Research progress of respiratory microecology and its relationship with respiratory tract diseases / 中华实用儿科临床杂志

With the development of microorganism detection technology and lower respiratory tract specimen collection technology, respiratory microecology has been widely understood.There are many kinds of respiratory flora, showing a high degree of homology between the various parts, but different dominant flora in each part.As an organ connected with the outside world, respiratory microecology is affected by many factors, such as environment, antibiotics, feeding mode, delivery mode, etc.Abundant studies have found that respiratory microecology is closely related to various respiratory tract diseases.The interaction between respiratory flora and the host can affect the occurrence and development of many respiratory tract diseases, such as respiratory tracy infections, asthma, chronic obstructive pulmonary disease, pulmonary cystic fibrosis, etc.Therefore, this paper mainly describe the composition of respiratory tract microecology, influencing factors and its relationship with diseases, and provides new ideas for clinicians in the diagnosis and treatment of respiratory diseases and drug development.

Functional respiratory re-education interventions in people with respiratory disease: a systematic literature review / Intervenciones de reeducación funcional respiratoria en la persona con enfermedad respiratoria: revisión sistemática de la literatura / Intervenções de reeducação funcional respiratória na pessoa com doença respiratória: revisão sistemática da literatura

ABSTRACT Objectives: to identify nursing interventions in rehabilitation, within the scope of functional respiratory reeducation, which allow a respiratory function improvement in people with respiratory disease. Methods: systematic literature review using the MEDLINE database search, adopting the PICO mnemonic and the Joanna Briggs Institute's assessment of the level of evidence and methodological quality. The search for randomized controlled trials was carried out in June 2021 considering the period from 2015 to 2020, in English or Portuguese. Results: a sample of nine randomized controlled trials with methodological quality was obtained which highlighted the use of positive expiratory pressure devices as an important component and intervention for respiratory functional reeducation. Conclusions: nursing interventions in rehabilitation with an emphasis on functional respiratory reeducation are essential, showing improvements in people's general health.

RESUMEN Objetivos: identificar las intervenciones de enfermería en rehabilitación, en el ámbito de la reeducación funcional respiratoria, que permiten una mejoría de la función respiratoria en persona con enfermedad respiratoria. Métodos: revisión sistemática de la literatura con recurso a la investigación en la base de datos MEDLINE, adoptando la mnemónica PICO y evaluación del nivel de evidencia y calidad metodológica señalado por Joanna Briggs Institute. En el mes de junio de 2021, fue realizada la investigación de estudios randomizados controlados, en el intervalo de 2015 a 2020, en inglés o portugués. Resultados: se obtuvo muestra de nueve estudios randomizados controlados, con calidad metodológica, de los cuales se destaca el uso de dispositivos de presión espiratoria positiva como una importante componente e intervención de reeducación funcional respiratoria. Conclusiones: las intervenciones de enfermería en rehabilitación con énfasis en la reeducación funcional respiratoria son fundamentales, evidenciándose mejorías en la salud general de las personas.

RESUMO Objetivos: identificar as intervenções de enfermagem em reabilitação, no âmbito da reeducação funcional respiratória, que permitem uma melhoria da função respiratória na pessoa com doença respiratória. Métodos: revisão sistemática da literatura com recurso à pesquisa na base de dados MEDLINE, adotando a mnemónica PICO e a avaliação do nível de evidência e qualidade metodológica salientado por Joanna Briggs Institute. No mês de junho de 2021, foi realizada a pesquisa de estudos randomizados controlados, no intervalo de 2015 a 2020, em inglês ou português. Resultados: obteve-se amostra de nove estudos randomizados controlados, com qualidade metodológica, dos quais se destaca o uso de dispositivos de pressão expiratória positiva como uma importante componente e intervenção de reeducação funcional respiratória. Conclusões: as intervenções de enfermagem em reabilitação com ênfase na reeducação funcional respiratória são fundamentais, evidenciando-se melhorias na saúde geral das pessoas.

