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INTRODUCTION: High-frequency chest wall oscillation (HFCWO) devices are used to improve airway clearance in various respiratory conditions. This study comprehensively assesses the evidence on efficacy and safety and identifies trends in scientific publications and patents across geographic regions. METHODS: This study utilized an integrated approach, combining bibliographic and bibliometric research with artificial intelligence (AI) tools. Four databases - PubMed, Europe Pubmed Central, Cochrane Database of Systematic Reviews, and CINAHL - were searched for systematic reviews on the effectiveness of treatment options for HFCWO. The AMSTAR-2 tool was used to evaluate the risk of bias in systematic reviews. Bibliographic research synthesized the evidence following PRISMA and Cochrane guidelines. The Dimensions platform was used for bibliometric analysis to provide insights into the global landscape. AI tools with prompt engineering tools Chain-of-Thoughts (CoT) and Tree of Thoughts (ToT) were used to enhance data extraction capabilities. RESULTS: The umbrella review identified 12 systematic reviews supporting the effectiveness of HFCWO in improving pulmonary function parameters, sputum characteristics, dyspnea, health scores, and quality of life in conditions including cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease (COPD), or neuromuscular diseases, with varying evidence of certainty. Eight of the twelve reviews had a moderate to high AMSTAR-2 confidence level, while several studies lacked sufficient descriptions of methods, treatment regimens, outcome measures, and adverse effects. Despite the absence of adverse events, the overall evidence quality between studies is evaluated as low to very low. Bibliometric analysis found a significant increase in global interest over the past two decades, with 230 research publications, 137 patents, and 56 clinical trials. CONCLUSIONS: The study highlights the potential of HFCWO devices in respiratory care but demands more robust evidence. The increasing interest in airway clearance devices highlights the necessity for HFCWO mechanism and safety research, underlining its therapeutic relevance in respiratory medicine. The interdisciplinary integration of AI tools and prompt engineering contributes to a nuanced understanding of the available evidence.

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Resumen Antecedentes: Las enfermedades respiratorias (ER) se analizan individualmente, posiblemente con subestimación de su carga total. Objetivo: Analizar la carga de las ER en México para población de 20 años o más de 1990 a 2021. Material y métodos: Se presenta la carga de ER en México a partir de estimaciones del estudio Global Burden of Disease en cuanto a mortalidad y años de vida saludable (AVISA) perdidos que comprenden recuentos, tasas por 100 000 y tasas estandarizadas por edad. Las ER se categorizaron en enfermedades respiratorias crónicas (ERC), infecciones respiratorias y cánceres respiratorios. Resultados: En 2021, las ER causaron la muerte de 336 728 adultos mayores de 20 años, lo que representó 30.5 % del total de defunciones, incremento cercano al triple respecto a 2019, principalmente debido a COVID-19. Las ERC contribuyeron con 3.4 % del total de muertes, las infecciones respiratorias con 25.9 % y los cánceres respiratorios con 1.2 %. La mortalidad y AVISA perdidos por ERC se incrementaron persistentemente, con variaciones entre los estados. Las tasas de mortalidad ajustadas por edad de las ERC disminuyeron desde 1990, excepto las enfermedades pulmonares intersticiales, que se incrementaron constantemente. Conclusión: Los significativos niveles de mortalidad y discapacidad debidos a enfermedades respiratorias en México exigen mejorar la prevención, investigación y abordar factores de riesgo como tabaquismo y contaminación, además de fomentar la capacitación médica continua.

Abstract Background: Respiratory diseases (RD) are often analyzed separately rather, possibly leading to an underestimation of their total burden. Objective: To analyze the burden of RD in Mexico for population aged 20 or older from 1990 to 2021. Material y methods: We present the burden of RD in Mexico based on estimates of the Global Burden of Disease study for mortality and disability-adjusted life years (DALYs), comprising counts, rates per 100,000, as well as age-standardized rates. RDs were categorized into three key groups: chronic respiratory diseases (CRD), respiratory infections (RI), and respiratory cancers. Results: In 2021, among those aged 20+, RDs were responsible for 336,728 deaths, which accounts for 30.5% of total deaths— a nearly threefold increase since 2019, primarily due to the COVID-19 pandemic. CRDs contributed with 3.4% of total deaths; RIs, with 25.9%; and respiratory cancers, with 1.2%. CRDs showed a continuous rise in deaths, crude mortality, and DALY rates across genders, with no signs of leveling. RD burden varied widely across states. Age-standardized CRD mortality rates have generally declined since 1990, except for interstitial lung diseases, which have consistently increased. Conclusion: The significant burden of mortality and disability due to RDs in Mexico underscores the necessity for enhanced prevention, research, and for addressing risk factors such as smoking and pollution. Ongoing healthcare training can help reduce RD burden.

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BACKGROUND: Respiratory diseases (RD) are often analyzed separately rather than collectively, possibly leading to an underestimation of their total burden. OBJECTIVE: To analyze the burden of RD in Mexico for population aged 20 or older from 1990 to 2021. MATERIAL AND METHODS: We present the burden of RD in Mexico based on estimates of the Global Burden of Disease study for mortality and disability-adjusted life years (DALYs), comprising counts, rates per 100,000, as well as age-standardized rates. RDs were categorized into three key groups: chronic respiratory diseases (CRD), respiratory infections (RI), and respiratory cancers. RESULTS: In 2021, among those aged 20+, RDs were responsible for 336,728 deaths, which accounts for 30.5% of total deaths -a nearly threefold increase since 2019, primarily due to the COVID-19 pandemic. CRDs contributed with 3.4% of total deaths; RIs, with 25.9%; and respiratory cancers, with 1.2%. CRDs showed a continuous rise in deaths, crude mortality, and DALY rates across genders, with no signs of leveling. RD burden varied widely across Mexican states. Age-standardized CRD mortality rates have generally declined since 1990, except for interstitial lung diseases, which have consistently increased. CONCLUSION: The significant burden of mortality and disability due to RDs in Mexico underscores the n|ecessity for enhanced prevention, research, and for addressing risk factors such as smoking and pollution. Ongoing healthcare training can help reduce RD burden.

