Resumen Introducción: Los esfuerzos de la lucha contra la tuberculosis (TB) se centran habitualmente en un diagnóstico precoz y un tratamiento eficaz y oportuno para romper la cadena de transmisión de Mycobacterium tuberculosis. Sin embargo, en los últimos años, coincidiendo con la asociación sindémica TB/COVID-19, han aparecido cada vez más evidencias sobre las graves secuelas clínicas, funcionales y psicosociales que puede ocasionar la TB, condición que se ha definido como enfermedad pulmonar post-tuber-culosis (PTLD). Aproximadamente, un tercio de los pacientes que sobreviven a la TB se enfrentan a esto, incluyendo síntomas respiratorios persistentes con exacerbaciones episódicas, insuficiencia respiratoria crónica, trastornos emocionales y desafíos psico-sociales que impactan negativamente en la calidad de vida y enfrentan un alto costo catastrófico. Objetivo: Proporcionar un modelo compartido, orientador y científicamente válido para diagnosticar, evaluar y tratar en forma oportuna a los pacientes con PTLD (prevención, diagnóstico, tratamiento y posible rehabilitación). Metodología: Es una investigación documental que incluye revisiones sistemáticas, meta-análisis, estudios observacionales y de las directrices existentes en los últimos años al respecto, sumado a una evaluación por expertos en el tema, con el propósito de adaptarlas a las condiciones locales de cada país latinoamericano. Conclusiones: Considerando la carga mundial, particularmente, latinoamericana de TB, y la carga estimada de la PTLD, se considera urgente el desarrollo de un consenso sobre este tema. Creemos que las recomendaciones de ALAT proporcionarán la base para la formulación y adopción de directrices nacionales para el manejo del PTLD en América Latina.

Abstract Introduction: Efforts to combat tuberculosis (TB) usually focus on early, rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, coinciding with the syndemic TB/COVID-19 asso-ciation, more and more evidence has proved the serious clinical, functional and psycho-social sequelae that TB can cause. This condition has been defined as Post-Pulmonary Disease Tuberculosis (PTLD) and it affects approximately one-third of the patients who survive TB, facing persistent respiratory symptoms with episodic exacerbations, chro-nic respiratory failure, emotional disorders and psychosocial challenges that negatively impact their life quality, meaning a high catastrophic cost. Objective: Provide a shared, guiding and scientifically valid model to promptly diagno-se, evaluate and treat patients with PTLD (prevention, diagnosis, treatment and possi-ble rehabilitation). Methodology: It is documentary research that includes systematic reviews, meta-analysis, observational studies and the guidelines that have existed in recent years in this regard, added to an evaluation by experts, with the purpose of adapting them to local conditions of each Latin American country. Conclusions: Considering the global and, particularly, the Latin American burden of TB, and the estimated burden of PTLD, the development of a consensus document on this topic is urgent. Therefore, we think ALAT recommendations will provide the basis for the formulation and adoption of national specific guidelines for the management of PTLD in Latin America.

Resumo Introdução: A alimentação é insuficiente para garantir níveis adequados de vitamina D no primeiro ano de vida, sendo necessária suplementação. A principal função do calcitriol é regular o metabolismo fosfo-cálcico. O seu défice pode resultar em hipocalcemia com manifestações clínicas graves. Caso Clínico: Uma lactente de seis meses do sexo feminino, melanodérmica, sob aleitamento materno exclusivo até aos cinco meses sem suplementação com colecalciferol, foi admitida por dificuldade respiratória que progrediu para episódios de bradicardia grave com necessidade de reanimação. O ecocardiograma mostrou miocardiopatia dilatada e a lactente foi internada na Unidade de Cuidados Intensivos. Teve vários episódios convulsivos e a avaliação neuroimagiológica foi sugestiva de encefalopatia hipóxico-isquémica. Analiticamente, tinha hipovitaminose D e hipocalcemia. Foi iniciada terapêutica de reposição, mas devido à ausência de melhoria e ao mau prognóstico, foram oferecidos cuidados paliativos e a lactente acabou por falecer. Discussão/Conclusão: A suplementação com vitamina D durante o primeiro ano de vida é essencial para prevenir alterações do metabolismo fosfo-cálcico associadas a miocardiopatia, choque cardiogénico e até morte.

