Prevalence of chronic respiratory symptoms and dyspnea and related factors in residents in China / 中华流行病学杂志

Objective: To understand the prevalence of chronic cough, chronic expectoration and dyspnea and related factors in residents aged ≥40 years in China, and provide basic data for the prevention and control of chronic respiratory diseases. Methods: Data were from 2014-2015 chronic obstructive pulmonary disease surveillance in China. The information about chronic respiratory symptoms were collected by face-to-face interview. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms and their 95%CI were estimated with complex sampling weights. Results: A total of 75 082 subjects were included in the analysis. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms in the Chinese aged ≥40 years were 3.75% (95%CI: 3.38%-4.11%), 5.83% (95%CI: 5.40%-6.26%), 2.45% (95%CI: 2.02%-2.87%) and 8.93% (95%CI: 8.25%-9.62%), respectively. The prevalence rates of chronic cough, chronic expectoration, dyspnea and chronic respiratory symptoms in patients with chronic respiratory diseases were relatively higher, which were 10.27%, 13.85%, 6.43%, 20.72% respectively. Multivariate logistic regression analysis showed that age, region, education level, occupation, BMI, family history of respiratory diseases, history of severe respiratory infections in childhood, exposure to dust or chemicals in workplace and smoking status affected the prevalence of chronic cough, chronic expectoration and dyspnea. The prevalence of the three types of chronic respiratory symptoms increased significantly with age, which were higher in western region, smokers and underweight/obese subjects. The three prevalence rates mentioned above were higher in those with a history of severe respiratory infection in childhood, those exposed to biomass fuel in household, and those exposed to dust or chemicals in workplace. Conclusions: The prevalence rate of chronic respiratory symptoms was high in residents aged ≥40 years in China. Many factors affected the prevalence of chronic respiratory symptoms. Comprehensive prevention and control measures targeting risk factors should be taken to reduce the burden of chronic respiratory diseases.

Factores asociados a mortalidad en pacientes hospitalizados con COVID-19: cohorte prospectiva en un hospital de referencia nacional de Perú / Factors associated with mortality in patients hospitalized with COVID-19: a prospective cohort in a Peruvian national referral hospital

Objetivos Describir las características clínicas y evaluar los factores asociados con la mortalidad de los pacientes adultos con la nueva enfermedad causada por coronavirus 2019 (COVID-19) ingresados a un hospital de referencia nacional de Perú. Métodos Se realizó un estudio de cohorte prospectivo. Se incluyó a pacientes mayores de 18 años hospitalizados con el diagnóstico de infección por coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2). Se excluyó a quienes ingresaron con prueba rápida serológica positiva al ingreso, sin clínica sugestiva ni imágenes compatibles. Los datos se recolectaron a partir de la historia clínica. Resultados Se incluyó un total de 813 adultos, 544 (66,9%) tuvieron COVID-19 confirmado. La media de la edad fue de 61,2 años (desviación estándar: 15) y 575 (70,5%) fueron de sexo masculino. Las comorbilidades más frecuentes fueron hipertensión arterial (34,1%) y obesidad (25,9%). Los síntomas más frecuentes al ingreso fueron disnea (82,2%) y tos (53,9%). Un total de 114 (14%) pacientes recibieron ventilación mecánica, 38 (4,7%) ingresaron a unidad de cuidados intensivos y 377 (46,4%) fallecieron. Se asociaron a la mortalidad el requerimiento de soporte ventilatorio, el mayor compromiso pulmonar y los marcadores inflamatorios. Encontramos que por cada 10 años que aumentó la edad, el riesgo de morir se incrementó en 32% (riesgo relativo: 1,32; intervalo de confianza 95%: 1,25 a 1,38). Aquellos pacientes que requirieron ingreso a unidad de cuidados intensivos y ventilación mecánica tuvieron 1,39 (intervalo de confianza 95%: 1,13 a 1,69) y 1,97 (intervalo de confianza 95%: 1,69 a 2,29) veces el riesgo de morir, respectivamente. Conclusión La mortalidad encontrada en nuestro estudio fue alta y estuvo asociada a la edad, marcadores inflamatorios y compromiso respiratorio.