ANTECEDENTES: Las enfermedades respiratorias (ER) se analizan individualmente, posiblemente con subestimación de su carga total. OBJETIVO: Analizar la carga de las ER en México para población de 20 años o más de 1990 a 2021. MATERIAL Y MÉTODOS: Se presenta la carga de ER en México a partir de estimaciones del estudio Global Burden of Disease en cuanto a mortalidad y años de vida saludable (AVISA) perdidos que comprenden recuentos, tasas por 100 000 y tasas estandarizadas por edad. Las ER se categorizaron en enfermedades respiratorias crónicas (ERC), infecciones respiratorias y cánceres respiratorios. RESULTADOS: En 2021, las ER causaron la muerte de 336 728 adultos mayores de 20 años, lo que representó 30.5 % del total de defunciones, incremento cercano al triple respecto a 2019, principalmente debido a COVID-19. Las ERC contribuyeron con 3.4 % del total de muertes, las infecciones respiratorias con 25.9 % y los cánceres respiratorios con 1.2 %. La mortalidad y AVISA perdidos por ERC se incrementaron persistentemente, con variaciones entre los estados. Las tasas de mortalidad ajustadas por edad de las ERC disminuyeron desde 1990, excepto las enfermedades pulmonares intersticiales, que se incrementaron constantemente. CONCLUSIÓN: Los significativos niveles de mortalidad y discapacidad debidos a enfermedades respiratorias en México exigen mejorar la prevención, investigación y abordar factores de riesgo como tabaquismo y contaminación, además de fomentar la capacitación médica continua.

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Introducción. El entrenamiento físico puede mejorar la capacidad de ejercicio, la disnea y la calidad de vida (CV) en pacientes con enfermedades respiratorias crónicas (ERC). En este contexto, el uso de oxígeno suplementario a través de una cánula nasal de alto flujo (CNAF) podría ser un dispositivo que permita tolerar mayores niveles de actividad con menos síntomas de esfuerzo físico, optimizando en última instancia la capacidad de ejercicio y la CV. Objetivo. Este protocolo pretende conducir una revisión sistemática para evaluar el efecto terapéutico de la CNAF durante el ejercicio físico en pacientes con ERC. Fuente de búsqueda. Se realizarán búsquedas en el Registro Cochrane Central de Ensayos Controlados (CENTRAL), PUBMED, Embase, Lilacs, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov y literatura gris. Criterios de elegibilidad. Examinaremos los ECA de acuerdo con los criterios de elegibilidad para su inclusión en nuestra revisión. Dos revisores examinarán de forma independiente cada estudio para la elegibilidad, la extracción de datos y la evaluación del riesgo de sesgo. Se combinarán los resultados mediante un metanálisis y se aplicará el sistema GRADE para evaluar la certeza de las pruebas para cada resultado. La medida de resultado primaria será la capacidad de ejercicio, y las medidas de resultado secundarias serán la calidad de vida, la disnea, la funcionalidad, la comodidad, las complicaciones y adherencia. Se realizarán metaanálisis para determinar la diferencia de medias (DM) o la DM estandarizada para los datos continuos y la razón de riesgo para los datos dicotómicos. Se realizarán análisis de subgrupos según los tipos y la gravedad de la enfermedad, las condiciones de ejercicio físico y el estado de los dispositivos de oxigenoterapia. Ética y difusión. Como los investigadores no accederán a información que pueda conducir a la identificación de un participante individual, no fue necesario a obtener aprobación ética. Número de registro de PROSPERO: CRD42022336263.

Background. Physical training can improve exercise capacity, dyspnoea, and quality of life (QoL) in patients with chronic respiratory diseases (CRDs). It has been suggested that using supplemental oxygen through a high-flow nasal cannula (HFNC) could lead to higher levels of activity to be tolerated with fewer symptoms of physical exertion, ultimately optimizing exercise capacity and QoL. Objective. To conduct a systematic review to assess the therapeutic effect of HFNC during physical exercise in patients with CRDs. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), PUBMED, Embase, Lilacs, Physiotherapy Evidence Database (PEDro), International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, and grey literature. Eligibility criteria. We will examine RCTs according to the eligibility criteria for inclusion in our review. Two reviewers will independently examine each study for eligibility, data extraction, and risk of bias assessment. We will combine the results using meta-analysis and apply the GRADE system to assess the certainty of the evidence for each outcome. The primary outcome will be exercise capacity, and secondary outcomes will be QoL, dyspnoea, functionality, comfort, complications, and adherence. We will perform meta-analyses to determine the mean difference (MD) or standardized MD for continuous data and the risk ratio for dichotomous data. Subgroup analyses will be performed according to types and severity of disease, physical exercise conditions, and condition of oxygen therapy devices. Ethics and Dissemination. As researchers will not access information that could lead to the identification of an individual participant, obtaining ethical approval was waived. Prospero registration number: CRD42022336263.

