Abstract Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS. deformity maturity AIS , (AIS) treatment review collected MetaAnalyses Meta Analyses PRISMA, PRISMA (PRISMA) MEDLINE (MEDLINE LILACS. LILACS . (LILACS) 63 1493 14 93 14.9 124 24 1.24 5506 55 06 55.06 1224 12 12.24 > ( 49%, 49 49% 49%) 5 5% FEV1 FEV (FEV1 FVC (FVC (AIS (PRISMA (LILACS 6 149 9 14. 2 1.2 550 0 55.0 122 12.2 4 (FEV 1. 55. 12.

Resumo A escoliose idiopática do adolescente (EIA) é considerada a deformidade vertebral de maior gravidade e ocorrência, que acomete crianças e adolescentes ainda na fase de desenvolvimento neuropsicomotor, antes de atingirem a maturidade esquelética. Este estudo teve como objetivo avaliar a abordagem cirúrgica da EIA, considerando resultados associados à redução de curvatura patológica, função pulmonar e repercussões na qualidade de vida dos adolescentes submetidos a tal tratamento. Revisão Sistemática de literatura, com abordagem quanti-qualitativa dos dados coletados, cuja estruturação se deu conforme as orientações de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) realizada nas bases de dados vinculadas à Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A amostra total dos estudos foi de 638 adolescentes com EIA, com uma idade média de 14,93 anos ± 1,24. A correção média da curvatura patológica principal nos estudos foi de 55,06% ± 12,24. Em todos os estudos selecionados com fusão espinhal posterior para correção da EIA verificou-se redução significativa das curvaturas patológicas (> 49%), sendo que a reincidência de curvatura em nenhum dos estudos superou um ganho patológico superior a 5%. Quanto à função pulmonar, os estudos apontaram ganhos significativos de volume expiratório forçado em 1 segundo (VEF1) e capacidade vital forçada (CVF) em pacientes com EIA grave. Além disso, não foram relatados prejuízos de função pulmonar após intervenção cirúrgica para correção da EIA. (EIA ocorrência neuropsicomotor esquelética tratamento literatura quantiqualitativa quanti qualitativa coletados MetaAnalyses Meta Analyses PRISMA (PRISMA MEDLINE (MEDLINE LatinoAmericana Latino Americana LILACS. LILACS . (LILACS) 63 1493 14 93 14,9 124 24 1,24 5506 55 06 55,06 1224 12 12,24 verificouse verificou > ( 49%, 49 49% , 49%) 5 5% VEF1 VEF (VEF1 CVF (CVF grave disso (LILACS 6 149 9 14, 2 1,2 550 0 55,0 122 12,2 4 (VEF 1, 55, 12,

Abstract Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome. venoocclusive veno occlusive PVOD (PVOD (PAH prognosis andor or precapillary pre phenotype etiologies analysis complications However smoking use trichloroethylene, trichloroethylene , trichloroethylene) DLCO, DLCO (DLCO) desaturation imaging opacities lines lymphadenopathies treatment 58yearold yearold 58 year old venouscapillary suspicion outcome (DLCO 5

Resumo A doença veno-oclusiva pulmonar (DVOP) e a hemangiomatose capilar pulmonar são tipos raros de substratos histopatológicos dentro do espectro da hipertensão arterial pulmonar (HAP) com prognóstico muito ruim. Caracterizam-se por um processo fibroproliferativo generalizado das veias e/ou capilares de pequeno calibre com preservação das veias maiores, resultando em um fenótipo de hipertensão pulmonar pré-capilar. A apresentação clínica é inespecífica e semelhante a outras etiologias de HAP. O diagnóstico definitivo é obtido por meio de análise histológica, embora a biópsia pulmonar não seja aconselhada devido ao maior risco de complicações. No entanto, alguns achados adicionais podem permitir um diagnóstico clínico presuntivo de DVOP, especialmente história de tabagismo, uso de drogas quimioterápicas, exposição a solventes orgânicos (particularmente tricloroetileno), baixa capacidade de difusão do monóxido de carbono (DLCO), dessaturação ao esforço e evidências de doença venosa sem doença cardíaca esquerda no exame de imagem, manifestada por uma tríade clássica de opacidades em vidro fosco, linhas septais, e linfadenopatias. O transplante pulmonar é o único tratamento eficaz e os pacientes devem ser encaminhados no momento do diagnóstico, devido à rápida progressão da doença e ao prognóstico ruim. Apresentamos o caso de um homem de 58 anos com HAP com características de envolvimento venoso/capilar em que a suspeita clínica, o pronto diagnóstico e o encaminhamento precoce para transplante pulmonar foram determinantes para um bom desfecho. venooclusiva veno oclusiva DVOP (DVOP (HAP ruim Caracterizamse Caracterizam se eou ou maiores précapilar. précapilar pré capilar. pré-capilar histológica complicações entanto tabagismo quimioterápicas particularmente tricloroetileno, tricloroetileno , tricloroetileno) DLCO, DLCO (DLCO) imagem fosco septais linfadenopatias 5 venosocapilar venoso desfecho (DLCO