Objectives To describe and assess clinical characteristics and factors associated with mortality in adult patients with COVID-19 admitted to a national referral hospital in Peru. Methods We conducted a prospective cohort study that included hospitalized patients older than 18 years with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis. Patients with a positive rapid serological test on admission but no respiratory symptoms nor compatible images were excluded. We collected the data from clinical records. Results A total of 813 adults were included, 544 (66.9%) with confirmed COVID-19. The mean age was 61.2 years (standard deviation: 15.0), and 575 (70.5%) were male. The most frequent comorbidities were hypertension (34.1%) and obesity (25.9%). On admission, the most frequent symptoms were dyspnea (82.2%) and cough (53.9%). A total of 114 (14.0%) patients received mechanical ventilation, 38 (4.7%) were admitted to the intensive care unit, and 377 (46.4%) died. The requirement for ventilatory support, greater lung involvement, and inflammatory markers were associated with higher mortality. It was found that for every 10-year age increase, the risk of dying increased 32% (relative risk: 1.32; 95% confidence interval: 1.25 to 1.38). Those who were admitted to the intensive care unit and and were placed on mechanical ventilation had 1.39 (95% confidence interval: 1.13 to 1.69) and 1.97 (95% confidence interval: 1.69 to 2.29) times the risk of dying compared to those who did not, respectively. Conclusion We found a high mortality rate among hospitalized patients associated with older age, higher inflammatory markers, and greater lung involvement.

Clinical and epidemiological characteristics of children with SARS-CoV-2 infection: a case series in Sinaloa / Características clínicas y epidemiológicas de la infección por SARS-CoV-2 en niños: serie de casos en Sinaloa

Abstract Background: The SARS-CoV-2 virus may affect both adults and children. Although COVID-19 has a lower prevalence in infancy and has been described as mild, the clinical characteristics may vary, and there is a possibility of complications. The objectives of this study were to describe the clinical and epidemiological aspects of confirmed COVID-19 pediatric cases in the state of Sinaloa, Mexico, during the first 3 months of the pandemic, and children admitted with COVID-19 to a secondary hospital. Methods: This case series includes all patients with SARS-CoV-2 infection confirmed by PCR (polymerase chain reaction) test, identified in the state epidemiological surveillance system (SISVER) between March 1 and May 31, 2020. Confirmed patients admitted to the Sinaloa Pediatric Hospital (HPS) in the same period are also described. Results: Fifty-one children with SARS-CoV-2 were included, of which ten were admitted to the HPS. The median age was 10 years. The more frequent symptoms were fever (78%), cough (67%), and headache (57%). Most cases were mild or asymptomatic. Three patients with comorbidities died. Only four of ten patients identified in HPS were admitted with the diagnosis of possible COVID-19. Conclusions: SARS-CoV-2 infection in children was mostly mild or asymptomatic, and the clinical presentation varied. There is a possibility of complications, especially in children with comorbidities.

Resumen Introducción: El SARS-CoV-2 puede afectar tanto a adultos como a niños. Aunque la COVID-19 presenta menor prevalencia en la infancia y se ha descrito como leve, las características clínicas pueden ser variables y existe la posibilidad de complicaciones. Los objetivos de este estudio fueron describir las características clínicas y epidemiológicas de los casos pediátricos confirmados en el Estado de Sinaloa, México, durante los primeros 3 meses de la pandemia, y de los niños con COVID-19 internados en un hospital de segundo nivel. Métodos: Esta serie de casos incluyó pacientes con infección por SARS-CoV-2 confirmados por prueba de reacción en cadena de la polimerasa (PCR), identificados en el Sistema de Vigilancia Epidemiológica de Enfermedades Respiratorias (SISVER) del 1 de marzo al 31 de mayo de 2020. Se describen también las características de todos los niños confirmados en el Hospital Pediátrico de Sinaloa (HPS) en las mismas fechas. Resultados: Se incluyeron 51 niños con infección por SARS-CoV-2, de los cuales 10 fueron internados en el HPS. La mediana de edad fue de 10 años. Los síntomas más frecuentes fueron fiebre (78%), tos (67%) y cefalea (57%). La mayoría de los casos fueron leves o asintomáticos. Tres pacientes con comorbilidad fallecieron. Solo cuatro de diez pacientes identificados en el HPS ingresaron bajo sospecha de COVID-19. Conclusiones: La infección por SARS-CoV-2 en los niños fue, en su mayoría, asintomática o leve, y la presentación fue variable. Existe la posibilidad de que se produzcan complicaciones, principalmente en niños con comorbilidad.

