Knowledge, confidence, and clinical experience of physiotherapists and multiprofessional team on pulmonary rehabilitation / Conocimiento, confianza y experiencia clínica de los fisioterapeutas y el equipo multiprofesional sobre la rehabilitación pulmonar / Conhecimento, confiança e experiência clínica dos fisioterapeutas e equipe multiprofissional sobre reabilitação pulmonar

ABSTRACT The knowledge deficit of health professionals has been a barrier to expanding and implementing of pulmonary rehabilitation (PR) services, despite the reported benefits of PR for individuals with Chronic Respiratory Disease (CRD). This study aims to assess the preparedness of health care professionals from two Brazilian cities to perform PR in the public health system. This is survey is part of a larger project to implement PR in the Brazilian public health system. A self-administered questionnaire was used to assess the knowledge (19 questions), training (7 questions), confidence (10 questions), and clinical experience (8 questions) of physical therapists (PT) and the multiprofessional team (MT) before a PR workshop. In total, 44 PT and 231 MT answered the questionnaire. The mean total knowledge score was 10±3 for PT and 6±3 for MT. Few physical therapist reported having "a lot" of experience (25%) and confidence (22.7%) to perform PR, as well as sufficient training to conduct the six-minute walk test (27.3%).Even fewer MT reported having "a lot" of experience (10%) and sufficient training (4.8%) to perform PR, as well as to plan the educational program for patients (10%) and the confidence to refer patients to PR (6.5%). This is the first study to evaluate the preparedness of professionals from the Brazilian public health network to provide PR. Notably, both PT and MT have low preparation to perform PR in the studied cities, reinforcing the need for continuing education.

RESUMEN El déficit de conocimientos entre los profesionales de la salud ha sido una barrera para la expansión e implementación de los servicios de rehabilitación pulmonar (RP) a pesar de sus beneficios comprobados para las personas con enfermedad respiratoria crónica (ERC). Este estudio de encuesta forma parte de un proyecto más amplio para implantar la RP en el sistema público sanitario brasileño mediante la evaluación de la preparación de los profesionales sanitarios de dos municipios brasileños para proporcionarla. Se utilizó un cuestionario autoadministrado para evaluar los conocimientos (19 preguntas), la formación (7 preguntas), la confianza (10 preguntas) y la experiencia clínica (8 preguntas) de los fisioterapeutas (FT) y del equipo multiprofesional (EM), aplicado previamente en un taller sobre RP. La puntuación media de los conocimientos fue de 10±3 para FT y de 6±3 para EM. Menos de un tercio de los FT afirmaron que tenían "mucha" experiencia (25%) y confianza (22,7%) para realizar la RP, así como formación suficiente para realizar la prueba de la marcha de seis minutos (27,3%). Pocos profesionales del EM declararon que tenían "mucha" experiencia (10%) y formación suficiente (4,8%) para realizar la RP, así como para planificar el programa educativo (10%) y tenían confianza para derivar a pacientes para la RP (6,5%). Este es el primer estudio que evalúa la preparación de los profesionales de la red pública de salud en Brasil para proporcionar la RP, y se observa que, en los municipios donde se realizó, tanto los FT como el EM están poco preparados para llevarla a cabo, lo que refuerza la necesidad de una formación continuada.

RESUMO O déficit de conhecimento dos profissionais de saúde tem sido uma barreira para a expansão e implementação dos serviços de reabilitação pulmonar (RP), apesar dos seus benefícios comprovados para indivíduos com doença respiratória crônica (DRC). Objetivo: avaliar o preparo dos profissionais de saúde de dois municípios brasileiros para fornecer a RP no sistema público de saúde. Esse estudo, do tipo survey, foi parte de um projeto maior para implementação da RP no sistema público de saúde brasileiro. Foi utilizado um questionário autoaplicável para avaliar o conhecimento (19 questões), o treinamento (7 questões), a confiança (10 questões) e a experiência clínica (8 questões) dos fisioterapeutas (FT) e da equipe multiprofissional (EM), aplicado antes de um workshop sobre RP. No total, 44 FT e 231 EM responderam o questionário. A pontuação média de conhecimento foi de 10±3 para FT e 6±3 para EM. Poucos FT referiam ter "muita" experiência (25%) e confiança (22,7%) para realizar RP, bem como treinamento suficiente para realizar o teste de caminhada de seis minutos (27,3%). Ainda menos profissionais da EM relataram ter "muita" experiência (10%) e treinamento suficiente (4,8%) para realizar RP, assim como para planejar o programa educacional dos pacientes (10%) e ter confiança para encaminhar pacientes para a RP (6,5%). Este é o primeiro estudo a avaliar o preparo dos profissionais da rede pública de saúde no Brasil para fornecer RP. Notavelmente, tanto FT quanto EM têm baixo preparo para realizar RP nos municípios estudados, reforçando a necessidade de realização de educação continuada.

"Interstitial lung abnormalities": translation to and use in Portuguese / Anormalidades pulmonares intersticiais: tradução e uso na língua portuguesa

Abstract Objective: To conduct a survey on the use of the term "interstitial lung abnormalities" in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic. Materials and Methods: A survey was sent via electronic message to various radiologists in Brazil, asking about their familiarity with the term, which translation of the term they use in Portuguese, and whether they use the criteria proposed by the Fleischner Society. Results: A total of 163 responses were received, from all regions of Brazil. Although the vast majority (88%) of the respondents stated that they were familiar with the term "interstitial lung abnormalities", there was considerable variation regarding the equivalent term they used in Portuguese. Conclusion: We suggest that the term "anormalidades pulmonares intersticiais" be used in order to standardize radiology reports and disseminate knowledge of these findings in Brazil.

