RESUMO
Los avances en medicina del sueño son de gran relevancia para enfrentar adecuadamente los trastornos del sueño en niños y adolescentes, procurando mitigar sus efectos multisistémicos y llevando a la práctica conductas de un mejor estándar. Este artículo de revisión se enfoca en mostrar los principales avances sobre trastornos respiratorios del sueño, refiriéndonos a las experiencias publicadas durante estos años de pandemia sobre avances epidemiológicos, consecuencias cardiovasculares, lectura de estudios de sueño y estudios domiciliarios; finalmente aspectos sobre tratamiento quirúrgico versus conservador, soporte ventilatorio y dispositivos autorregularles ambulatorios para titulación.
Advances in sleep medicine are of great relevance to adequately address sleep disorders in children and adolescents, seeking to reduce their multisystem effects and implementing better standard behaviors. This review article focuses on showing the main advances on sleep-disordered breathing, referring to the experiences published during these pandemic years on epidemiological advances, cardiovascular consequences, reading sleep studies and home studies; finally, aspects of surgical versus conservative treatment, ventilatory support and ambulatory self-regulating devices for titration.
RESUMO
INTRODUCTION: Cystic Fibrosis (CF) is the most frequent chronic hereditary disease in the white race. Although the impact on the quality of life of this disease is significant, there are no validated instruments in the Chilean population to measure it. OBJECTIVE: To carry out a cultural and linguistic adaptation and validate the content and reliability of the CFQ-R Cystic Fibrosis Questionnaire, Spanish version 2.0. PATIENTS AND METHOD: The process was carried out in two stages. The first stage consists of an ins trumental design to adapt it culturally and linguistically, evaluate content validity by consulting ex perts, and test the comprehension of the questionnaire in patients and parents through qualitative interviews and a focus group. In the second stage with an observational and cross-sectional design in a sample of 122 people with CF or their caregivers, the behavior of the questionnaire was analyzed using descriptive statistics and Cronbach's alpha for reliability. RESULTS: Stage 1: the instrument in its three versions is considered valid with Lynn's index > 0.8 and Validity Coefficient > 0.7. Stage 2: The adolescent/adult and parent/caregiver versions obtain Cronbach's a > 0.7 and an average > 3 in most dimensions. CONCLUSION: The questionnaire is adapted and validated in the Chilean population and requires minor modifications. This version is reliable, valid, and allows the assessment of the quality of life in people with CF. It is suggested to increase the sample for the analysis of construct validity with a larger number of patients.
Assuntos
Fibrose Cística , Qualidade de Vida , Adolescente , Adulto , Criança , Chile , Estudos Transversais , Fibrose Cística/diagnóstico , Humanos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Resumen El aumento de la expectativa de vida de niños y adolescentes con enfermedades respiratorias crónicas ha llevado a implementar estrategias como la rehabilitación respiratoria (RR). El presente artículo profundiza en las distintas indicaciones de la RR en distintos niveles de atención médica, distinto grado de dependencias tecnológicas y diversas patologías como: Fibrosis Quística, Bronquiolitis Obliterante, Enfermedades Neuromusculares, anomalías de caja torácica y escoliosis.
The increase in the life expectancy of children and adolescents with chronic respiratory diseases has led to implement strategies such as respiratory rehabilitation (RR). This article delves into the different indications of RR at different levels of medical care, different level of technological dependencies and different pathologies such as: Cystic Fibrosis, Bronchiolitis Obliterans, Neuromuscular Diseases, Rib cage abnormalities and Scoliosis.
Assuntos
Humanos , Criança , Adolescente , Transtornos Respiratórios/reabilitação , Terapia Respiratória , Bronquiolite Obliterante/reabilitação , Doença Crônica , Fibrose Cística/reabilitaçãoRESUMO
Sudden unexpected death in infancy (SUDI) - defined as the death of a child under 1 year of age du ring sleep with no initially obvious cause - remains one of the most common causes of post-neonatal mortality. Approximately 3,500 infants die annually in the United States from sleep-related deaths. A complex and multifactorial origin is postulated in a vulnerable infant. However, the pathophysiology of SUDI has not been fully understood. Health care providers play a key role in promoting preventive measures described in the literature, which include sleeping in a supine position on a firm surface, avoiding smoking and co-sleeping, promoting breastfeeding, among others. The objective of this re view is to summarize the main epidemiological and physiopathological characteristics of SUDI, and safe sleep-related factors.