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OBJECTIVE: To analyse the GARD perspective on the health effects of outdoor air pollution, and to synthesise the Portuguese epidemiological contribution to knowledge on its respiratory impact. RESULTS: Ambient air pollution has deleterious respiratory effects which are more apparent in larger, densely populated and industrialised countries, such as Canada, Iran, Brazil and Portugal, but it also affects people living in low-level exposure areas. While low- and middle-income countries (LMICs), are particularly affected, evidence based on epidemiological studies from LMICs is both limited and heterogeneous. While nationally, Portugal has a relatively low level of air pollution, many major cities face with substantial air pollution problems. Time series and cross-sectional epidemiological studies have suggested increased respiratory hospital admissions, and increased risk of respiratory diseases in people who live in urban areas and are exposed to even a relatively low level of air pollution. CONCLUSIONS: Adverse respiratory effects due to air pollution, even at low levels, have been confirmed by epidemiological studies. However, evidence from LMICs is heterogeneous and relatively limited. Furthermore, longitudinal cohort studies designed to study and quantify the link between exposure to air pollutants and respiratory diseases are needed. Worldwide, an integrated approach must involve multi-level stakeholders including governments (in Portugal, the Portuguese Ministry of Health, which hosts GARD-Portugal), academia, health professionals, scientific societies, patient associations and the community at large. Such an approach not only will garner a robust commitment, establish strong advocacy and clear objectives, and raise greater awareness, it will also support a strategy with adequate measures to be implemented to achieve better air quality and reduce the burden of chronic respiratory diseases (CRDs).

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RESUMEN: El Hospital Josefina Martínez está especializado en atención de niños con enfermedades respiratorias crónicas. En él hemos implementado un modelo de atención odontológica, bajo sedación endovenosa, monitorización cardiorespiratoria con participación de un equipo multidisciplinario. Objetivos: Describir la atención odontológica en pacientes hospitalizados con enfermedades respiratorias crónicas. Identificar las patologías bucales más prevalentes y los tratamientos realizados. Material y Método: El estudio se realizó incluyendo las atenciones odontológicas bajo sedación endovenosa, entre los años 2014-2016, considerando a 18 pacientes hospitalizados. Todos recibieron sedación y analgesia con Midazolam-Ketamina con monitorización continua no invasiva durante el procedimiento. Resultados: Se encontró una alta prevalencia de gingivitis, anomalías dentomaxilares y patologías de erupción. La lesión de caries tuvo baja prevalencia. Los tratamientos realizados fueron: profilaxis, destartarje, aplicación de barniz de clorhexidina y/o flúor, exodoncias, exposición quirúrgica de dientes y restauraciones. Conclusiones: Es importante mostrar nuestra experiencia, ya que hemos realizado tratamientos en forma oportuna, eficiente y de bajo costo, mejorando la salud bucal de los niños. Además fueron atendidos sin necesitar traslado a otro centro de salud, permitiendo resolver las urgencias y la atención odontológica integral de los pacientes.

ABSTRACT: The Josefina Martínez Hospital specializes in the care of children with chronic respiratory diseases. There, we implemented a model of dental care under intravenous sedation and cardiorespiratory monitoring, with the participation of a multidisciplinary team. Objective: Describe dental care in hospitalized patients with chronic respiratory diseases. Identify the most prevalent oral diseases and the treatments performed. Materials and Methodology: The study was conducted including dental care under intravenous sedation, between 2014 and 2016, considering 18 hospitalized patients. All received sedation and analgesia with Midazolam-Ketamine with continuous non-invasive monitoring during the procedure. Results: A high prevalence of gingivitis, dentomaxillary abnormalities and eruption disorders was found. Caries lesion had a low prevalence. The treatments performed were: prophylaxis, scaling, application of chlorhexidine and / or fluoride varnish, extractions, surgical exposure of teeth and restorations. Conclusion: It is important to show our experience, since we have made timely, efficient and low cost treatments, improving the oral health of children. In addition, they were attended without requiring the transfer to other health centers, which allowed to meet the emergencies and the comprehensive dental care of the patients.

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BACKGROUND: As the emerging economies, the BRICS (Brazil, Russia, India, China, and South Africa) shared 61.58% of the global chronic respiratory diseases (CRD) deaths in 2017. This study aimed to assess the secular trends in CRD mortality and explore the effects of age, period, and cohort across main BRICS countries. METHODS: Data were obtained from the Global Burden of Disease Study (GBD) 2019 and analyzed using the age-period-cohort (APC) model to estimate period and cohort effects between 1990 and 2019. The net drifts, local drifts, longitudinal age curves, period/cohort rate ratios (RRs) were obtained through the APC model. RESULTS: In 2019, the CRD deaths across the BRICS were 2.39 (95%UI 1.95 to 2.84) million, accounting for 60.07% of global CRD deaths. Chronic obstructive pulmonary disease (COPD) and asthma remained the leading causes of CRD deaths. The age-standardized mortality rates (ASMR) have declined across the BRICS since 1990, with the most apparent decline in China. Meanwhile, the downward trends in CRD death counts were observed in China and Russia. The overall net drifts per year were obvious in China (-5.89%; -6.06% to -5.71%), and the local drift values were all below zero in all age groups for both sexes. The age effect of CRD presented increase with age, and the period and cohort RRs were following downward trends over time across countries. Similar trends were observed in COPD and asthma. The improvement of CRD mortality was the most obvious in China, especially in period and cohort effects. While South Africa showed the most rapid increase with age across all CRD categories, and the period and cohort effects were flat. CONCLUSIONS: BRICS accounted for a large proportion of CRD deaths, with China and India alone contributing more than half of the global CRD deaths. However, the declines in ASMR and improvements of period and cohort effects have been observed in both sexes and all age groups across main BRICS countries. China stands out for its remarkable reduction in CRD mortality and its experience may help reduce the burden of CRD in developing countries.