Resumo Objetivo: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema. Materiais e Métodos: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a familiarização com o termo, qual tradução em português utilizam e se usam os critérios propostos pela diretriz da Sociedade Fleischner. Resultados: Foram recebidas 163 respostas de todas as regiões do Brasil e a grande maioria dos radiologistas respondeu estar familiarizado com o termo interstitial lung abnormalities (88%), mas houve grande variação em relação ao termo utilizado como tradução para o português. Conclusão: Sugerimos a padronização do termo "anormalidades pulmonares intersticiais", a fim de uniformizar os relatórios radiológicos e difundir esta entidade no País.

Recuperación de la frecuencia cardíaca en pacientes con enfermedad pulmonar intersticial difusa

Introducción: La enfermedad pulmonar intersticial difusa no soporta el ejercicio, debido a la sensación de disnea y fatiga durante el esfuerzo de baja intensidad. La recuperación de la frecuencia cardíaca se relaciona con el desempeño en el test de caminata de los seis minutos. Objetivo: Determinar las diferencias sociodemográficas de la función y la capacidad pulmonar en pacientes con enfermedad intersticial difusa, a partir de la recuperación de la frecuencia cardíaca durante el test de caminata de los seis minutos. Métodos: Se realizó un estudio descriptivo de corte transversal. Se calculó la recuperación de la frecuencia cardíaca a partir de la diferencia entre el final del test y los cinco minutos de la prueba. Se conformaron dos grupos de comparación, anormal versus normal, en variables sociodemográficas de la función pulmonar y la capacidad funcional. Resultados: Se vincularon 38 pacientes en el grupo normal y en el anormal 26. En el primero predominaron la edad de 62,26 ± 15,82 y los hombres (52,6 %); mientras que en el grupo anormal los años promediaron entre 58,77 ± 13,23 y sobresalieron las mujeres (61,5 %). Se presentó un valor p < 0,05 del grupo recuperación de la frecuencia anormal en la distancia recorrida, disnea y fatiga al final, un minuto y a los cinco minutos de culminar el test. Conclusiones: Los pacientes con enfermedad pulmonar intersticial difusa con una recuperación de la frecuencia cardíaca anormal presentaron peores resultados en la distancia recorrida, volumen de oxígeno, los equivalentes metabólicos, disnea y fatiga de los miembros inferiores.

Introduction: Diffuse interstitial lung disease does not tolerate exercise, due to the sensation of dyspnea and fatigue during low-intensity exertion. Heart rate recovery is related to performance in the six-minute walk test. Objective: To determine sociodemographic differences in lung function and capacity in patients with diffuse interstitial lung disease, based on heart rate recovery during the 6-minute walk test. Methods: A descriptive cross-sectional study was performed. Heart rate recovery was calculated from the difference between the end of the test and the five minutes of the test. Two comparison groups were formed, abnormal versus normal, in sociodemographic variables of pulmonary function and functional capacity. Results: 38 patients were included in the normal group and 26 in the abnormal group. In the normal group, age was 62.26 ± 15.82 and men were predominant (52.6 %); while in the abnormal group, age averaged 58.77 ± 13.23 and women were predominant (61.5 %). A p-value < 0.05 of the abnormal frequency recovery group was presented in the distance run, dyspnea at the end, fatigue at the end, 1 minute and at 5 minutes after the culmination of the test. Conclusions: Patients with diffuse interstitial lung disease with abnormal heart rate recovery had worse results in distance run, oxygen volume, metabolic equivalents, dyspnea and lower limb fatigue.

Relative incidence of interstitial lung diseases in Brazil / Incidência relativa de doenças pulmonares intersticiais no Brasil

ABSTRACT Objective: To assess the relative frequency of incident cases of interstitial lung diseases (ILDs) in Brazil. Methods: This was a retrospective survey of new cases of ILD in six referral centers between January of 2013 and January of 2020. The diagnosis of ILD followed the criteria suggested by international bodies or was made through multidisciplinary discussion (MDD). The condition was characterized as unclassifiable ILD when there was no specific final diagnosis following MDD or when there was disagreement between clinical, radiological, or histological data. Results: The sample comprised 1,406 patients (mean age = 61 ± 14 years), and 764 (54%) were female. Of the 747 cases exposed to hypersensitivity pneumonitis (HP)-related antigens, 327 (44%) had a final diagnosis of HP. A family history of ILD was reported in 8% of cases. HRCT findings were indicative of fibrosis in 74% of cases, including honeycombing, in 21%. Relevant autoantibodies were detected in 33% of cases. Transbronchial biopsy was performed in 23% of patients, and surgical lung biopsy, in 17%. The final diagnoses were: connective tissue disease-associated ILD (in 27%), HP (in 23%), idiopathic pulmonary fibrosis (in 14%), unclassifiable ILD (in 10%), and sarcoidosis (in 6%). Diagnoses varied significantly among centers (c2 = 312.4; p < 0.001). Conclusions: Our findings show that connective tissue disease-associated ILD is the most common ILD in Brazil, followed by HP. These results highlight the need for close collaboration between pulmonologists and rheumatologists, the importance of detailed questioning of patients in regard with potential exposure to antigens, and the need for public health campaigns to stress the importance of avoiding such exposure.