ABSTRACT Objectives: To describe persistent symptoms and lung function in mild cases of COVID-19 six months after infection. Methods: Data collection was performed through a semi-structured questionnaire containing information on the participants’ demographic and anthropometric data, the disease in the acute phase, and persistent symptoms six months after COVID-19 using spirometry and manovacuometry. Results: A total of 136 participants were evaluated, of whom 64% were male, with a mean age of 38.17 ± 14.08 years and a body mass index (BMI) of 29.71 ± 17.48 kg/m2. The main persistent symptoms reported were dyspnea on exertion (39.7%), memory loss (38.2%), and anxiety (48.5%). Considering lung function, the participants reached 88.87 ± 17.20% of the predicted forced vital capacity (FVC), 86.03 ± 22.01% of the forced expiratory volume in one second (FEV1), and 62.71 ± 25.04% of peak expiratory flow (PEF). Upon manovacuometry, 97.41 ± 34.67% of the predicted inspiratory force (Pimax) and 66.86 ± 22.97% of the predicted expiratory force (Pemax) were observed. Conclusions: Six months after COVID-19 infection, a reduction in PEF and MEP was observed. Among the most commonly reported persistent symptoms were fatigue, tiredness with the slightest exertion, anxiety and depression, memory loss, and deficits in concentration. Objectives COVID19 COVID 19 COVID-1 infection Methods semistructured semi structured data phase manovacuometry Results 13 evaluated 64 male 3817 38 17 38.1 1408 14 08 14.0 BMI (BMI 2971 29 71 29.7 1748 48 17.4 kgm2 kgm kg m2 m kg/m2 39.7%, 397 39.7% , 39 7 (39.7%) 38.2%, 382 38.2% 2 (38.2%) 48.5%. 485 48.5% . 5 (48.5%) 8887 88 87 88.8 1720 20 17.20 FVC, FVC (FVC) 8603 86 03 86.0 2201 22 01 22.01 FEV1, FEV1 FEV (FEV1) 6271 62 62.7 2504 25 04 25.04 PEF. (PEF) 9741 97 41 97.4 3467 34 67 34.67 Pimax (Pimax 6686 66 66.8 2297 22.97 Pemax (Pemax observed Conclusions fatigue depression concentration COVID1 1 COVID- 6 381 3 38. 140 0 14. 297 29. 174 4 17. kg/m 39.7 (39.7% 38.2 (38.2% 48.5 (48.5% 888 8 88. 172 17.2 (FVC 860 86. 220 22.0 (FEV1 627 62. 250 25.0 (PEF 974 9 97. 346 34.6 668 66. 229 22.9 39. (39.7 (38.2 48. (48.5 22. (FEV 25. 34. (39. (38. (48. (39 (38 (48 (3 (4 (

