Función pulmonar y capacidad ventilatoria en pacientes hemodializados según exposición a entrenamiento físico intradiálisis / Pulmonary function and ventilatory capacity in hemodialysis patients according to exposure to intra-dialysis physical training

Resumen Introducción: la enfermedad renal crónica es un proceso progresivo e irreversible; con frecuencia lleva a un estado terminal, donde los pacientes necesitan de diálisis o trasplante. Se ha demostrado que la función pulmonar y la capacidad ventilatoria se ven comprometidas en estos pacientes, y se incrementan con la exposición a hemodiálisis y el sedentarismo. Objetivo: comparar la función pulmonar y la capacidad ventilatoria de pacientes hemodializados, según exposición a entrenamiento físico intradiálisis. Materiales y métodos: estudio de tipo cuantitativo, no experimental, descriptivo y transversal; la población de estudio comprendió 12 pacientes hemodializados mediante fístula arteriovenosa, entre 40 y 80 años de edad, en la unidad de diálisis del Hospital Base de Valdivia y que obtuvieron más de 24 puntos en el test Minimental. El análisis estadístico se realizó con el programa SPSS (versión 11.5 para Windows) y el nivel de significancia estadística a través de la prueba de Wilcoxon y Mann-Whitney (p<0,05). Resultados: la comparación de la pimometría inicial y final en los pacientes con y sin entrenamiento kinésico no mostró una diferencia estadísticamente significativa (p>0,05); sin embargo, se observó que los sujetos sometidos a entrenamiento kinésico presentan mayores valores en la presión inspiratoria máxima inicial y final en comparación con aquellos que no han sido entrenados. Conclusión: el entrenamiento físico intradiálisis provoca un efecto positivo en el sistema respiratorio. Los sujetos sometidos a hemodiálisis tienden a presentar valores bajo el predicho tanto en función pulmonar como en capacidad ventilatoria, siendo mayormente afectados con el envejecimiento y tiempo de exposición a hemodiálisis.

Abstract Introduction: The chronic kidney disease (CKD) is an irreversal progressive process which takes to a terminal state, where patients need permanent dialysis or even a transplant. It has been shown that the lung function and ventilatory capacity are compromised in these patients, increasing the alteration with exposure to hemodialysis and sedentarism. Objective: To compare the lung function and ventilatory capacity of hemodialysis patients, according to exposure to intradialysis physical training. Material and Methods: Study of quantitive type, not experimental, descriptive and transverse. The study population included 12 ambulatory patients between 40 and 80 years old, undergoing hemodialysis with arteriovenous fistula in the dialysis unit of Valdivia's Central Hospital, and who obtained more than 24 points in the Minimental Test. The statistical analysis was performed with the SPSS program (version 11.5 for Windows) and the level of statistical significance through the Wilcoxon and Mann-Whitney test (p<0.05). Results: The comparison of the initial and final pimometry in patients with and without physical training did not show a statistically significant difference (p>0.05), however it was observed that the subjects exposed to physical training have higher values in the initial and final maximum inspiratory pressure compared to those who have not been trained. Conclusion: Intradialysis physical training causes a positive effect on the respiratory system. The subjects submitted to hemodialysis tend to present under predicted values in both lung function and ventilatory capacity, being mostly affected with aging and time of exposure to hemodialysis.

Successful rescue with videolaryngoscopy after failed fibroscopy in anticipated difficult airway: case series / Rescate exitoso con videolaringoscopia luego de fibroscopia fallida en vía aérea difícil anticipada: serie de casos

Abstract Introduction: In the management of the anticipated difficult airway (DA), awake intubation is the strategy of choice. In this context, flexible fibroscopy is the tool most widely used as the first choice. However, there is always the rare case where it may fail. Important findings: Six successful rescue cases using videolaryngoscopy following failed fibroscopy in patients with anticipated DA, and 1 case of rescued extubation of an airway previously secured with fiberoptic bronchoscopy. Conclusion: Videolaringoscopy may be an adequate tool to use as a backup plan for the management of an anticipated DA.

Resumen Introducción: En el manejo de vía aérea difícil anticipada la estrategia de elección es la intubación con el paciente despierto. En este contexto, la fibroscopia flexible es la herramienta más utilizada como plan A; sin embargo, en raras ocasiones puede fallar. Hallazgos importantes: Se presentan seis casos de rescates exitosos con videolaringoscopia luego de fibroscopia fallida en pacientes con vía aérea difícil anticipada, y un caso de rescate de extubación de vía aérea asegurada previamente con fibrobroncoscopio. Conclusión: La videolaringoscopia puede ser una adecuada herramienta como plan B para el manejo de la vía aérea difícil anticipada.