RESUMO Objetivo: Avaliar a frequência relativa de casos incidentes de doenças pulmonares intersticiais (DPI) no Brasil. Métodos: Levantamento retrospectivo de casos novos de DPI em seis centros de referência entre janeiro de 2013 e janeiro de 2020. O diagnóstico de DPI seguiu os critérios sugeridos por órgãos internacionais ou foi feito por meio de discussão multidisciplinar (DMD). A condição foi caracterizada como DPI não classificável quando não houve um diagnóstico final específico após a DMD ou houve discordância entre dados clínicos, radiológicos ou histológicos. Resultados: A amostra foi composta por 1.406 pacientes (média de idade = 61 ± 14 anos), sendo 764 (54%) do sexo feminino. Dos 747 casos expostos a antígenos para pneumonite de hipersensibilidade (PH), 327 (44%) tiveram diagnóstico final de PH. Houve relato de história familiar de DPI em 8% dos casos. Os achados de TCAR foram indicativos de fibrose em 74% dos casos, incluindo faveolamento, em 21%. Autoanticorpos relevantes foram detectados em 33% dos casos. Biópsia transbrônquica foi realizada em 23% dos pacientes, e biópsia pulmonar cirúrgica, em 17%. Os diagnósticos finais foram: DPI associada à doença do tecido conjuntivo (em 27%), PH (em 23%), fibrose pulmonar idiopática (em 14%), DPI não classificável (em 10%) e sarcoidose (em 6%). Os diagnósticos variaram significativamente entre os centros (c2 = 312,4; p < 0,001). Conclusões: Nossos achados mostram que DPI associada à doença do tecido conjuntivo é a DPI mais comum no Brasil, seguida pela PH. Esses resultados destacam a necessidade de uma estreita colaboração entre pneumologistas e reumatologistas, a importância de fazer perguntas detalhadas aos pacientes a respeito da potencial exposição a antígenos e a necessidade de campanhas de saúde pública destinadas a enfatizar a importância de evitar essa exposição.

Connective tissue disease-associated interstitial lung disease / Doença pulmonar intersticial associada a doença do tecido conjuntivo

ABSTRACT Connective tissue disease-associated interstitial lung disease (CTD-ILD) represents a group of systemic autoimmune disorders characterized by immune-mediated organ dysfunction. Systemic sclerosis, rheumatoid arthritis, idiopathic inflammatory myositis, and Sjögren's syndrome are the most common CTDs that present with pulmonary involvement, as well as with interstitial pneumonia with autoimmune features. The frequency of CTD-ILD varies according to the type of CTD, but the overall incidence is 15%, causing an important impact on morbidity and mortality. The decision of which CTD patient should be investigated for ILD is unclear for many CTDs. Besides that, the clinical spectrum can range from asymptomatic findings on imaging to respiratory failure and death. A significant proportion of patients will present with a more severe and progressive disease, and, for those, immunosuppression with corticosteroids and cytotoxic medications are the mainstay of pharmacological treatment. In this review, we summarized the approach to diagnosis and treatment of CTD-ILD, highlighting recent advances in therapeutics for the various forms of CTD.

RESUMO Doença pulmonar intersticial associada à doença do tecido conjuntivo (DPI-DTC) representa um grupo de distúrbios autoimunes sistêmicos caracterizados por disfunção de órgãos imunomediada. Esclerose sistêmica, artrite reumatoide, miosite inflamatória idiopática e síndrome de Sjögren são as DTC mais comuns que apresentam acometimento pulmonar, bem como pneumonia intersticial com achados autoimunes. A frequência de DPI-DTC varia de acordo com o tipo de DTC, mas a incidência total é de 15%, causando um impacto importante na morbidade e mortalidade. A decisão sobre qual paciente com DTC deve ser investigado para DPI não é clara para muitas DTC. Além disso, o espectro clínico pode variar desde achados assintomáticos em exames de imagem até insuficiência respiratória e morte. Parte significativa dos pacientes apresentará doença mais grave e progressiva, e, para esses pacientes, imunossupressão com corticosteroides e medicamentos citotóxicos são a base do tratamento farmacológico. Nesta revisão, resumimos a abordagem do diagnóstico e tratamento de DPI-DTC, destacando os recentes avanços na terapêutica para as diversas formas de DTC.

Relación de la enfermedad periodontal inflamatoria crónica con enfermedades sistémicas

Introducción: La enfermedad periodontal es una infección inmunoinflamatoria crónica de origen multifactorial. Puede avanzar a nivel sistémico por el paso de bacterias y sus productos al torrente sanguíneo, lo cual constituye un factor de riesgo para alteraciones sistémicas. La revisión bibliográfica se realizó de julio 2022 hasta febrero 2023. Se utilizaron las bases de datos PubMed, SciELO y Elsevier y el motor de búsqueda Google Académico. Objetivos: Describir la relación de la enfermedad periodontal inflamatoria crónica con enfermedades sistémicas. Desarrollo: La medicina periodontal estudia la relación que existe entre las periodontopatías y enfermedades sistémicas, como las cardiovasculares, cerebrovasculares, pulmonares, la renal crónica, la artritis reumatoide y el Alzheimer. Las bacterias provenientes de las bolsas periodontales pasan hacia la circulación sanguínea, producen infección metastásica y daño metastásico, mediante la producción de endotoxinas, lipopolisacáridos e inflamación metastásica. Conclusiones: La enfermedad periodontal crónica constituye un factor de riesgo para el desarrollo de enfermedades cardiovasculares, pulmonares, renales, trastornos cerebrovasculares, artritis reumatoide y el Alzheimer debido a reacciones inflamatorias producidas por microorganismos patogénicos; se establece una relación bidireccional entre estas enfermedades y las periodontopatías.

Introduction: Periodontal disease is a chronic immunoinflammatory infection of multifactorial origin. It can advance at a systemic level due to the passage of bacteria and their products into the bloodstream, which constitutes a risk factor for systemic alterations. The bibliographic review was carried out from July 2022 to February 2023. The PubMed, SciELO and Elsevier databases and the Google Scholar search engine were used. Objectives: Describe the relationship of chronic inflammatory periodontal disease with systemic diseases. Development: Periodontal medicine studies the relationship between periodontopathies and systemic diseases, such as cardiovascular, cerebrovascular, pulmonary, chronic kidney disease, rheumatoid arthritis and Alzheimer's. Bacteria from periodontal pockets pass into the blood circulation, producing metastatic infection and metastatic damage, through the production of endotoxins, lipopolysaccharides and metastatic inflammation. Conclusions: Chronic periodontal disease constitutes a risk factor for the development of cardiovascular, pulmonary, renal diseases, cerebrovascular disorders, rheumatoid arthritis and Alzheimer's due to inflammatory reactions produced by pathogenic microorganisms; A bidirectional relationship is established between these diseases and periodontopathies. The analysis of this relationship and the mechanisms by which it occurs guarantees the development of a more integrative care practice.

