RESUMO
OBJECTIVE: The objective of this study is to evaluate the impact of social distancing resulting from COVID-19 in hospitalizations for infections of the upper airways (URTI), such as acute laryngitis, tracheitis, and otitis media in children aged 0 to 9 years in Brazil, considering that they share the same forms of transmission. METHODS: Data on hospitalizations for acute airway changes and their complications in children <9 years old were obtained from the Database of the Brazilian Department of Public Health Informatics for the period 2015 to 2020. These data were also analyzed by macroregions of Brazil (North, Northeast, Southeast, South, and Midwest). The effect of the social distancing strategy on the increase of acute laryngitis, tracheitis, otitis media, and mastitis, as absolute and relative reductions, was calculated by analyzing the annual calculation of 2015-2019 vs 2020. RESULTS: All the hospitalizations compared in the Unified Health System (SUS) for laryngitis and acute tracheitis and otitis media decreased, considering all states of Brazil. The largest reduction in hospitalization reduction was in the North, with -94% in 2015-2019 vs 2020 in cases of laryngitis and acute tracheitis, and in the Midwest, with - 85% in 2015-2019 vs 2020 in cases of otitis media. CONCLUSION: Hospitalizations for laryngitis, acute tracheitis, and acute otitis media in children <9 years old decreased between March and July 2020 in Brazil, when social distancing measures were adopted due to the COVID-19 pandemic.
Assuntos
COVID-19 , Laringite , Mastoidite , Otite Média , Traqueíte , Brasil/epidemiologia , Criança , Feminino , Hospitalização , Humanos , Laringite/epidemiologia , Otite Média/epidemiologia , Pandemias , Distanciamento Físico , SARS-CoV-2 , Traqueíte/epidemiologiaRESUMO
Introducción: el reflujo faringolaríngeo se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero existen factores capaces de perpetuarlo: disfunción del esfínter esofágico, tiempo de exposición y sensibilidad del tejido al material refluido, estos elementos permiten considerar al reflujo faringolaríngeo como una entidad diferente del reflujo gastroesofágico. Material y método: Estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron al servicio de Otorrinolaringología y Gastroenterología de la Clínica Universitaria Reina Fabiola Córdoba Argentina, por sintomatología de reflujo faringolaríngeo y gastroesofágico. Entre mayo/2016 y mayo/2017. Los hallazgos de reflujo faringolaríngeo por fibrolaringoscopía flexible y de esofagitis por videoendoscopía digestiva alta de cada paciente se compararon con la prueba de Chi cuadrado. Se consideró significativo un valor de p ≤0,05. Resultados: Se incluyeron 49 pacientes entre 7 y 80 años; de éstos, el 45% son de género masculino, y 55% femenino. El 100% de los pacientes presentaron criterios fibrolaringoscópicos diagnósticos de reflujo faringolaríngeo; por el contrario, la videoendoscopía digestiva alta mostró que solo el 55% de los pacientes tenían signos de esofagitis (p= 0,24). Conclusiones: En este estudio no se observó una correlación diagnóstica entre los signos de la fibrolaringoscopía y videoendoscopía digestiva alta en relación al diagnóstico de reflujo faringolaríngeo y esofagitis. No se encontró una diferencia entre ambos géneros y los signos de reflujo faringolaríngeo y esofagitis. La frecuencia de las manifestaciones otorrinolaringológicas del reflujo faringolaríngeo se relaciona directamente con el incremento de la edad; sobre todo, la cuarta década de la vida.