Teste rápido molecular para tuberculose: custo e contribuições / Prueba rápida molecular de la tuberculosis: costo y contribuciones / Rapid molecular assay for tuberculosis: cost and contributions

Objetivo: identificar o custo da tecnologia Gene Xpert MTB/Rif® e analisar sua contribuição para o diagnóstico rápido da tuberculose. Método: estudo quantitativo e retrospectivo realizado no período de 2014 a 2016. A busca de dados foi realizada no Sistema de Informação de Agravo de Notificação e no Gerenciador de Ambiente Laboratorial. Os dados foram analisados com base nas técnicas de estatística descritiva por meio da distribuição de frequência absoluta e relativa. Resultados: foram estudados 196 casos e a média de tempo para a realização do exame para diagnóstico da tuberculose por meio do Gene Xpert MTB/Rif® foi de dois dias, com custo de R$ 35,20 por exame realizado. Conclusão: os custos da tecnologia Gene Xpert MTB/Rif® são relativamente superiores ao da baciloscopia de escarro, porém têm-se grandes vantagens quanto ao tempo para a liberação do resultado do exame e maior sensibilidade e especificidade oferecida pelo teste rápido molecular.

Objetivo: identificar el costo de la tecnología Gene Xpert MTB/Rif® y analizar su contribución para el diagnóstico rápido de la tuberculosis. Método: estudio cuantitativo, retrospectivo, realizado en el período de 2014 a 2016. Se realizó la búsqueda de datos en el Sistema de Información de Notificación de Enfermedades y en el Supervisor del Entorno de Laboratorio. Los datos fueron analizados con base en las técnicas de la estadística descriptiva por medio de distribución de frecuencias absolutas y relativas. Resultados: se estudiaron 196 casos y el promedio de tiempo para realizar el examen para el diagnóstico de la tuberculosis por medio del Gene Xpert MTB/Rif® fue de dos días, con un costo de 35.20R$ por cada examen realizado. Conclusión: los costos de la tecnología Gene Xpert MTB/Rif® son relativamente más altos que los de la baciloscopía, pero tienen grandes ventajas en el tiempo para la publicación de los resultados del examen y mayor sensibilidad y especificidad ofrecidos por prueba rápida molecular.

Objective: to identify the cost of the Gene Xpert MTB/Rif® technology and analyze its contribution to the rapid diagnosis of tuberculosis. Method: quantitative and retrospective study, carried out in the period from 2014 to 2016. Data search was performed on the Information System of Disease Notification and on the Laboratory Environment Manager. The data were analyzed based on the techniques of descriptive statistics through distribution of absolute and relative frequency. Results: 196 cases were studied, and the average time to perform the test for diagnosis of tuberculosis through Gene Xpert MTB/Rif® was two days, with a cost of 35.20R$ per test performed. Conclusion: the costs of Gene Technology Xpert MTB/Rif® are relatively higher than that of sputum smear microscopy, but have great advantages in time to release the test result and higher sensitivity and specificity offered by the rapid molecular assay.

Guía de práctica clínica para el diagnóstico y tratamiento de la neumonía en la niña y el niño / Technical guide: Clinical practice guide for the diagnosis and treatment of pneumonia in girls and boys

La publicación describe los criterios para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en los menores de 12 años, contribuyendo a la reducción de la morbilidad y mortalidad por esta enfermedad, priorizando a las niñas y los niños, menores de 5 años.

Particularities and clinical applicability of saccharin transit time test

Introduction: The importance ofmucociliary clearance (MCC) for the respiratory system homeostasis is clear. Therefore, evaluating this defense mechanism is fundamental in scientific research and in the clinical practice of pulmonology and of associated areas. However, MCC evaluation has not been so usual due to the complexity ofmethods that use radiolabeled particles. Nevertheless, as an interesting alternative, there is the saccharin transit time (STT) test. This method is reproducible, simple to perform, noninvasive, does notdemand high costs, and has been widely used in studies of nasalMCC. Although the STT test is widely used, there is still lack of a detailed description of its realization. Objective: The present literature review aims to provide basic information related to the STT test andto present the findings of the previous studies that usedthismethod, discussing variations in its execution, possible influences on the obtained results and limitations of the method, as well as to relate our experience with the use of STT in researches. Data Synthesis: There are several factors that can alter the results obtained from STT tests, which would raise difficulties with proper interpretation and with the discussion of the results among different studies. Conclusions: Saccharin transit time is awidely usedmethod for the evaluation of nasal MCC, and therefore, the standardization related to the previous and concurrent to test orientations, and also its execution, become essential to improve its accuracy, and allow comparisons among different studies (AU)

Valeurs spirométries de référence dans la population bantoue de Kinshasa de 20 à 70 ans