Caracterización de pacientes con COVID-19 grave atendidos en un hospital de referencia nacional del Perú / Description of patients with severe COVID-19 treated in a national referral hospital in Peru

RESUMEN Con el objetivo de describir las manifestaciones de pacientes con enfermedad por coronavirus 2019 (COVID-19), se evaluaron variables sociodemográficas, antecedentes, manifestaciones clínicas y radiológicas, tratamientos y evolución en pacientes que ingresaron por emergencia, del 6 al 25 de marzo de 2020, al Hospital Nacional Edgardo Rebagliati Martins en Lima. Se registraron 17 pacientes: el 76% eran varones, edad promedio de 53,5 años (rango de 25 a 94); el 23,5% había regresado del extranjero; 41,2% referido de otros establecimientos de salud; 41,2% ingresó a ventilación mecánica; falleció el 29,4% (5 pacientes). Los factores de riesgo detectados fueron adulto mayor, tener hipertensión arterial y obesidad; los principales síntomas, tos, fiebre y disnea; los hallazgos de laboratorio frecuentes, proteína C reactiva elevada y linfopenia; la presentación radiológica predominante, el infiltrado pulmonar intersticial bilateral. Se reporta una primera experiencia en el manejo de pacientes con diagnóstico de la COVID-19 grave en el Perú.

ABSTRACT In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.

Infección por el nuevo coronavirus 2019 en niños

RESUMEN La enfermedad del coronavirus 2019 (COVID-19) es poco frecuente en niños y su salud se ve poco comprometida en la mayoría de casos. La presentación clínica más común es tos, fiebre y eritema faríngeo, los casos graves suelen presentarse con taquipnea. El curso de la enfermedad es de una a dos semanas. Los hallazgos de laboratorio son inespecíficos, entre ellos, linfopenia, elevación de la proteína C reactiva y la procalcitonina. En fases iniciales, la radiografía torácica es usualmente normal, y los hallazgos tomográficos más comunes son consolidaciones con signo del halo, vidrio esmerilado y nódulos pequeños, que afectan principalmente las zonas subpleurales. El manejo es sintomático y, en los casos graves, debe estar enfocado a brindar soporte respiratorio. Se recomienda que la manipulación de las secreciones respiratorias sea limitada y que se tengan las mismas precauciones para evitar contaminación que en pacientes adultos.

ABSTRACT COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.

Body mass index, asthma, and respiratory symptoms: a population-based study / Índice de massa corpórea, asma e sintomas respiratórios: um estudo de base populacional

ABSTRACT Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.

RESUMO Objetivo: Estimar a prevalência de sintomas respiratórios e asma de acordo com o índice de massa corpórea (IMC) em indivíduos com idade ≥ 40 anos e avaliar os fatores associados ao relato de diagnóstico médico de asma. Métodos: Estudo transversal de base populacional realizado no município de Florianópolis (SC), com coleta domiciliar de dados e processo de amostragem probabilístico. Foram coletadas informações demográficas, assim como sobre relato de diagnóstico médico de asma, sintomas respiratórios, medicações em uso e comorbidades. Também foram realizadas medidas antropométricas e espirometria pré- e pós-broncodilatador. O IMC foi categorizado em normal (IMC < 25 kg/m2), sobrepeso (25 kg/m2 ≥ IMC < 30 kg/m2) e obesidade (IMC ≥ 30 kg/m2). Resultados: Foram avaliados 1.026 indivíduos, 274 (26,7%) com IMC normal, 436 (42,5%) com sobrepeso e 316 (30,8%) obesos. A prevalência de diagnóstico médico de asma foi de 11,0%. A prevalência de obesidade foi maior em mulheres (p = 0,03) e em entrevistados com escolaridade < 4 anos (p < 0,001) ou com renda familiar entre 3-10 salários mínimos. Obesos, quando comparados com aqueles com sobrepeso e peso normal, relataram mais frequentemente diagnóstico médico de asma (16,1%, 9,9% e 8,0%, respectivamente; p = 0,04), dispneia (35,5%, 22,5% e 17,9%, respectivamente; p < 0,001) e sibilos no último ano (25,6%, 11,9% e 14,6%, respectivamente; p < 0,001). Esses resultados foram independentes do status tabágico. Além disso, obesos tinham uma chance três vezes maior de relato de diagnóstico médico de asma do que não obesos (p = 0,005). Conclusões: Houve associação significativa entre o relato de diagnóstico médico de asma em indivíduos com idade ≥ 40 anos e IMC ≥ 30 kg/m2. Ser obeso triplicou a chance de diagnóstico médico de asma.