Assuntos
Morte Súbita do Lactente , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Fatores de Risco , Sono , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/prevenção & controleRESUMO
Since December 2019, the outbreak of a novel coronavirus SARS Cov-2 has been reported in Wuhan, China. Currently, the new coronavirus disease has been declared a worldwide pandemic. Compared to adults, reporting of cases in pediatric patients has been significant smaller. The objective of this article is to provide epidemiological information of COVID-19, especially pediatric. Most of the confirmed cases of children are declared to be a cluster disease. The clinic is oligosymptomatic, less severe and with concentrated risk in children under 1 year of age and with comorbidity. In Chile, pediatric patients represent about 6% of the total number of infected and overall lethality is significantly lower than adults. The main control measures to reduce effective reproduction are mass testing, social distancing and school closure, without dismissing individual responsibility. The adequate supply of personal protection elements is key to avoid nosocomial infection and the compromise of healthcare providers.
A partir de diciembre del 2019, se ha reportado el brote de una nueva infección por SARS Cov-2 en Wuhan, China. Actualmente, la enfermedad por el nuevo coronavirus 2019 ha alcanzado el estatus de pandemia. El reporte de casos en pacientes pediátricos ha sido escaso. El objetivo de este artículo es entregar información epidemiológica del COVID-19, especialmente pediátrica. Los niños han presentado enfermedad en clusters, secundaria a contacto con parientes enfermos. La clínica es oligosintomática, menos severa y mayor riesgo concentrado en menores de 1 año y con comorbilidad. En Chile, los pacientes pediátricos representan cerca del 6% del total y la letalidad global es notablemente más baja que en adultos. Las principales medidas de control para la reducción de la reproducción efectiva son el testeo masivo, distanciamiento social y cierre escolar, sin desestimar la responsabilidad individual. El adecuado abastecimiento de elementos de protección personal es clave para evitar la infección nosocomial y del personal de salud.
Assuntos
Humanos , Criança , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Betacoronavirus , Chile/epidemiologia , PandemiasRESUMO
In December 2019, a novel virus called SARS-CoV-2 emerged in China. In March 2020, the World Health Organization (WHO) declared that the world was undergoing a pandemic. With a massive outbreak of severe cases and deaths, there has been an urgency in the medical community to seek effective treatments to prevent the progression of the disease and reduce its fatality rate. This review analyzes the therapeutic options available for the disease based on the recommendations from WHO, scientific societies and the still scarce scientific evidence available on treatment of CoVID-19.
En diciembre del 2019 emergió un nuevo virus denominado SARS-CoV-2 en China. En marzo de 2020 la Organización Mundial de la Salud (OMS) declaró que el mundo estaba sufriendo una pandemia. Con un gran brote de casos graves y fallecidos se ha producido una urgencia en la comunidad médica por buscar tratamientos efectivos para evitar la progresión de la enfermedad y disminuir su letalidad. En esta revisión se analizan las opciones terapéuticas disponibles para la enfermedad en base a las recomendaciones de la OMS, de sociedades científicas y a la aún escasa evidencia científica disponible para el tratamiento del CoVID-19.
Assuntos
Humanos , Criança , Pneumonia Viral/terapia , Infecções por Coronavirus/terapia , Betacoronavirus , Oxigenoterapia , Pneumonia Viral/tratamento farmacológico , Respiração Artificial/métodos , Fatores de Risco , Infecções por Coronavirus/tratamento farmacológicoRESUMO
The better understanding of the global activity of vitamin D has led to an intense search for its involvement in non-skeletal diseases. This article presents an updated review of the relationship between vitamin D and pediatric respiratory pathology. A literature search was performed in PUBMED using free terms and MESH terms: vitamin D, asthma, respiratory system diseases, and bronchiolitis. Stu dies in human patients younger than 18 years and animals, published in English and Spanish until 2017 were included. 507 articles were found, of which 43 were included. Indirect evidence suggests a role of vitamin D and fetal lung maturation. In relation to pediatric pulmonary pathology, studies are scarce and inconclusive. Recent meta-analyses performed with individualized evaluation of the participants shows an important protective role of vitamin D supplementation in the prevention of severe asthma exacerbations and acute viral infections. In bronchiolitis, the results are contradictory, with no clear relationship between plasma levels and severity. There is not enough evidence to assess the benefits of vitamin D supplementation in cystic fibrosis and tuberculosis. A direct relationship between the severity of sleep-related breathing disorders and vitamin D plasma levels has recently been proposed, although the exact mechanisms involved in this association are unknown. Current information suggests that vitamin D supplementation may represent a cost-effective strategy in redu cing important causes of infant morbidity and mortality.