Investigation of Feline calicivirus infection in cats with upper respiratory tract disease in Diyarbakir, Turkey / Investigação de infecção por calicivírus felino em gatos com doença do trato respiratório superior na região de Diyarbakir, Turquia

Feline calicivirus is among the most common pathogenic microorganisms in upper respiratory tract disease (URTD) and oral lesions of cats. It leads to stomatitis, oral ulceration, ocular and nasal discharge, conjunctivitis, fever, lameness, anorexia, hypersalivation, pneumonia, respiratory distress, coughing, and depression in infected cats. This study aimed to determine the role of Feline calicivirus (FCV) in cats with the upper respiratory tract disease in the Diyarbakir region, Turkey, to provide treatment for infected cats and contribute to the disease prophylaxis. The study material consisted of 10 cats (control group) considered to be healthy according to the clinical examination and 20 cats with URTD that were not vaccinated against Feline calicivirus infection of different breeds, ages, and genders brought to Dicle University Veterinary Faculty Prof. Dr. Servet SEKIN Polyclinic with URTD. After routine clinical examinations of the animals, oral and conjunctival swabs and blood samples were taken. Hematological and biochemical analyzes of blood samples were performed. Swab samples were analyzed by the polymerase chain reaction (PCR) method for the diagnosis of the agent. Oral lesions, hypersalivation, ocular and nasal discharge, coughing, and breathing difficulties were seen in clinical examinations of cats with URTD. Feline calicivirus was detected in only one cat's conjunctival swab sample in PCR analyses. As a result, we found that Feline calicivirus infection was present in cats with URTD in the Diyarbakir region, and 5% positivity was found in cats with clinical symptoms according to PCR analysis.(AU)

O calicivírus felino está entre os microrganismos patogênicos mais comuns nas doenças do trato respiratório superior de gatos, determinando estomatites, ulcerações orais, descarga ocular e nasal, conjuntivite, febre, manqueira, anorexia, hipersalivação, pneumonia, distúrbios respiratórios, tosse e depressão. O presente trabalho foi delineado para determinar o papel do calicivírus felino (CVF) em gatos com doenças do trato respiratório superior na região de Diyarbakir, Turquia. Com o objetivo de orientar a prescrição do tratamento para os gatos infectados e contribuir com a profilaxia da doença. O material de estudo consistiu em 10 gatos saudáveis sem qualquer problema de saúde e 20 gatos acometidos por doenças do trato respiratório superior que não haviam sido vacinados contra a infecção pelo calicivírus felino. Os animais de diferentes raças, idades e gêneros foram encaminhados para a Universidade de Dicle, na Faculdade de Veterinária, na policlínica Professor Dr. Servet Sekin. Após o exame clínico de rotina dos animais, foram colhidos swabs orais e da conjuntiva e amostras de sangue. Análises hematológicas e bioquímicas das amostras de sangue foram realizadas e os swabs foram analisados pelo método da reação em cadeia pela polimerase (PCR) para diagnóstico do agente. Nos gatos infectados foram constatadas: lesões orais, hipersalivação, descargas oculares e nasais, tosse e dificuldade respiratória. O calicivírus felino foi detectado pela técnica de PCR no swab conjuntival de apenas um gato. A conclusão obtida foi que a infecção pelo calicivírus felino foi detectada pela técnica de PCR na região de Diyarbakir, Turquia, em gatos com doença do trato respiratório superior com a frequência de 5%.(AU)

Kinesiología respiratoria en pacientes asmáticos en edad escolar / Respiratory physiotherapy in asthmatic school-age patients

The role of respiratory physiotherapy in the asthmatic school-age patient is based on three pillars: evaluative, therapeutic and educational, which have gradually been incorporated and developed. Respiratory physiotherapy has advanced significantly, incorporating cardiorespiratory function tests into its diagnostic and follow-up services, allowing the execution of these tests at the primary level of healthcare. Manual and instrumental respiratory physiotherapy techniques increase the level of control of asthmatic patients. The evidence found in literature invites us to innovate the methodology we use at educational interventions in children and adolescents, with the inclusion of new technologies to motivate and generate meaningful learning in patients as well as in their parents/caregivers, thus improving adherence to treatment and achieving the desired control of the disease