Introduction: les valeurs spirométriques de référence ne sont pas extrapolables entre populations, étant tributaires de nombreuses variables humaines et environnementales, d'où l'intérêt des études locales dans ce domaine. L'objectif est de déterminer des valeurs de référence chez des adultes sains de Kinshasa. Méthodes: une étude transversale incluant 7443 sujets (3208 femmes, 43%). Le VEMS, la CVF et le DEP ont été corrélés aux données anthropométriques. Cinq groupes d'âge ont été constitués et les comparaisons effectuées en fonction du sexe, de l'âge, de l'IMC et de la pratique d'une activité sportive.Résultats: les différences sont évidentes entre sexes, pour le VEMS (3,00 vs 2,21 L), la CVF (3,19 vs 2,38 L), et le DEP (6,8 vs 5,70 L/s); de même que pour les tranches d'âge extrêmes. Elles sont comprises entre: 2,33 et 4,54 vs 1,93-3,3 L dans le groupe de 20-29 ans et 1,76-3,39 vs 1,60 vs 2,53 L chez les 60-70 ans; pour La CVF entre 2,44-4,89 vs 1,96-3,56 L et 1,79-3,78 vs 1,66-2,74 L; pour le DEP entre 4,34-12,2 vs 3,62-8,58 L/s et 2,99-6,76 vs 2,99-7,34L/s chez les 60-70 ans. Conclusion: les différences liées au genre, à l'âge, aux données anthropométriques ainsi qu'à la pratique d'une activité sportive sont évidentes. Ces résultats justifient des enquêtes plus étendues et montrent la pertinence des valeurs basées sur les percentiles dans la déterminantion d'un référentiel spirométrique dans une population donnée

Mammomonogamus laryngeus: a human case report in florianopolis, Santa Catarina, Brazil

Mammomonogamus laryngeus (sin.: Syngamus laryngeus) is a nematode which parasites the respiratory tract of some animals. It is occasionally seen in humans, who present symptoms similar to other diseases with respiratory manifestations, such as a chronic dry cough and chest pain, in addition to a "foreign body" sensation in the throat. It can be diagnosed through rhinolaryngoscopy or bronchoscopy examinations, but this often occurs only after spontaneous expectoration of the worms, a long period of symptomatology and the use of several types of medication. In this report, we describe a case of syngamosis in Florianópolis (Santa Catarina, Brazil). The patient consulted several health professionals during the course of the disease and was prescribed numerous drugs. Diagnosis was eventually reached after the spontaneous expectoration of a nematode couple

Ion mobility spectrometry: the diagnostic tool of third millennium medicine

SUMMARY Ion mobility spectrometry (IMS) is a fast, low cost, portable, and sensitive technique that separates ions in a drift tube under the influence of an electric field according to their size and shape. IMS represents a non-invasive and reliable instrumental alternative for the diagnosis of different diseases through the analysis of volatile metabolites in biological samples. IMS has applications in medicine in the study of volatile compounds for the non-invasive diagnose of bronchial carcinoma, chronic obstructive pulmonary disease, and other diseases analysing breath, urine, blood, faeces, and other biological samples. This technique has been used to study complex mixtures such as proteomes, metabolomes, complete organisms like bacteria and viruses, monitor anaesthetic agents, determine drugs, pharmaceuticals, and volatile compounds in human body fluids, and others. Pharmaceutical applications include analysis of over-the-counter-drugs, quality assessment, and cleaning verification. Medical practice needs non-invasive, robust, secure, fast, real-time, and low-cost methods with high sensitivity and compact size instruments to diagnose different diseases and IMS is the diagnostic tool that meets all these requirements of the Medicine of the future.

RESUMO A espectrometria de mobilidade iônica (IMS) é uma técnica rápida, de baixo custo, portátil e sensível que separa íons em um tubo de deriva sob a influência de um campo elétrico de acordo com seu tamanho e forma. A IMS representa uma alternativa instrumental não invasiva e confiável para o diagnóstico de diferentes doenças por meio da análise de metabólitos voláteis em amostras biológicas. A IMS possui aplicações em medicina no estudo de compostos voláteis para o diagnóstico não invasivo de carcinoma brônquico, doença pulmonar obstrutiva crônica e outras doenças que analisam respiração, urina, sangue, fezes e outras amostras biológicas. A IMS tem sido usada para estudar misturas complexas, como proteomas, metabólitos, organismos completos como bactérias e vírus, monitorar agentes anestésicos, determinar drogas, produtos farmacêuticos e compostos voláteis em fluidos corporais e outros fluidos. As aplicações farmacêuticas incluem análises de medicamentos sem receita, avaliação de qualidade e verificação de limpeza. A prática médica precisa de métodos não invasivos, robustos, seguros, rápidos, em tempo real e de baixo custo com instrumentos de alta sensibilidade e tamanho compacto para diagnosticar diferentes doenças e a IMS é a ferramenta de diagnóstico que atende a todos esses requisitos da medicina do futuro.

