 16% in secondary school). Infection among adolescents was associated with school contact with symptomatic cases (OR 2.5; 95%CI 1­6.80; p = 0.04). No case of influenza was detected. Conclusion. RSV was isolated in one fourth of the study population, with a higher frequency in pre-school; among adolescents, it was associated with school contact with symptomatic cases. No case of influenza was detected.

Association of recurrent upper respiratory tract infections with low production of oxygen intermediates in children

Abstract Objectives: Upper respiratory tract infections in children generally have significant morbidity and mortality. There is little data available about functional immaturity of the immune system and the child's susceptibility to infections at the beginning of their lives, thus, justifying a more specific immunological analysis. Method: Analysis of hemograms and innate and adaptive immune responses in 95 children between age 1 to 6 years with episodes of recurrent respiratory infections (test group n = 39) and without these episodes (control group n = 56) was carried out. The production of reactive oxygen intermediates by peripheral blood cells stimulated by phorbol myristate acetate was analyzed. Additionally, the number of B lymphocytes, auxiliary T lymphocytes, and cytotoxic cells was determined using flow cytometry. Results: Results from both groups did not show statistically significant differences in red blood cells, total leukocytes count, and the differential neutrophils, eosinophils, basophils, lymphocytes, and monocytes count. The analysis of the number of B lymphocytes, auxiliary T lymphocytes (LTCD4), and cytotoxic cells (LTCD8) also did not show any difference between both groups. However, the production of radical oxygen intermediates was significantly reduced in the test group as compared to the control group (p < 0.05). Conclusions: There was no difference in the analysis of hemograms, leukograms, or the number of lymphocytes, LTCD4, LTCD8, or LTCD19. The reduced production of oxygen intermediates in the affected group suggests that these children's microbicide capacity is compromised, which may be related to their recurrent respiratory infections.

Neumonías graves bacterianas en niños menores de 1 año / Severe bacterial pneumonia in children under 1 year of age / Pneumonias bacterianas graves em crianças menores de 1 ano

RESUMEN La neumonía es una infección común y potencialmente grave que tiene una prevalencia importante en la infancia y causa más muerte que cualquier otra enfermedad en el mundo en niños menores de 5 años. Con el objetivo de caracterizar el comportamiento de neumonía grave bacteriana en los menores de 1 año, ingresados en la unidad de cuidados intensivos pediátrico, en el 2do semestre del año 2019.Se realizó un estudio descriptivo, observacional y retrospectivo en este año. El universo estuvo constituido por 37 pacientes a los que se les diagnosticó neumonía que requirió ingreso hospitalario y la muestra quedó representada por 32 pacientes que cumplieron con los criterios de inclusión y exclusión. El grupo de 0-4 meses(50%), el sexo masculino (68.8 %), la zona rural (71.9%), la vía de ingreso por cuerpo de guardia (56.3 %), la estadía hospitalaria menor de 72 horas en UTIP (68.8 %) y las acciones de enfermería independientes (46.8%), fueron los hallazgos más significativos encontrados. El grupo de edad entre 0-4 meses, del sexo masculino y de procedencia rural predominó en el estudio. El cuerpo de guardia fue la vía de ingreso que más se utilizó. Los pacientes tuvieron una estadía hospitalaria menor de 3 días y las acciones de enfermería independientes en la neumonía grave bacteriana fueron las que más se utilizaron.

ABSTRACT Pneumonia is a common and potentially serious infection that has a significant prevalence in childhood and causes more death than any other disease in the world in children under the age of 5. With the aim of characterizing the behavior of severe bacterial pneumonia in children under 1 year, admitted to the pediatric intensive care unit, in the 2nd semester of 2019. A descriptive, observational and retrospective study was conducted this year. The universe consisted of 37 patients who were diagnosed with pneumonia that required hospital admission and the sample was represented by 32 patients who met the inclusion and exclusion criteria. The group of 0-4 months (50%), the male sex (68.8%), the rural area (71.9%), the route of admission by guard corps (56.3%), the hospital stay less than 72 hours in PICU (68.8%) and the independent nursing actions (46.8%), were the most significant findings found.The age group between 0-4 months, male and rural origin predominated in the study. The guard corps was the most widely used route of entry. Patients had a hospital stay of less than 3 days and independent nursing actions in severe bacterial pneumonia were the most widely used.