RESUMO Objetivos: Descrever os sintomas persistentes e a função pulmonar em casos leves de COVID-19 seis meses após a infecção. Métodos: A coleta de dados foi realizada por meio de um questionário semiestruturado contendo informações sobre dados demográficos e antropométricos dos participantes, a doença na fase aguda e os sintomas persistentes seis meses após a COVID-19, utilizando espirometria e manovacuometria. Resultados: Um total de 136 participantes foram avaliados, dos quais 64% eram do sexo masculino, com uma idade média de 38,17 ± 14,08 anos e índice de massa corporal (IMC) de 29,71 ± 17,48 kg/m2. Os principais sintomas persistentes relatados foram dispneia ao esforço (39,7%), perda de memória (38,2%) e ansiedade (48,5%). Considerando a função pulmonar, os participantes atingiram 88,87 ± 17,20% da capacidade vital forçada (CVF) prevista, 86,03 ± 22,01% do volume expiratório forçado no primeiro segundo (VEF1) e 62,71 ± 25,04% do pico de fluxo expiratório (PFE). Na manovacuometria, observou-se 97,41 ± 34,67% da força inspiratória prevista (Pimáx) e 66,86 ± 22,97% da força expiratória prevista (Pemáx). Conclusões: Seis meses após a infecção por COVID-19, observou-se uma redução no PFE e na PEM. Dentre os sintomas persistentes mais comumente relatados estavam fadiga, cansaço com o mínimo esforço, ansiedade e depressão, perda de memória e déficits de concentração. Objetivos COVID19 COVID 19 COVID-1 Métodos COVID19, 19, manovacuometria Resultados 13 avaliados 64 masculino 3817 38 17 38,1 1408 14 08 14,0 IMC (IMC 2971 29 71 29,7 1748 48 17,4 kgm2 kgm kg m2 m kg/m2 39,7%, 397 39,7% , 39 7 (39,7%) 38,2% 382 2 (38,2% 48,5%. 485 48,5% . 5 (48,5%) 8887 88 87 88,8 1720 20 17,20 CVF (CVF 8603 86 03 86,0 2201 22 01 22,01 VEF1 VEF (VEF1 6271 62 62,7 2504 25 04 25,04 PFE. (PFE) observouse observou se 9741 97 41 97,4 3467 34 67 34,67 Pimáx (Pimáx 6686 66 66,8 2297 22,97 Pemáx. Pemáx (Pemáx) Conclusões PEM fadiga depressão concentração COVID1 1 COVID- 6 381 3 38, 140 0 14, 297 29, 174 4 17, kg/m 39,7 (39,7% 38,2 (38,2 48,5 (48,5% 888 8 88, 172 17,2 860 86, 220 22,0 (VEF 627 62, 250 25,0 (PFE 974 9 97, 346 34,6 668 66, 229 22,9 (Pemáx 39, (39,7 (38, 48, (48,5 22, 25, 34, (39, (38 (48, (39 (3 (48 ( (4

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296. longterm long term sequelae COVID19 COVID 19 COVID-1 databases MEDLINE MEDLINE® Science Science™ LILACSIBECS LILACS IBECS LILACS/IBECS EMBASE Additionally NewcastleOttawa Newcastle Ottawa Scale descriptions 24 77 A Syndrome life functionality mortality work rehospitalization symptoms followup follow up 14 months capacity standards scales points methodologies However pandemics outbreaks funded www.crd.york.ac.uk/prospero wwwcrdyorkacukprospero www crd york ac uk prospero (www.crd.york.ac.uk/prospero CRD42021190296 CRD COVID1 COVID- 2 7 CRD4202119029 CRD420211902 CRD42021190 CRD4202119 CRD420211 CRD42021 CRD4202 CRD420 CRD42 CRD4