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Resumo: Introdução: As doenças respiratórias crônicas representam uma grande carga de invalidez e morte em todo o mundo. Esses problemas foram agravados pela pandemia COVID-19, aumentando a demanda por cuidados de enfermagem. Objetivo: Analisar as ações de enfermagem a pacientes com doenças respiratórias crônicas, associadas à infecção por COVID-19. Método: Estudo observacional, descritivo e retrospectivo com percurso longitudinal, realizado em um hospital de referência para COVID-19 em um município da região sul do Brasil. A fonte de dados foram 42 prontuários eletrônicos de pacientes com doenças respiratórias crônicas e infecção por COVID-19, internados entre março de 2020 e fevereiro de 2021. A coleta de dados foi feita por meio de um formulário com questões referentes à situação sociodemográfica e clínica dos pacientes, e as ações de enfermagem, feitas de acordo com as taxonomias Diagnósticos de enfermagem da North American Nursing Diagnosis Association International (NANDA-I), Classificação de Resultados de Enfermagem (NOC) e Classificação de Intervenções de Enfermagem (NIC). As variáveis foram agrupadas, categorizadas e analisadas descritivamente de acordo com sua distribuição. Resultados: Em relação ao perfil sociodemográfico, a proporção entre homens e mulheres foi equitativa com razão de 1:1, a idade média dos pacientes foi de 56,5 anos, 57,1% deles entre 40 e 69 anos e 85,7% residindo em zona urbana. Em relação ao quadro clínico, a doença crônica prevalente foi a asma (61,9%), seguida da hipertensão arterial (59,5%). Apesar de menos da metade dos pacientes necessitarem de internação em Unidade de Terapia Intensiva (40,4%), observou-se alta mortalidade (58,8%) entre eles, predominantemente em mulheres (60%) com idade superior a 60 anos. A hipertensão foi encontrada em 100% dos falecidos, assim como outras doenças cardiovasculares (70%), asma, DPOC e diabetes foram encontrados na mesma proporção (50%). Em relação às ações de enfermagem, 16 diagnósticos segundo a taxonomia NANDA-I e 48 intervenções segundo a taxonomia NIC foram descritos pelos profissionais de enfermagem nos registros, a maioria deles voltada à identificação, controle e redução de problemas respiratórios e/ou derivados da infecção, bem como à prevenção de possíveis riscos. Nenhuma descrição dos resultados foi encontrada de acordo com a taxonomia NOC. Conclusões: Constatou-se que as ações de enfermagem para o cuidado às pessoas com doenças respiratórias acometidas pelo COVID-19 estão voltadas para o tratamento e controle dos sintomas respiratórios e do processo infeccioso. Em relação às intervenções de enfermagem, a maioria foi direcionada à dimensão fisiológica. Os resultados deste estudo evidenciam a importância da prática de enfermagem no contexto da pandemia COVID-19 no cuidado às pessoas com doenças respiratórias crônicas, oferecendo uma visão da variedade de atividades desenvolvidas pelos profissionais de enfermagem durante o processo assistencial.

Abstract: Introduction: Chronic respiratory diseases represent a high burden of disability and death worldwide. These problems were exacerbated by the COVID-19 pandemic, increasing the demand for nursing care. Objective: To analyze the nursing actions for patients with chronic respiratory diseases associated with COVID-19 infection. Method: Observational, descriptive and retrospective study with a longitudinal course, developed in a reference hospital for COVID-19 in a city in southern Brazil. The data source was 42 electronic medical records of patients with chronic respiratory diseases and COVID-19 infection, hospitalized between March 2020 to February 2021. Data collection was carried out using a form that consists of information on the sociodemographic and clinical profile of the patients, and the main nursing actions carried out according to the North American Nursing Diagnosis Association International (NANDA-I), the Nursing Outcomes Classification (NOC) and the Nursing Intervention Classification (NIC) taxonomies. The variables were grouped and categorized into sociodemographic, clinical, and those related to nursing actions to later be analyzed descriptively according to their distribution. Results: In relation to the sociodemographic profile, the proportion between men and women was equitable with a ratio of 1:1, the average age of the patients was 56.5 years with 57.1% of these between 40 and 69 years and 85, 7% residing in the urban area. Regarding the clinical profile, the most prevalent chronic disease was Asthma (61.9%), followed by Hypertension (59.5%). Although less than half of the patients required hospitalization in the Intensive Care Unit (40.4%), a high mortality rate (58.8%) among them was observed, predominantly in women (60.0%) older than 60 years. Hypertension was found in 100% of the deceased, as well as other cardiovascular diseases (70.0%), asthma, COPD and diabetes were found in the same proportion (50.0%). Regarding nursing actions,16 diagnoses according to the NANDA-I taxonomy and 48 interventions according to the NIC taxonomy were described by the nursing professionals in the registries, most of them aimed at the identification, control and reduction of respiratory problems and / or those derived from infection, as well as the prevention of possible risks. No description of results was found according to the NOC taxonomy. Conclusions: It was found that nursing actions for the care of people with respiratory diseases affected by COVID-19 are mainly focused on the treatment and control of respiratory symptoms and the infectious process. Regarding nursing interventions, most were directed to the physiological dimension. The results of this study highlight the importance of nursing practice in the context of the COVID-19 pandemic, especially in the care of people with chronic respiratory diseases, offering a vision of the great variety of activities developed by the nursing professionals during the caring process.