El rol de la kinesiología respiratoria en el paciente asmático en etapa escolar, se basa en tres pilares: evaluativo, terapéutico y educativo, los cuales se han ido paulatinamente incorporando y desarrollando con el paso del tiempo. La kinesiología respiratoria ha avanzado significativamente, incorporando pruebas de función cardiorrespiratoria a su arsenal de prestaciones diagnósticas y de seguimiento, permitiendo la ejecución de éstas en el nivel primario de atención. Mediante la utilización de técnicas manuales e instrumentales, permite potenciar el nivel de control de los pacientes asmáticos. La literatura nos invita a innovar en la metodología a utilizar para realizar una intervención educativa efectiva en niños y adolescentes, incluyendo las nuevas tecnologías disponibles para motivar y generar un aprendizaje significativo en el paciente como en los padres/cuidadores, mejorando así la adherencia al tratamiento y por ende logrando el anhelado control de la enfermedad

Correlation between clinical signs of feline conjunctivitis and molecular detection of felid herpesvirus-1, feline calicivirus, chlamydophila felis and mycoplasma felis in cats from shelters in Rio de Janeiro / Correlação entre sinais clínicos da conjuntivite felina e a detecção molecular de felid herpesvirus-1, feline calicivirus, chlamydophila felis e mycoplasma felis em gatos de abrigos no Rio de Janeiro

Objectives: To perform molecular diagnosis of microbial agents (FHV-1, FCV, Mycoplasma felis, and Chlamydophila felis) in kittens with conjunctivitis and correlate the clinical signs with clinical severity. Material and Methods: A total of 108 conjunctival swab were collected from kittens without (G1; n = 40) and with (G2; n = 68) clinical signs of conjunctivitis. Animals from G2 group were scored from 1 (mild) to 4 (severe) according to the severity of conjunctivitis. All samples were submitted to PCR and RT-PCR. Results: FHV-1 was detected in 62/108 (57.4%) of samples, FCV in 40/108 (37.0%), M. felis in 11/108 (10.2%) and C. felis in 26/108 (24.1%). Mixed infections were detected in 39/108 (36.1%). In G1, 28/40 (70.0%) were positive for one or more agents, in G2, 58/68 (85.3%) were positive (P = 0.03). In 1, single infections by FHV-1were found in 21/40 (52.5%) samples, FCV in 2/40 (5.0%), C. felis in 1/40 (2.5%), and no pathogens were detected in 12/40 (30%) of samples, while mixed infections accounted for 29/40 (72.5%) of the cases. In G2, single FHV-1 infections were found in 31/68 (45.6%) samples, FCV in 10/68 (14.7 %), M. felis in 2/68 (3.0%) and C. felis also in 2/68 (3.0%), and no pathogens were detected in 10/68 (14.7%) samples, while mixed infections accounted for 36/68 (52.0%) of the cases. They were categorized as grade 1, 20/68 (29.4%), grade 2, 14/68 (20.6%), grade 3, 21/68 (30.9%) and grade 4, 13/68 (19.1%). The presence of FHV-1 and FCV is equally distributed among the four categories. More severe clinical signs, scores 3 and 4, are related to coinfections by C. felis and M. felis. Conclusions: FHV-1, FCV, C. felis and M. felis were identified in feline conjunctivitis. Co-infections are related to more severe cases of conjunctivitis.Molecular diagnosis is helpful to detect asymptomatic carriers and is a rapid and accurate method to determine the pathogen of feline conjunctivitis.(AU)