Introduction: pharyngolaryngeal reflux. Its etiology, the retrograde flow of gastric contents towards the pharynx would be the origin, but there are factors, capable of perpetuating it: dysfunction of the esophageal sphincter, time of exposure and sensitivity of the tissue to the refluxed material, which allows pharyngolaryngeal reflux to be considered as a different entity from gastroesophageal reflux. Material and method: Observational, retrospective and analytical study of patients who have consulted the service of Otorhinolaryngology and Gastroenterology of the Reina Fabiola University Clinic, due to symptomatology of pharyngolaryngeal reflux and gastroesophageal reflux. Between May/2016 and May/2017. The findings of pharyngolaryngeal reflux by fiber-optic laryngoscopy and esophagitis by upper gastrointestinal endoscopy of each patient were compared with the Chi square test. A value of p ≤0.05 was considered significant. Results: We included 49 patients between 7 and 80 years old; 45% of them were male and 55% were female. 100% of the patients had fiber-optic laryngoscopy diagnostic criteria of pharyngolaryngeal reflux. In contrast, upper digestive endoscopy showed that only 55% of the patients had signs of esophagitis (p = 0.24). Conclusions: In this study, wasn´t observed a diagnostic correlation between the signs of fiber-optic laryngoscopy and upper gastrointestinal endoscopy in relation to the diagnosis of pharyngolaryngeal reflux and esophagitis. We did not find a difference between both genders and signs of esophageal pharyngolaryngeal reflux. The frequency of otorhinolaryngological manifestations of pharyngolaryngeal reflux is directly related to the increase in age.
Introdução: o refluxo faringolaríngeo. Sua etiologia é o fluxo retrógrado de conteúdo gástrico para a faringe, mas existem fatores capazes de perpetuá- lo: disfunção do esfíncter esofágico, tempo de exposição e sensibilidade do tecido ao material refluído, o que permite considerar o refluxo faringolaríngeo como uma entidade diferente do refluxo gastroesofágico. Material e métodos: Estudo observacional, retrospectivo e analítico de amostra de pacientes que consultaram o serviço de Otorrinolaringologia e Gastroenterologia da Clínica Universitária Reina Fabiola, devido à sintomatologia de refluxo faringolaríngeo e refluxo gastroesofágico, entre maio/2016 e maio/2017. Os achados do refluxo faringolaríngeo por fibrolaringoscopia flexível e esofagite por endoscopia digestiva alta de cada paciente foram comparados com o teste do chi-quadrado. Um valor de p ≤ 0,05 foi considerado significativo. Resultados: Foram estudados 49 pacientes entre 7 e 80 anos; destes, 45% do sexo masculino e 55% do sexo feminino. 100% os pacientes apresentavam critérios fibrolaringoscópicos para refluxo faringolaríngeo. Em contraste, a endoscopia digestiva alta mostrou que apenas 55% dos pacientes apresentavam sinais de esofagite (p = 0,24). Conclusões: Neste estudo, não foi observada correlação diagnóstica entre os sinais de fibrolaringoscopia e endoscopia digestiva alta em relação ao diagnóstico de refluxo faringolaríngeo e esofagite. Não foi encontrada diferença entre os sexos e os sinais de refluxo faringoaríngeo e esofagite. A freqüência das manifestações otorrinolaringoló- gicas do refluxo faringolaríngeo está diretamente relacionada ao aumento de idade.
Assuntos
Masculino , Feminino , Humanos , Adolescente , Adulto , Criança , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório , Laringoscopia , Esofagite , Refluxo Gastroesofágico , Laringite , Refluxo Laringofaríngeo , Laringite/epidemiologiaRESUMO
Introducción: La laringitis fúngica es una patología poco planteada en pacientes inmunocompetentes, sin embargo se debería tener en consideración en el diagnóstico diferencial de leucoplaquias en estos pacientes, más aún con factores predisponentes como reflujo faringolaríngeo, tabaquismo crónico y/o uso de corticoides. Objetivo: Presentar una serie de casos de pacientes inmunocompetentes con diagnóstico clínico de laringitis fúngica y tratamiento antimicótico empírico. Describir la asociación con factores predisponentes claves. Material y método: Estudio retrospectivo que incluyó a 11 pacientes con diagnóstico clínico de laringitis fúngica por correlación de la clínica, factores predisponentes y hallazgos en la videoestroboscopía laríngea (leucoplaquias múltiples en los pliegues vocales) sumado a la respuesta a tratamiento empírico con fluconazol oral. Se realizó además una revisión de la literatura disponible hasta el año 2015. Resultados: Todos los diagnósticos fueron clínicos correlacionando síntomas con hallazgo de leucoplaquias características en la laringe. El principal factor asociado fue el reflujo faringolaríngeo (91%) seguido por uso de corticoides (55%). Todos los pacientes fueron tratados con un esquema empírico de fluconazol oral por 14-21 días. El 100% de los pacientes respondió de forma exitosa al uso de este fármaco con remisión de los síntomas y de las lesiones laríngeas. Conclusión: El diagnóstico clínico y tratamiento con fluconazol oral como tratamiento de primera línea generarían buena tasa de respuesta, siempre que se correlacionen los síntomas y signos del paciente con los hallazgos encontrados en la laringe.