Resumen: Introducción: Las enfermedades respiratorias crónicas representan una alta carga de discapacidad y muerte a nivel mundial. Estos problemas fueron agravados por la pandemia de COVID-19, aumentando la demanda de cuidados de enfermería. Objetivo: Analizar las acciones de enfermería para pacientes con enfermedades respiratorias crónicas asociadas a la infección por COVID-19. Método: se trata de un estudio observacional, descriptivo y retrospectivo de curso longitudinal, realizado en un hospital de referencia para COVID-19 en un municipio de la región sur de Brasil. La fuente de datos fueron 42 historias clínicas electrónicas de pacientes portadores de enfermedades respiratorias crónicas e infección por COVID-19, hospitalizados entre el periodo de marzo de 2020 a febrero de 2021. La recolección de los datos se realizó por medio de un formulario que consta de informaciones sobre el perfil sociodemográfico, clínico de los pacientes y las principales acciones de enfermería realizadas según las taxonomías Diagnósticos de enfermería de la North American Nursing Diagnosis Association International (NANDA-I), Clasificación de los Resultados de Enfermería (NOC) e Clasificación de las Intervenciones de Enfermería (NIC). Las variables fueron agrupadas y categorizadas en sociodemográficas, clínicas y las relacionadas con las acciones de enfermería para posteriormente ser analizadas de forma descriptiva según su distribución. Resultados: En relación al perfil sociodemográfico, la proporción entre hombres y mujeres fue equitativa con una razón de 1:1, la edad promedio de los pacientes fue de 56,5 años con 57,1% de estos entre los 40 y 69 años, y 85,7% residiendo en el área urbana. Al respecto del perfil clínico, la enfermedad crónica más prevalente fue el Asma (61,9%), seguida por la Hipertensión arterial (59,5%), Aunque menos de la mitad de los pacientes requirió de internación en la Unidad de Terapia Intensiva (40,4%), una alta mortalidad (58,8%) fue observada entre estos, predominantemente en mujeres (60,0%) con edad mayor a 60 años. Se encontró hipertensión en el 100% de los fallecidos, así como otras enfermedades cardiovasculares (70,0%), el asma, la EPOC y la diabetes se encontraron en igual proporción (50,0%). En cuanto a las acciones de enfermería, 16 diagnósticos según la taxonomía NANDA-I y 48 intervenciones según la taxonomía NIC fueron descritas por los profesionales de enfermería en los registros, siendo la mayoría orientadas a la identificación, control y disminución de problemas respiratorios y/o derivados de la infección, así como la prevención de posibles riesgos. No se encontró descripción de resultados de acuerdo a la taxonomía NOC. Conclusiones: Se encontró que las acciones de enfermería para el cuidado de personas con enfermedades respiratorias afectadas por COVID-19 se enfocan principalmente en el tratamiento y control de los síntomas respiratorios y el proceso infeccioso. En cuanto a las intervenciones de enfermería, la mayoría se dirigieron a la dimensión fisiológica. Los resultados de este estudio destacan la importancia de la práctica de enfermería en el contexto de la pandemia por COVID-19, en especial en la atención a personas con enfermedades respiratorias crónicas, ofreciendo una visión de la gran variedad de actividades desarrolladas por los profesionales de enfermería durante el proceso de cuidar.

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BACKGROUND: Chronic respiratory diseases (CRD) are a major public health problem worldwide. In the current epidemiological context, CRD have received much interest when considering their correlation with greater susceptibility to SARS-Cov-2 and severe disease (COVID-19). Increasingly more studies have investigated pathophysiological interactions between CRD and COVID-19. AREA COVERED: Animal experimentation has decisively contributed to advancing our knowledge of CRD. Considering the increase in ethical restrictions in animal experimentation, researchers must focus on new experimental alternatives. Two-dimensional (2D) cell cultures have complemented animal models and significantly contributed to advancing research in the life sciences. However, 2D cell cultures have several limitations in studies of cellular interactions. Three-dimensional (3D) cell cultures represent a new and robust platform for studying complex biological processes and are a promising alternative in regenerative and translational medicine. EXPERT OPINION: Three-dimensional cell cultures are obtained by combining several types of cells in integrated and self-organized systems in a 3D structure. These 3D cell culture systems represent an efficient methodological approach in studies of pathophysiology and lung therapy. More recently, complex 3D culture systems, such as lung-on-a-chip, seek to mimic the physiology of a lung in vivo through a microsystem that simulates alveolar-capillary interactions and exposure to air. The present review introduces and discusses 3D lung cultures as robust platforms for studies of the pathophysiology of CRD and COVID-19 and the mechanisms that underlie interactions between CRD and COVID-19.

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Introducción: Los pacientes hospitalizados con altas dependencias tecnológicas respiratorias son cada vez más frecuentes y generan largas estadías en unidades de cuidados intensivos. Las estrategias que mitiguen su impacto han sido escasamente descritas. Objetivo: Describir 6 años de experiencia de una Unidad de Ventilación Mecánica Prolongada Pediátrica.Métodos: Estudio retrospectivo. Se incluyeron todos los niños ingresados a la Unidad entre 10-2012 y 12-2018. Se realizó estadística descriptiva e inferencial, analizando tiempos de hospitalización y reingresos. Se compararon distintas variables según tipo de patología y ventilación mecánica.Resultados: 113 pacientes registraron 310 ingresos a la Unidad. Edad de ingreso: 2,2 años (0,6-8,8); varones: el 60,2 %. Patologías: enfermedad neuromuscular (el 22,1 %), enfermedad pulmonar crónica (el 20,4 %), daño neurológico (el 34,5 %), obstrucción de vía aérea superior (el 9,7 %), cardiopatía (el 3,5 %), síndrome de Down (el 9,7 %). Se utilizaron 10 507 días/cama; con índice ocupacional del 92,6 %, el 54,8 % de traslados a la Unidad de Cuidados Intensivos y el 66,1 % de reingresos. Hospitalización media: 16 días (6,5-49,0); diferencias en edad de ingreso según patologías (p = 0,032). Hubo más reingresos en niños con daño neurológico y síndrome de Down (p = 0,004). Los niños con asistencia ventilatoria invasiva presentaron más días de hospitalización (p < 0,001) y reingresos (p < 0,001).Conclusión: El índice ocupacional fue superior al 90 %; permitió mayor disponibilidad de camas intensivas y egresar a todos los pacientes. Los niños con asistencia ventilatoria invasiva se hospitalizaron más tiempo y reingresaron más