O objetivo deste estudo foi realizar diagnóstico molecular de agentes microbiológicos (FHV-1, FCV, Mycoplasma felis e Chlamydophila felis) em gatos filhotes e associar a presença dos patógenos à gravidade dos sinais clínicos de conjuntivite. Foram coletadas um total de 108 amostras de suabe conjuntival de filhotes felinos assintomáticos (G1; n = 40) e sintomáticos (G2; n = 68). Animais do G2 foram categorizados de 1 (leve) até 4 (grave), de acordo com o quadro clínico de conjuntivite. As 108 amostras foram submetidas à PCR e RT-PCR. O FHV-1 foi detectado em 57,4% das amostras, o FCV em 37%, o M. felis em 10,2% e o C. felis em 24,1%. Coinfecções, por sua vez, foram detectadas em 36,1%. No G1, 70% das amostras foram positivas para um ou mais patógenos. No G2, 85,3% apresentavam infecções (P = 0,03). No G1, monoinfecções por FHV-1 foram diagnosticadas em 52,5% das amostras, por FCV em 5%, por C. felis em 2,5%, e em 30% das amostras analisadas nenhum dos patógenos estudados foi encontrado. Coinfecções, por sua vez, estavam presentes em 72,5% das amostras. No G2, monoinfecções por FHV-1 foram encontradas em 45,6% das amostras, por FCV em 14,7 %, por M. felis em 3% e por C. felis também em 3%. Nenhum dos patógenos estudados foi encontrado em 14,7% das amostras analisadas. Coinfecções, responsáveis por 52% dos casos, foram categorizados como Grau 1 (29,4%), Grau 2 (20,6%), Grau 3 (30,9%) e Grau 4 (19,1%). A presença de FHV-1 e FCV está igualmente distribuída entre as quatro categorias. Os sinais clínicos mais graves (graus 3 e 4) estão relacionados a coinfecções por C. felis e M. felis. Os agentes microbiológicos FHV-1, FCV, C. felis e M. felis foram encontrados em animais com conjuntivite. Coinfecções estão relacionadas aos casos mais graves. Por fim, concluiu-se que o diagnóstico molecular, além de detectar portadores assintomáticos, é um método rápido e acurado para o diagnóstico do patógeno causador da conjuntivite felina.(AU)

Burden of Respiratory Disease in Korea: An Observational Study on Allergic Rhinitis, Asthma, COPD, and Rhinosinusitis

PURPOSE: The Asia-Pacific Burden of Respiratory Diseases (APBORD) study is a cross-sectional, observational one which has used a standard protocol to examine the disease and economic burden of allergic rhinitis (AR), asthma, chronic obstructive pulmonary disorder (COPD), and rhinosinusitis across the Asia-Pacific region. Here, we report on symptoms, healthcare resource use, work impairment, and associated costs in Korea. METHODS: Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Participants and their treating physician completed a survey detailing respiratory symptoms, healthcare resource use, and work productivity and activity impairment. Costs included direct medical cost and indirect cost associated with lost work productivity. RESULTS: The study enrolled 999 patients. Patients were often diagnosed with multiple respiratory disorders (42.8%), with asthma/AR and AR/rhinosinusitis the most frequently diagnosed combinations. Cough or coughing up phlegm was the primary reason for the medical visit in patients with a primary diagnosis of asthma and COPD, whereas nasal symptoms (watery runny nose, blocked nose, and congestion) were the main reasons in those with AR and rhinosinusitis. The mean annual cost for patients with a respiratory disease was US$8,853 (SD 11,245) per patient. Lost productivity due to presenteeism was the biggest contributor to costs. CONCLUSIONS: Respiratory disease has a significant impact on disease burden in Korea. Treatment strategies for preventing lost work productivity could greatly reduce the economic burden of respiratory disease.

Investigation of protection knowledge and practice of respiratory infection in senior middle school students in Chengdu / 国际检验医学杂志

Objective To understand the protection knowledge and practice to cope with common respiratory infection in senior middle school students in Chengdu ,and to provide basis for carrying out school health education and the establishment intervention model of respiratory infection .Methods A self-administered questionnaire was conducted among 2 237 senior one students in two senior middle schools in Chengdu .Results In terms of basic knowledge of common respiratory diseases ,47 .47% of the students had adequate total awareness scores .Respiratory diseases cognitive knowledge was not comprehensive enough .Especially for the under-standing of certain knowledge ,there was misunderstanding .The awareness rates for prevention of respiratory diseases and the treat-ment of behavior were high ,and they were 87 .54% and 71 .43% ,respectively .Conclusion The senior middle school students in Chengdu have some education demand of respiratory disease ,and schools should strengthen publicity and health education .

Readmission risk factors for children admitted to pediatric intensive care unit with respiratory tract disease

PURPOSE: Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression. METHODS: Among 286 children admitted to Seoul St. Mary's Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review. RESULTS: Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO2)/fraction of inspiratory oxygen (FiO2), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence. CONCLUSION: For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO2/FiO2 can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor.