Abstract Introduction: Dietary intake is insufficient to provide adequate levels of vitamin D during the first year of life and supplementation is required. The main function of calcitriol is to regulate calcium-phosphorus metabolism. Its deficiency can lead to hypocalcemia with severe clinical manifestations. Case Report: A six-month-old melanodermic female infant, exclusively breastfed until five months of age without cholecalciferol supplementation, was admitted for respiratory distress that progressed to severe bradycardia requiring resuscitation. Cardiac ultrasound was compatible with dilated cardiomyopathy, and the girl was admitted to the Intensive Care Unit. She later developed seizures, and neuroimaging was compatible with hypoxic-ischemic encephalopathy. Laboratory studies revealed hypovitaminosis D and hypocalcemia. Replacement therapy was initiated. Due to lack of improvement and poor prognosis, palliative care was provided, and the patient eventually died. Discussion/Conclusions: Vitamin D supplementation in the first year of life is essential to prevent calcium-phosphorus metabolism disorders and secondary cardiomyopathy, cardiogenic shock, and even death.

Resumen Este artículo registra saberes botánicos y médicos en el departamento de Artigas, Uruguay. La investigación se llevó a cabo entre los años 2017 y 2018. Mediante observaciones y entrevistas a diferentes actores sociales vinculados a la práctica de la medicina popular, se logró recabar información para su posterior sistematización y análisis. En Artigas fueron identificadas 142 plantas pertenecientes a 65 familias botánicas, siendo las familias Asteraceae, Myrtaceae, Fabaceae, Apiaceae y Lamiaceae las más recurrentes. De estas especies, 131 son utilizadas como medicinales. Las restantes plantas poseen otros usos etnobotánicos como ser alimentos, condimento, maderable, pintura corporal y usos indígenas. Las plantas medicinales son utilizadas principalmente para tratar afecciones del sistema digestivo (23%), sistema sensorial (13%), sistema genitourinario (12%) y sistema respiratorio (11%). La principal forma de consumo es a través de la infusión (46%) y la parte utilizada principalmente es la hoja (48%). Asimismo, fueron identificadas una gran diversidad de prácticas de la medicina popular, dando como resultado una etnomedicina caracterizada en base al uso de plantas medicinales.

Summary This article presents botanical and medical knowledge in the department of Artigas, Uruguay. The research was carried out between 2017 and 2018. Information through observations and interviews with different social actors linked to the practice of popular medicine was collected to systematize and analyze. In Artigas, 142 plant species belonging to 65 botanical families were identified, with Asteraceae, Myrtaceae, Fabaceae, Apiaceae and Lamiaceae as the most recurrent ones. Of these species 131 are used as medicinal. The remaining have other ethnobotanical uses, such as food, seasoning, timber, body paint, and native traditions. Medicinal plants are mainly used to treat disorders of the digestive system (23%), sensory system (13%), genitourinary system (12%) and respiratory system (11%). The main form of consumption is through infusion (46%) and the part used are mainly leaves (48%) Likewise, a great diversity of popular medicine practices were identified, resulting in an ethnomedicine characterized on the use of medicinal plants.

RESUMEN El SARS-CoV-2 y sus secuelas se constituyen reto para la salud pública global. La repercusión sobre la relación estructura-función a nivel pulmonar, es un área de investigación activa, donde la fibrosis pulmonar pos-COVID-19 destaca preocupantemente. CIMAvax-EGF® es un vacunal inductor de una potente respuesta inmune anti-EGF y es empleada en el tratamiento de enfermedades oncológicas como las neoplasias de pulmón. Los ensayos clínicos han demostrado un sólido perfil de seguridad, a pesar de ser esta una población vulnerable. Entre las rutas moleculares calves en la fibrosis, destaca por su rol el factor de crecimiento transformante beta, en base a su actividad crítica en la trasformación miofibroblástica y la transición epitelio-mesénquima; a nivel molecular la señalización mediada por el receptor de factor de crecimiento epidérmico es un punto de confluencia entre la fibrosis y las neoplasias de origen epitelial. En este contexto los resultados de la introducción de CIMAvax-EGF® en el tratamiento de pacientes con neoplasia de pulmón de células no pequeñas avanzada, sugieren un efecto de contención clínicamente significativo. En este manuscrito abordamos, en base a evidencias experimentales y clínicas, los supuestos que justifican racionalmente un beneficio terapéutico medible en pacientes con trastornos respiratorios post-COVID-19, con el uso de CIMAvax-EGF®.

ABSTRACT SARS-CoV-2 and its consequences constitute a challenge for global public health. The impact on the structure-function relationship at the lung level is an area of active research, where post-COVID-19 pulmonary fibrosis stands out worryingly. CIMAvax-EGF® is a vaccine that induces a powerful anti-EGF immune response and is used in the treatment of oncological diseases such as lung neoplasms. Clinical trials have demonstrated a strong safety profile, despite this being a vulnerable population. Among the key molecular pathways in fibrosis, transforming growth factor beta stands out for its role, based on its critical activity in myofibroblastic transformation and epithelial-mesenchymal transition; at the molecular level, signaling mediated by the epidermal growth factor receptor is a point of confluence between fibrosis and neoplasms of epithelial origin. In this context, the results of the introduction of CIMAvax-EGF® in the treatment of patients with advanced non-small cell lung neoplasia suggest a clinically significant containment effect. In this manuscript, we address, based on experimental and clinical evidence, the assumptions that rationally justify a measurable therapeutic benefit in patients with post-COVID-19 respiratory disorders, with the use of CIMAvax-EGF®.