Introduction: Hospitalized patients with high respiratory technology dependency are increasingly common and result in lengthy stays in intensive care units. Strategies mitigating its impact have been scarcely described.Objective: To describe a 6-year experience in a Pediatric Prolonged Mechanical Ventilation Unit.Methods: Retrospective study. All children admitted to the unit between October 2012 and December 2018 were included. Descriptive and inferential statistical methods were used, analyzing lengths of stay and readmissions. Different outcome measures were compared according to the type of pathology and mechanical ventilation.Results: A total of 113 patients had 310 admissions to the unit. Age at admission: 2.2 years (0.6-8.8); males: 60.2 %. Pathologies: neuromuscular disease (22.1 %), chronic lung disease (20.4 %), neurological damage (34.5 %), upper airway obstruction (9.7 %), heart disease (3.5 %), Down syndrome (9.7 %). A total of 10 507 bed-days were used; with a 92.6 % occupancy rate, 54.8 % of transfers to the intensive care unit, and 66.1 % of readmissions. Mean length of stay: 16 days (6.5-49.0); differences in age at admission observed by pathology (p = 0.032). More readmissions were observed in children with neurological damage and Down syndrome (p = 0.004). Children with invasive ventilation were observed to have a longer length of stay (p < 0.001) and more readmissions (p < 0.001).Conclusion: The occupancy rate at the PMVU was over 90 %, which allowed more available intensive care beds and discharging all patients. Children with invasive ventilation had a longer length of stay and more readmissions.

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INTRODUCTION: Hospitalized patients with high respiratory technology dependency are increasingly common and result in lengthy stays in intensive care units. Strategies mitigating its impact have been scarcely described. OBJECTIVE: To describe a 6-year experience in a Pediatric Prolonged Mechanical Ventilation Unit. METHODS: Retrospective study. All children admitted to the unit between October 2012 and December 2018 were included. Descriptive and inferential statistical methods were used, analyzing lengths of stay and readmissions. Different outcome measures were compared according to the type of pathology and mechanical ventilation. RESULTS: A total of 113 patients had 310 admissions to the unit. Age at admission: 2.2 years (0.6-8.8); males: 60.2 %. PATHOLOGIES: neuromuscular disease (22.1 %), chronic lung disease (20.4 %), neurological damage (34.5 %), upper airway obstruction (9.7 %), heart disease (3.5 %), Down syndrome (9.7 %). A total of 10 507 bed-days were used; with a 92.6 % occupancy rate, 54.8 % of transfers to the intensive care unit, and 66.1 % of readmissions. Mean length of stay: 16 days (6.5- 49.0); differences in age at admission observed by pathology (p = 0.032). More readmissions were observed in children with neurological damage and Down syndrome (p = 0.004). Children with invasive ventilation were observed to have a longer length of stay (p < 0.001) and more readmissions (p < 0.001). CONCLUSION: The occupancy rate at the PMVU was over 90 %, which allowed more available intensive care beds and discharging all patients. Children with invasive ventilation had a longer length of stay and more readmissions.

Introducción: Los pacientes hospitalizados con altas dependencias tecnológicas respiratorias son cada vez más frecuentes y generan largas estadías en unidades de cuidados intensivos. Las estrategias que mitiguen su impacto han sido escasamente descritas. Objetivo: Describir 6 años de experiencia de una Unidad de Ventilación Mecánica Prolongada Pediátrica. Métodos: Estudio retrospectivo. Se incluyeron todos los niños ingresados a la Unidad entre 10-2012 y 12-2018. Se realizó estadística descriptiva e inferencial, analizando tiempos de hospitalización y reingresos. Se compararon distintas variables según tipo de patología y ventilación mecánica. Resultados: 113 pacientes registraron 310 ingresos a la Unidad. Edad de ingreso: 2,2 años (0,6-8,8); varones: el 60,2 %. Patologías: enfermedad neuromuscular (el 22,1 %), enfermedad pulmonar crónica (el 20,4 %), daño neurológico (el 34,5 %), obstrucción de vía aérea superior (el 9,7 %), cardiopatía (el 3,5 %), síndrome de Down (el 9,7 %). Se utilizaron 10 507 días/cama; con índice ocupacional del 92,6 %, el 54,8 % de traslados a la Unidad de Cuidados Intensivos y el 66,1 % de reingresos. Hospitalización media: 16 días (6,5-49,0); diferencias en edad de ingreso según patologías (p = 0,032). Hubo más reingresos en niños con daño neurológico y síndrome de Down (p = 0,004). Los niños con asistencia ventilatoria invasiva presentaron más días de hospitalización (p < 0,001) y reingresos (p < 0,001). Conclusión: El índice ocupacional fue superior al 90 %; permitió mayor disponibilidad de camas intensivas y egresar a todos los pacientes. Los niños con asistencia ventilatoria invasiva se hospitalizaron más tiempo y reingresaron más.

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Introducción: Los biomarcadores son sustancias biológicas o bioquímicas que aparecen como respuesta del organismo ante ciertos tipos de tumores y que reflejan la etapa y el grado de estos. Objetivo: Determinar la asociación de los marcadores tumorales con los procesos respiratorios crónicos. Métodos: Se realizó un estudio descriptivo y transversal de 306 pacientes diagnosticados con enfermedades respiratorias crónicas, atendidos en las consultas comunitarias de neumología de la provincia de Santiago de Cuba, de enero del 2014 a diciembre del 2018. Resultados: En la serie predominaron el sexo masculino y las edades de 60 a 69 años, así como las enfermedades intersticiales, la bronquitis crónica y la enfermedad pulmonar obstructiva crónica. De igual modo, resultaron importantes los estudios radiológicos para la detección de procesos neoplásicos, sobre todo el empleo de la tomografía axial computarizada. Por otra parte, los marcadores que presentaron valores alterados fueron el CYFRA 21.1 y el CA 72.4, de manera que se demostró su asociación con los procesos respiratorios crónicos. Conclusiones: Los biomarcadores tumorales son una herramienta útil en el seguimiento de pacientes con neoplasias malignas, pero también muestran valores alterados ante la presencia de varias enfermedades respiratorias crónicas sin que ello represente la existencia de un proceso maligno.