Occupational exposure to air pollutants: particulate matter and respiratory symptoms affecting traffic-police in Bogotá / Exposición ocupacional a contaminantes atmosféricos: material particulado y síntomas respiratorios en policías de tránsito de Bogotá

Objectives Quantifying personal exposure to particles less than 10 micrometres in diameter (PM10) and determining the prevalence of respiratory symptoms in traffic-police officers working in Bogotá's metropolitan area. Methods This was a cross-sectional study of 574 traffic-police officers divided into two groups (477 traffic-police and 97 police working in an office). They were given a questionnaire inquiring about respiratory symptoms, toxicological medical evaluation, lung function tests and personal PM10 monitoring. The differences between groups were found using stratified analysis (i.e. comparing odds ratios). Multivariate analysis of factors related to symptoms and diagnosis of respiratory alteration was also performed. Results Respiratory symptoms concerned a higher prevalence of cough, expectoration and rhinosinusitis in the traffic-police group. Medical examination revealed that the traffic-police group had higher nasal irritation prevalence; lung function tests showed no difference. Mean PM10 levels were higher for the traffic-police group (139.4 μg/m³), compared to the office work group (86.03 μg/m³). Discussion PM10 values in both groups did not exceed allowable limits for respirable particles in the workplace according to ACGIH standards. Traffic-police exposed to air pollution had an increased risk of developing respiratory symptoms and signs, thereby agreeing with the results of this and other studies. Personal monitoring is a valuable tool when quantifying the concentration of PM10to which an individual has been exposed during a normal workday. This study contributes towards further research in to the effects of PM10 in populations at risk.

Objetivos Cuantificar la exposición personal a partículas menores de 10 micras (PM10) y determinar la prevalencia de síntomas respiratorios en policías de tránsito que trabajan en el área metropolitana de Bogotá. Métodos Estudio transversal de 574 policías divididos en dos grupos (477 policías de tránsito y 97 policías de oficina). Se les aplicó cuestionario sobre síntomas respiratorios, evaluación médica toxicológica, pruebas de función pulmonar y monitoreo personal a PM10. Las diferencias entre los grupos se hallaron mediante análisis estratificado y calculo Odds Ratio. Se realizó análisis multivariado de factores relacionados con los síntomas y diagnósticos de alteración respiratoria. Resultados Síntomas respiratorios como tos, expectoración y rinosinusitis tuvieron mayor prevalencia en los policías de tránsito. El examen médico mostró mayor prevalencia de signos de irritación nasal en los policías de tránsito. Pruebas de función pulmonar no mostraron diferencias. Los niveles promedio de PM10 fueron mayores en el grupo de tránsito (139,4 g/m³) comparados con el de oficina (86,03 g/m³). Discusión Los valores de PM10 en ambos grupos no exceden los límites permisibles de partículas respirables en el lugar de trabajo por la ACGIH. Los policías de tránsito expuestos a la contaminación del aire tienen mayor riesgo de desarrollar síntomas y signos respiratorios, como lo muestran este y otros estudios. El monitoreo personal es una herramienta valiosa para cuantificar la concentración de PM10a la cual un individuo está expuesto durante la jornada laboral. Este estudio contribuye a una mayor investigación sobre los efectos de PM10 en las poblaciones en riesgo.

Contaminación del aire y enfermedad respiratoria en menores de cinco años de Bogotá, 2007 / Air pollution and respiratory illness in children aged less than 5 years-old in Bogotá, 2007

Objetivos Determinar la relación entre contaminación del aire extra e intramuros por material particulado MP10 con síntomas respiratorios en niños menores de 5 años en tres localidades del Distrito Capital. Métodos Estudio de cohortes. 315 niños y niñas de jardines ubicados en zona de mayor exposición a material particulado MP10, y 304 de jardines en zona de menor exposición. Se siguieron las cohortes por 19 semanas, teniendo en cuenta síntomas respiratorios. Se midió material particulado intramuros y extramuros en los jardines. Se determinaron prevalencias y asociación entre variables. Resultados Hubo una diferencia de promedios de MP intramuros entre mayor y menor exposición de 85.6 μg/m³vs. 61.8 μg/m³ (p<0,05). 74.3 % de los niños presentaron sibilancias en el último año, con diferencia entre mayor y menor exposición de 79,6 % vs 69,0 % (p<0,05). Sibilancias y expectoración estuvieron asociados a mayor exposición a MP10 (RR 1,39 y 1,30). Factores asociados a síntomas respiratorios: tabaquismo pasivo, el antecedente de bajo peso al nacer, el antecedente de sibilancias, la cercanía del jardín o vivienda a menos de 100 metros de chimeneas, vías de alto flujo vehicular, vías en mal estado y colecho. Discusión Un niño menor de 5 años expuesto a MP10 tiene 1,70 veces más riesgo de presentar ausentismo escolar por enfermedad respiratoria aguda, una disminución del MP10 reduciría en un 41,1 % este ausentismo escolar.