Resumen Los trastornos del sueño son frecuentes en niños y afectan al desarrollo neurológico, con importante repercusión cognitiva, emocional y conductual. Existe una alta prevalencia de trastornos del sueño (TS) en los trastornos del neurodesarrollo (TND), como trastorno del espectro autista (TEA) y trastorno por déficit de atención con hiperactividad (TDAH). Los TS en población pediá trica tienen una prevalencia del 6-25%, mientras que en los niños con TND esta cifra asciende al 50-80%. En los TND se observa un incremento de las dificultades para conciliar el sueño, de los despertares nocturnos y de la somnolencia diurna. Así mismo, presentan alteracio nes del ritmo circadiano y trastornos respiratorios del sueño. Como consecuencia se produce una reducción de la alerta para las actividades diarias con incremento de trastornos conductuales, problemas emocionales y dificultades académicas asociadas a disfunciones eje cutivas y de memoria. La evaluación del sueño debe formar parte sistemática en la valoración clínica de los niños con TND, con el fin de realizar un diagnóstico y un tratamiento adecuados a cada caso, permitiendo mejorar la calidad de vida del niño y de su familia.

Abstract Sleep disorders are common in children and affect neurological development with important cognitive, emotional and behavioral repercussions. There is a high prevalence of sleep disorders (SD) in neurodevelop mental disorders (NDD) such as autism spectrum dis order (ASD) and attention-deficit hyperactivity disorder (ADHD). Sleep disorders in pediatric population have a prevalence of 6-25%, while in children with NDD this number rises to 50-80%. In NDDs, higher rates of dif ficulties in falling asleep, nocturnal awakenings and daytime sleepiness are observed. Disturbances in the circadian rhythm as well as respiratory sleep disorders are also observed. Consequently, there is a decrease in alertness for daytime activities with increased be havioral disorders, emotional problems and academic difficulties associated with executive and memory dys functions. Sleep assessment has to be a systemic part in the clinical evaluation of children with NDDs, so as to give a convenient diagnosis and treatment in each case, allowing to improve the quality of life of children and their families.

RESUMEN Introducción: El empleo del ozono como agente terapéutico es uno de los descubrimientos más notables en la medicina alternativa. A pesar de su extendido uso, es tóxico por vía inhalatoria, la exposición a este gas puede producir, daños de la vía respiratoria superior y del epitelio bronquial. Objetivo: Evaluar la exposición ocupacional a ozono en áreas de tratamiento de ozonoterapia de La Habana. Métodos: Estudio exploratorio descriptivo, se estudiaron 21 trabajadores de 16 áreas de tratamiento de ozonoterapia, se les realizaron análisis clínicos, incluyendo ceruloplasmina, además de pruebas funcionales ventilatorias. Se determinaron las concentraciones de ozono en el aire del ambiente laboral en 29 áreas de tratamiento. Resultados: La insuflación rectal fue la forma de aplicación más utilizada. El 42,8 % refirieron padecer de rinitis alérgica, seguido de gripes frecuentes y de asma bronquial. El 33,3 % de los valores de la ceruloplasmina resultaron alterados. Los resultados de las pruebas funcionales ventilatorias mostraron que el 28,6 % de los trabajadores presentaron patrón obstructivo. En la evaluación ambiental se reportaron 2 centros de salud con concentraciones promedio por encima de los límites admisibles. Conclusiones: La hipertensión arterial y la rinitis alérgica fueron las patologías más frecuentes. Las cifras de ceruloplasmina alteradas se presentaron en trabajadores con mayor tiempo de exposición. Los trastornos ventilatorios obstructivos observados, coinciden con las patologías respiratorias referidas por los trabajadores. El 93,1 % de los valores de concentración promedio, en el aire de la zona de trabajo, se comportó por debajo de los límites admisibles.

ABSTRACT Introduction: The use of ozone as a therapeutic agent is one of the most notable discoveries in alternative medicine. Despite its widespread use, it is toxic by inhalation; exposure to this gas can cause damage to the upper respiratory tract and bronchial epithelium. Objective: To evaluate occupational exposure to ozone in ozone therapy treatment areas of Havana. Methods: Descriptive exploratory study, 21 workers from 16 ozone therapy treatment areas were studied, clinical analyzes were performed, including ceruloplasmin, in addition to ventilatory functional tests. Ozone concentrations in the air of the work environment were determined in 29 treatment areas. Results: Rectal insufflation was the most used form of application. 42.8% reported suffering from allergic rhinitis, followed by frequent flu and bronchial asthma. 33.3% of ceruloplasmin values were altered. The results of the ventilatory functional tests showed that 28.6% of the workers presented an obstructive pattern. In the environmental evaluation, 2 health centers were reported with average concentrations above the admissible limits. Conclusions: High blood pressure and allergic rhinitis were the most frequent pathologies. The altered ceruloplasmin levels occurred in workers with longer exposure times. The obstructive ventilatory disorders observed coincide with the respiratory pathologies reported by the workers. 93.1% of the average concentration values, in the air of the work area, were below the permissible limits.