Paracoccidoidomicosis: Reporte de 4 casos

La paracoccidioidomicosis (PCM) es una infección causada por hongos patógenos humanos del género Paracoccidioides. Es una micosis sistémica que puede afectar cualquier órgano. Se describen con este reporte cuatro casos de paracoccidioidomicosis con diferentes presentaciones clínicas, tiempo de evolución, con afectación mucocutánea, pulmonar, glándulas suprarrenales, sistema nervioso entre otros, principalmente en adultos varones de diferentes edades y profesiones, tanto inmunosuprimidos como inmunocompetentes, teniendo en común el contacto con el suelo. Se demuestra de esta manera la importancia de considerar esta patología ante una sospecha clínica de micosis sistémica para así realizar una confirmación temprana y tratamiento oportuno ya que presenta buena respuesta terapéutica antimicótica y mejoría clínica.

Paracoccidioidomycosis (PCM) is an infection caused by human pathogenic fungi of the genus Paracoccidioides. This report describes: 4 cases of paracoccidioidomycosis diagnosed with different clinical presentations, different times of evolution, with mucocutaneous, pulmonary, adrenal gland, and nervous system involvement, among others, mainly in male adults of different ages and professions, both immunosuppressed and immunocompetent, having in common contact with the ground. In this way, PCM is a systemic mycosis that can affect any organ and therefore the importance of considering this pathology when a diagnostic suspicion of systemic mycosis is presented in order to make an early diagnosis and timely treatment since it presents a good therapeutic response, antifungal and clinical improvement.

La fibrosis quística en niños en el Ecuador / Cystic fibrosis in children in Ecuador

Objetivo: analizar la fibrosis quística en niños en el Ecuador. Metodología: Revisión sistemática de 21 publicaciones relacionadas al tema, específicamente 13 articulos de investigación en contexto ecuatoriano. Resultados y conclusión: En el Ecuador la incidencia de la enfermedad es de 1 por cada 11.110 habitantes y cada año nacen aproximadamente 23 niños con esta afección, teniéndose en cuenta las mutaciones en el CFTR, entorpecen el diagnóstico molecular, así como se ha estudiado un caso pediátrico de FQ con complicaciones en pancreatitis, siendo esto inusual en la población infantil, siendo considerable proseguir con investigaciones conducentes a tener una mejor referencia científica de la FQ en el Ecuador.

Objective: to analyze cystic fibrosis in children in Ecuador. Methodology: Systematic review of 21 publications related to the subject, specifically 13 research articles in the Ecuadorian context. Results and conclusion: In Ecuador the incidence of the disease is 1 for every 11,110 inhabitants and each year approximately 23 children are born with this condition, taking into account CFTR mutations, which hinder molecular diagnosis, as well as a study pediatric case of CF with complications in pancreatitis, this being unusual in the child population, it is important to continue with research leading to a better scientific reference of CF in Ecuador.

Paraccocidiomicosis sistémica en consumidor crónico de corticoides

La Paracoccidiomicosis es una infección endémica. Junto con la histoplasmosis, son las infecciones micóticas más frecuentes en Latinoamérica. Esta micosis puede ser de afección local o sistémica, con un marcado trofismo por los pulmones, órganos linfoides, hígado, glándulas suprarrenales, piel y mucosa. Presentamos el caso de un varón adulto, consumidor crónico de corticoides, que desarrolla una paracoccidiomicosis sistémica con afección pulmonar y de glándulas suprarrenales con buena repuesta a la terapéutica antifúngica.

Paracoccidiomycosis is an endemic infection, together with histoplasmosis, they are the most frequent fungal infections in Latin America. This mycosis can be of local or systemic affection, with a marked trophism by the lungs, lymphoid organs, liver, adrenal glands, skin and mucosa. We present the case of an adult male, chronic steroid user, who develops systemic paracoccidiomycosis with pulmonary and adrenal gland involvement with good response to antifungal therapy.

Perfil de pacientes evaluados con el Test de Capacidad de Difusión de Monóxido de Carbono: Una experiencia chilena

Antecedentes: La prueba de capacidad de difusión de monóxido de carbono (DLCO) es una evaluación de función pulmonar rutinaria y no invasiva clínicamente útil para determinar el estado de la función pulmonar en pacientes con trastornos crónicos como la enfermedad pulmonar intersticial difusa (EPID). Objetivo: Describir el perfil sociodemográfico y clínico de usuarios de la prueba DLCO en Valdivia, Chile. Materiales y Métodos: Estudio observacional, retrospectivo, de base documental. A partir de registros de 490 pacientes que se realizaron la prueba DLCO entre 2017 y 2019, se describen características sociodemográficas, clínicas y reporte de consumo de cigarrillo como cigarrillos/d e índice paquetes/año (IPA), comparando por sexo. Resultados: La mayor proporción de evaluados fueron mujeres (61%), con una edad mediana de 65 años, mayor en mujeres (66 vs 64 años; p = 0,0361). La mayoría consultaron por EPID (54,5%). Según estado nutricional, 38% presentó preobesidad y 24,7% obesidad I (24,7%), destacando que 40,5% de las mujeres y 33% de los hombres se encontraron en alguna categoría de obesidad. Entre quienes reportaron información de consumo de cigarrillos (n = 346, 70,6%), 14,7% (n = 51) eran consumidores actuales, con un consumo mediano de 10 cigarrillos/d, sin diferencias por sexo. Entre exfumadores (n = 144; 50% hombres/mujeres) hubo significativamente menor consumo diario (5 vs 15; p = 0,0300) y de IPA (7 vs 18; p = 0,0083) en mujeres. Conclusiones: En usuarios de DLCO el principal diagnóstico de consulta fue EPID. Destacó alta frecuencia de obesidad y tabaquismo, sin diferencia de consumo por sexo en fumadores actuales, pero sí en exfumadores.