Manifestaciones clínicas y evolución de seis primeros casos reportados de COVID-19 en personal médico de Perú / Clinical manifestations and course of the first six reported cases of COVID-19 in the medical doctors of Peru

INTRODUCCIÓN: El personal de salud, entre ellos los médicos, es parte fundamental en primera línea de defensa ante la pandemia de COVID-19, causada por SARS-Cov-2. OBJETIVO: Caracterizar la clínica y evolución de los primeros casos de contagio por coronavirus en médicos de Perú. METODOLOGÍA: Se presentan una serie de seis casos de médicos infectados por coronavirus, con positividad confirmada para COVID-19, mostrando la evolución diaria desde el diagnóstico de la enfermedad, sus principales signos y síntomas, la evolución de los mismos y hasta el desenlace en cada caso. RESULTADOS: De los casos estudiados, cinco fueron hombres, tenían una mediana de edad de 28 años (rango intercuartílico: 27 a 33). Tres de ellos trabajaban más de 12 horas al día en servicios de hospitalización y emergencia; y tres no contaban con mascarilla como método de protección personal. Los síntomas más frecuentes fueron la temperatura axilar superior a 38 grados Celsius, el malestar general, la tos seca y la odinofagia (este último en tres pacientes). En cuanto al diagnóstico con la prueba molecular, tuvo una mediana de tres días de demora (con rango: de 2 a 6 días). Los síntomas que más persistieron fueron la tos seca (presente durante 10 días en cuatro médicos), y la disgeusia como síntoma único, que tuvo la mayor duración (15 días en un solo médico). En los seis casos la evolución fue favorable. Sin embargo, aún se tienen deficiencias para la definición de reincorporación laboral a sus centros hospitalarios. DISCUSIÓN: A pesar de ser un número pequeño de casos, es el primer reporte en personal de salud y que detalla día a día la evolución de los síntomas de COVID-19. Esto puede servir para la salud ocupacional, e incluso como base para la vigilancia y monitorización de los casos en una población mayor.

INTRODUCTION: Health personnel, including physicians, are a fundamental part of the first line of defense against the SARS-CoV-2 pandemic. OBJECTIVE: To characterize the clinical manifestations and course of the first cases of contagion by SARS-CoV-2 in doctors of Peru. METHODOLOGY: We present a series of six cases of doctors infected by SARS-CoV-2, with confirmed positivity for COVID-19, showing the daily evolution from the diagnosis of the disease, its main signs and symptoms, evolution, and until the outcome in each case. RESULTS: Five were men. The median age was 28 years (interquartile range: 27 to 33). In three cases the physician worked more than 12 hours a day in emergency and hospitalization services and not wear a mask at all times. The most frequent symptoms were axillary temperature above 38°C, malaise, dry cough, and odynophagia (the latter in three of the cases). The diagnosis was made at a median of 3 days (interquartile range: 3 to 4 days). The symptoms that persisted the most were dry cough (present during ten days in four doctors). Dysgeusia was the only symptom with the most extended duration (15 days in only one doctor). In the six cases, the course was favorable. However, these doctors found it difficult to return to functions in their hospital centers adequately. DISCUSSION: Despite a small number of cases, it is the first report detailing the evolution of symptoms day by day, which can help for occupational health and even for case surveillance and monitoring.

Sintomáticos respiratorios en personas atendidas en establecimientos de salud del Ministerio de Salud en Lima, Perú / Respiratory symptoms in people attended in health facilities of the Ministry of Health in Lima, Peru

RESUMEN Objetivo. El objetivo de este estudio fue determinar el porcentaje de sintomáticos respiratorios (SR), según la definición programática, entre las personas que en condiciones habituales acuden a consulta en los establecimientos de salud de primer nivel del Ministerio de Salud en Lima, e identificar el porcentaje de pacientes con tuberculosis entre los SR y entre tosedores de más de siete días. Materiales y métodos. Estudio transversal en pacientes que acudieron a consulta en 57 centros de salud. Se identificó a los pacientes con tos y expectoración de más de siete días y SR, a quienes se les tomó una muestra de esputo para descarte de tuberculosis mediante baciloscopía y cultivos. Resultados. Se encuestaron 10 421 personas. El 2,7% presentaron tos con expectoración por ≥7 días y solo el 1,1% fueron SR; 215 pacientes fueron examinados para descarte de tuberculosis. Siete (5,9%) de los SR y ocho (4,8%) de los pacientes con tos de 7-14 días tuvieron tuberculosis. Conclusión. El porcentaje de SR en establecimientos de salud del Ministerio de Salud en Lima fue menor al 5% esperado, con un rango de 0,8% en Callao hasta 1,5% en Lima Ciudad. El porcentaje de tuberculosis entre tosedores de 7-14 días y SR concuerda con el hallado en otros estudios locales. Se debe considerar la posibilidad de disminuir la meta de SR a menos del 5% y ampliar el despistaje de tuberculosis a pacientes con tos ≥7 días en las Direcciones de Salud con altas incidencias de tuberculosis.