Exercise respiratory symptomatology is frequent in young athletes. In these patients, bronchoconstriction during exercise with or without asthma, the laryngeal obstruction induced by exercise and respiratory pattern disorders in the exercise are the three conditions that must be investigated. In differential diagnosis, organic or structural thoracic or extrathoracic causes should be ruled out. The study is complex but useful to confirm the diagnosis of any of the three conditions. The treatment must be multidisciplinary with individual approach.

Resumen La sintomatología respiratoria relacionada con el ejercicio es frecuente en atletas jóvenes. En estos pacientes la broncoconstricción durante el ejercicio con o sin asma, la obstrucción laríngea inducida por el ejercicio y los trastornos del patrón respiratorio en el ejercicio son las tres condiciones que deben ser investigadas. En el diagnostico diferencial se deben descartar causas torácicas o extratorácicas orgánicas o estructurales. El estudio es complejo pero útil para confirmar el diagnóstico cualquiera de las tres condiciones. El tratamiento debe ser multidisciplinario con enfoque individual.

Resumen Desde tiempos remotos las plantas medicinales han constituido un recurso muy importante en la vida diaria del poblador peruano, por ello la importancia de estudios relacionados a este recurso. La presente investigación tuvo como objetivo realizar un estudio etnobotánico y determinar la importancia cultural de las plantas medicinales del distrito de Quinua (Huamanga, Ayacucho). Se recolectaron especímenes de la flora medicinal silvestre y se formularon entrevistas abiertas y semiestructuradas a los pobladores del lugar. Se reportan 115 especies medicinales agrupadas en 90 géneros y 44 familias con mayor representación de especies en Asteraceae (33 spp.), Fabaceae (10 spp.), Lamiaceae (siete spp.) y Solanaceae (cinco spp.). Se registran 17 subcategorías de dolencias y/o enfermedades, siendo los trastornos del sistema digestivo, sistema genitourinario, inflamaciones, sistema músculo esquelético, sistema respiratorio y síndromes culturales los que mayor número de especies presentaron con 101, 76, 76, 64, 59 y 50 especies, respectivamente. Las plantas medicinales de mayor importancia cultural son Urtica urens, Equisetum bogotense, Plantago major, Oenothera rosea, Tara spinosa, Ambrosia arborescens, Clinopodium brevicalyx, Lupinus ballianus, Schinus molle y Clinopodium breviflorum. Finalmente, los pobladores del distrito de Quinua poseen un gran conocimiento sobre las plantas medicinales y aún las siguen utilizando dentro de la medicina tradicional.

Abstract Since ancient times, medicinal plants have been a very important resources in the daily life of the Peruvian population, research related to this resource being of importance. This study aimed to conduct an ethnobotanical investigation and determine the cultural importance of medicinal plants in the Quinua district (Huamanga, Ayacucho). Specimens of wild medicinal flora were collected, and open and semi-structured interviews were conducted with the local residents. A total of 115 medicinal plant species were identified, grouped into 44 families and 90 genera. The families with the highest representation of species were Asteraceae (33 spp.), Fabaceae (10 spp.), Lamiaceae (seven spp.), and Solanaceae (five spp.). A total of 17 subcategories of ailments and/or diseases are registered, with disorders of the digestive system, genitourinary system, inflammations, musculoskeletal system, respiratory system, and cultural syndromes having the highest number of species, with 101, 76, 76, 64, 59, and 50 species, respectively. The most culturally important medicinal plants identified were Urtica urens, Equisetum bogotense, Plantago major, Oenothera rosea, Tara spinosa, Ambrosia arborescens, Clinopodium brevicalyx, Lupinus ballianus, Schinus molle, and Clinopodium breviflorum. In conclusion, the residents of the Quinua district possess extensive knowledge of medicinal plants and continue to use them within traditional medicine.