RESUMO A pneumonia é uma infecção comum e potencialmente grave que tem uma prevalência significativa na infância e causa mais morte do que qualquer outra doença no mundo em crianças menores de 5 anos. Como objetivo de caracterizar o comportamento de pneumonia bacteriana grave em crianças menores de 1 ano, internado na unidade de terapia intensiva pediátrica, no 2º semestre de 2019. Este ano, foi realizado um estudo descritivo, observacional e retrospectivo. O universo era composto por 37 pacientes diagnosticados com pneumonia que necessitavam de internação hospitalar e a amostra foi representada por 32 pacientes que atenderam aos critérios de inclusão e exclusão. O grupo de 0-4 meses (50%), o sexo masculino (68,8%), a área rural (71,9%), a rota de internação por corpo de guarda (56,3%), a internação hospitalar inferior a 72 horas no PICU (68,8%) e as ações independentes de enfermagem (46,8%), foram os achados mais significativos encontrados. A faixa etária entre 0-4 meses, de origem masculina e rural, predominou no estudo. O corpo de guarda foi a rota de entrada mais utilizada. Os pacientes tiveram uma internação hospitalar de menos de 3 dias e as ações independentes de enfermagem em pneumonia bacteriana grave foram as mais utilizadas.

Antimicrobial prescription trends in pediatric inpatients at tertiary care teaching hospital

Background: Use of antibiotics in special population like children is not same as adult. Pediatric age group will have difference in pharmacokinetics, pharmacodynamics, efficacy, and safety of drugs. In children, the maturity of major organs will be in developing stage which would affect the absorption, metabolism, distribution, and excretion of drugs. Hence, irrational prescription of drugs may lead to many adverse effects ranging from mild to severe. In developing countries like India, we do not have much unbiased information on the currently used drugs. Hence, the current study focused on antibiotic use among pediatric population using data from a tertiary care teaching hospital. Aim and Objectives: The objectives of the study were as follows: (i) To observe antibiotic prescription trends in in-patients of pediatric ward and (ii) to analyze rationality of antibiotic prescription. Materials and Methods: It is a prospective observational study which was conducted over a period of 1 year. Institutional Ethics Committee approval was taken before conducting the study. The data of inpatients of pediatric ward were collected in a separate well-designed preform. Inpatients with age group of 0–14 years were included in the study. Results: Out of 1050 patients, 471 were below the age group of 1 year, 220 patients were between 1 and 5 years, and 359 patients were above the age of 5 years. The percentage of patients with antibiotic prescribed was 92.1%. Respiratory tract infections were predominantly seen among children, especially bronchopneumonia was seen in 6.6% of the patients. Among the antibiotics, amikacin (483) was most commonly prescribed followed by cefotaxime (414) and ceftriaxone (301). Conclusion: In our study, we have found that antimicrobials were most commonly used drugs in the form of injectable. To prevent development of antimicrobial resistance, there is necessary of antibiotic policy in each and every hospitals of India.

Impact of morbidity among under-five children: A meta-analysis

The burden of morbidity and mortality among infants is the highest in developing countries. The future economic growth of a country depends upon the well-being of the infants of today; hence, infants need the utmost attention of society through organized medical care and social activities. Feeding infants and young children properly are essential for their growth, development, nutritional status, health, and survival. Improper feeding practices may lead to irreversible outcomes like malnutrition, infectious diseases, attention deficit, memory failure, lower IQ, and lifelong poor cognitive and behavioral development. This review was taken to assess the cause, prevalence, and impact of various morbidities during infancies. The literature search covered both conceptual and specific literature. The specific literature search was on the assessment of morbidities among infants. Morbidities were further classified into diarrhea, acute respiratory infections (ARIs), and fever. Factors affecting each morbidity during the first year of life were classified as International and Indian studies. The studies were further categorized based on methodology as cross-sectional, prospective studies, systematic reviews, and meta-analysis. We conclude that the incidence of morbidities specifically ARIs, diarrhea, and fever have a debilitating effect on the growth and development of infants. Further research is required to assess the impact of morbidity on growth and development in children.