Objectives Determining the relationship between indoor and outdoor air pollution caused by particulate matter PM10 and respiratory symptoms in children aged younger than 5 years-old in three locations in Bogota. Methods This was a cohort study, involving 315 children in kindergartens located in the area of greatest exposure to PM10, and 304 in kindergartens located in an area of less exposure. The cohort was followed-up for 19 weeks considering respiratory symptoms. Particulate matter was intramurally and extramurally measured in the kindergartens. Prevalence and association between variables were determined. Results There was a difference regarding average intramural PM between higher and lower exposure (85.6 ug/m³cf 61.8 g/m³; p<0.05); 74.3 % of the children had suffered wheezing during the last year, difference between greater and lesser exposure being 79.6 % cf 69.0 % (p<0.05). Wheezing and coughing were associated with greater exposure to PM10 (RR 1.39 and 1.30). Factors associated with respiratory symptoms concerned passive smoking, having a history of low birth weight, a history of wheezing, a child's kindergarten or home being within 100 meters of (industrial) chimneys, high traffic flow routes, roads in disrepair and bed-sharing. Discussion A child aged less than 5 years-old exposed to PM10 had a 1.7 times higher risk of truancy due to acute respiratory illness; a decrease in PM10 reduced such truancy by 41.1 %.

Detection of aspiration using 99Tcm-sulfur colloid salivary scintigraphy in patients with respiratory tract diseases / 中华核医学与分子影像杂志

Objective To establish and assess the utility of 99Tcm-sulfur colloid (SC) salivary imaging in the routine evaluation of pulmonary aspiration in adult patients with respiratory tract diseases.Methods Eight patients (7 men,1 woman; age range 68 to 80 years,mean age (76 ± 4) years) with respiratory tract disease and history of aspiration by clinical assessment were evaluated prospectively by 99Tcm-SC salivary imaging from April to July 2012.A dose of 74.0 MBq 99Tcm-SC was added to 20 ml saline,mixed well,and administered orally to patients.Dynamic imaging was acquired with posterior projection for 30 min at a rate of 30 s per frame.Two experienced physicians assessed all examination results and reached consensus for final diagnosis.Radioactivity detected at either the bronchi or within the lung fields was reported as positive for aspiration.This study was approved by the institutional review board of Hospital Ethical Committee,and the written informed consent was obtained from patients or their guardians.Results All patients were positive for aspiration by 99Tcm-SC salivary imaging (8/8).Aspiration into bilateral main bronchus was seen in 2 cases,right main bronchus and branch in 4 cases,and left main bronchus and branch in 2 cases.Aspirated tracer could be visualized as early as 3 min,latest at 24 min,and the median was 19 min.Conclusion 99Tcm-SC salivary imaging is useful for the detection of aspiration in adult patients with respiratory tract diseases.

Aerossolterapia / Aerossoltherapy

As doenças do trato respiratório têm uma elevada prevalência emnosso meio. A via inalatória é a preferida para a administração da terapia. Vários dispositivos, com diferentes características, estão disponíveis no mercado. Esta revisão teve o objetivo de descrever os tipos de dispositivos, suas vantagens e desvantagens, e indicações de uso conforme cada faixa etária, além de abordar alguns aspectos técnicos relevantes para a obtenção de melhores resultados com a terapia inalatória. Evidências científicas enfatizam novas formas de administração de medicação inalatória. Nebulizadores convencionais apresentam numerosos inconvenientes. Aerossóis com espaçadores/aerocâmaras permitem melhora na deposição pulmonar, resultando, principalmente em pacientes sem coordenação adequada, em uma melhor relação custo-benefício do que outros métodos tradicionalmente utilizados. Naqueles que conseguem gerar altos fluxos inspiratórios, os inaladores de pó seco podem ser utilizados.