Endoscopía del sueño inducida por medicamentos en pacientes con Síndrome de Apneas e Hipoapneas del Sueño / Drug induced sleep endoscopy in patients with obstructive sleep apneas and hypopneas / Endoscopia do sonho induzido por drogas em pacientes com síndrome de apneas e hipoapneas do sonho

INTRODUCCIÓN: La endoscopia del sueño inducida bajo medicación ha demostrado ser una herramienta de una gran validez y utilidad en el topodiagnóstico de las obstrucciones producidas en las roncopatías y en los síndromes de apneas e hipoapneas obstructivas del sueño. Se presentan los resultados de un protocolo estandarizado de la endoscopia del sueño inducida bajo medicación en una institución hospitalaria argentina, siendo uno de los primeros estudios descritos en el país. MATERIAL Y MÉTODO: Estudio retrospectivo. Pacientes con diagnóstico de síndrome de apneas e hipopneas del sueño mayores de 18 años fueron incluidos entre junio de 2013 a junio de 2015. Se realizó un análisis univariado descriptivo con utilización de test de Chi cuadrado para significancia estadística.

INTRODUCTION: Drug induced sleep endoscopy has been described as a useful tool in the anatomic diagnosis of obstructions due to roncopathies and obstructive sleep apnea and hypopnea. This research shows the results of standardized drug induced sleep endoscopy protocol in an Argentinian Hospital. It is one of the first studies described in this country. MATERIAL AND METHOD: Retrospective study. Patients with diagnosis of sleep apnea and hyponea syndrome over 18 years were included between June 2013 and June 2015. An univariate analysis was performed using Chi-square test for statistical significance

INTRODUÇÃO: Induzida endoscopia sono sob medicação provou ser uma ferramenta de grande validade e utilidade no topodiagnóstico das obstruções geradas em síndromes ronco e apneia-hipopneia obstrutiva do sono. Apresentamos os resultados de um protocolo induzida endoscopia sono sob medicação padronizado em uma instituição hospitalar na Argentina, sendo um dos primeiros estudos descritos no país. MATERIAL E MÉTODO: Estudo retrospectivo. Os pacientes diagnosticados com apnéia do sono e síndrome hipopnéia acima de 18 anos foram recrutados a partir de junho de 2013 a junho de 2015. A análise univariada descritiva por meio do teste Qui-quadrado foi realizado para significância estatística.

Avaliação de danos em nasofibroscópio flexível desinfetado com ácido peracético / Assessment of damages in flexible naso-fibroscope disinfected with peracetic acid / Evaluación de daños en nasofibroscopio flexible desinfectado con ácido peracético

Objetivo: Avaliar a ocorrência de possíveis danos em nasofibroscópios causados pela desinfecção em ácido peracético. Método: Pesquisa aplicada. Três nasofibroscópios novos, submetidos à desinfecção com ácido peracético, foram acompanhados e fotografados em microscópio esteroscópio, ao longo de 18 meses, para avaliar o comportamento do polímero e da fibra do nasofibroscópio, relacionado ao uso desse desinfetante. Houve capacitação das equipes de enfermagem e médica com ênfase no manuseio correto e no processamento seguro das fibras. Resultados: As fibras foram analisadas e fotografadas regularmente, durante o período do estudo, totalizando 3.979 usos. Foi observado, em todas as fibras, craquelamento do excedente de material adesivo em torno da área de vedação das fibras, sem comprometimento funcional. Um nasofibroscópio flexível (NFF), após mais de 2.000 usos, apresentou fissuras superficiais na cobertura da ponta distal da fibra, sem, contudo, comprometer o teste de vedação. Conclusão: O ácido peracético, na formulação utilizada e no período estudado, não causou danos funcionais ou oxidação nos NFFs, apesar de o fabricante recomendar a desinfecção por solução de aldeídos.

Objective: To evaluate possible damages in naso-fiberscopes caused by disinfection with peracetic acid. Method: Applied research. Three new naso-fiberscopes subjected to disinfection with peracetic acid were monitored and photographed under stereoscopic microscope, for 18 months, to evaluate the behavior of the polymer and fiber naso-fiberscopes, related to the use of this disinfectant. Nurses and medical team were trained with emphasis on the correct handling and safe processing of the fibers. Results: Fibers were regularly analyzed and photographed during the study period, totaling 3,979 uses. In all fibers, cracking of the excess adhesive material around the fiber sealing area was observed, without functional impairment. After more than 2,000 uses, a flexible naso-fiberscope (FNF) developed surface cracks at the distal tip of the fiber cover, without however compromising the sealing test. Conclusion: The peracetic acid did not cause functional damage or oxidation in the FNFs, in the formulation used and during the study period, although the manufacturer recommends aldehydes solution to disinfect.