Sistema de seguimiento y control eProtect infecciones respiratorias / eProtect respiratory infection monitoring and control system

Las infecciones del tracto respiratorio (ITR) son una de las principales causas de morbilidad y mortalidad en todo el mundo, y representan el 4,4 % de las muertes en todas las edades. A nivel mundial, se han observado disminuciones en la mortalidad causada por las ITR después de la introducción de las vacunas conjugadas contra Haemophilus influenzae tipo b, tos ferina y neumocócica. Sin embargo, las ITR siguen siendo una de las principales causas de mortalidad entre los niños pequeños y los ancianos en los países de ingresos bajos y medios. Se planteó un estudio donde se aplicó un sistema de seguimiento que sirvan para monitorear la vigilancia de las infecciones respiratorias agudas (IRA) en servicios de salud, por laboratorio y en unidades centinela en Perú. Participaron 67 médicos generales o cirujanos de 8 servicios de pediatría. 1453 casos de las IRA fueron de etiología viral, identificando al virus sincitial respiratorio (63,94%), Influenza AH1N1 (16,59%); en el caso de las neumonías bacterianas se aislaron Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae y Streptococcus beta hemolyticus. Durante la última década de reforma del sistema de salud, Perú ha hecho de la construcción de su sistema de APS una prioridad. Sin embargo, el sistema se enfrenta actualmente a desafíos para proporcionar atención de alta calidad y valor a la población debido a deficiencias en varias dimensiones. El sistema de APS ayudará a responder a la transición epidemiológica actual y futura epidemia brotes de manera más eficaz(AU)

Respiratory tract infections (RTIs) are one of the leading causes of morbidity and mortality worldwide, accounting for 4.4% of deaths in all ages. Globally, declines in mortality from RTIs have been observed after the introduction of Haemophilus influenzae type b, pertussis, and pneumococcal conjugate vaccines. However, RTIs remain a leading cause of mortality among young children and the elderly in low- and middle-income countries. A study was proposed where a monitoring system was applied to monitor the surveillance of acute respiratory infections (ARI) in health services, by laboratory and in sentinel units in Peru. A total of 67 general practitioners or surgeons from 8 pediatric services participated. 1453 cases of ARI were of viral aetiology, identifying the respiratory syncytial virus (63.94%), Influenza AH1N1 (16.59%); in the case of bacterial pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus beta hemolyticus were isolated. During the last decade of health system reform, Peru has made building its PHC system a priority. However, the system currently faces challenges in providing high quality and value care to the population due to deficiencies in several dimensions. The PHC system will help respond to current epidemiological transition and future epidemic outbreaks more effectively(AU)

Climate changes, air pollution and allergic diseases in childhood and adolescence

Abstract Objective: To analyze the impacts of climate change on the development of immature respiratory and immune systems in children. Source of data: The authors of the present study performed a non-systematic review of English, Spanish, and Portuguese articles published in the last five years in databases such as PubMed, EMBASE, and SciELO. The terms used were air pollution OR climate changes OR smoke, AND children OR health. Synthesis of data: The increase in the prevalence of some diseases, such as allergic ones, is attributed to the interactions between genetic potential and the environment. However, disordered growth combined with inadequate waste management has caused problems for the planet, such as heatwaves, droughts, forest fires, increased storms and floods, interference in food crops and their nutritional values, changes in the infectious disease pattern, and air pollution resulting from the continuous use of fossil fuels. Children, beings still in the development stage with immature respiratory and immune systems, are the primary victims of the climate crisis. Conclusions: The authors documented that prenatal and postnatal exposure to ambient air pollutants will accelerate or worsen the morbidity and mortality of many health conditions, including allergic diseases. Ambient air pollutants change the microbiota, interfere with the immune response, and take direct action on the skin and respiratory epithelium, which facilitates the penetration of allergens. Understanding how the children and adolescent health and well-being are affected by climate change is an urgent matter.