Abstract Objective: This study aims to correlate the RAPID score with the 3-month survival and surgical results of patients undergoing lung decortication with stage III pleural empyema. Methods: This was a retrospective study with the population of patients with pleural empyema who underwent pulmonary decortication between January 2019 and June 2022. Data were collected from the institution’s database, and patients were classified as low, medium, and high risk according to the RAPID score. The primary outcome was 3-month mortality. Secondary outcomes were the length of hospital stay, readmission rate, and the need for pleural re-intervention. Results: Of the 34 patients with pleural empyema, according to the RAPID score, patients were stratified into low risk (23.5 %), medium risk (47.1 %), and high risk (29.4 %). The high-risk group had a 3-month mortality of 40 %, while the moderate-risk group hada 6.25 % and the low-risk group had no deaths within 90days, confirmingagood correlation with the RAPID score (p < 0.05). Sensitivity and specificity for the primary outcome in the high-risk score were 80.0 % and 79.3%, respectively. The secondary outcomes did not reach statistical significance. Conclusions: In this retrospective series, the RAPID score had a good correlation with 3-month mortality in patients undergoing lung decortication. The morbidity indicators did not reach statistical significance. The present data justifies further studies to explore the capacity of the RAPID score to be used as a selection tool for treatment modality in patients with stage III pleural empyema. Objective 3month month 3 Methods 201 2022 institutions institution s database stay rate reintervention. reintervention re intervention. intervention re-intervention Results 23.5 235 23 5 (23. , %) 47.1 471 47 1 (47. 29.4 294 29 4 (29. %. . highrisk moderaterisk moderate 625 6 25 6.2 lowrisk 90days days p 0.05. 005 0.05 0 05 0.05) 800 80 80. 793 79 79.3% respectively significance Conclusions series 20 202 23. 2 (23 47. (47 29. (29 62 6. 00 0.0 8 7 79.3 (2 (4 0. 79. (

RESUMEN 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.

ABSTRACT 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.

Abstract Objectives: The purpose of this study is to investigate the lung function in Chronic Rhinosinusitis (CRS) patients with Chronic Cough (CC). Methods: A total of 1413 CC patients were retrospectively screened and 109 CRS patients with CC were enrolled. Lung function, Lund-Mackay Computed Tomography (CT) score, smoking status, peripheral blood eosinophil count, and immunoglobulin E concentration in serum samples, and Sino-Nasal Outcome Test were examined. Normal control subjects are also recruited. Results: The Forced Expiratory Volume in 1 second (FEV1.0), Percent Predicted FEV1.0, and FEV1.0/Forced Vital Capacity (FVC) ratio in the patients were significantly low as compared with the control subjects. The FEV1.0/FVC ratio was negatively correlated with the Lund-Mackay CT scores of the patients with a high CT score. Conclusions: The CRS patients with CC should be investigated with lung function. In addition, the multidisciplinary evaluation including a pulmonologist is needed to manage the CRS patients with CC. Level of evidence: Level 4. Objectives (CRS . (CC) Methods 141 10 enrolled LundMackay Lund Mackay (CT score status count samples SinoNasal Sino Nasal examined recruited Results FEV10 FEV FEV1.0 , FEV1 0 (FEV1.0) FEV10Forced FEVForced FVC (FVC FEV10FVC FEVFVC Conclusions addition evidence 4 (CC 14 FEV1. (FEV1.0 (FEV1. (FEV1 (FEV

ABSTRACT. Oxidative stress is the result of an imbalance between the production of oxidant precursors and the capacity of antioxidant defense. Oxygen free radicals play an important role in causing diseases. In this study, the protective effect of ethanolic avocado on apoptosis caused by oxidative damage in the tissue of albino rats was investigated. 24 male albino rats of the Faculty of Veterinary Medicine in Mosul, Iraq, which were kept in standard conditions for at least 10 days before and through the experimental work, were examined. Four groups of rats include the control group (healthy group), the group of male rats with ethanolic avocado consumption; The third group of male rats that were treated with 0.5% of hydrogen peroxide H2O2; and the fourth group of male rats that were treated with both 0.5% H2O2 and avocado ethanolic extract (50 mg kg-1 BW) for four weeks. After fixing the tissues of the liver, kidney, lung, spleen and testis in 10% buffered formalin, they were stained with hematoxylin. TUNEL assay was performed using the TUNEL cell death assay kit to detect apoptotic cells. In this investigation, the histology results in four groups of rats showed that in the rats that were treated with avocado, there were minor tissue changes in their liver, kidney, and intestine, and the tissues of these organs were healthy. In TUNEL staining, it was also shown that there are no apoptotic cells in the liver, kidney and testis cells in avocado-treated rats. The results showed that ethanolic Avocado is useful against oxidative stress damage and it may be used to protect tissues against oxidative stress. ABSTRACT defense diseases study investigated 2 Mosul Iraq 1 work examined healthy group, , group) consumption 05 0 5 0.5 HO H O H2O 50 (5 kg1 kg kg- BW weeks liver lung formalin hematoxylin investigation intestine staining avocadotreated 0. (

