Reactance inversion in moderate to severe persistent asthma: low birth weight, prematurity effect, and bronchodilator response.

INTRODUCTION: Reactance inversion (RI) has been associated with impaired peripheral airway function in persistent asthma. However, there is little to no data about the difference between asthmatic children with and without RI. This study aimed to detect clinical and lung function differences in moderate-severe asthmatic children with and without RI. METHODS: This study was conducted between 2021 and 2022 in asthmatic school-age children. Impulse oscillometry (IOS) and spirometry were performed according to ATS/ERS standards. RESULTS: A total of 62 patients, with a mean age of 8.4 years, 54.8% were males and were divided into three groups: group 1 (32.3%) with no RI, group 2 (27.4%) with RI but disappearing after bronchodilator test and group 3 (40.3%) with persistent RI after bronchodilator test. Children in groups 2 and 3 had significantly lower birth weights than in group 1. Group 2 had lower gestational age compared to group 1. FEV1 and FEF25-75 of forced vital capacity were significantly lower in groups 2 and 3. In group 3, R5, AX, R5-20, and R5-R20/R5 ratios were significantly higher. Bronchodilator responses (BDR) in X5c, AX, and R5-R20 were significantly different between groups and lower in group 3. CONCLUSION: RI is frequently found in children with moderate-severe persistent asthma, particularly in those with a history of prematurity or low birth weight. In some patients, RI disappears after the bronchodilator test; however, it, persists in those with the worst pulmonary function. RI could be a small airway dysfunction marker.

"Reactance inversion" at low frequencies during lung function measurement by impulse oscillometry in children with persistent asthma.

BACKGROUND: Small airway dysfunction (SAD) in asthma can be measured by impulse oscillometry (IOS). Usually, the reactance should decrease with decreases in frequency oscillation. Sometimes an upward shift of the curve at low frequencies can be observed together with lower than expected reactance values. The actual value of the reactance at 5 Hz (X5) is calculated by the Sentry Suite application of the Jaeger Master screen iOS system™, providing the corrected X5 parameter (CX5). Our hypothesis is that correction of X5 is common in persistent asthma and it correlates better than X5 with the IOS parameters for evaluating SAD. METHODS: In this transversal study, we evaluated 507 children (3-18 years old) using IOS-spirometry (Sentry Suite, Vyntus®). Resistance of all airways (R5), reactance area (AX), resonant frequency (Fres), X5, CX5, difference between R5 and R20 (D5-20), and spirometry parameters were analyzed. Reactance inversion and CX5 prevalence by age range was determined. The mean IOS-Spyrometry values in children with and without CX5 were compared, and correlations with each IOS-spirometry parameter in the age groups were performed. RESULTS: CX5 was found in 83.5% of preschool children, 66.2% of schoolchildren, and 43.3% of adolescents (p < 0.001). The means of R5, AX, and D5-20 were significantly higher and FEV1 was significantly lower in children with CX5 (p < 0.05). In all ages, CX5 correlated better than X5 with IOS-spirometry parameters. CONCLUSION: Reactance inversion and CX5 are frequent in asthmatic children, decrease with age, and correlate more closely than X5 with other IOS-spirometry parameters for evaluating SAD.

[Tritherapy with cystic fibrosis transmembrane conductance regulator protein modulators in cystic fibrosis]. / Triterapia con moduladores de la proteína de conductancia de transmembrana en fibrosis quística.

Recent studies have shown that therapy with Cystic fibrosis transmembrane conductance regulator (CFTR) modulators in Cystic Fibrosis (CF) patients with Elexacaftor-Tezacaftor-Ivacaftor (ETI) decreases exacerbations and improves lung function and quality of life. OBJECTIVE: to report the clinical response in the first patient in our setting treated with ETI. CLINICAL CASE: 14-year-old female patient with severe cystic fibrosis phenotype, heterozygous for the Phe508del mutation (Phe508del/1078delT), with moderate pulmonary involvement and pancreatic insufficiency (PI). The patient started ETI therapy after the disease entered a phase of clinical and pulmonary function deterioration. From the second visit (45 days) until the end of the follow-up (365 days), the patient experienced a significant improvement in the quality-of-life domains measured by the CFQ-R 14+ questionnaire. In the pulmonary function study at 45 and 365 days, FVC increased by 21% and 22%, FEV1 by 20% and 27%, and FEF 25-75 by 23% and 37%, respectively. Nutritional assessment para meters in the first six months of follow-up showed an increase in wBMI from 1.6 to 5.6 k. No adverse effects were observed. CONCLUSION: treatment with ETI in our CF patient showed a remarkable im provement in quality of life, pulmonary function, and nutritional status.

Evolutionary lung function evaluated by impulse oscillometry in preschoolers with asthma. / Función pulmonar evolutiva evaluada por oscilometría de impulso en prescolares con asma.