Background: The carbon monoxide diffusion capacity test (DLCO) is a clinically useful, routine, non-invasive lung function assessment to determine the status of lung function in patients with chronic disorders such as interstitial lung disease (ILD). Aim: To describe the sociodemographic and clinical profile of users of the DLCO test in Valdivia, Chile. Materials and Methods: Observational, retrospective, documentary-based study. From the records of 490 patients who underwent the DLCO test between 2017 and 2019, sociodemographic and clinical characteristics and reports of cigarette consumption are described, such as cigarettes/d and pack-year index (PYI), comparing by sex. Results: The highest proportion of those evaluated were women (61%), with a median age of 65 years, higher in women (66 vs. 64 years; p = 0.0361). The majority consulted for ILD (54.5%). According to nutritional status, 38% presented pre-obesity and 24.7% obesity I (24.7%), highlighting that 40.5% of women and 33% of men were in some category of obesity. Among those who reported information on cigarette consumption (n = 346, 70.6%), 14.7% (n = 51) were current consumers, with a median consumption of 10 cigarettes/d, without differences by sex. Among exsmokers (n = 144; 50% men/women) there was significantly less daily (5 vs 15; p = 0.0300) and IPA (7 vs 18; p = 0.0083) consumption in women. Conclusions: In DLCO users, the main consultation diagnosis was ILD. High frequency of obesity and smoking stood out, with no difference in consumption by sex in current smokers, but yes in ex-smokers.

Ecografía pulmonar en la evaluación del paciente crítico / Lung ultrasound in the evaluation of critically ill patients

Introducción: La ecografía es una técnica de imagen no invasiva que permite explorar diferentes órganos de manera inmediata, constituye un instrumento de alto valor diagnóstico al alcance del profesional de la salud, y es utilizada en todas las especialidades médicas. En los últimos años, la evolución tecnológica ha permitido que los aparatos de ecografía sean más pequeños, portátiles, y con una alta resolución, tal es el caso de la ecografía clínica o ecografía a pie de cama. La ecografía del paciente crítico ha cambiado la práctica médica; específicamente la ecografía pulmonar se debe realizar en todos los pacientes con enfermedad pulmonar aguda. Objetivo: Aportar el conocimiento teórico necesario para promover el uso de la ecografía pulmonar en la evaluación del paciente crítico, y contribuir, mediante su aplicación, a la disminución del riesgo de exposición a las radiografías. Métodos: Se efectuó una revisión de la literatura médica actualizada sobre el papel de la ecografía pulmonar en la evaluación del paciente crítico, en el período de julio a diciembre de 2021. Se utilizaron los siguientes motores de búsqueda: SciELO, Medigraphic y Google Académico. Conclusiones: En el contexto actual, la ecografía pulmonar ha adquirido un papel protagónico, pues su uso facilita una evaluación frecuente y no invasiva del paciente crítico con afección pleuropulmonar. Su aplicación garantiza la disminución del riesgo de exposición a las radiografías.

Introduction: ultrasound is a non-invasive imaging technique that allows us to explore different organs immediately; it constitutes an instrument of high diagnostic value within the reach of health professionals and used in all medical specialties. In recent years, technological evolution has allowed ultrasound devices to be smaller, portable and with high resolution, such is the case of clinical ultrasound or bedside ultrasound. Bedside ultrasound in critically ill patients has changed medical practice; specifically, lung ultrasound should be performed in all patients with acute lung disease. Objective: to provide the necessary theoretical knowledge in order to promote the use of lung ultrasound in the evaluation of critically ill patients, as well as to contribute, through its application, to reduce the risk of exposure to radiographs. Methods: a review of the updated medical literature on the role of lung ultrasound in the evaluation of the critically ill patients was performed from July to December 2021. SciELO, Medigraphic and Google Scholar were the search engines used. Conclusions: lung ultrasound has acquired a leading role in the current context, since its use facilitates a non-invasive and common evaluation of the criticall ill patients with pleuropulmonary disease. Its application guarantees the reduction of the risk of exposure to X-rays.

Lobectomías pulmonares en Colombia: una caracterización demográfica y clínico-patológica / Pulmonary lobectomies in Colombia: a demographic and clinicopathological characterization

Introducción. La lobectomía pulmonar es uno de los procedimientos más frecuentes en la cirugía torácica en Colombia y a nivel mundial. El objetivo de este estudio fue proporcionar información sobre el comportamiento clínico de los individuos sometidos a este tipo de cirugías. Métodos. Estudio observacional retrospectivo en un Hospital Universitario de Cali, Colombia, que incluyó todos los pacientes sometidos a lobectomía pulmonar, por causas benignas o malignas, entre los años 2010 y 2020. La información se extrajo del registro institucional de cirugía de tórax, obteniendo datos demográficos, clínicos y patológicos. Resultados. Se evaluaron los registros clínicos de 207 individuos. El 55,5 % eran mujeres, la edad promedio fue 58 años y el 41 % tuvieron antecedente de tabaquismo. En el 51,6 % de los casos se diagnosticaron neoplasias, de las cuales el 47,8 % eran primarias de pulmón, siendo el adenocarcinoma el subtipo más común. Las enfermedades benignas no tumorales representaron el 48,3 % de los casos y la causa más frecuente fueron las infecciones, dentro de las que se incluyeron 17 casos de tuberculosis pulmonar. La técnica más frecuente fue la cirugía toracoscópica video asistida (82,6 %). Presentaron un porcentaje de reintervención del 5,8 %, 10,6 % de complicaciones severas y una mortalidad hospitalaria del 4,3 %. Conclusión. La población evaluada muestra una carga alta de comorbilidades y riesgo operatorio elevado; de forma consecuente, al compararla con otras series internacionales, se encontró un porcentaje mayor de complicaciones perioperatorias y mortalidad.