Objetivo: Evaluar la ocurrencia de posibles daños en nasofibroscopios causados por la desinfección en ácido peracético. Método: Estudio aplicado. Tres nasofibroscopios nuevos, sometidos a la desinfección con ácido peracético, fueron acompañados y fotografiados en microscopio esteroscopio, a lo largo de 18 meses, para evaluar el comportamiento del polímero y de la fibra del nasofibroscopio, relacionado al uso de ese desinfectante. Hubo capacitación de los equipos de enfermería y médica con énfasis en el manejo correcto y en el procesamiento seguro de las fibras. Resultados: Las fibras fueron analizadas y fotografiadas regularmente, durante el período del estudio, totalizando 3.979 usos. Fue observado, en todas las fibras, craquelado del excedente de material adhesivo alrededor del área de sellado de las fibras, sin comprometimiento funcional. Un nasofibroscopio flexible (NFF), tras más de 2.000 usos, presentó fisuras superficiales en la cobertura de la punta distal de la fibra, sin, con todo, comprometer el test de sellado. Conclusión: El ácido peracético, en la formulación utilizada y en el período estudiado, no causó daños funcionales u oxidación en los NFFs, a pesar del fabricante recomendar la desinfección por solución de aldehídos.

Comparación de la capacidad predictiva de dos escalas para el diagnóstico de tuberculosis en niños / Comparison of the predictive ability of two scoring systems for the diagnosis of tuberculosis in children

El diagnóstico de tuberculosis en la infancia exige una fuerte presunción diagnóstica por su forma de presentación paucibacilar. Distintos sistemas de puntuación y algoritmos se han desarrollado para sortear esta dificultad. Entre ellos, la escala diagnóstica de Keith Edwards y la de Stegen modificada por Toledo (Stegen-Toledo). Objetivos. Comparar la capacidad predictiva de la escala diagnóstica de Keith Edwards con la de la escala de Stegen-Toledo. Estimar la capacidad predictiva diagnóstica de la radiografía de tórax en forma individual. Población, material y métodos. Pacientes atendidos en un Servicio de Neumonología Pediátrica de la Ciudad de Buenos Aires entre 2009 y 2012. Para el análisis de la capacidad predictiva diagnóstica, se utilizó el test de chi-cuadrado y, para comparar su desempeno, la prueba de Mc Nemar extendida. Resultados. Keith Edwards: sensibilidad de 19,62%, especificidad de 97,62% (p < 0,0001). Stegen-Toledo: sensibilidad de 43,54%, especificidad de 97,82% (p < 0,0001). La sensibilidad entre ambas escalas presentó una diferencia significativa (p < 0,05), sin diferencias en la especificidad. Radiografía de tórax: sensibilidad de 91,15%, especificidad de 87,72% (p < 0,0001). Conclusión. La escala de Keith Edwards presentó una menor sensibilidad diagnóstica que la de Stegen-Toledo en este grupo de pacientes, sin diferencias en la especificidad. La radiografía de tórax presentó una sensibilidad de 91,15% para el diagnóstico de tuberculosis en este grupo de pacientes.

Diagnosing childhood tuberculosis requires a strong diagnostic suspicion due to its paucibacillary manifestation. Different scoring systems and algorithms have been developed to deal with such challenge skillfully. These include the Keith Edwards diagnostic score and Stegen's criteria modified by Toledo (Stegen-Toledo). Objectives. To compare the predictive ability of the Keith Edwards diagnostic score to that of the Stegen-Toledo scoring system. To estimate the predictive diagnostic ability of chest X-rays individually. Population, Material and Methods. Patients seen at the Department of Pediatric Pulmonology of the City of Buenos Aires between 2009 and 2012. A² test was used to analyze the predictive diagnostic ability, and performance was compared using the extended McNemar test. Results. Keith Edwards: 19.62% sensitivity, 97.62% specificity (p < 0.0001). Stegen-Toledo: 43.54% sensitivity, 97.82% specificity (p < 0.0001). Sensitivity was significantly different between both scoring systems (p < 0.05), but no differences were observed in terms of specificity. Chest X-ray: 91.15% sensitivity, 87.72% specificity (p < 0.0001). Conclusion. The Keith Edwards scoring system showed a lower diagnostic sensitivity than the Stegen-Toledo score in this group of patients, with no differences observed in terms of specificity. The chest X-ray showed a 91.15% sensitivity to diagnose tuberculosis in this group of patients.

Conceitos atuais sobre avaliação da maturidade pulmonar fetal / Current concepts on the assessment of fetal lung maturity

A Síndrome do Desconforto Respiratório (SDR), também conhecida como Doença da Membrana Hialina, é uma das principais causas de morbidade e mortalidade neonatal. O principal fator associado à SDR é a produção insuficiente de surfactante pulmonar, o que geralmente está associada à prematuridade. Alguns protocolos internacionais recomendam que a confirmação da maturidade pulmonar fetal seja realizada em partos eletivos antes de 39 semanas de gestação. Diversos são os métodos capazes de avaliar a maturidade pulmonar fetal, como a Relação Lecitina/Esfingomielina,a Pesquisa de Corpos Lamelares, a Relação Surfactante/Albumina, o percentual deFosfatidilglicerol, o Índice de Estabilidade da Espuma e o Shake Test ou Teste de Clements. Este estudo visa apresentar os principais métodos disponíveis e as recomendações atuais sobre quando realizar a avaliação da maturidade pulmonar fetal.(AU)