The prevalence of respiratory diseases is high in Brazil. Inhalation isthe preferred route of delivery for therapy. Various inhalation devices, with different characteristics, are available. The objective of this review was to describe those devices, their advantages, disadvantages, and indications for each age group, as well as to address certain relevant technical aspects of obtaining optimal results with inhalation therapy. New means of delivering inhaled therapy have been described. Conventional nebulizers have a number of disadvantages. Aerosol inhalation via spacers or holding chambers seems to be another method, resulting, specifically in patients without adequate coordination, in a relative superior cost-benefit relationship in comparison with traditional methods. In patients who can generate high inspiratory flow rates, dry power inhalers can be used.

The cost of connecting poor households to natural gas in Colombia and its impact on health, 2007 / Impacto en la salud y el costo de conexión de gas natural domiciliario en los hogares pobres en Colombia, 2007

Objective Assessing the cost of subsidizing access to household natural gas (HNG) and its impact on the health of about 35,000 poor households (socioeconomic strata 1 and 2) in Colombia, sponsored by a Global Partnership on Output-Based Aid (GPOBA) project. Methods The following studies were combined: an analysis of secondary data and analysis of databases provided by the Promigas foundation, demographic data from the 2005 DANE census and databases regarding Central Bank economic statistical series; an analysis of the burden of disease estimated from parameters identified in previous studies; an analysis of the cost of the burden of illness and the estimated costs which were avoided by implementing the HNG connections program; and an analysis of the cost effectiveness of the program linking homes to HNG services. Results The OBA project led to about 4,000 to 5,000 cases of acute respiratory disease (ARD) and 1,200 to 2,300 outpatient cases of chronic obstructive pulmonary disease (COPD) being avoided during the study period; around 1,200 hospitalizations due to ARD and 500 due to COPD were also avoided. Forty-five to 170 deaths (representing about 45,000 to 90,000 disability-adjusted life years (DALY)) were also avoided. The economic cost of the burden of disease arising from ARI and COPD in such scenario without HNG would have been between 10.7 and 23.6 million dollars, whilst HNG led to costs becoming reduced by about 32 %. Conclusions This study was a good estimator of the potential impact of the poorest and most vulnerable households gaining universal access to HNG.

Objetivo Valorar el impacto sanitario y económico de subsidiar el acceso al Gas Natural Domiciliario (GND) a hogares pobres (estratos socioeconómicos 1 y 2) en Colombia, auspiciado por Global Partnership on Output Based Aid (GPOBA), proyecto OBA. Métodos Se combinaron los siguientes estudios: a) Análisis de bases de datos secundarios tomadas de Fundación Promigas, censo DANE 2005, y series estadísticas del Banco de la República b) Análisis de carga de enfermedad estimada a partir de los parámetros de estudios previos c) Análisis de costos de la carga de enfermedad estimada y de los costos evitados luego de implementado el programa de conexiones de GND d) Análisis de costo efectividad del programa de conexiones de los hogares al servicios de GND. Resultados La presencia del proyecto OBA evitaría, durante el periodo de estudio, cerca de 4 mil y 5 mil casos ambulatorio de IRA y entre 1 200 y 2 300 de EPOC. Además, se evitarían cerca de 1200 hospitalizaciones por IRA y cerca de 500 por EPOC. Igualmente se evitaría entre 45 y 170 muertes que representaría cerca de 45 mil a 90 mil AVAD. Los costos económicos de la carga de enfermedad por IRA y EPOC en el escenario sin GND serían entre 10,7 y 23,6 millones de dólares mientras que con GND los costos se reducirían en cerca de un 32 %. Conclusiones El presente estudio es un buen estimador de los potenciales efectos de la universalización del acceso al GND por parte de los hogares más pobres y vulnerables.

Hipersensibilidad tipo I frente a los ácaros del polvo doméstico: mecanismos inmunológicos y diagnóstico / Type I hypersensitivity to the house dust mites: immune mechanisms and diagnosis