Abstract: Viral infections are the main cause of acute respiratory failure in infants, which can progress to acute respiratory distress syndrome (ARDS), with high morbidity and mortality, so it is essential to imple ment strategies that prevent this progression. Recently, it has been proposed that increased work of breathing would not only be a warning symptom during the evolution of acute respiratory failure, but also a mechanism for the progression of injury, both lungs and diaphragm, coining the concept of patient self-inflicted lung injury. Since the first reports of ARDS, the usefulness of the use of con tinuous positive airway pressure (CPAP) has been raised, a non-invasive respiratory support therapy with wide access and low cost, capable of improving oxygenation and work of breathing. In this re view, we summarize the current concepts of physiological bases, preclinical and clinical studies that support the theoretical capacity of CPAP to prevent ARDS progression, and the clinical experience of early implementation of bubble CPAP in the Pediatric Ward of the Hospital Dr. Franco Ravera Zunino, allowing a marked reduction in pediatric ICU admissions and the use of invasive mechanical ventilation.

Resumen: Las infecciones virales son la principal causa de insuficiencia respiratoria aguda en lactantes, pudien do progresar hacia un síndrome de dificultad respiratoria agudo (SDRA), de elevada morbilidad y mortalidad, por lo que es fundamental implementar estrategias que prevengan esta progresión. Recientemente se ha planteado que el trabajo respiratorio aumentado no sería sólo un síntoma de alerta durante la evolución de una insuficiencia respiratoria aguda, sino un mecanismo de progresión de daño, tanto pulmonar como diafragmático, acuñándose el concepto de daño pulmonar auto-inflingido por el paciente. Desde las primeros reportes de SDRA, se ha planteado la utilidad del uso de presión positiva continua en la vía aérea (CPAP), una terapia de soporte respiratorio no invasivo de amplio acceso y bajo costo, capaz de mejorar la oxigenación y el trabajo respiratorio. En esta revisión, actualizamos las bases fisiológicas, estudios preclínicos y clínicos que sustentan la capacidad teórica de CPAP de prevenir la progresión de SDRA, y la experiencia clínica de implementación temprana de CPAP de burbujas en Sala de Pediatría del Hospital Dr. Franco Ravera Zunino, permitiendo reducir marcadamente los ingresos a UCI pediátrica y el uso de ventilación mecánica invasiva.

ABSTRACT Introduction. Children require special dedication to achieve high quality spirometry. Objective. This work evaluates the frequency of acceptable maneuvers in schoolchildren, the usefulness of incentive gestures to optimize the obtaining of high-quality tests, and performs an analysis of adjustments to several reference equations. Material and Methods. Forced expiratory maneuvers were performed in a group of schoolchildren from Asunción, Paraguay, choosing variables recommended for interpretation in a portable spirometer, to evaluate the frequency of high quality tests. Those who did not achieve acceptable studies were subjected to training with a roll whistle (toy) to evaluate their subsequent performance. The high-quality results were matched to expected values determined by various equations to evaluate adequacy. Results. Of 113 schoolchildren, 58,4% were able to achieve grade A or B maneuvers. After the stimulus with the roll whistle, the frequency of acceptable studies rose to 79,6%. The reference parameters with the best fit were those determined by the Global Lung Initiative (GLI). Conclusion. Playful incentives are an alternative to obtaining acceptable spirometry tests in schoolchildren, which, with the use of GLI parameters, would adjust the clinical management of certain respiratory diseases.