Introduction: Biomarkers are biological or biochemical substances which emerge as a response of the organism on certain types of tumors and which reflect the stage or degree of them. Objective: To determine the association of tumoral markers with the chronic respiratory events. Methods: A descriptive and cross-sectional study of 306 patients diagnosed with chonic respiratory diseases and assisted at the Pneumology community outpàtients from Santiago de Cuba province was carried out from January, 2014 to December, 2018. Results: Male sex and ages between 60 o 69 years as well as interstitial diseases, chronic bronchitis and the chronic obstructive pulmonary disease predominated in the series. Likewise, radiological studies were also important for detecting neoplasic processes, mainly with the use of the axial computerized tomography. On the other side, markers presenting altered values were the CYFRA 21.1 y el CA 72.4, so that its association with the chronic respiratory processes. Conclusions: Tumoral biomarkers are an usefull tool in the follow-up of patients with malignant neoplasies, but also they show altered values in the presence of different chronic respiratory diseases, which doesn´t mean there is a malignant process.

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Chronic respiratory diseases compromise oxygenation to a variable degree and cause problems in the use of nutrients, the generation of energy and the use of it by different tissues and organs, with potential damage to respiratory function and non-respiratory systems. The available evidence indicates that both the available energy and some micronutrients, particularly with antioxidant activity, during pregnancy, are key for an adequate lung development and therefore an adequate pulmonary function in preterm infants, infants and older children, particularly if they attend bronchopulmonary dysplasia. However, both maternal and fetal malnutrition, as well as deficiencies of certain nutrients and the presence of overweight or obesity in the child, would influence the development of asthma in childhood. With regard to nutritional assistance, correction of nutritional deficit as well as micronutrients are essential in the treatment of diseases such as bronchopulmonary dysplasia, bronchiolitis obliterans and asthma. This review aims to establish how nutrition determines the development, evolution and prognosis of these pathologies and the need to consider nutritional assistance in the comprehensive care of these patients.

Las enfermedades respiratorias crónicas comprometen la oxigenación en grado variable y ocasionan problemas en el uso de los nutrientes, la generación de energía y la utilización de ésta por los distintos tejidos y órganos, con potencial daño en la función respiratoria y en los sistemas no respiratorios. La evidencia disponible señala que tanto la energía disponible y algunos micronutrientes, particularmente con actividad antioxidante, durante la gestación, son claves para un adecuado desarrollo pulmonar y por lo tanto una adecuada función pulmonar en prematuros, lactantes y niños mayores, en particular si cursan con displasia broncopulmonar. Sin embargo tanto la desnutrición materna y fetal, como las deficiencias de ciertos nutrientes y la presencia de sobrepeso u obesidad en el niño, influirían en el desarrollo de asma en la infancia. En lo referente a la asistencia nutricional, la corrección del déficit nutricional así como de micronutrientes, es indispensable en el tratamiento de enfermedades como la displasia broncopulmonar, la bronquiolitis obliterante y el asma. Esta revisión pretende establecer cómo la nutrición determina el desarrollo, evolución y pronóstico de estas patologías y la necesidad de considerar la asistencia nutricional en la atención integral de estos pacientes.

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Introducción. La Escala hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale, HADS) es un instrumento de pesquisa, utilizado para evaluar sintomatología emocional en diferentes poblacionesy patologías médicas. Este estudio analiza las propiedades psicométricas y la estructura factorial de la HADS en adolescentes con enfermedad crónica y las diferencias en función de la patología médica. Método. La HADS fue administrada a una muestra de 302 adolescentes con enfermedad crónica. Se realizaron análisis factoriales exploratorios con una submuestra de 100 adolescentes y análisis factoriales confirmatorios con el resto de los participantes (202) para analizar la validez y fiabilidad de la HADS (14 ítems); además se calculó el análisis de la varianza de un factor para analizar las diferencias entre patologías. Resultados. Pacientes de 12 a 16 años de edad, con una distribución similar por género; el 43 % padecía enfermedades respiratorias, y el 47 %, endocrinológicas. La estructura original de dos factores (ansiedad y depresión) fue la que mostró buenos índices de ajuste e incorporó un factor de 2° orden (malestar emocional). Tres de los ítems originales de la escala fueron eliminados; se obtuvo, finalmente, una nueva versión de 11 ítems. Esta mostró adecuadas propiedades psicométricas y se observaron diferencias entre pacientes con diabetes mellitus 1 y con patología respiratoria, pero no en talla baja, en el factor de depresión. Conclusiones. Esta escala presenta una adecuada fiabilidad y validez en pacientes con enfermedad crónica pediátrica y resulta útil para la detección temprana de clínica ansioso-depresiva en el ámbito sanitario.