ABSTRACT Objective. The aim of this study was to determine the percentage of symptomatic respiratory (SR) cases, according to the programmatic definition, among people who attend medical offices at first-level health facilities of the Ministry of Health in Lima under normal circumstances. The study also aims at identifying the percentage of patients with tuberculosis among the RS and among coughers over seven days. Materials and Methods. Cross-sectional study of patients attending consultations at 57 health centers. Patients with cough and phlegm lasting more than seven days and RS were identified and a sputum sample was taken to rule out tuberculosis by smear and culture. Results. A total of 10,421 people was surveyed. A 2.7% had cough with phlegm for ≥7 days and only 1.1% were SR; 215 patients were screened for tuberculosis. Seven (5.9%) of the RS and eight (4.8%) of the patients with a 7-14-day cough had tuberculosis. Conclusions. The percentage of RS in the Ministry of Health's health facilities in Lima was less than the expected 5%, ranging from 0.8% in Callao to 1.5% in Lima City. The percentage of tuberculosis among coughers (lasting 7-14 days) and RS is consistent with the findings of other local studies. Consideration should be given to lowering the RS target to less than 5% and expanding tuberculosis screening to patients with cough ≥7 days at the Health Divisions with high tuberculosis incidence.

Seroprevalencia de Bordetella pertussis en el personal de enfermería y médicos residentes del Hospital Infantil de México Federico Gómez / Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez

Resumen Introducción Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.

Abstract Background Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

Valoración mediante espirometría de mineros del carbón de Paipa, Colombia / Spirometry in a population of coal miners in Paipa, Colombia

RESUMEN Introducción: Las enfermedades respiratorias derivadas de la exposición a material en partículas, como sucede en la minería del carbón, continúa siendo un reto investigativo en el país y un problema de salud pública. La espirometría es una prueba de la función respiratoria, fundamental para el diagnóstico y la vigilancia de este tipo de enfermedades pulmonares crónicas. Objetivo. Determinar los valores de la espirometría en la población minera de carbón del municipio de Paipa, y su asociación con la edad y el tiempo de exposición laboral. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal. Se diligenció el cuestionario de enfermedad respiratoria ocupacional de la American Thoracic Society (ATS), se registraron las mediciones de la espirometría y se interpretaron siguiendo las recomendaciones internacionales. Resultados. La muestra incluyó 226 trabajadores de minas de carbón de Paipa; en 12,3 % (n=28) de ellos se registraron alteraciones leves, de tipo obstructivo o restrictivo. En 35 % (n=80) hubo disminución de la relación entre la capacidad vital forzada y el volumen espirado en el primer segundo (CVF/VEF1 ). Se encontró una asociación estadísticamente significativa entre el rango de edad (p=0,002) y los años de trabajo minero (p=0,34), además de trastornos restrictivos y obstructivos. Asimismo, hubo una asociación estadísticamente significativa entre el rango de edad (p<0,01) y los años de trabajo minero (p<0,01), de diferente seriedad en el patrón de las mediciones de la espirometría. Conclusiones. La espirometría es una prueba útil para detectar la presencia de trastornos respiratorios en la población minera del carbón. La enfermedad respiratoria en estos mineros estuvo significativamente asociada con el tiempo de exposición.

ABSTRACT Introduction: Respiratory diseases resulting from exposure to particulate matter such as in coal mining remains a research challenge in this country and a public health issue. Spirometry is a basic test of fundamental respiratory function for the diagnosis and monitoring of these types of chronic lung diseases. Objective: To determine spirometric values in the coal mining municipality of Paipa and their association with age and occupational exposure times. Materials and methods: We conducted a descriptive cross-sectional study. The occupational respiratory disease questionnaire of the American Thoracic Society (ATS) was completed while spirometric measurements were performed and interpreted in accordance with international recommendations for conducting the test. Results: The sample consisted of 226 coal mining workers of the municipality of Paipa. Twenty-eight subjects (12.3%) of the sample showed patterns of obstructive and restrictive respiratory disease with mild degrees of severity. Eighty subjects (35%) showed a decrease in the forced vital capacity ratio/expiratory volume in one second (FVC/FEV1 ). A statistically significant association between age range (p=0.002) and years of mining work (p=0.34) with the development of restrictive and obstructive disorders was found. Also, there was a statistically significant association between age range (p<0.01) and years of mining work (p<0.01) with various degrees of severity of the spirometric pattern. Conclusions: Spirometry is a useful test for detecting the presence of respiratory disorders in the population of coal miners. The time of exposure was significantly associated with the respiratory disease exhibited by these miners.