ABSTRACT: Hemoptysis associated with respiratory disorders are some findings of caudal vena cava thrombosis (CVCT) in cattle. Nevertheless, CVCT may be accompanied by a broad spectrum of clinical signs and gross lesions. This study reported the frequency of CVCT in cattle necropsied in Southern Brazil and described its clinical signs, as well as pathological findings. From a total of 1,976 postmortem examination reports in cattle in Southern Brazil, there were 30 cases (1.5%) of CVCT. In the clinical evaluation, the main clinical course was chronic (13/30), followed by peracute (7/30), acute (4/30), and subacute (5/30). Hemoptysis (17/30), dyspnea (8/30), and anorexia or hyporexia (7/30) were the most reported clinical signs. Septic thrombophlebitis of the caudal vena cava (24/30), hepatic abscesses (24/30), pulmonary hemorrhage (23/30), and embolic pneumonia (19/30) were the main lesions observed at the necropsy. We concluded that CVCT is a relevant cause of death in bovines from Santa Catarina state, mainly in adult dairy cows. The disease is characterized by a wide range of clinical signs and lesions, requiring attention from veterinarians for the correct diagnosis. Furthermore, the association between the clinical history, clinical signs, and lesions is essential for the diagnosis of CVCT in cattle.

RESUMO: Hemoptise associada a sinais respiratórios são achados típicos de tromboembolismo da veia cava caudal (TVCC) em bovinos. Todavia, o TVCC pode estar acompanhado de um amplo espectro de sinais clínicos e lesões macroscópicas. Esse estudo tem por objetivo relatar a frequência do diagnóstico de TVCC em bovinos necropsiados no sul do Brasil e descrever os sinais clínicos, assim como achados patológicos dessa condição. De um total de 1.976 exames post-mortem realizados em bovinos no Sul do Brasil, 30 casos de TVCC foram diagnosticados (1,5%). No exame clínico, o principal curso clínico observado foi crônico (13/30), seguido do hiperagudo (7/30), agudo (4/30) e subagudo (5/30), em um caso o histórico clínico não foi fornecido. Hemoptise (17/30), dispneia (8/30) e anorexia ou hiporexia (7/30) foram os sinais clínicos mais comumente relatados. Tromboflebite séptica da veia cava caudal (24/30), abscessos hepáticos (24/30), hemorragia pulmonar (23/30) e pneumonia embólica (19/30) foram as principais lesões observadas na necropsia. Com esse trabalho conclui-se que TVCC é uma causa relevante de morte em bovinos no estado de Santa Catarina, principalmente em vacas leiteiras adultas. A doença é caracterizada por uma variedade de sinais clínicos e lesões, necessitando de atenção dos veterinários para o correto diagnóstico. Ainda, a associação entre o histórico clínico, sinais clínicos e lesões de necropsia é essencial para o diagnóstico de TVCC em bovinos.

ABSTRACT Objective: To compare and analyze pulmonary function and respiratory mechanics parameters between healthy children and children with cystic fibrosis. Methods: This cross-sectional analytical study included healthy children (HSG) and children with cystic fibrosis (CFG), aged 6–13 years, from teaching institutions and a reference center for cystic fibrosis in Florianópolis/SC, Brazil. The patients were paired by age and sex. Initially, an anthropometric evaluation was undertaken to pair the sample characteristics in both groups; the medical records of CFG were consulted for bacterial colonization, genotype, and disease severity (Schwachman-Doershuk Score — SDS) data. Spirometry and impulse oscillometry were used to assess pulmonary function. Results: In total, 110 children were included, 55 in each group. In the CFG group, 58.2% were classified as excellent by SDS, 49.1% showed the ΔF508 heterozygotic genotype, and 67.3% were colonized by some pathogens. Statistical analysis revealed significant differences between both groups (p<0.05) in most pulmonary function parameters and respiratory mechanics. Conclusions: Children with cystic fibrosis showed obstructive ventilatory disorders and compromised peripheral airways compared with healthy children. These findings reinforce the early changes in pulmonary function and mechanics associated with this disease.

RESUMO Objetivo: Comparar e analisar parâmetros de função pulmonar e de mecânica respiratória entre escolares saudáveis e com fibrose cística (FC). Métodos: Estudo transversal que incluiu escolares saudáveis (GES) e com FC (GFC), com idades entre seis e 13 anos, provenientes de instituições de ensino e de um centro de referência da FC em Florianópolis/SC, Brasil, pareados por idade e sexo, respectivamente. Inicialmente, conduziu-se avaliação antropométrica para pareamento e caracterização de ambos os grupos e, no GFC, consultou-se prontuário médico para registro dos dados de colonização bacteriana, genótipo e gravidade da doença (Escore de Schwachman-Doershuk — ESD). Para a avaliação da função pulmonar, realizou-se espirometria e a avaliação da mecânica respiratória foi conduzida por meio do sistema de oscilometria de impulso. Resultados: Participaram 110 escolares, 55 em cada grupo. No GFC, 58,2% foram classificados pelo ESD como excelentes, 49,1% apresentaram genótipo ∆F508 heterozigoto e 67,3% eram colonizados por alguma patógeno. Houve diferença significativa (p<0,05) na maioria dos parâmetros de função pulmonar e de mecânica respiratória entre os grupos. Conclusões: Escolares com FC apresentaram distúrbio ventilatório obstrutivo e com comprometimento de vias aéreas periféricas, em comparação aos escolares hígidos. Esse evento reforça o início precoce da alteração de função pulmonar e de mecânica respiratória nessa enfermidade, evidenciados pelos achados desta investigação.