Infections respiratoires aigües virales chez les enfants de moins de 15 ans à Conakry: étiologies et prise en charge / Acute viral respiratory infections of children aged 0-15 years in the city of Conakry: aetiologies and management

Introduction. Les infections respiratoires aiguës (IRA) sont des pathologies ubiquitaires très fréquentes, touchant aussi bien les adultes que les enfants. L'inclusion des vaccins conjugués, contre les pneumocoques et l'Haemophilus influenzae type B a modifié l'épidémiologie en réduisant la prévalence de ces bactéries dans les atteintes infectieuses respiratoires, la prédominance virale est devenue la règle. Notre travail avait pour objectif d'identifier les principaux virus responsables d'IRAS chez les enfants au service de pédiatrie de Donka de décrire la prise en charge des enfants. Patients et méthodes. Étude descriptive prospective de 6 mois allant du 01 Avril au 30 Septembre 2022 incluant les enfants admis au service pour IRAS dont une PCR a été réalisée sur prélèvement nasopharyngé. Résultats. Une proportion de 3,3% des 1584 enfants avaient une IRA virale. 51,1% avaient moins de 5 ans. La proportion des filles était de 63,05% et 76,09% des enfants étaient vaccinés selon le programme élargi de vaccination (PEV). Les motifs de consultation les plus fréquents étaient : fièvre, difficulté respiratoire, asthénie physique, myalgie et toux. La bronchiolite était le diagnostic le plus fréquent. Le diagnostic clinique et radiologique était dominé par la bronchiolite, la bronchopneumonie et la pneumonie. La PCR était positive dans 3,26% des cas dont 2/3 pour le virus influenza et 1/3 pour le coronavirus. Le paracétamol, l'oxygénation, l'antibiothérapie et le sérum physiologique dominaient le traitement. Conclusion. La prévalence des IRA reste élevée avec une faible implication virale. Une étude plus poussée comprenant la microbiologie des prélèvements nasopharyngés et la PCR est nécessaire

Introduction. Acute respiratory infections (ARI) are very common ubiquitous pathologies, affecting both adults and children. The inclusion of conjugate vaccines, against pneumococci and Haemophilus influenzae type b, has changed the epidemiology by reducing the prevalence of these bacteria in respiratory infectious diseases, viral predominance has become the rule. The aim of our study was to identify the main viruses responsible for ARI in children at the Donka Pediatric Department and to secribe the management of patients. Patients and methods. This was a prospective descriptive study of 6 months from 01 April to 30 September 2022 including children admitted to the service for IRAS whose PCR was performed on nasopharyngeal swab. Results. A proportion of 3.3% of the 1584 children had viral SARI. 51.1% were under 5 years of age. The proportion of girls was 63.05% and 76.09% of children were vaccinated according to the EPI. The most common reasons for consultations were fever, difficulty breathing, physical asthenia, myalgia and cough. Bronchiolitis was the most common diagnosis, Clinical and radiological diagnosis was dominated by bronchiolitis, bronchopneumonia and pneumonia. PCR was positive in 3.26% of cases including 2/3 for influenza virus and 1/3 for coronavirus. Paracetamol, oxygenation, antibiotic therapy and saline dominated treatment. Conclusion. The prevalence of SARI remains high with low viral involvement. Further study including bacteriology of nasopharyngeal specimens and PCR is needed

Association between Environmental Factors and the Incidence of Acute Respiratory Infection in Children under Five in East Nusa Tenggara, Indonesia

@#Introduction: ARI (Acute Respiratory Infection) is one of the main causes of death among children under five in many countries worldwide. In Indonesia, 10% of ARI cases occur in East Nusa Tenggara, which is the highest prevalence of ARI in this country, with 90% of them leading to under-five mortality. There are various factors that cause the prevalence of ARI. In East Nusa Tenggara itself, environmental factors are suspected to be the risk factors for this disease. This study aims to analyse the association between environmental factors and the incidence of ARI among children under five years old in East Nusa Tenggara. Methods: A cross-sectional study was conducted by analysing secondary data sets obtained from DHS, with a total of 337 subjects examined in this study. Multivariate logistic regression was applied to investigate the association between ARI and various environmental factors. Results: This study found that the prevalence of ARI among children under five years old in East Nusa Tenggara was 9.04% of all subjects. ARI was significantly associated with the types of residence (OR 2.2, 95%CI 1.1-4.3) and passive smoking status (OR 4.7, 95%CI 1.8-12.4) as its risk factors. In addition, there was strong association between ARI and the types of roof (OR 3.3, 95%CI 1.3-8.9) as its protective factor. Conclusion: Based on the findings of this study, it can be concluded that the incidence of ARI in children under five years old was closely associated with residential area, smoke exposure, and roof materials.