Prevalencia de sintomáticos respiratorios en población peruana de 15 a más años: análisis secundario de la Encuesta Demográfica y de Salud Familiar, 2013 - 2015 / Prevalence of symptomatic respiratory cases in the peruvian population aged 15 years and above: secondary analysis of the demographic and family health survey, 2013-2015

El objetivo del estudio fue estimar la prevalencia de sintomáticos respiratorios (SR) en población peruana de 15 a más años entre el 2013 y 2015. Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES). Los sujetos de estudio fueron los entrevistados de 15 años a más que completaron las preguntas: ¿actualmente tiene usted tos con flema? y ¿hace cuánto tiempo tiene usted tos con flema?. Se definió como SR a la persona con tos y flema de 15 o más días de duración. La prevalencia de SR el año 2013 fue 3,3% (intervalo de confianza al 95% [IC 95%]: 2,8% a 3,9%), 3,8% el 2014 (IC95%: 3,5% a 4,1%) y 3,3% el 2015 (IC95% de 3,0 a 3,6%). La prevalencia de SR fue mayor al 5% en personas de 60 a más años, en población de los quintiles más pobres y en residentes de zonas rurales. Concluimos que entre tres a cuatro de cada cien peruanos de 15 a más años se reporta tos con flema de ≥15 días. La proporción de SR varía según región del país. Se recomienda evaluar y ajustar la meta de sintomáticos respiratorios esperados para los establecimientos de salud del Perú.

The objective of this study was to estimate the prevalence of symptomatic respiratory (SR) cases in the Peruvian population aged 15 years and over between 2013 and 2015. A secondary analysis of the Demographic and Family Health Survey (ENDES) was carried out. The subjects of the study were people aged 15 years and over who answered these interview questions: Do you currently have a cough with phlegm? How long have you had a cough with phlegm? People who had had a cough and phlegm for 15 days or more were defined as having SR. The prevalence of SR was 3.3% in 2013 (95% confidence interval [95% CI]: 2.8-3.9%), 3.8% in 2014 (95% CI: 3.5-4.1%), and 3.3% in 2015 (95% CI: 3.0-3.6%). The prevalence of SR was greater than 5% in people aged 60 years and over, in people in the poorest quintile, and in residents of rural areas. We conclude that 3-4% of Peruvian people aged 15 years and over report cough with phlegm for ≥15 days. The proportion with SR varies according to the region of the country. It is recommended that the expected number of symptomatic SR cases be assessed and that Peruvian healthcare be adjusted as necessary.

Pertussis Prevalence in Korean Adolescents and Adults with Persistent Cough

We investigated the prevalence of pertussis in Korean adolescents and adults with persistent cough. Study population was adolescents (aged 11-20 yr) and adults (> or = 21 yr old) who showed persistent cough of 1-8 weeks' duration. Pertussis was diagnosed by culture, polymerase chain reaction (PCR), and serology. A total of 310 subjects participated in this study, and 76 cases (24.5%) met the criteria for laboratory-confirmed pertussis. The majority of the pertussis cases (66/76) were confirmed by serology, while 3 cases (1.0%) were diagnosed with culture, and 10 cases (3.2%) were detected with PCR. Of the 76 subjects diagnosed with pertussis, 20/86 cases were adolescents and 56/224 cases were adults. Neither adolescents nor adults received adolescent-adult booster against pertussis within the previous 5 yr. Pertussis can be a primary cause of persistent cough in Korean adolescents and adults.

Comparação temporal das prevalências de asma e rinite em adolescentes em Fortaleza, Brasil: temporal changes / Prevalences of asthma and rhinitis among adolescents in the city of Fortaleza, Brazil

OBJETIVO: Descrever as prevalências de asma e rinite em adolescentes de 13-14 anos de idade em Fortaleza (CE) em 2010 e compará-las com as prevalências obtidas em um inquérito em 2006-2007. MÉTODOS: Estudo transversal envolvendo uma amostragem probabilística de 3.015 e 3.020 adolescentes, respectivamente, em 2006-2007 e 2010, utilizando o protocolo do International Study of Asthma and Allergies in Childhood. RESULTADOS: Na comparação entre os dois períodos, não houve diferenças significativas em relação a sibilos cumulativos, asma ativa, quatro ou mais crises de sibilos no último ano, prejuízo do sono por sibilos > 1 noite/semana e crises limitando a fala. Em 2010, houve um aumento significativo na prevalência de sibilos após exercícios, tosse seca noturna e asma diagnosticada (p < 0,01 para todos). Em 2010, houve uma redução significativa na prevalência de rinite diagnosticada (p = 0,01), enquanto não houve diferenças significativas entre os dois períodos nas prevalências de rinite cumulativa, rinite atual e rinoconjuntivite. Em ambos os períodos, tosse seca noturna, rinite atual e rinoconjuntivite foram significativamente mais prevalentes nas mulheres que nos homens (p < 0,01 para todos). Também nos dois períodos, asma ativa, rinite atual e rinoconjuntivite foram significativamente mais prevalentes nos alunos das escolas particulares do que naqueles das escolas públicas (p < 0,01 para todos). CONCLUSÕES: Nossos dados mostram que as prevalências de sintomas de asma e rinite continuam altas entre os adolescentes de 13-14 anos em Fortaleza, com predomínio no gênero feminino e em alunos de escolas particulares.