The Respiratory Distress Syndrome (RDS), also known as hyaline membrane disease, is a major cause of neonatal morbidity and mortality. The main factor associated with RDS is the insufficient production of pulmonary surfactant, which is usually associated with prematurity. Some international guidelines recommend that the confirmation of fetal lung maturity is performed in elective deliveries before 39 weeks of gestation. There are several methods to assess fetal lung maturity, such as the Lecithin/Sphingomyelin ratio, the Lamellar Body Count, the Surfactant/Albumin ratio, the percentage of phosphatidylglycerol, the Foam Stability Index and the Shake Test or Clements test. This study aims to present the main available methods and current recommendations on when to conduct the evaluation of fetal lung maturity.(AU)

Comportamiento clínico-epidemiológico del asma bronquial en menores de 15 años / Bronchial Asthma Clinical and epidemiological pattern in children younger 15 years

El asma bronquial es la enfermedad crónica más frecuente de la infancia, cuya prevalencia estimada en Cuba es de 8,2 por ciento. La identificación y el control de los factores de riesgo constituyen un pilar importante en el manejo de esta entidad. Objetivos: caracterizar el comportamiento clínico-epidemiológico del asma bronquial en menores de 15 años del policlínico Ana Betancourt. Métodos: se realizó un estudio descriptivo de corte transversal, durante el período del mes de abril de 2010 a marzo de 2011. Inicialmente se aplicó el cuestionario ISSAC para identificar un posible subregistro de asma. Se empleó la clasificación Global Initiative for Asthma 2007, que permitió agrupar clínicamente a los menores en cuatro categorías. Finalmente se aplicó, a la totalidad de la muestra, un cuestionario para la identificación de los factores de riesgo. Resultados: se identificó una morbilidad oculta de 9,3 por ciento. Con asma leve intermitente: 30 pacientes; leve persistente: 21; moderado persistente: 28 y con asma severa: 14. La totalidad de los pacientes tenían antecedentes familiares de atopia y desencadenaban las crisis con los cambios climáticos. El 95,0 por ciento era sensible a inhalantes respiratorios y en el 64,0 por ciento de los hogares se detectó la presencia de fumadores. Conclusiones: el asma bronquial persiste como una enfermedad infradiagnosticada. En el orden epidemiológico, los antecedentes familiares de atopia y los cambios de tiempo, aventajaron a los restantes factores de riesgo asociados...

Bronchial Asthma is the most common chronic disease of childhood in Cuba whose estimated prevalence is 8.2 percent. The identification and control of its risk factors is an important pillar in the management of this entity. Objective: to characterize the clinical and epidemiological behavior of Asthma in children younger 15 years at Ana Betancourt polyclinic. Methods: a descriptive cross-sectional study was conducted from April 2010 to March 2011. Initially the ISSAC questionnaire was used to identify a possible asthma underreporting. 2007 Global Initiative for Asthma classification was used, which allowed clinically grouping minors into four categories. Finally, a questionnaire to identify risk factors was applied to the entire sample. Results: a hidden morbidity of 9.3 percent was identified. With mild intermittent asthma: 30 patients; mild persistent: 21; persistent moderate 28; and severe asthma: 14. All the patients had a family history of atopy, and crises were triggered by weather changes. 95.0 percent were sensitive to respiratory inhalants and 64.0 percent was detected to have smokers at home. Conclusions: bronchial Asthma persists as an underdiagnosed disease. Regarding the epidemiological aspect, family history of atopy and weather changes, outdid the other associated risk factors...

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul / Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

OBJETIVO: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. MÉTODOS: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. RESULTADOS: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração > 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. CONCLUSÕES: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Human coronavirus ocurrence in different populations of Sao Paulo: a comprehensive nine-year study using a pancoronavirus RT-PCR assay

Human coronaviruses (HCoVs) are considered one of the most common respiratory viruses associated with respiratory tract illnesses. An emergent human coronavirus was identified as the causal agent of an epidemic of severe acute respiratory syndrome (SARS) during 2002-2003. The severity of the disease combined with its rapid spread requires the continuous surveillance of coronaviruses in worldwide populations. Epidemiological and clinical data of HCoVs infectious in the Brazilian population are scarce and restricted to one or two groups of patients. Our study aimed to investigate retrospectively the presence of HCoVs in different populations of São Paulo presenting acute respiratory tract infections (ARIs) during the years of 2001-2010. A pancoronavirus RT-PCR was performed in this study. Coronaviruses were detected in 126 (11.5%) of 1,087 specimens. Peaks detection frequency was observed during 2002-2004 and 2008-2009, with the highest detection in 2008. The prevalence of HCoVs was higher among children with heart diseases (24.6%), patients under stem cell transplantation program (24.3%) and renal transplanted patients (20.2%). Coryza, cough and fever were the most common symptoms at presentation of positive cases and wheezing, a lower respiratory tract infection symptom was reported by 12% of the total, and 27% of high at-risk patients. HCoVs may have an important role among patients with underlying conditions and transplanted ones