RESUMEN Introducción. Los niños requieren especial dedicación para lograr espirometrías de calidad. Objetivo. Este trabajo evalúa la frecuencia de maniobras aceptables en escolares, la utilidad de gestos de incentivo para optimizar la obtención de pruebas de alta calidad y realiza un análisis de ajuste a varias ecuaciones de referencia. Materiales y Métodos. Se realizaron maniobras espiratorias forzadas en un grupo de escolares de Asunción- Paraguay, escogiendo variables recomendadas para la interpretación en un espirómetro portátil, para evaluar la frecuencia de pruebas de calidad. Aquellos que no consiguieron estudios aceptables, fueron sometidos a un entrenamiento con silbato en rollo (juguete) para evaluar el desempeño ulterior. Los resultados de alta calidad fueron pareados a valores esperados determinados por diversas ecuaciones buscando evaluar el grado de adecuación. Resultados. De 113 escolares, el 58,4% pudo conseguir maniobras de grado A o B. Después del estímulo con el silbato en rollo, la frecuencia de estudios aceptables ascendió a 79,6%. Los parámetros de referencia con mejor ajuste fueron aquellos determinados por la Global Lung Initiative (GLI). Conclusión. Los incentivos lúdicos son una alternativa para optimizar la obtención de pruebas de espirometría en escolares, que con el uso de parámetros de GLI adecuarían el manejo clínico de ciertas enfermedades respiratorias.

Resumo: A atrofia muscular espinhal 5q, em sua apresentação precoce, está associada a eventos de insuficiência ventilatória no primeiro ano de vida, mesmo naqueles pacientes com intervenção farmacológica específica. Esta evolução deve-se ao comprometimento da musculatura inspiratória, expiratória e da deglutição com impacto adicional e relevante na capacidade de tosse. O suporte ventilatório não invasivo, somado às estratégias de recrutamento de volume pulmonar e facilitação da tosse manual e mecânica, são ferramentas que conseguem evitá-los. Porém, se esses pacientes necessitarem de intubação, serão difíceis de extubar com os protocolos habitualmente utilizados em unidades de terapia intensiva pediátrica. Este artigo de revisão aborda as informações existentes para evitar que a falha ventilatória e a intubação levem à traqueostomia como interface para ventilação mecânica invasiva. Detalha os protocolos de desmame na atrofia muscular espinhal, que, como em outros pacientes com doenças neuromusculares sem comprometimento do primeiro neurônio motor, permitem a transição para suporte ventilatório não invasivo.

Resumen: La atrofia muscular espinal 5q, en su modalidad de presentación temprana, se asocia a eventos de insuficiencia ventilatoria dentro del primer año de vida, incluso en aquellos pacientes con intervención farmacológica específica. Esta evolución se debe al compromiso de los músculos inspiratorios, espiratorios y de la deglución con impacto adicional y relevante en la capacidad tusígena. El soporte ventilatorio no invasivo, sumado a estrategias de reclutamiento de volumen pulmonar, y facilitación de la tos manual y mecánica, son herramientas que logran evitarlos. Sin embargo, si estos pacientes requieren ser intubados, son difícilmente extubables con los protocolos habitualmente utilizados en las unidades de cuidado intensivo pediátrico. Este artículo de revisión aborda la información existente para evitar que el fallo ventilatorio y la intubación deriven en una traqueostomía como interfase para la ventilación mecánica invasiva. Detalla aquellos protocolos de destete en atrofia muscular espinal, que al igual que en otros pacientes con enfermedades neuromusculares sin compromiso de la primera motoneurona, permiten la transición al soporte ventilatorio no invasivo.

Summary: 5q spinal muscular atrophy, at early presentation, is associated with events of ventilatory failure within the first year of life, even in those patients with specific pharmacological intervention. This evolution is due to the involvement of the inspiratory, expiratory and swallowing muscles with an additional and relevant impact on coughing capacity. Non-invasive ventilatory support, added to lung volume recruitment strategies, and facilitation of manual and mechanical cough, are tools used to avoid them. However, if these patients require intubation, they are difficult to extubate with the commonly used protocols in pediatric intensive care units. This article review addresses the existing information to prevent ventilatory failure and intubation leading to a tracheostomy as an interface for invasive prolonged mechanical ventilation. It describes the weaning protocols in spinal muscular atrophy, which, as in other patients with neuromuscular diseases without involvement of the first motor neuron, enable the transition to non-invasive ventilatory support.