Resumo: Os distúrbios respiratórios são de grande importância, pois limitam o desempenho esportivo. Isso resulta em grandes perdas econômicas devido à consequente interrupção do treinamento, custos de tratamento médico ou até mesmo a aposentadoria precoce do cavalo afetado. O lavado broncoalveolar (BAL) permite a coleta de amostras das vias aéreas distais e é usado para o diagnóstico precoce de várias patologias das vias aéreas inferiores em cavalos. Embora o BAL seja uma ferramenta de diagnóstico usada em todo o mundo, os relatórios nacionais são escassos. O objetivo deste estudo foi diagnosticar distúrbios respiratórios inflamatórios de forma precoce usando o BAL em cavalos Puro-Sangue Inglês de corrida ativos no Hipódromo Nacional de Maroñas. Foram selecionados 12 cavalos com alterações citológicas no BAL compatíveis com patologias das vias aéreas inferiores. Foi constatado o diagnóstico de asma leve/moderada em equinos sintomáticos e assintomáticos, hemorragia pulmonar induzida por exercício (EIPH) em estágios subclínicos e inflamação não específica do pulmão. Em resumo, foi demonstrado que a citologia do BAL é uma ferramenta complementar essencial para o diagnóstico precoce das vias aéreas inferiores em equinos, especialmente em animais assintomáticos ou com sintomas leves/moderados.

Abstract: Alterations of the respiratory system are of great importance since they limit sporting performance. This results in great economic losses due to the consequent interruption of training, medical treatment costs or even the early retirement of the affected horse. Bronchoalveolar lavage (BAL) allows sampling of the distal airways and is used for early diagnosis of various lower airway pathologies in equines. Although BAL is a diagnostic tool used worldwide, national reports are scarce. The objective of this study was to diagnose inflammatory respiratory disorders in an early manner using the BAL technique in active Thoroughbred horse race at the Maroñas National Racecourse. Twelve equines presenting BAL cytological alterations compatible with lower airway pathologies were selected. The diagnosis of mild/moderate asthma in both symptomatic and asymptomatic equines, exercise-induced pulmonary hemorrhage (EIPH) in subclinical stages and non-specific lung inflammation was found. In summary, it could be proved that the cytological study of BAL is a fundamental complementary tool for the early diagnosis of the lower airways in equines, especially in asymptomatic animals or with mild/moderate symptomatology.

Resumen: Las alteraciones del aparato respiratorio tienen gran importancia ya que limitan el rendimiento deportivo. Esto trae como consecuencias grandes pérdidas económicas debido a la consecuente interrupción del entrenamiento, costos de tratamiento médico o incluso el retiro anticipado del caballo afectado. El lavaje broncoalveolar (BAL) permite la toma de muestras de las vías aéreas distales y se utiliza para el diagnóstico precoz de diversas patologías de las vías aéreas bajas en equinos. A pesar de que el BAL es una herramienta diagnóstica utilizada a nivel mundial, los reportes son escasos a nivel nacional. El objetivo de este estudio fue diagnosticar desórdenes respiratorios inflamatorios de manera precoz utilizando la técnica del BAL en caballos raza pura sangre de carrera activos y radicados en el Hipódromo Nacional de Maroñas. Se seleccionaron 12 equinos que presentaban alteraciones citológicas del BAL compatibles con patologías de las vías aéreas bajas. Se constató el diagnóstico de asma leve/moderado tanto en equinos sintomáticos como asintomáticos, hemorragia pulmonar inducida por el ejercicio (HPIE) en estadios subclínicos e inflamación inespecífica del pulmón. En suma, se pudo comprobar que el estudio citológico del BAL es una herramienta complementaria fundamental para el diagnóstico precoz de las vías aéreas bajas en equinos, especialmente en animales asintómaticos o con signología leve/moderada.