OBJECTIVE: To describe the prevalences of asthma and rhinitis in adolescents (13-14 years of age) in the city of Fortaleza, Brazil, in 2010, comparing the results with those obtained in a prevalence survey conducted in 2006-2007. METHODS: This was a cross-sectional study involving probabilistic samples of 3,015 and 3,020 adolescents in surveys conducted in 2006-2007 and 2010, respectively. The International Study of Asthma and Allergies in Childhood protocol was used on both occasions. RESULTS: Comparing the two periods, there were no significant differences regarding cumulative wheezing, active asthma, four or more wheezing attacks within the last year, sleep disturbed by wheezing more than one night per week, and speech-limiting wheezing. The prevalences of exercise-induced wheezing, dry cough at night, and physician-diagnosed asthma were significantly higher in 2010 than in the 20062007 period (p < 0.01 for all). The prevalence of physician-diagnosed rhinitis was significantly lower in 2010 (p = 0.01), whereas there were no significant differences between the two periods regarding cumulative rhinitis, current rhinitis, and rhinoconjunctivitis. In both periods, dry cough at night, current rhinitis, and rhinoconjunctivitis were significantly more prevalent in females than in males (p < 0.01 for all). Also in both periods, active asthma, current rhinitis, and rhinoconjunctivitis were more prevalent in private school students than in public school students (p < 0.01 for all). CONCLUSIONS: Our data show that the prevalences of asthma and rhinitis symptoms remain high among females and private school students.

Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

OBJETIVO: Identificar factores asociados con el cumplimiento del consumo de suplementos con micronutrimentos múltiples (MM) o con hierro y vitamina A (FEVITA) en niños (<24 meses de edad). MATERIAL Y MÉTODOS: Información de un ensayo clínico aleatorizado, doble ciego en una localidad semirrural en México. Se calculó el porcentaje de cumplimiento (n=465 niños), cumplimiento adecuado (CA: >80%) y su asociación con varias características. RESULTADOS: El cumplimiento fue alto (MM: 78.2%, FEVITA: 80.1%; p<0.05). Los momios de CA fueron 59% mayores en niños del grupo FEVITA que en MM (p=0.052). Escolaridad materna (p<0.001), peso al nacer del niño (p=0.003), porcentaje de tiempo con tos (p<0.001) y con fiebre (p=0.024) y marginalmente, la condición indígena materna (p=0.071) se asociaron con el CA. CONCLUSIONES: La alta tasa de cumplimiento fue consistente con otros estudios. Es necesaria mayor investigación sobre factores fisiológicos, culturales, sociales y operativos relacionados con el cumplimiento del consumo de suplementos.

Claves para el manejo práctico de la tos crónica en pediatría / Keys for practical management of chronic cough in childhood

La tos es un mecanismo defensivo fisiológico que contribuye a liberar a la vía aérea de material extraño y generalmentees consecuencia de procesos breves y autolimitados. La tos crónica, definida, por su persistencia por más de 8 semanas,debe obligar al pediatra clínico a agudizar su ingenio en busca del diagnóstico etiológico.Una cuidadosa historia clínica y un examen físico detallado son los pilares fundamentales del diagnóstico; la indicaciónde estudios complementarios dependerá de los resultados de la valoración clínica inicial.La exacta identificación etiológica de la tos crónica debe ser seguida por un tratamiento específico. El abordaje sintomáticocon antitusivos y mucolíticos es excepcionalmente necesario, generalmente decepcionante y no exento de efectostóxicos. Es imperativo evitar la masiva prescripción de estos fármacos puesto que en la mayoría de los casos propende a laprolongación del síntoma con la consecuente alteración de la calidad de vida de los niños.

Cough is a physiological defense mechanism to help clear excessive secretions and foreign material from the airways andis usually short and therefore self-limiting process. Chronic cough, defined by its persistence for more than 8 weeks, is areal clinical challenge for pediatricians who should focus their efforts in search for etiological diagnosis.A careful medical history and physical examination are the mainstays of diagnosis; the indication of further studiesdepends on the results of initial clinical assessment.The exact etiological identification of chronic cough must be followed by specific treatment. The symptomatic approachwith over the counter medications such as antitussives and mucolytic drugs is exceptionally necessary and generally disappointingbecause they may have toxic effects. Is imperative to avoid the massive prescription of these drugs because in mostcases tends to prolongation of symptoms with a consequent impact on the quality of life of children.