ABSTRACT Introduction: The Cuban vaccine CIMAvax-EGF® is useful in non-small cell lung cancer (NSCLC) patients with high serum concentrations of epidermal growth factor ([EGF]), the current predictor of response. However, the discrimination between healthy individuals and NSCLC patients by [EGF], which determines the diagnostic accuracy and efficacy of the biomarker, is questionable. The controversy occurs mainly due to methodological deficiencies in its estimation. Methods: This work presents a new methodology for the quantification of human serum EGF, aimed at controlling the factors causing bias and variability in the estimates. The approach includes the development of the quantification kit UMELISA EGF®, the standardization of sera separation, and the normalization of [sEGF] regarding platelets count, as well as its interpretation. Results: The study revealed that patients and controls differ only by circulating EGF, measured in sera separated 1h after phlebotomy ([EGF]1h) and not by the total EGF in platelets, estimated in sera collected 4h after blood draw ([EGF]4h). Several variables related to EGF, with discriminatory power (diagnostic value) and potentiality as a biomarker, were identified. Specially circulating ([EGF]1h) and platelet-retained EGF ([EGF]4h-[EGF]1h), both normalized by platelets count, discriminate better patients from healthy controls than circulating or total EGF. Conclusions, the greater discriminatory capacity of the normalized variables indicates their more direct relationship with the biology of the tumor, compared to the current efficacy biomarker; as well as its better performance in predicting the response to anti-EGF/EGFR therapies and to the CIMAvax-EGF® in particular; which, together with the safety and low cost of the UMELISA EGF® test, suggests its possible use in the screening and early diagnosis of the disease in populations at risk.

RESUMEN Introducción: La vacuna cubana CIMAvax-EGF®, es útil en pacientes con cáncer de pulmón de células no pequeñas con altas concentraciones séricas de factor de crecimiento epidérmico, su actual predictor de respuesta. Sin embargo, la discriminación por factor de crecimiento epidérmico entre individuos sanos y pacientes con cáncer de pulmón de células no pequeñas, que determina la exactitud diagnóstica y eficacia del biomarcador, es cuestionable debido principalmente a deficiencias metodológicas en su medición. Métodos: En este trabajo se desarrolló una metodología para la cuantificación de factor de crecimiento epidérmico sérico humano, dirigida a controlar los factores causa de sesgo y variabilidad en las estimaciones. La misma incluyó el desarrollo del estuche de cuantificación UMELISA EGF®, la estandarización de la separación de los sueros y la normalización de las concentraciones con referencia al conteo plaquetario, así como su interpretación. Resultados: El estudio evidenció que pacientes y controles sanos se diferencian por el factor de crecimiento epidérmico en circulación, medido en sueros separados 1 h después de la flebotomía ([EGF]1h), y no por su provisión total en plaquetas, estimada en sueros colectados 4 h después de la extracción de la sangre ([EGF]4h). Varias variables relacionadas con el factor de crecimiento epidérmico, con poder discriminatorio (valor diagnóstico) y potencialidad como biomarcador en cáncer de pulmón de células no pequeñas, fueron identificadas. En particular el factor de crecimiento epidérmico circulante ([EGF]1h) y el retenido en las plaquetas ([EGF]4h-[EGF]1h), ambos normalizados por conteo plaquetario, discriminan mejor los pacientes que el EGF circulante o total. Conclusiones, la mayor capacidad discriminatoria de las variables normalizadas indica su relación más directa con la biología del tumor, comparadas con el biomarcador de eficacia actual; así como su mejor desempeño en la predicción de respuesta a terapias anti EGF/EGFR y a la vacuna CIMAvax-EGF® en particular; lo que unido a la inocuidad y el bajo costo de la prueba UMELISA EGF®, sugiere su posible empleo en la pesquisa y el diagnóstico temprano de la enfermedad en poblaciones de riesgo.

BACKGROUND. There is a dearth of information on the relationship between indoor air pollution and lung function, especially among sub-Saharan African children. OBJECTIVE. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern Cape Province of South Africa (SA). METHODS. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PM from 23 classrooms was measured with a handheld particle counter and lung function was assessed with a handheld spirometer. RESULTS. Mean (standard deviation) PM5 levels were higher (109.96 (75.39) μg/m³) than PM10 (84.84 (63.28) μg/m³) and PM25 (39.45 (26.38) μg/m³). PM25, PM5 and PM10 correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV25-75 , as well as peak expiratory flow (PEF) but correlated positively (p<0.001) with the FEV1/FVC ratio. CONCLUSION. PM in classrooms showed a negative relationship with lung function in the study population.