Vivir en residencias de ancianos ¿Factor pronóstico de mortalidad en infecciones respiratorias? / Living in nursing homes. Prognostic factor of mortality in respiratory infections?

Resumen La infección respiratoria es uno de los diagnósticos más frecuentes en el ámbito sanitario asociado a una elevada mortalidad. Residir en una residencia de ancianos podría ser un factor de riesgo predictivo de mortalidad. El objetivo fue estudiar las características de los pacientes con infección respiratoria según procedieran de su domicilio o de residencias de ancianos, y analizar si la procedencia es un factor de riesgo de mortalidad. Se trata de un estudio de cohortes prospectivo. Participaron 208 pacientes con infección respiratoria ingresados en un Servicio de Medicina Interna. Se recogieron variables clínicas, analíticas, epidemio lógicas, pronosticas y terapéuticas realizándose un análisis multivariado. Los pacientes tuvieron una edad media 83 años y 135 (64.9%) procedían de su domicilio. El 44.7% presentaban insuficiencia cardiaca como antecedente clínico. La mayoría cumplían criterios de pluripatología, polifarmacia y tenían una dependencia moderada según índice de Barthel. La mortalidad durante el internamiento hospitalario fue de 16 pacientes (7.7%), y durante el seguimiento a seis meses de 37 (17.8%). Los procedentes de residencias de ancianos presentaron una mayor mortalidad, un 37%, que los que vivían en su propio domicilio, un 19,3% (p = 0.005). En el análisis multivariado los factores pronósticos de mortalidad fueron un mayor nivel de urea al ingreso (OR = 2.33, IC 95% = 1.06-5.11) y la no prescripción de oxígeno al alta (OR = 2.96, IC 95% = 1.29-6.82). En conclusión, se observó un mayor porcentaje de mortalidad en los pacientes procedentes de residencias de ancianos, sin embargo, es necesario realizar más investigaciones para clarificar si el residir en un centro geriátrico puede ser considerado un factor de riesgo independiente de mortalidad.

Abstract Respiratory infection is one of the most frequent diagnoses associated with high mortality. Living in a nursing home could be a predictive risk factor for mortality. The objective was to study the characteristics of patients with respi ratory infection according to whether they came from their home or nursing homes, and to analyze whether their origin is a risk factor for mortality. It was a prospective cohort study, that included 208 patients with respiratory infection admitted to the Internal Medicine Service, that participated in the study. Clinical, analytical, epidemiologi cal, prognostic and therapeutic variables were collected and a multivariate analysis was performed. Patients had an average age of 83 years and 64.9% came from their home. 44.7% had heart failure as a clinical history. Most of patients met criteria of pluripatology, polypharmacy and were moderately dependent according to Barthel's index. Mortality at admission was 16 patients (7.7%), and during the six-month follow-up of 37 patients (17.8%). Those coming from nursing homes had a higher mortality rate, 37%, than those who lived in their own home, 19.3% (p = 0.005). In the multivariate analysis, the prognostic factors for mortality were a higher level of urea at admission (OR = 2.33, IC 95% = 1.06-5.11) and the non-prescription of oxygen at discharge (OR = 2.96, IC 95% = 1.29-6.82). In conclusion, a higher percentage of mortality is observed in patients coming from nursing homes, however further research is needed to clarify whether living in a residence for elderly can be considered an independent risk factor for mortality.

Recomendaciones para el manejo de las infecciones respiratorias agudas bajas en menores de 2 años. Actualización 2021 / Recommendations for the management of acute lower respiratory infections in children under 2 years of age. Update 2021

Las infecciones respiratorias agudas bajas (IRAB) continúan representando una importante causa de morbimortalidad en nuestro medio. El manejo normatizado de casos constituye una valiosa herramienta para enfrentarlas.Además de los aspectos relacionados con el diagnóstico y tratamiento de estas enfermedades, el análisis de factores de riesgo (tanto biológicos como socioambientales), desde una perspectiva local y actual, permitie implementar medidas efectivas de control y/o prevención, así como identificar aquellos pacientes susceptibles de presentar formas graves o complicaciones.Desde 1996 la Sociedad Argentina de Pediatría asumió el desafío de generar un documento que guíe el manejo integral de los pacientes con IRAB. En esta cuarta actualización se incluyen los últimos adelantos en el tema.