Introduction. The pulmonary lobectomies is one of the most common procedures in thoracic surgery in Colombia and worldwide. The objective of this study is to provide information on the clinical behavior of individuals who underwent this type of surgeries. Methods. Retrospective observational study at a University Hospital in Cali, Colombia, including all individuals who had pulmonary lobectomies, between the years 2010 to 2020 for benign and malignant causes. The information was extracted from the institutional registry of thoracic surgery, obtaining demographic, clinical and pathological data. Results. The clinical records of 207 individuals were evaluated, 55.5% were women, the average age was 58 years, and 41% had a history of smoking. Of these cases, 51.6% were diagnosed with neoplasms, of which 47.8% were primary lung neoplasms, with adenocarcinoma being the most common subtype. As for benign diseases, they represented 48.3% of the cases and the most frequent cause was infections, including 17 cases of pulmonary tuberculosis. The most frequent technique was video-assisted thoracoscopic surgery in 82.6%, with a reoperation rate of 5.8%, up to 10.6% of severe complications, a median hospital stay of 6 days, and a hospital mortality of 4.3%.Conclusion. The population evaluated shows a high burden of comorbidities and high operative risk; consequently, when compared with other international series, it shows a higher percentage of perioperative complications, hospital stay, and mortality.

Risco de exacerbação de asma em adolescentes usuários de dispositivos eletrônicos de liberação de nicotina: uma revisão sistemática e metanálise / Risk of asthma exacerbation in adolescent users of electronic nicotine delivery systems: a systematic review and meta-analysis

Este trabalho tem como objetivo investigar a associação entreo o uso dos cigarros eletrônicos e doenças pulmonares em adolescentes. Foi realizada uma revisão sistemática na base de dados PubMed. Os termos Mesh incluídos na busca foram "Electronic Nicotine Delivery Systems" e "Lung Diseases" e sinônimos no título e abstract, com o filtro de idade "child: birth - 18 years", para buscar artigos relacionados ao uso de cigarros eletrônicos e doenças pulmonares em adolescentes. Os critérios de elegibilidade consistiram em: usuários adolescentes, exposição ao cigarro eletrônico e doença pulmonar como desfecho. Os artigos foram selecionados por uma revisão pareada de maneira independente, primeiramente com a leitura dos títulos e resumos, seguida da leitura integral dos artigos selecionados, os quais foram analisados pela ferramenta New Castle-Ottawa quanto sua qualidade, e receberam entre 5 e 7 estrelas. Os dados encontrados foram extraídos para a realização da metanálise. Inicialmente foram encontrados 61 artigos, sendo seis considerados elegíveis, todos transversais e com aplicação de questionários. Na metanálise foi encontrada uma associação significativa entre o uso de cigarro eletrônico e exacerbação de asma (OR ajustado 1,44; IC 95% 1,17­1,76). Não foram encontrados estudos que avaliassem a associação do cigarro eletrônico e outras doenças pulmonares, incluindo EVALI (E-cigarette or Vaping product use-Associated Lung Injury), em adolescentes. Na metanálise foi encontrada uma associação significativa entre exacerbações de asma e uso de cigarros eletrônicos em adolescentes com asma crônica e nos previamente hígidos.

This study aims to investigate the association between electronic cigarette use and lung disease in adolescents. A systematic review was conducted in PubMed. We used the MeSH terms "Electronic Nicotine Delivery Systems" and "Lung Diseases" as well as synonyms in the title and abstract, with the age filter "child: birth - 18 years" to search for articles related to electronic cigarette use and lung disease in adolescents. The eligibility criteria consisted of adolescent users and exposure to e-cigarettes that resulted in lung disease. The articles were selected by independent assessment, reading first the titles and abstracts, then the full text of the selected articles. The Newcastle-Ottawa Scale was used to assess study quality, and the included studies received between 5 and 7 stars. Finally, the data were extracted for meta-analysis. Initially, 61 articles were found and 6 were considered eligible, all of which were cross-sectional and applied questionnaires. The meta-analysis found a significant association between electronic cigarette use and asthma exacerbation (adjusted OR 1.44 95% CI 1.17 - 1.76). However, no studies evaluated the association with other lung diseases, including electronic cigarette or vaping product use-associated lung injury in adolescents. The metaanalysis revealed a significant association between e-cigarette use and asthma exacerbation among adolescents with chronic asthma, as well as among their previously healthy peers.

Taquipnea persistente como manifestación inicial de hiperplasia de células neuroendocrinas: reporte de un caso clínico / Persistent tachypnea as initial manifestation of hyperplasia of neuroendocrine cells: case report

Se realiza revisión de la literatura y presentación de un caso clínico de Hiperplasia de Células Neuroendocrinas en paciente lactante masculino que inicia su padecimiento a los 3 meses de vida con dificultad respiratoria caracterizada por retracciones subcostales y taquipnea persistente, posterior-mente a los 8 meses de edad se agrega hipoxemia respirando aire ambiente que requiere uso de oxígeno suplementario continuo. Tiene antecedente de tres hospitalizaciones, con diagnóstico de Bronquiolitis y Neumonía atípica, realizándose panel viral respiratorio con reporte negativo. El paciente persiste con sintomatología respiratoria a pesar de tratamientos médicos, por lo que se deriva a neumología pediátrica, unidad de enfermedad pulmonar intersticial del lactante, iniciando protocolo de estudio, se realiza tomografía tórax de alta resolución, que evidencia imágenes en vidrio despulido en lóbulo medio y región lingular, además de atrapamiento aéreo. Se concluye el diagnóstico de Hiperplasia de Células neuroendocrinas con base a la clínica y hallazgos tomográficos. La Hiperplasia de Células Neuroendocrinas es una patología pulmonar intersticial poco frecuente, cuyo diagnóstico es clínico y radiológico, en la minoría de los casos se requiere biopsia pulmonar para confirmación. Puede ser fácilmente confundida con otras enfermedades respiratorias comunes, por lo que es importante sospecharla para realizar un diagnóstico precoz. La mayor parte de los casos evolucionan con declinación de los síntomas, mejorando espontáneamente en los primeros años de vida.