Abstract: Spirometry is the most widely used and standardized respiratory function test. In 2019, the American Thoracic Society and the European Respiratory Society updated the international guidelines for its execution. The COVID-19 pandemic forced the establishment of better biosafety parameters and has renewed interest in respiratory medicine in the world, including physiological evaluation. The present manuscript summarizes these changes incorporating recommendations and suggestions for countries with limited resources.

Resumen: La espirometría es la prueba de función respiratoria más utilizada y estandarizada. En el año 2019, la Sociedad Americana del Tórax y la Sociedad Respiratoria Europea actualizaron los lineamientos internacionales para su ejecución. La pandemia de COVID-19 ha obligado a establecer mejores parámetros de bioseguridad y ha renovado el interés por la medicina respiratoria en el mundo, incluyendo la evaluación funcional. El presente manuscrito es una propuesta de procedimiento de espirometría ajustado a los cambios e incorpora recomendaciones y sugerencias para países con recursos limitados.

Abstract: Introduction: diffuse interstitial lung diseases (DILD) are a group of diseases that compromise the alveolar and capillary basement membranes, that is, the anatomical interstitium. Exercise and education are recommended intervention strategies for patients regardless of the cause of DILD. Objective: to establish the effects of a physical exercise and education program in patients with idiopathic pulmonary fibrosis and other DILD on dyspnea, functional aerobic capacity, anxiety/depression and health-related quality of life. Material and methods: quasi-experimental study, all patients were linked for convenience and signed the informed consent. They were divided into two groups: patients with idiopathic pulmonary fibrosis and other DILD, evaluated before and after the exercise and education program in clinical variables, functional capacity, anxiety/depression and quality of life. Results: 68 patients were linked, 30 with idiopathic pulmonary fibrosis and 36 with other DILD. Both groups presented improvements in the distance traveled in the 6-minute walk test, dyspnea and quality of life p-value ≤ 0.05. The idiopathic pulmonary fibrosis group presented improvements in anxiety and depression and the other DILD group in anxiety. Conclusion: all patients present significant improvements in functional capacity, dyspnea, anxiety and quality of life, the group of idiopathic pulmonary fibrosis additionally improves in depression, being the variable with significant changes between the groups.

Resumen: Introducción: las enfermedades pulmonares intersticiales difusas son un grupo de enfermedades que comprometen las membranas basales alveolares y capilares, es decir, el intersticio anatómico. El ejercicio y la educación son estrategias de intervención recomendadas para los pacientes sin importar la causa de las enfermedades pulmonares intersticiales difusas. Objetivo: establecer los efectos de un programa de ejercicio físico y educación en pacientes con fibrosis pulmonar idiopática y otras enfermedades pulmonares intersticiales difusas en la disnea, capacidad aeróbica funcional, ansiedad/depresión y calidad de vida relacionada con la salud. Material y métodos: estudio cuasiexperimental, todos los pacientes se vincularon por conveniencia y firmaron el consentimiento informado. Se dividieron en dos grupos: pacientes con fibrosis pulmonar idiopática y casos con otras enfermedades pulmonares intersticiales difusas, evaluados antes y después del programa de ejercicio y educación en variables clínicas, capacidad funcional, ansiedad/depresión y calidad de vida. Resultados: se vincularon 68 pacientes, 30 con fibrosis pulmonar idiopática y 36 con otras enfermedades pulmonares intersticiales difusas. Ambos grupos presentaron mejorías en la distancia recorrida en la prueba de marcha de los seis minutos, la disnea y la calidad de vida p ≤ 0.05. El grupo de fibrosis pulmonar idiopática presentó mejorías en la ansiedad y depresión, y el grupo de otras enfermedades pulmonares idiopáticas en la ansiedad. Conclusión: todos los pacientes presentaron mejorías significativas en la capacidad funcional, disnea, ansiedad y calidad de vida. El grupo de fibrosis pulmonar idiopática adicionalmente mejoró en la depresión, siendo la variable con cambios significativos entre los grupos.