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them.In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications.Since 1996, the Sociedad Argentina de Pediatría asumed the challenge of generating a document that guides the comprehensive management of patients with ARI. This fourth update includes the latest advances on the subject.

Impacto del uso de PCR múltiple en diagnóstico etiológico y tratamiento de infecciones respiratorias agudas en un hospital privado del norte del país / Impact of the use of multiplex PCR on etiological diagnosis and treatment of acute respiratory infections in a private hospital of the north of the country

Resumen Antecedentes y objetivo: Las enfermedades del sistema respiratorio son causa frecuente de prescripción de antibióticos. Actualmente se emplean nuevas tecnologías para su diagnóstico como el FilmArray Respiratory Panel. El objetivo de este estudio es identificar la correlación entre el diagnóstico y tratamiento de infecciones de vías respiratorias con el resultado de PCR para virus respiratorios. Material y métodos: Estudio descriptivo, transversal, retrospectivo, se incluyeron 134 pacientes atendidos en el Hospital Christus Muguerza en Saltillo, Coahuila. Para todos los casos se analizaron los resultados del panel y el tratamiento que recibieron los pacientes. Resultados: El 58 % recibió tratamiento antibiótico a su ingreso, el 13 % tratamiento combinado (antibiótico + antiviral), 27 % recibió tratamiento sintomático y el 2 % fue tratado con antiviral de primera instancia. Posterior al resultado el 38 % continuó con antibiótico, el 30 % con antibiótico y antiviral, 13.8 % se manejó con antiviral y el 18.2 % con tratamiento sintomático. Conclusión: A pesar de la alerta mundial por la resistencia a los antimicrobianos se sigue tratando a los pacientes con antibióticos, por una situación que se cree está influenciada por varios factores.

Abstract Background and objective: Respiratory system diseases represent one of the leading cause of prescription of antibiotics. At present, new technologies for the diagnosis are being used, including the FilmArray Respiratory Panel. The objective was to identify the correlation between the diagnosis and treatment of respiratory tract infections with the result of PCR for respiratory viruses. Material and methods: Descriptive, cross-sectional, restrospective study. 134 patients were included treated at the Christus Muguerza Hospital in Saltillo, Coahuila. For all cases, the positive results of this test and the treatment patients received were analyzed. Results: 58 % received antibiotic treatment at admission, 13 % received combined treatment (antibiotic + antiviral), 27 % received symptomatic treatment since their admission and 2 % whit antiviral. After receiving a positive result for respiratory viruses, 38 % continued with antibiotics, 30 % with antibiotics and antivirals, 13.8 % only managed with antivirals and 18.2% with symptomatic treatment. Conclusion: Although we are currently on global alert for resistance to antibiotics, there is a lack of awareness about the prescription of antibiotics, due to a situation which is believed to be influenced by several factors.

Virus respiratorios y características clínico-epidemiológicas en los episodios de infección respiratoria aguda / Respiratory viruses and clinical- epidemiological characteristics in episodes of acute respiratory infection

RESUMEN Con el objetivo de determinar la frecuencia viral y las características clínico-epidemiológicas en los episodios de infección respiratoria aguda de pacientes del Instituto Nacional de Salud del Niño San Borja en Lima, se analizó la información de los episodios de pacientes que requirieron al menos una prueba de inmunofluorescencia directa desde el 1 de enero del 2017 al 31 de diciembre del 2018. Se identificaron 1153 episodios en 707 pacientes. La mediana de la edad fue de 1 año y el 55% fueron del sexo masculino. La frecuencia viral fue del 13,4%; el virus respiratorio sincitial se identificó en el 10,7% de los episodios. La frecuencia viral fue mayor en los menores de 1 año (16,2%); en aquellos con enfermedad congénita respiratoria (38,9%) y durante el otoño (24,2%). Los síntomas más comunes fueron tos (70,3%) y fiebre (53,4%); y los principales diagnósticos fueron neumonía viral (31,8%) y bronquiolitis (23,4%). Se concluye que la frecuencia viral respiratoria estuvo relacionada con la edad, estacionalidad y patología preexistente.