INTRODUCTION: Impulse oscillometry (IOS) is useful for measuring lung function in preschool children. Our objec tive was to describe the alterations and evolutionary profile of IOS in asthmatic children under 6 years of age after one year of follow-up. PATIENTS AND METHOD: 62 preschoolers performed IOS at the begin ning of the study and after one year. The proportion of altered IOS and bronchodilator response (BR +) at both times was compared, in addition to sub-analysis according to asthma control and presence of atopy. For the statistical analysis, we used McNemar's %2 and the Student's t-test with a 5% a error. RESULTS: The initial IOS was altered in 80.6% and in 64.5%% after one year (p = 0.04). 77.4% of the children presented BR+ at the beginning of the study and 83.9% after one year. The uncontrolled asthma group presented a significant improvement in the X5 and D5-20 means, but the controlled asthma group did not. In atopic patients, only uncontrolled asthmatics improved X5, AX, and D5-20. CONCLUSION: IOS shows alterations in a high percentage of preschoolers with uncontrolled asthma, which decreases significantly at one year, but remains altered and with BR + in most children. Ad ditional studies are required to identify different preschool asthma phenotypes and their evolution with treatment.

Revisión del diagnóstico de enfermedad celíaca a propósito de casos presentados en el Hospital de Constitución / Revision of the diagnosis of celiac disease in relation to cases presented at the Hospital de Constitución

Enfermedad descrita (EC) clínicamente por Samuel Gee en 1888. el decubrimiento de Dicke del papel del gluten en la patogenia de la enfermedad, permitió que en 1950, Sakula y Shiner demostraran los cambios característicos de la mucosa intestinal en los pacientes con la enfermedad, la respuesta a la retirada y reincorporación del gluten. en 1970 la ESPGAN (sociedad europea de gastroenterología y nutrición pediátrica) definió la EC como una incapacidad permanente, para tolerar el gluten de la dieta, caracterizada por anomalías histológicas de la mucosa duodeno yeyunal, evidencia clínica y analítica de trastornos de la absorción intestinal cuando la dieta contiene gluten y remisión clínica e histológica tras la exclusión del gluten en la dieta. su prevalencia varía de acuerdo a las regiones, ya que es mas frecuente en europa y estados unidos. En un estudio de la ESPGAN en 1992 se encontró una prevalencia de 1/1000 nacidos vivos. Se cree que en España la prevalencia alcanzaría a 1/300-500 habitantes. la incidencia en estados unidos asciende aproximadamanete a 1:10.000 nacidos vivos. La incidencia real de la enfermedad en los paises de América latina no se conoce, aún cuando su diagnóstico es relativamente frecuente en Argentina, Cuba, Chile, México y Uruguay, entre otros. Dado que se sabe que los casos abiertamente clínicos constituyen sólo la punta del "iceberg", es muy probable que la prevalencia real de la enfermedad en estos países sea mucho más alta de lo que tradicionalmente se ha pensado. La EC se presenta más frecuentemente en personas caucásicas y aquellos cuyos ancestros provienen del norte y sur de Europa. Alrededor del 70 porciento de los casos ocurren en mujeres. La enfermedad celíaca parece ser la primera causa de malabsorción grave, con desnutrición acentuada y retraso del crecimiento en pacientes pediátricos de Chile. Aunque su frecuencia parece estar disminuyendo, es posible que se esté subdiagnosticando una gran cantidad de casos y que sólo sea el número de pacientes con manifestaciones inequívocamente clínicas el que está declinando.

Epidemiología del pie diabético en el consultorio externo del Hospital de Constitución / Epidemiology of the diabetic foot at the Hospital de Constitución

Los diabéticos están viviendo cada vez más años debido a los avances de la medicina. El trabajo de los médicos debe estar orientado a lograr una buena calidad de vida para ellos y evitar la aparición de complicaciones crónicas. quisimos enfocar nuestro estudio en el pie diabético por tratarse de una de las complicaciones más temidas por los pacientes y más costosas para las instituciones de la salud encargadas de su tratamiento. Realizamos una encuesta de factores de riesgo a 146 pacientes del policlínico de diabetes de nuestro hospital. Se complementó esta encuesta con datos de la ficha clínica y con hallazgos del examen físico. Los resultados revelaron que los diabéticos jóvenes y de sexo masculino son los que menos se preocupan por el cuidado de los pies. La mayoría de los pacientes diabéticos tiene al menos un factor de riesgo para presentar esta enfermedad. La prevalencia de la insuficiencia arterial periférica es un poco menor al 15 por ciento publicado por la literatura internacional, mientras que la neuropatía mantiene una prevalencia similar a otros estudios internacionales. Las manifestaciones clínicas de riesgo de presentar pie diabético que más se repiten son la infección micótica y las deformidades de los pies. Encontramos un alto porcentaje de diabéticos con pies de alto riesgo (> de 20 puntos). La mayoría de los pacientes con antecedentes de úlcera o amputación previa tenían más de 8 factores de riesgo, eran portadores de neuropatía y se trataban con hipoglicemiantes orales