Prevalência de sintomáticos respiratórios em regiões do Distrito Federal, Brasil / Prevalence of respiratory symptoms in areas of the Federal District, Brazil

A captação de sintomáticos respiratórios (SR) é importante para a detecção precoce de tuberculose. O objetivo deste estudo foi estimar a prevalência de SR em três regiões administrativas (RA) do Distrito Federal, Brasil. Para tanto, foi utilizada a técnica de amostragem por conglomerados (30 por 7) proposta pela Organização Mundial da Saúde. Foram definidos como SR os indivíduos com 15 anos ou mais residentes nas RAs Estrutural, Itapoã ou Varjão e que apresentassem tosse há pelo menos 3 semanas na data da entrevista. A prevalência de SR em Estrutural e Varjão foi de 5,7 por cento (IC95 por cento: 2,4 a 9,0), e em Itapoã, de 4,8 por cento (IC95 por cento: 1,6 a 7,9), com efeito de desenho próximo de 1,0. Em Estrutural e Itapoã, menos anos de estudo, e em Itapoã e Varjão, menor renda, estiveram associados com ser SR. O tabagismo esteve associado com a presença de sintomas respiratórios em todas as RAs. A prevalência de SR está de acordo com aquela encontrada em outras áreas com perfil socioeconômico semelhante ao das áreas estudadas.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7 percent in Estrutural and Varjão (95 percent CI: 2.4-9.0) and 4.8 percent in Itapoã (95 percentCI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

Sintomatología respiratoria y enfermedad pulmonar obstructiva crónica y su asociación a contaminación intradomiciliaria en el área metropolitana de Santiago: estudio platino / Association between indoor pollution, respiratory symptoms and COPD in Santiago, Chile: platino study

The aim of this study is to report the association between indoor pollution (IP), chronic respiratory symptoms (CRS) and chronic obstructive pulmonary disease (COPD). Data provided from PLATINO study considering a sample of 1.208 subjects 40 and over years old population in Santiago, Chile. Analyses regarding indoor air pollution variables, smoking, environmental tobacco smoke (ETS) and lifetime exposure to occupational dust and CRS and COPD as main outcomes was performed. Crude and adjusted prevalence odds ratios (POR) were calculated using logistic regression, adjusting for potential confounders. Variables explaining higher COPD risk were age > 60 years (POR 3.94, CI95 percent 2.87-5.41, p < 0.01) and males (POR 2.08, CI95 percent 1.53-2.83, p < 0.01). Exposure to coal IP was associated with CRS (POR 1.41, CI95 percent 1.05-1.89; p = 0.024), as well as exposure to firewood IP (POR 1.42, CI95 percent 1.04-1.93; p = 0.029) and ETS (POR 2.15, CI95 percent 1.24-3.73, p = 0.006). Exposure to coal, firewood and ETS are independent risk factors for CRS. Association between exposure to IP and COPD was not observed.

El objetivo de la comunicación fue evaluar la asociación entre contaminación intradomiciliaria (CID) y la presencia de síntomas respiratorios crónicos (SRC) y Enfermedad Pulmonar Obstructiva Crónica (EPOC). Se analizó información del estudio de prevalencia Platino en base a una muestra de población general de 1.208 sujetos de 40 y más años de Santiago, Chile. Se analizó la CID derivada del uso de combustibles sólidos, exposición a humo ambiental (EHAT) y el reporte de exposición previa a polvo de origen ocupacional calculando Odds Ratio de Prevalencia (ORP) crudos y ajustados por potenciales variables confundentes. Las variables que determinan mayor riesgo de EPOC fueron edad mayor 60 años (ORP 3,9; IC95 por ciento 2,9-5,4; p < 0,01) y sexo masculino (OR 2,08; IC95 por ciento 1,5-2,8; p < 0,01). La CID derivada de carbón se asoció con síntomas respiratorios crónicos (ORP 1,4; IC95 por ciento 1,05-1,89; p = 0,024), al igual que el antecedente de exposición a humo de leña (ORP 1,4, IC95 por ciento 1,04-1,9; p = 0,029) y EHAT (ORP 2,1, IC95 por ciento 1,2-3,7; p = 0,006). La exposición a carbón, leña y EHAT constituyen factores de riesgo independientes para presentar SRC. No se encontró asociación entre CID y EPOC.