ABSTRACT The aim of the study was to determine the viral frequency and clinical-epidemiological characteristics in the episodes of acute respiratory infection in patients of the Instituto Nacional de Salud del Niño San Borja in Lima, the information of the episodes of patients who required at least one direct Immunofluorescence test from January 1, 2017 to December 31, 2018 was analyzed. 1153 episodes were identified in 707 patients. The median age was 1 year and 55% were male. The viral frequency was 13.4%; respiratory syncytial virus was identified in 10.7% of the episodies. The viral frequency was higher in children under 1 year of age (16.2%); in those with congenital disease respiratory (38.9%) and during the autumn (24.2%). The most common symptoms were cough (70.3%) and fever (53.4%); and the main diagnoses, viral pneumonia (31.8) and bronchiolitis (23.4%). It is concluded that the respiratory viral frequency was related to age, seasonality and pre-existing pathology.

Virus respiratorios y características clínico-epidemiológicas en los episodios de infección respiratoria aguda / Respiratory viruses and clinical- epidemiological characteristics in episodes of acute respiratory infection

RESUMEN Con el objetivo de determinar la frecuencia viral y las características clínico-epidemiológicas en los episodios de infección respiratoria aguda de pacientes del Instituto Nacional de Salud del Niño San Borja en Lima, se analizó la información de los episodios de pacientes que requirieron al menos una prueba de inmunofluorescencia directa desde el 1 de enero del 2017 al 31 de diciembre del 2018. Se identificaron 1153 episodios en 707 pacientes. La mediana de la edad fue de 1 año y el 55% fueron del sexo masculino. La frecuencia viral fue del 13,4%; el virus respiratorio sincitial se identificó en el 10,7% de los episodios. La frecuencia viral fue mayor en los menores de 1 año (16,2%); en aquellos con enfermedad congénita respiratoria (38,9%) y durante el otoño (24,2%). Los síntomas más comunes fueron tos (70,3%) y fiebre (53,4%); y los principales diagnósticos fueron neumonía viral (31,8%) y bronquiolitis (23,4%). Se concluye que la frecuencia viral respiratoria estuvo relacionada con la edad, estacionalidad y patología preexistente.

ABSTRACT The aim of the study was to determine the viral frequency and clinical-epidemiological characteristics in the episodes of acute respiratory infection in patients of the Instituto Nacional de Salud del Niño San Borja in Lima, the information of the episodes of patients who required at least one direct Immunofluorescence test from January 1, 2017 to December 31, 2018 was analyzed. 1153 episodes were identified in 707 patients. The median age was 1 year and 55% were male. The viral frequency was 13.4%; respiratory syncytial virus was identified in 10.7% of the episodies. The viral frequency was higher in children under 1 year of age (16.2%); in those with congenital disease respiratory (38.9%) and during the autumn (24.2%). The most common symptoms were cough (70.3%) and fever (53.4%); and the main diagnoses, viral pneumonia (31.8) and bronchiolitis (23.4%). It is concluded that the respiratory viral frequency was related to age, seasonality and pre-existing pathology.

Máscaras caseiras na pandemia de COVID-19: recomendações, características físicas, desinfecção e eficácia de uso / Mascarillas caseras en la pandemia de COVID-19: recomendaciones, características físicas, desinfección y eficacia de uso / Homemade masks in the COVID-19 pandemic: recommendations, physical characteristics, disinfection and efficacy

Objetivo: Descrever as recomendações, características físicas, métodos de desinfecção e eficácia de uso de máscaras caseiras na redução da transmissão da COVID-19. Métodos: Realizou-se busca nas bases de dados MEDLINE, SciELO e Google Scholar, além das recomendações oficiais de uso. Resultados: Foram incluídas 31 referências. A capacidade de filtração de tecidos variou entre 5% e 98%. Tecidos 100% algodão em duas ou três camadas apresentaram eficácia de filtração entre 70% e 99% em estudos in vitro. Máscaras caseiras, cirúrgicas e respiradores apresentaram respirabilidade entre 2,2 e 3,0 Pascal. A capacidade de redução da propagação de microrganismos por pessoas usando máscaras caseiras foi três vezes menor do que usando máscaras cirúrgicas, embora tenha sido superior ao não uso de máscaras. Conclusão: A respirabilidade de máscaras caseiras mostrou-se adequada, enquanto a capacidade de filtração parece ser inferior à das máscaras cirúrgicas, mas superior a não se usar máscara. Não há evidências que respaldem a eficácia e efetividade das máscaras caseiras.