RESUMO Objetivo: analisar fatores neonatais e socioeconômicos associados ao desenvolvimento de agravos agudos de saúde de prematuros tardios e moderados no primeiro ano de vida. Método: estudo epidemiológico, longitudinal, em que foram acompanhados 151 prematuros (nascidos com idade gestacional de 32 a 37 semanas incompletas) durante o primeiro ano de vida. A coleta de dados ocorreu, trimensalmente, por meio de instrumento de caracterização com variáveis neonatais e socioeconômicas. O acompanhamento se deu por meio da utilização de formulários, aplicados via telefonema aos pais dos prematuros, para identificação dos agravos agudos de saúde. Os dados foram submetidos à estatística analítica com a aplicação da correlação de Pearson. Resultados: os agravos agudos apresentaram tendência linear ao longo do primeiro ano de vida. As afecções gastrointestinais foram mais frequentes nos primeiros meses, e a alergia de pele e as afecções respiratórias ocorreram mais frequentemente ao final do primeiro ano de vida. A vitalidade neonatal foi fator associado a maior intensidade de agravos agudos. Conclusão: a intensidade dos agravos agudos tem correlação significativa com fatores neonatais no primeiro trimestre de vida.

ABSTRACT Objective: to analyze neonatal and socioeconomic factors associated with the development of acute health problems in late and moderate preterm infants in the first year of life. Method: longitudinal epidemiological study, in which 151 premature babies (born with a gestational age of 32 to 37 incomplete weeks) were followed during the first year of life. Data collection occurred, quarterly, using a characterization instrument with neonatal and socioeconomic variables. Monitoring took place using forms, applied via telephone call to parents of premature babies, to identify acute health problems. The data were subjected to analytical statistics using Pearson's correlation. Results: acute illnesses showed a linear trend throughout the first year of life. Gastrointestinal disorders were more frequent in the first months, and skin allergies and respiratory disorders occurred more frequently at the end of the first year of life. Neonatal vitality was a factor associated with greater intensity of acute illnesses. Conclusion: the intensity of acute illnesses has a significant correlation with neonatal factors in the first trimester of life.

RESUMEN Objetivo: analizar los factores neonatales y socioeconómicos asociados al desarrollo de problemas de salud agudos en prematuros tardíos y moderados durante el primer año de vida. Método: estudio epidemiológico, longitudinal, en el que se siguieron 151 prematuros (nacidos con una edad gestacional de 32 a 37 semanas incompletas) durante el primer año de vida. La recolección de datos se realizó trimestralmente mediante un instrumento de caracterización con variables neonatales y socioeconómicas. El seguimiento se llevó a cabo mediante la utilización de formularios aplicados por teléfono a los padres de los prematuros, para la identificación de problemas de salud agudos. Los datos se sometieron a un análisis estadístico utilizando la correlación de Pearson. Resultados: los problemas de salud agudos mostraron una tendencia lineal a lo largo del primer año de vida. Las afecciones gastrointestinales fueron más frecuentes en los primeros meses, y las alergias cutáneas y las afecciones respiratorias ocurrieron más a menudo al final del primer año de vida. La vitalidad neonatal fue un factor asociado a una mayor intensidad de problemas de salud agudos. Conclusión: la intensidad de los problemas de salud agudos tiene una correlación significativa con factores neonatales en el primer trimestre de vida.

BACKGROUND: Oral feeding practices of young patients on high-flow oxygen (HFO2) have been controversial. Limited literature exists on this topic, but new studies suggest introducing oral feeds OBJECTIVE: This study aims to describe the changes in swallowing and feeding of a group of young children on HFO2 METHOD: Twelve participants (mean age 34.17 months [s.d. = 3.97]) on HFO2 were assessed clinically at the bedside using the Schedule of Oral Motor Assessment. Assessments were conducted twice to determine the change in characteristics: upon approval from the managing doctor when respiratory stability on HFO2 was achieved and for a second time on the last day of receiving HFO2 (mean 2.6 days apart). Patients received standard in-patient care and speech therapy intervention RESULTS: Most participants displayed typical oral motor function at initial and final assessments for liquid, puree and semi-solid consistencies. Purees and soft solid consistencies were introduced to most participants (n = 11, 91.7%). Solids and chewables were challenging for all participants during both assessments. Half of the participants displayed gagging and a wet vocal quality with thin liquids at the initial assessment only CONCLUSION: This small-scale study found that HFO2 should not preclude oral diets, but in this sample, small amounts of oral feeding could be introduced with caution, in an individualised manner, and with a collaborative multidisciplinary approach. Further research is essential CONTRIBUTION: Partial oral feeding of specific consistencies was possible during the assessment of young paediatric in-patients on HFO2. Monitoring of individual patient characteristics and risk factors by a specialist feeding team is essential