A review of the literature and presentation of a clinical case of Neuroendocrine Cell Hyperplasia in a male infant patient who begins his condition at 3 months of age with respiratory distress characterized by subcostal retractions and persistent tachypnea is presented. After 8 months of age hypoxemia is added requiring continuous oxygen therapy. He has a history of three hospitalizations, with a diagnosis of bronchiolitis and atypical pneumonia, respiratory viral panel has a negative report. The patient persists with respiratory symptoms despite medical treatments, so it is referred to pediatric pulmonology, initiating study protocol for interstitial lung disease of the infant. A high resolution chest tomography is performed, which evidences images in polished glass in the middle lobe and lingular region, in addition to air entrapment. The diagnosis of neuroendocrine cell hyperplasia is concluded based on clinical and tomographic findings. Neuroendocrine Cell Hyperplasia is a rare interstitial pulmonary pathology, whose diagnosis is clinical and radiological. Lung biopsy is required only in the minority of cases for confirming diagnosis. It can be easily confused with other common respiratory diseases, so it is important to suspect it to make an early diagnosis. Most cases evolve with decline in symptoms, improving spontaneously in the first years of life.

Progressive fibrotic interstitial lung disease / Doença pulmonar intersticial fibrosante progressiva

ABSTRACT Many interstitial lung diseases (ILDs) share mechanisms that result in a progressive fibrosing phenotype. In Brazil, the most common progressive fibrosing interstitial lung diseases (PF-ILDs) are chronic hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, unclassified ILD, and connective tissue diseases. PF-ILD is seen in approximately 30% of patients with ILD. Because PF-ILD is characterized by disease progression after initiation of appropriate treatment, a diagnosis of the disease resulting in fibrosis is critical. Different criteria have been proposed to define progressive disease, including worsening respiratory symptoms, lung function decline, and radiological evidence of disease progression. Although the time elapsed between diagnosis and progression varies, progression can occur at any time after diagnosis. Several factors indicate an increased risk of progression and death. In the last few years, antifibrotic drugs used in patients with idiopathic pulmonary fibrosis have been tested in patients with PF-ILD. The effects of nintedanib and placebo have been compared in patients with PF-ILD, a mean difference of 107.0 mL/year being observed, favoring nintedanib. The U.S. Food and Drug Administration and the Brazilian Health Regulatory Agency have approved the use of nintedanib in such patients on the basis of this finding. Pirfenidone has been evaluated in patients with unclassified ILD and in patients with other ILDs, the results being similar to those for nintedanib. More studies are needed in order to identify markers of increased risk of progression in patients with ILD and determine the likelihood of response to treatment with standard or new drugs.

RESUMO Muitas doenças pulmonares intersticiais (DPI) compartilham mecanismos que resultam em um fenótipo fibrosante progressivo. No Brasil, as doenças pulmonares intersticiais fibrosantes progressivas (DPI-FP) mais comuns são a pneumonite de hipersensibilidade crônica, a fibrose pulmonar idiopática, a DPI não classificada e as doenças do tecido conjuntivo. A DPI-FP é observada em aproximadamente 30% dos pacientes com DPI. Como a DPI-FP é caracterizada pela progressão da doença após o início do tratamento adequado, é fundamental diagnosticar a doença que resulta em fibrose. Diferentes critérios foram propostos para definir doença progressiva, incluindo piora dos sintomas respiratórios, declínio da função pulmonar e evidências radiológicas de progressão da doença. Embora o tempo decorrido entre o diagnóstico e a progressão varie, a progressão pode ocorrer a qualquer momento após o diagnóstico. Vários fatores indicam risco aumentado de progressão e morte. Nos últimos anos, antifibróticos usados em pacientes com fibrose pulmonar idiopática foram testados em pacientes com DPI-FP. Os efeitos do nintedanibe e placebo foram comparados em pacientes com DPI-FP, com diferença média de 107,0 mL/ano a favor do nintedanibe. A Food and Drug Administration (EUA) e a Agência Nacional de Vigilância Sanitária aprovaram o uso do nintedanibe em tais pacientes com base nesse achado. A pirfenidona foi avaliada em pacientes com DPI não classificada e em pacientes com outras DPI, e os resultados foram semelhantes aos do nintedanibe. Mais estudos são necessários para identificar marcadores de risco aumentado de progressão em pacientes com DPI e determinar a probabilidade de resposta ao tratamento com medicamentos-padrão ou novos.

Displasia broncopulmonar y severa restricción del crecimiento intrauterino en neonato de 850 gramos al nacer

Introducción: La displasia broncopulmonar es una enfermedad pulmonar crónica de inicio en edad neonatal. La restricción del crecimiento intrauterino se define como fracaso del feto para alcanzar su potencial de crecimiento genéticamente determinado. Objetivo: Describir el manejo interdisciplinario de la displasia broncopulmonar y revisar la literatura sobre el tema. Caso clínico: Se presenta el caso de un neonato hijo de madre adolescente producto de su primera gestación, la cual llevó un adecuado control prenatal. Presentó restricción del crecimiento intrauterino grado IV caracterizada por alteraciones en el ultrasonido Doppler en relación con insuficiencia placentaria severa y oligohidramnios, motivo por el cual se interrumpe el embarazo por parto distócico por cesárea a las 34+1 semanas, con bolsa rota al nacer, líquido amniótico claro y muy escaso. Nace en buenas condiciones clínicas con 850 gramos de peso. En los primeros días de vida, comenzó con manifestaciones clínicas de sepsis; se diagnosticó enterocolitis necrotizante luego presentó un súbito deterioro clínico debido a la aparición de hemorragia pulmonar. Con 695 gramos de peso, se inició tratamiento con ventilación mecánica invasiva, la cual se prolongó por un período de 30 días. Después del destete de la ventilación mecánica, el niño mantuvo una dependencia del oxígeno durante 71 días más; como manifestación de la displasia broncopulmonar. Se realizaron interconsultas con especialistas en Cardiología, Hematología, Imagenología, Nutrición, Inmunología y Genética; y, en colectivo, se decidió, la terapéutica desarrollada. El neonato evolucionó satisfactoriamente. Conclusiones: Se mostró el manejo interdisciplinario de la displasia broncopulmonar. Se consultó la bibliografía actualizada.