Objetivo: Describir las recomendaciones, características físicas, métodos de desinfección y efectividad de mascarillas caseras para reducir la transmisión de COVID-19. Métodos: La búsqueda se realizó en las bases de datos MEDLINE, SciELO y Google Scholar, además de las recomendaciones oficiales de uso. Resultados: Se incluyeron 31 referencias. La capacidad de filtración de los tejidos varió entre 5% y 98%. Los tejidos al 100% de algodón, en dos o tres capas, mostraron eficiencia de filtración entre 70% y 99%, en estudios in vitro. Mascarillas caseras, quirúrgicas y de respiradores mostraron respirabilidad entre 2,2 y 3,0 Pascal. La capacidad de reducir la propagación de microorganismos por personas que usan máscarillas caseras fue tres veces menor que cuando usaban mascarillas quirúrgicas, pero superior a no usarlas. Conclusión: La respirabilidad de las mascarillas caseras puede ser adecuada, mientras que la eficiencia de filtración parece ser inferior a la de las mascarillas quirúrgicas, pero superior a no utilizar mascarilla. No hay evidencia que respalde su eficacia y efectividad.

Objective: To describe the recommendations, physical characteristics, disinfection methods and efficacy of the use of homemade face masks to reduce COVID-19 transmission. Methods: We searched MEDLINE, SciELO, and Google Scholar, in addition to the official recommendations for the use of masks. Results: Thirty-one references were included. Fabric filtration efficiency ranged from 5% to 98%. The filtration efficacy of three layered 100% cotton fabric face masks ranged from 70% and 99% in vitro studies. Homemade, surgical, and respirator masks showed breathability between 2.2 and 3.0 Pascal. The capacity to reduce the spread of microorganisms by people wearing homemade face masks was three times lower when compared to those wearing surgical masks, although this capacity was higher when compared to those who did not wear masks. Conclusion: The breathability of homemade masks proved to be adequate, while the filtration ability seemed to be lower than that of surgical masks, but it was better than not wearing any masks at all. There is no evidence to support the efficacy and effectiveness of homemade masks.

Contaminación ambiental e infecciones respiratorias en niños / Environmental pollution and respiratory infections in children

La contaminación ambiental afecta a más del 90% de la población mundial, y es considerado un factor de morbi-mortalidad respiratoria desde mediados de 1900. Sin embargo, al día de hoy las políticas públicas no han logrado mejorar en forma sustancial la calidad del aire. Siendo causante de más de 3.7 millones de muertes anuales según datos OMS. Los niños son los principales afectados debido a diferencias anatómicas, fisiológicas y de estilos de vida. Dentro de las complicaciones más frecuentes se encuentran las infecciones respiratorias, pero además puede verse afectado el desarrollo neurológico, patologías oncológicas, enfermedades crónicas (diabetes y asma), alteraciones cardiovasculares, malformaciones congénitas y salud mental entre otros. En el siguiente artículo se revisará la evidencia científica en relación a la contaminación ambiental, como afecta al sistema inmune y el microbioma, generando un aumento en las infecciones respiratorias de los niños.

Environmental pollution affects more than 90% of the world population, and is considered a factor of respiratory morbidity and mortality since the mid-1900s. However, to date public policies have not substantially improved air quality. Being the cause of more than 3.7 million deaths annually according to data from the World Health Organization (WHO), children are more susceptible due to anatomical, physiological and lifestyle differences with adults. Respiratory infections are among the most frequent complications, but neurological development, oncological pathologies, chronic diseases (diabetes and asthma), cardiovascular disorders, congenital malformations and mental health, can be attributed to pollution. The following article will review the scientific evidence of environmental pollution, how it affects the immune system and the microbiome, generating an increase in respiratory infections in children.