La rinitis alérgica es una enfermedad respiratoria crónica de alta prevalencia y que tiene gran impacto en la calidad de vida y el desempeño laboral o escolar. Se relaciona estrechamentecon otras enfermedades alérgicas como el asma, la sinusitis y otras afecciones como la conjuntivitis y la otitis. Uno de los principales alérgenos que ocasionan la rinitis alérgica son los ácaros del género Dermatophagoides, en especial las especies D. pteronyssinus y D. farinae, aunque también se ha demostrado la importancia del ácaro Blomia tropicalis en estas afecciones.En este artículo de revisión se analiza la importancia de las reacciones alérgicas frente a estos ácaros, en especial del género Dermatophagoides, tomando en cuenta los estudios realizados en el contexto nacional y latinoamericano; también se explican los mecanismos inmunológicos de la hipersensibilidad tipo I en los pacientes sensibilizados con dichos alérgenos, incluyendo elproceso de sensibilización y de producción de IgE específica, así como el papel de las citocinas en este proceso. Así mismo, se discutirán los métodos diagnósticos y los esquemas terapéuticos que se utilizan, incluyendo la inmunoterapia.

Allergic rhinitis is a chronic respiratory disease of high prevalence that has great impact on the standard of living, and the performance at work or school. Allergic rhinitis is related with other allergic diseases, such as asthma, sinusitis, conjunctivitis, and otitis. One of the main allergens that cause it are the mites belonging to the Dermatophagoides genus, mostly the species D. pteronyssinus and D. farinae, although other studies have shown the importance of Blomia tropicalis in these allergic conditions. This review article aims to analyze the meaning of allergicreactions to such mites, especially those of the genus Dermatophagoides, with regards to studies performed in a national and Latin-American context. It also explains the immunological mechanisms linked to the processes of type I hypersensitivity in patients sensitized to these allergens, includingthe sensitization mechanism and specific lgE production, and the role of cytokines as part of the process. In addition, the diagnostic methods and treatments used, including immunotherapy, will be discussed.

Frequency and Clinical Outcome of the Respiratory Tract Disease in Full-term Infant

PURPOSE: To investigate the frequency of underlying diseases associated with respiratory distress in full-term infants, as well as its relation to the mode of delivery and clinical outcomes. METHODS: We conducted a retrospective review of 4,264 infants who had been admitted to the neonatal intensive care unit (NICU) of Chonnam University Hospital (CUH) over 5 years from January 2000 to December 2004. Full-term infants with respiratory distress such as transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), congenital pneumonia, meconium aspiration syndrome (MAS) and pneumothorax were included. We analysed the incidence of underlying disease, its relation to the mode of delivery, rate of mechanical ventilator therapy, prevalence of hypoxic ischemic encephalopathy (HIE), mortality and the length of hospitalization of surviving patients. RESULTS: Of the 4,264 patients who admitted to the NICU of CUH over the last five years, preterm infants made up 2,278 (53.4%) and full-term infants made up 1,982 (46.5%). The number of full-term patients who admitted due to respiratory distress associated with respiratory system problems excluding a congenital anomaly was 246 (12.4%). The most common underlying disease was TTN (n=161, 65.4%), and the next was RDS (n=39, 15.9 %), congenital pneumonia (n=11, 4.5%), MAS (n=7.9, 8.5%), and pneumothorax (n=14, 5.7 %). RDS was more statistically common in full-term infants born by Caesarian section (P<0.05). But there was no difference according to the mode of delivery statistically in other respiratory tract diseases. The rate of mechanical ventilator therapy was significantly higher in RDS and MAS, and the prevalence of HIE was higher in MAS (P<0.05). Mortalities of RDS and MAS were 7.7% and 9.5% each. There was no significant difference in the length of hospitalization of surviving patients. CONCLUSION: TTN was the most common respiratory tract disease in the full-term infant, and RDS was more common in the infant who was born by Cesarean section. The rates of mechanical ventilator therapy and mortality were significantly higher in the infants with RDS and MAS, and HIE was exclusively manifested by infants with MAS.

Tonsil-pharyngeal streptococci infections in patients with respiratory tract diseases at the Department of Pediatrics, Military Hospital No108

At the Military Hospital No108, from August 2000 to May 2002, 111 patients with respiratory tract disease were studied perspectively. Results showed that the most vulnerable age 1-5 years old (26.13%), 5-10 years old (41.44%). 26 cases were infected with streptococci (23.42%). Among respiratory tract infectious patient streptococci A 26% were isolated, cartaphalis 18%. Among bronchitis patients, Streptococci A 14%, M cartahalis 12%. Among rhumatism arthritis patients Streptococci alpha 12%, cartahalis 6%