Introduction: Bronchopulmonary dysplasia is a chronic lung disease of neonatal age onset. Intrauterine growth restriction is defined as failure of the fetus to reach its genetically determined growth potential. Objective: To describe the interdisciplinary management of bronchopulmonary dysplasia and review the literature on the subject. Case report: The case of a newborn son of an adolescent mother, product of her first pregnancy, which had an adequate prenatal control, is presented. She presented grade IV intrauterine growth restriction characterized by alterations in the Doppler ultrasound in relation to severe placental insufficiency and oligohydramnios, which is why the pregnancy was terminated due to dystocic delivery by cesarean section at 34+1 weeks, with a ruptured bag at birth, liquid clear and very scanty amniotic. He was born in good clinical condition with a weight of 850 grams. In the first days of life, he began with clinical manifestations of sepsis; necrotizing enterocolitis was diagnosed, then he presented a sudden clinical deterioration due to the appearance of pulmonary hemorrhage. Weighing 695 grams, treatment with invasive mechanical ventilation was started, which lasted for a period of 30 days. After weaning from mechanical ventilation, the child remained oxygen dependent for a further 71 days; as a manifestation of bronchopulmonary dysplasia. Interconsultations were made with specialists in Cardiology, Hematology, Imaging, Nutrition, Immunology and Genetics; and, collectively, it was decided, the therapy developed. The neonate evolved satisfactorily. Conclusions: The interdisciplinary management of bronchopulmonary dysplasia was shown. The updated literature was consulted.

Patient care in cystic fibrosis centers: a real-world analysis in Brazil / Assistência ao paciente em centros de fibrose cística: análise do mundo real no Brasil

ABSTRACT Objective: To analyze the characteristics of cystic fibrosis (CF) care centers (CFCCs) in Brazil. Methods: A questionnaire was sent to the coordinators of all 51 registered CFCCs between May and September of 2021. Results: The response rate was 100%. Southeastern Brazil is the region where most of the CFCCs in the country are located (21 centers; 41%), followed by the southern and northeastern regions (11 centers each; 21.5%), the central-western region (6; 12%), and the northern region (2; 4%). A total of 4,371 patients with CF were cared for in Brazil during the study period, ranging from 7 to 240 patients per center (mean, 86 patients/center; median, 75 patients/center); 2,197 patients (50%) were cared for in centers in the southeastern region of the country, particularly in the state of São Paulo (33%), the remaining patients being treated in southern Brazil (1,014 patients, 23%), northeastern Brazil (665 patients, 15%), central-western Brazil (354 patients, 8%), and northern Brazil (141 patients, 4%). Overall, 47 centers (92%) reported having an incomplete multidisciplinary team; 4 (8%) lacked essential team members; 6 (12%) lacked a physical therapist; 5 (10%) lacked a dietitian; 17 (33%) lacked outpatient nursing care; 13 (25%) lacked outpatient social work services; 14 (27%) lacked a psychologist; and 32 (63%) lacked a clinical pharmacist. Seven CFCCs (14%) in the northern and northeastern regions of Brazil reported that the quality of newborn screening for CF was poor. All centers reported having difficulties in accessing CF medications. Conclusions: Brazilian CFCCs experience multiple problems, including inadequate staffing, infrastructure, testing, and medication supply. There is an urgent need to regulate the implementation of CF referral centers and an appropriate network structure for the diagnosis and follow-up of CF patients using optimal treatment recommendations.

RESUMO Objetivo: Analisar as características dos centros de tratamento de fibrose cística (CTFC) no Brasil. Métodos: Entre maio e setembro de 2021, um questionário foi enviado aos coordenadores de todos os 51 CTFC registrados. Resultados: A taxa de resposta foi de 100%. O Sudeste do Brasil é a região onde está a maioria dos CTFC do país (21 centros; 41%), seguida pelas regiões Sul e Nordeste (11 centros cada; 21,5%), Centro-Oeste (6; 12%) e Norte (2; 4%). No total, 4.371 pacientes com fibrose cística (FC) foram atendidos no Brasil durante o período do estudo, variando de 7 a 240 pacientes por centro (média de 86 pacientes/centro; mediana de 75 pacientes/centro); 2.197 pacientes (50%) foram atendidos em centros da região Sudeste, particularmente no estado de São Paulo (33%), e os demais receberam atendimento nas regiões Sul (1.014 pacientes, 23%), Nordeste (665 pacientes, 15%), Centro-Oeste (354 pacientes, 8%) e Norte (141 pacientes, 4%). Do total de CTFC, 47 (92%) relataram que a equipe multidisciplinar estava incompleta; em 4 centros (8%), as equipes multidisciplinares careciam de membros essenciais; 6 centros (12%) careciam de fisioterapeuta; 5 (10%) careciam de dietista; 17 (33%) careciam de cuidados ambulatoriais de enfermagem; 13 (25%) careciam de serviços ambulatoriais de assistência social; 14 (27%) careciam de psicólogo e 32 (63%) careciam de farmacêutico clínico. Sete CTFC (14%) nas regiões Norte e Nordeste relataram que a qualidade da triagem neonatal de FC era ruim. Todos os centros relataram dificuldades de acesso a medicamentos para FC. Conclusões: Os CTFC brasileiros enfrentam múltiplos problemas: pessoal inadequado, infraestrutura inadequada, testes inadequados e fornecimento inadequado de medicamentos. Há uma necessidade urgente de regulamentar a implantação de centros de referência em FC e de uma rede adequada para o diagnóstico e acompanhamento de pacientes com FC com base nas recomendações para o tratamento ideal da doença.