Isolation and identification of feline calicivirus and feline herpesvirus in Southern Brazil

Feline calicivirus (FCV) and feline herpesvirus type 1 (FHV-1) are the two primary causes of upper respiratory tract disease in cats. The aim of this study was to demonstrate the distribution of FCV and FHV-1 among the feline population of several counties in Rio Grande do Sul State, Brazil. To this end, conjunctival and nasal swabs were collected from 302 cats from different locations, including households, breeding catteries, veterinary clinics, animal hospitals and experimental research facilities. The samples were collected between July 2006 to June 2009. The virus isolation was performed in CRFK cells and, subsequently, the identification was confirmed by PCR. FCV, FHV-1, or both were isolated from 55 cats from 28 different locations. FCV alone was isolated from 52.7% (29/55) of the animals that tested positively, FHV-1 alone was isolated from 38.2% (21/55) of the animals that tested positively, and co-infection were detected in 9.1% (5/55) of the animals that tested positively. Virus detection was more prevalent in cats that were less than 1 year old, among animals that shared a living space with other cats, and females. FCV and FHV-1 were isolated from vaccinated cats. In addition, both viruses were isolated from cats that showed no signs of disease. The results suggest that a carrier state is common for both viruses in the evaluated population. A search for other causes of respiratory disease in that population is necessary; and further studies relating to the molecular characterization of viruses and vaccine efficacy are also necessary.

Manifestações clínicas e análise histopatológica pulmonar relacionadas a diferentes doenças em pacientes com tromboembolismo pulmonar fatal – um estudo em autópsias / Clinical manifestations and pulmonary histopathological analysis related to different diseases in patients with fatalpulmonary thromboembolism – an autopsy study

Introdução: Tromboembolismo pulmonar (TEP) é uma das mais graves complicações dentre pacientes hospitalizados e permanece subdiagnosticado. Ainda hoje, sua fisiopatologia não está completamente elucidada. Objetivos: Correlacionar comorbidades, neoplasias, cirurgias e achados histológicos às manifestações clínicas associadas ao TEP. Métodos: Entre 2001 a 2008, foram revisadas 291 autópsias de pacientes cuja causa de morte foi TEP. Os seguintes dados foram obtidos: idade, sexo, manifestações clínicas, achados histológicos e principais doenças de base/comorbidades, neoplasias e cirurgias da última internação. Os achados histológicos foram categorizados em: dano alveolar difuso (DAD), edema agudo de pulmão (EAP), hemorragia intra alveolar (HIA) e pneumonia intersticial linfo-plasmocítica (PILP). Odds ratios foram obtidas por regressão logística e foram consideradas significativas quando p < 0,05. Resultados: A mediana de idade foi 64 anos. Cerca de 64% dos pacientes apresentava doenças cardiovasculares. O achado pulmonar mais prevalente foi EAP. Apenas 13% dos casos apresentaram suspeita clínica. Insuficiência respiratória esteve associada a EAP, HIA e DAD; assim como instabilidade hemodinâmica a HIA e DAD. Conclusões: Foram encontradas importantes associações entre achados clínicos e histológicos em pacientes com TEP. A compreensão dos mecanismos fisiopatológicos envolvidos com cada doença associada a TEP pode auxiliar no diagnóstico e no tratamento da doença.

Introduction: Pulmonary thromboembolism (PTE) is one of the most fatal complications among hospitalized patients and remains undiagnosed. Its physiopathology and its epidemiology aren’t widely known in literature. Objectives: To correlate underlying diseases, different cancers and surgeries to histological findings and in-vivo manifestations associated to fatal PTE from autopsy reports. Methods: From 2,001 to 2,008, were reviewed 291 autopsies of patients whose cause of death was PTE. The following data were obtained: age, sex, clinical invivo manifestations, post-mortem pathological patterns and mainassociated underlying diseases, cancers and surgeries performed in last hospitalization. The pulmonary histopathological changes were categorized in: diffuse alveolar damage (DAD), pulmonary edema (PE), alveolar hemorrhage (AH) and lympho/plasmacytic interstitial pneumonia (LPIP). Odds ratios of positive relations were obtained by logistic regression and were considered significative when p < 0.05. Results: The median age was 64 years. 64% ofpatients presented cardiovascular illness associated to PTE. The most prevalent pulmonary finding was PE. Only 13% of cases had clinical suspect. Acute respiratory failure was positively related to PE, AH and DAD; as well hemodynamic instability to AH and DAD. Conclusions: We found important relations between clinical data and histological findings of fatal PTE patients. The understanding of pulmonary physiopathological mechanism involved with eachPTE-associated disease can improve diagnosis in order to offer prompt treatment and reduce mortality.