BACKGROUND: Progressive respiratory muscle weakness and ineffective cough contribute to morbidity and mortality in children with neuromuscular disorders (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength and reduce respiratory morbidity. This study aimed to determine the safety and efficacy of IMT in children with NMD. METHODS/DESIGN: A randomised cross-over study compared a 3-month intervention (IMT) with control periods (no IMT). Children diagnosed with NMD (5 years - 18 years) performed 30 breaths (at 30% of maximum inspiratory mouth pressure [Pimax]) with an electronic threshold device, twice daily. During the control period, participants did not perform any IMT. DISCUSSION: Twenty three children (median [interquartile range {IQR}] age of 12.33 [10.03-14.17] years), mostly male (n = 20) and non-ambulant (n = 14) participated. No adverse events related to IMT were reported. No difference in median patient hospitalisation and respiratory tract infection (RTI) rates between non-training and intervention periods (p = 0.60; p = 0.21) was found. During IMT, Pimax and peak cough flow improved with a mean ± standard deviation (s.d.) of 14.57 ± 15.67 cmH2O and 32.27 ± 36.60 L/min, compared to 3.04 ± 11.93 cmH2O (p = 0.01) and −16.59 ± 48.29 L/min (p = 0.0005) during the non-training period. Similar to other studies, spirometry did not show a significant change. CONCLUSION: A 3-month IMT programme in children with NMD appears safe and well-tolerated, with significant improvement in respiratory muscle strength and cough efficacy. CLINICAL IMPLICATIONS: Inspiratory muscle training could be considered a cost-effective adjunct to respiratory management in children with NMD. TRIAL REGISTRATION: Pan African Clinical Trial Registry, PACTR201506001171421, https://pactr.samrc.ac.za.

Abstract Background Spinal muscular atrophy (SMA-5q) is a neurodegenerative disease characterized by progressive muscle atrophy, hypotonia, and weakness, with SMA 1 presenting symptoms within the first 6 months of life. Disease-modifying therapies have been approved, with better outcomes with earlier treatment. Objective To describe the safety and clinical efficacy of disease-modifying therapies based on SMN1 and SMN2 gene strategies concerning motor, respiratory, and bulbar function. Patients with SMA 1 were divided into 2 groups: those exclusively on nusinersen (group 1) and those transitioning to onasemnogene abeparvovec (OA) (group 2). Methods Over 18 months, patients were assessed using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) scale, developmental milestones, ventilation needs and duration, nutritional support needs, consistency of food, and signs of dysphagia. There were ten patients, divided between the groups; in group 1, the average age for starting nusinersen was 53.6 (12–115) months, and, in group 2, the age was 7 (1–12) months for nusinersen and 15.2 (10–19) months for OA. Results Our results indicate that 70% of patients reached some motor milestones, with group 1 increasing by 10.2 points on the CHOP-INTEND scale, while group 2 increased by 33 points. Additionally, 90% of the patients experienced no respiratory decline, and 30% maintained oral feeding. No serious adverse effects or deaths were recorded. Conclusion Both groups showed improvement in motor function and stabilization of respiratory and bulbar function, with the difference between the groups possibly being related to the earlier treatment initiation. Thus, the present study provides valuable insights into the real-world safety and clinical efficacy of disease-modifying therapies for SMA 1 patients.

Resumo Antecedentes A atrofia muscular espinhal (AME-5q) é uma doença neurodegenerativa caracterizada por atrofia muscular progressiva, hipotonia e fraqueza. Na AME 1 os sintomas iniciam-se no primeiro semestre de vida. Terapias modificadoras de doença foram aprovadas e demonstram melhores resultados quanto mais cedo forem iniciadas. Objetivo Descrever a segurança e a eficácia clínica das terapias modificadoras de doença quanto às funções motora, respiratória e bulbar. Os pacientes com AME 1 foram divididos em 2 grupos: os que faziam uso exclusivamente de nusinersena (grupo 1) e os que transacionaram para onasemnogene abeparvovec (OA) (grupo 2). Métodos Durante 18 meses, os pacientes foram avaliados utilizando a escala Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), marcos do desenvolvimento, necessidade e duração da ventilação, necessidade de suporte nutricional, consistência dos alimentos e sinais de disfagia. Dividiram-se dez pacientes entre os grupos; no grupo 1, a idade média para início do nusinersena foi de 53,6 (12–115) meses e, no grupo 2, a idade foi de 7 (1–12) meses para o nusinersena e 15,2 (10–19) meses para OA. Resultado Nossos resultados indicam que 70% dos pacientes atingiram algum marco motor, com o grupo 1 aumentando 10,2 pontos na escala CHOP-INTEND, e o grupo 2 aumentando 33. Ademais, 90% dos pacientes não apresentaram declínio respiratório e 30% mantiveram alimentação oral. Não houve efeitos adversos graves ou mortes. Conclusão Ambos os grupos apresentaram melhoria na função motora e estabilização da função respiratória e bulbar, com a diferença entre os grupos sendo possivelmente relacionada com o início mais precoce do tratamento. Assim, este estudo fornece informações valiosas sobre a segurança e eficácia clínica destas terapias para pacientes com AME 1.