Assuntos
Doenças Respiratórias/etiologia , Deficiência de Vitamina D/complicações , Biomarcadores/sangue , Criança , Suplementos Nutricionais , Humanos , Pulmão/embriologia , Pediatria , Doenças Respiratórias/tratamento farmacológico , Doenças Respiratórias/prevenção & controle , Fatores de Risco , Vitamina D/sangue , Vitamina D/fisiologia , Vitamina D/uso terapêutico , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/sangue , Vitaminas/fisiologia , Vitaminas/uso terapêuticoRESUMO
Existen diversos lisados bacterianos, siendo OM-85 (Broncho-Vaxom®) el que posee mayor evidencia en cuanto a su rol inmunoprotector sobre infecciones respiratorias en población pediátrica. Sus mecanismos de acción producen efectos inmunomoduladores que potencialmente podrían prevenir el asma en etapas precoces de la vida, actuar sobre la disminución de crisis y ser un aporte a la terapia convencional del asma. Este artículo expone las principales evidencias en relación con estos compuestos, con enfoque en la actualidad y el desarrollo futuro, en especial sobre OM-85.
There are several bacterial lysates, being OM-85 (Broncho-Vaxom®) the one with the greatest evidence regarding its immunoprotective role on respiratory infections in the pediatric population. Its mechanisms of action produce immunomodulatory effects that could potentially prevent asthma in early stages of life, act on the reduction of crisis and be a contribution to conventional asthma therapy. This article shows the main evidences in relation to these compounds, the current focus and future development, especially on OM-85.
Assuntos
Humanos , Infecções Respiratórias/prevenção & controle , Asma/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Asma/complicações , Asma/imunologia , Antibacterianos/uso terapêuticoRESUMO
Resumen: El mejor entendimiento sobre la actividad global de la vitamina D, ha llevado a una intensa búsque da de sus implicancias en enfermedades no esqueléticas. En este artículo se presenta una revisión actualizada de la relación entre la vitamina D y la patología respiratoria pediátrica. Se realizó una búsqueda bibliográfica en PUBMED utilizando términos libres y MESH: vitamina D, enfermedades del sistema respiratorio, asma, bronquiolitis. Se seleccionó estudios en humanos menores de 18 años y animales, publicados en inglés y español hasta el 2017. Se encontraron 507 artículos, de los cuales se incluyeron 43. Evidencia indirecta apunta hacia un rol de la vitamina D y la maduración pulmonar fetal. En relación a la patología pulmonar pediátrica, los estudios son escasos y poco concluyentes. Nuevos meta - análisis, con evaluación individualizada de los participantes, muestran un importante rol protector de la suplementación en la prevención de exacerbaciones asmáticas severas e infecciones virales agudas. En bronquiolitis los resultados son contradictorios, sin relación clara entre niveles plasmáticos y severidad. No existe suficiente evidencia que evalué los beneficios en fibrosis quística y tuberculosis. Recientemente se ha propuesto una relación directa entre la severidad de los trastornos respiratorios del sueño y los niveles plasmáticos de vitamina D, aunque se desconoce los mecanismos exactos involucrados a esta asociación. La información actual permite suponer que la suplementación de vitamina D puede representar una estrategia costo - efectiva en la reducción de importantes causas de morbimortalidad infantil.
Abstract: The better understanding of the global activity of vitamin D has led to an intense search for its involvement in non-skeletal diseases. This article presents an updated review of the relationship between vitamin D and pediatric respiratory pathology. A literature search was performed in PUBMED using free terms and MESH terms: vitamin D, asthma, respiratory system diseases, and bronchiolitis. Stu dies in human patients younger than 18 years and animals, published in English and Spanish until 2017 were included. 507 articles were found, of which 43 were included. Indirect evidence suggests a role of vitamin D and fetal lung maturation. In relation to pediatric pulmonary pathology, studies are scarce and inconclusive. Recent meta-analyses performed with individualized evaluation of the participants shows an important protective role of vitamin D supplementation in the prevention of severe asthma exacerbations and acute viral infections. In bronchiolitis, the results are contradictory, with no clear relationship between plasma levels and severity. There is not enough evidence to assess the benefits of vitamin D supplementation in cystic fibrosis and tuberculosis. A direct relationship between the severity of sleep-related breathing disorders and vitamin D plasma levels has recently been proposed, although the exact mechanisms involved in this association are unknown. Current information suggests that vitamin D supplementation may represent a cost-effective strategy in redu cing important causes of infant morbidity and mortality.