Introduction. The Hospital Anxiety and Depression Scale (HADS) is a screening instrument that assesses emotional symptoms in different populations and medical conditions.This study analyzes the psychometric properties and factor structure of the HADS in adolescents with chronic disease and the differences based on their medical condition. Method. The HADS was administered to a sample of 302 adolescents with chronic disease. Exploratory factor analyses were done in a sub-sample of 100 adolescents, while confirmatory factor analyses were performed in the rest of participants (202) to examine the validity and reliability of the HADS (14 items); an analysis of variance for a single factor was also done to study differences among diseases.Results. Patients were aged 12-16 years, with a similar sex ratio; 43 % had respiratory diseases and 47 %, endocrine disorders. The original two-factor structure (anxiety and depression) showed adequate fit indices and incorporated a second-order factor (emotional distress). Three of the original items were removed, thus obtaining a new 11-item version. This showed adequate psychometric properties, and differences were observed between patients with type 1 diabetes mellitus and those with respiratory disease, but not in terms of short stature, in the depression factor.Conclusions. The HADS displays an adequate reliability and validity in pediatric patients with chronic disease and is useful for the early detection of anxiety and depression in the health care setting

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INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a screening instrument that assesses emotional symptoms in different populations and medical conditions. This study analyzes the psychometric properties and factor structure of the HADS in adolescents with chronic disease and the differences based on their medical condition. METHOD: The HADS was administered to a sample of 302 adolescents with chronic disease. Exploratory factor analyses were done in a subsample of 100 adolescents, while confirmatory factor analyses were performed in the rest of participants (202) to examine the validity and reliability of the HADS (14 items); an analysis of variance for a single factor was also done to study differences among diseases. RESULTS: Patients were aged 12-16 years, with a similar sex ratio; 43 % had respiratory diseases and 47 %, endocrine disorders. The original two-factor structure (anxiety and depression) showed adequate fit indices and incorporated a second-order factor (emotional distress). Three of the original items were removed, thus obtaining a new 11-item version. This showed adequate psychometric properties, and differences were observed between patients with type 1 diabetes mellitus and those with respiratory disease, but not in terms of short stature, in the depression factor. CONCLUSIONS: The HADS displays an adequate reliability and validity in pediatric patients with chronic disease and is useful for the early detection of anxiety and depression in the health care setting.

Introducción. La Escala hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale, HADS) es un instrumento de pesquisa, utilizado para evaluar sintomatología emocional en diferentes poblacionesy patologías médicas. Este estudio analiza las propiedades psicométricas y la estructura factorial de la HADS en adolescentes con enfermedad crónica y las diferencias en función de la patología médica. Método. LaHADSfue administrada a una muestra de 302 adolescentes con enfermedad crónica. Se realizaron análisis factoriales exploratorios con una submuestra de 100 adolescentes y análisis factoriales confirmatorios con el resto de los participantes (202) para analizar la validez y fiabilidad de la HADS (14 ítems); además se calculó el análisis de la varianza de un factor para analizar las diferencias entre patologías. Resultados. Pacientes de 12 a 16 años de edad, con una distribución similar por género; el 43 % padecía enfermedades respiratorias, y el 47 %, endocrinológicas. La estructura original de dos factores (ansiedad y depresión) fue la que mostró buenos índices de ajuste e incorporó un factor de 2° orden (malestar emocional). Tres de los ítems originales de la escala fueron eliminados; se obtuvo, finalmente, una nueva versión de 11 ítems. Esta mostró adecuadas propiedades psicométricas y se observaron diferencias entre pacientes con diabetes mellitus 1 y con patología respiratoria, pero no en talla baja, en el factor de depresión. Conclusiones. Esta escala presenta una adecuada fiabilidad y validez en pacientes con enfermedad crónica pediátrica y resulta útil para la detección temprana de clínica ansioso-depresiva en el ámbito sanitario.

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Introducción: Se ha estipulado que los niños con condiciones crónicas de salud, pueden tener un alto riesgo de caries. Aunque la literatura sobre caries tempranas de la infancia (CTI) es extensa, poco se sabe acerca de su prevalencia en niños con estas condiciones. Objetivo: Conocer la prevalencia de CTI en niños con enfermedades respiratorias crónicas (ERC) en el Hospital Calvo Mackenna, Santiago, Chile y determinar su asociación con CTI. Pacientes y Método: Se realizó un estudio de corte transversal, sobre un total de 120 niños de 2 a 5 años 11 meses de edad, un grupo de estudio de 60 niños con ERC y un grupo control de 60 niños sanos fueron analizados. Se diagnosticó CTI de acuerdo a la definición aceptada por la AAPD, mediante un examen oral realizado por un operador bajo condiciones estandarizadas. Para el análisis estadístico se utilizó el programa Stata 11. Resultados: La prevalencia de CTI fue de 53 por ciento en niños con ERC y 25 por ciento en niños sanos (p < 0,0001). El valor de Qdds Ratio para niños con ERC fue de 7,046 mostrando un incremento del riesgo de CTI, comparado con niños sanos. (95 por ciento CI: 2,372-20,929). Conclusión: En esta población, los niños con ERC presentan una alta prevalencia de CTI. En esta muestra se encontró una asociación estadísticamente significativa entre CTI y ERC.

Introduction: Children with chronic health conditions may have an increased risk for developing caries. Although the literature on early childhood cavities (ECC) is extensive, little is known about its prevalence in children with these conditions. objective: To determine the prevalence of ECC in children with chronic respiratory disease (CRD) at Luis Calvo Mackenna Hospital in Santiago, Chile, and to determine their association. Patients and Methods: A cross-sectional study was performed on 120 children aged 2 to 5 years 11 months, a study group of 60 children with CRD and a control group of 60 healthy children were analyzed. ECC was diagnosed meeting the ALAPD criteria, an oral exam conducted by an operator under standardized conditions. The Stata 11 program was used for statistical analysis. results: The prevalence of ECC was 53 percent in children with CRD and 25 percent in healthy children (p < 0.0001). The value of odds ratio for children with CRD was 7.046 showing an increased risk of ECC compared with healthy children. (95 percent CI: 2.372 to 20.929). Conclusion: In this population, children with CRD have a high prevalence of ECC. In this sample, a statistically significant association between ECC and CRD was found.

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