Avaliação da utilidade clínica de novos testes diagnósticos em tuberculose: o papel dos ensaios clínicos pragmáticos / Evaluation of the clinical utility of new diagnostic tests for tuberculosis: the role of pragmatic clinical trials

A tuberculose é uma das principais doenças infecciosas em países em desenvolvimento, e o tempo durante o qual a cadeia de transmissibilidade é mantida tem sido apontado como um dos principais fatores de perpetuação da doença. Nesse contexto, novas ferramentas para o diagnóstico têm sido aprovadas pelas agências regulamentadoras nesses países, e sua incorporação é quase imediatamente implementada pelos programas governamentais de controle da tuberculose. As intervenções na área da saúde têm sido cada vez mais investigadas em ensaios clínicos explanatórios (que avaliam seus efeitos benéficos) e em ensaios clínicos pragmáticos (que auxiliam na tomada de decisão). Nós argumentamos que a avaliação de novas técnicas diagnósticas para a detecção da tuberculose não deveria escapar dessa mesma lógica de escrutínio.

Tuberculosis is one of the major infectious diseases in developing countries, and the length of time for which the chain of transmission is maintained has been implicated as a major factor in the perpetuation of the disease. In this context, regulatory agencies in such countries have approved new diagnostic tools, which have been almost immediately incorporated into the national tuberculosis control programs. Health interventions have been increasingly investigated in clinical trials, including explanatory trials (in order to evaluate the beneficial effects of such interventions) and pragmatic trials (in order to aid in the decision-making process). We argue that the evaluation of new diagnostic techniques for the detection of tuberculosis should not escape this same logic of evaluation.

Perfil de aeroalérgenos intradomiciliarescomuns no Brasil: revisão dos últimos 20 anos / Profile of common indoor aeroallergens in Brazil: review of the last 20 years

Objetivo: Abordar os alérgenos identificados no Brasil, bem como sua concentração e importância clínica. Fontes de dados: esquisa em base de dados do LILACS e PubMed, artigos originais e revisões publicadas nos últimos 20 anos, bem como dissertações e teses que tratam sobre a prevalência e exposição de aeroalérgenos no Brasil. Síntese dos dados: O perfil de alérgenos tem sido estudado em várias localidades do Brasil e do mundo. Contudo, com o surgimento de técnicas que permitem a avaliação de componentes alergênicos na poeira, os estudos se tornaram mais precisos no que se refere ao tipo e a concentração do alérgeno. A avaliação da exposição alergênica realizada em estudos no Brasil mostra que ocorre uma variação de acordo com cada região. Isso se deve, provavelmente, às condições ambientais e climáticas. Contudo, os ácaros são os mais prevalentes. O Dermatophagoides pteronyssinus é o principal alérgeno nas regiões litorâneas e de temperaturas mais amenas, seguido pela Blomia tropicalis. Na região central do país, há predomínio do Dermatophagoides farinae, possivelmente pelo clima seco e quente. Além disso, alguns estudos avaliam a exposição dos indivíduos não só em seus domicílios, mas também em locais públicos. Conclusões: O conhecimento da exposição alergênica em diferentes ambientes é fundamental para identificar quais os alérgenos clinicamente relevantes, e assim propiciar tratamento adequado aos pacientes. Como se trata de um processo dinâmico com diversas variáveis se modificando ao longo dos anos, são necessárias reavaliações periódicas para estabelecer mudanças no perfil de alérgenos em cada região.

Objective: To approach which are the allergens found in Brazil in recent years, their concentration and clinical relevance. Sources: A search on database LILACS and PubMed, original articles and reviews published in the last 20 years, as well as dissertations and theses that deal with prevalence and exposure to allergens in Brazil. Results: The allergen profile has been studied in several locations in Brazil and worldwide. However, with the emergence of techniques allowing the evaluation of allergenic components, the studies on the type and concentration of allergen became more accurate. The assessment of allergen exposure in studies conducted in Brazil shows variations occurring each region. This is probably due, to different environmental and climatic conditions. Domestic mites are the most prevalent allergen. Dermatophagoides pteronyssinus is a major allergen in the coastal regions and warmer temperatures, followed by Blomia tropicalis. In the central region, there is a predominance of Dermatophagoides farinae, possibly due to dry and warm climate. In addition, some studies assess the exposure of individuals not only in their homes, but also in public places. Conclusions: The knowledge of allergen exposure in diferente environments is essential to identify clinically relevant allergens and then supply adequate treatment to allergic patients. Since this is a dynamic process with many variables that change over the years, periodic assessment of environmental allergens are necessary to establish changes in the profile and dispersion of aeroallergens in each region.