Assuntos
Humanos , Criança , Doenças Respiratórias/etiologia , Deficiência de Vitamina D/complicações , Pediatria , Doenças Respiratórias/prevenção & controle , Doenças Respiratórias/tratamento farmacológico , Vitamina D/fisiologia , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/sangue , Vitaminas/fisiologia , Vitaminas/sangue , Vitaminas/uso terapêutico , Biomarcadores/sangue , Fatores de Risco , Suplementos Nutricionais , Pulmão/embriologiaRESUMO
Introducción: El cuidador familiar cuestiona su capacidad para cuidar cuando la persona que cuida sufre una descompensación aguda de la enfermedad crónica y requiere hospitalización en una unidad de pacientes críticos. En esta situación, se hace fundamental determinar la autoeficacia o capacidad del cuidador para organizar y ejecutar un cuidado que sea eficaz y que permita prevenir conductas riesgosas, tanto para su salud como para la de su familiar. Objetivo: Conocer la percepción de autoeeficacia del cuidador familiar de la persona en estado crítico por descompensación de su enfermedad crónica, que se encuentra en las Unidades de Paciente Crítico del Hospital Dr. Guillermo Grant Benavente de Concepción, y relacionarla con sus características biopsicosociales y con los indicadores de morbilidad de la persona hospitalizada. Metodología: Estudio cuantitativo, correlacional y de corte transeccional. Se aplicó la Escala de Autoeficacia para el Cuidado, la Escala de Autoestima y un cuestionario semiestructurado a 97 cuidadores familiares. Resultados: La autoeficacia fue mayor en los cuidadores hombres y se obtuvo una relación estadísticamente significativa con edad, nivel de estudios, autoestima, conocimiento del tratamiento y duración de la enfermedad. Conclusiones: Se observó cómo algunas características biopsicosociales del cuidador e indicadores de morbilidad de la persona en estado crítico se relacionan con su percepción de autoeeficacia e influyen en su decisión de adoptar una conducta promotora de salud frente a su autocuidado y el de su familiar.
Introduction: The familial caregivers question their capacity to care when patients suffer acute decompensations due to their chronic illnesses and require hospitalization in critical patients units. In these situations, it is fundamental to determine the caregiver self-efficacy in organizing and providing care which is effective and allows the prevention of risk-posing behaviors, both from the patients as well as from the patients' families. Objective: To explore the self-efficacy perception of familial caregivers towards the persons in critical status admitted to Critical Patient Units of the ''Dr. Guillermo Grant Benavente de Concepción'' hospital, as well as the related associations with bio-psycho-social characteristics and morbidity indicators. Methodology: This is a quantitative, correlational and trans-sectional study. A Care Self-Efficacy scale, a Self-Esteem scale, and a semi-structured questionnaire were conducted with 97 familial caregivers. Results: Self-Efficacy was higher among male caregivers, and statistically significant relations with age, level of studies, self-esteem, knowledge of the treatment, and illness duration were found. Conclusions: It was observed that some bio-psycho-social characteristics of the caregiver, as well as some morbidity indicators of the person in critical status, were associated to the caregivers' perception of their self-efficacy, and to the patients' strength to adopting health-promoting conducts towards themselves and their families.
Introdução: O cuidador familiar questiona a sua capacidade para cuidar quando o paciente sofre uma descompensação aguda da doença crónica e requer hospitalização em una unidade de pacientes críticos. Nesta situação, faz-se fundamental determinar a auto eficácia ou capacidade do cuidador para organizar e executar um cuidado que seja eficaz e que permita prevenir condutas arriscadas, tanto para sua saúde como a de seu familiar. Objetivo: Conhecer a percepção de auto eficácia do cuidador familiar com o paciente em estado crítico por descompensação de sua patologia crónica, que se encontra nas Unidades de Paciente Crítico do Hospital Dr. Guillermo Grant Benavente de Concepción, e relacioná-la com suas caraterísticas biopsicossociais e com os indicadores de mobilidade da pessoa hospitalizada. Metodologia: Estudo quantitativo, correlacional e de corte transeccionado. Aplicou-se a Escala de Auto eficácia para o Cuidado, a Escala de Autoestima e um questionário semiestruturado a 97 cuidadores familiares. Resultados: A auto eficácia foi maior nos cuidadores homens e obteve-se uma relação estatisticamente significativa com idade, nível de estudos, autoestima, conhecimento do tratamento e duração da doença. Conclusões: Observou-se como algumas caraterísticas biopsicossociais do cuidador e indicadores de mobilidade da pessoa em estado crítico, relacionam-se com sua percepção de auto eficácia e influenciam em sua decisão de adoptar uma conduta promotora de saúde perante a seu autocuidado e de seu familiar.