Introduction: The fungal laryngitis is an unusual disease in immunocompetent patients, however should take into consideration in the differential diagnosis of leukoplakias, especially in patients with predisposing factors such as pharyngolaryngeal reflux, use of inhaled, oral or intravenous corticosteroids. Aim: Describe a series of cases of fungal laryngitis in immunocompetent patients with clinical diagnosis and empirical antifungal treatment. In addition, finding the association with predisposing factors keys. Material and method: Retrospective study of 11 patients with diagnosis of fungal laryngitis according to clinical presentation, predisposing factors and findings in the laryngeal videostroboscopy (vocal folds leukoplakias) joined the response to empirical treatment with oral fluconazole. Also an extensive literature review was conducted until 2015. Results: The main predisposing factor was the pharyngolaryngeal reflux (91%) followed by use of corticosteroids (55%). All patients were treated empirically with fluconazole for 14-21 days. 100% of patients responded successfully, with remission of symptoms and laryngeal lesions. Conclusion: Clinical diagnosis and treatment with fluconazole as first-line treatment generate good response rate, provided that the patient's symptoms and signs with the findings in the larynx are correlated.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Laringite/microbiologia , Laringite/epidemiologia , Prega Vocal , Refluxo Gastroesofágico/complicações , Fluconazol/uso terapêutico , Laringite/imunologia , Laringite/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Corticosteroides/uso terapêutico , Complicações do Diabetes , ImunocompetênciaRESUMO
We present the problem of viral croup or acute laryngotracheitis as an important respiratory issue in children that often prompts parents to seek physician consultation. Despite its frequency, there is still controversy among the medical team regarding its treatment. The problem will be defined and analyzed in-depth in terms of pathogenesis, to finally suggest a simple, clinically effective treatment than can be applied in any emergency service. We highlight the importance of epinephrine and corticosteroids in the acute treatment of these patients...
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Crupe/epidemiologia , Crupe/prevenção & controle , Laringite/diagnóstico , Laringite/epidemiologia , Laringite/etiologia , Laringite/prevenção & controle , Laringite/terapiaRESUMO
OBJECTIVES: The objective was to apply quality indicators in respiratory disease triage during a set time period. METHODS: This was a retrospective, descriptive, and comparative study of all patients attending the emergency department of Acosta Ñu Children's Hospital with breathing difficulty, between January 1 and July 31, 2011. RESULTS: Two thousand five hundred eighty-two patients were included in the study. The delay in medical care according to severity of breathing difficulty was as follows: for critical patients, 1 minute (100% compliance); for emergencies, 6.4 minutes (93.4% compared with 95% standard); for urgencies, 15.8 minutes (90% compared with the standard 90%); and for semiurgencies, 35 minutes (92.4% vs. 85% standard). Regarding to the admission-triage time indicator: mean time was 6.1 minutes; 2220 patients (86%) were classified in less than 10 minutes from the time of hospital admission, and 2453 (95%) were evaluated before 15 minutes. Respiratory rate was recorded in 2368 patients (91.7%), and pulse oximetry in 2443 (94.6%). Both parameters were recorded in 2271 children (88%). Errors in classification were detected, mainly tendency to underestimate the risk or exacerbate the clinical situation; 441 patients underwent subtriage (20.5%), and 44 overtriage (1.7%). There were drawbacks to classify emergencies error rate 45.8% (P < 0.00001). Relationship between pathophysiologic diagnosis and triage level was significant (P < 0.00001). CONCLUSIONS: Indicators of triage quality were acceptably met in respiratory disease. Breathing difficulty was identified and classified as urgent, although problems arouse at differentiation between moderate and severe dyspnea.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Transtornos Respiratórios/diagnóstico , Triagem/normas , Broncopatias/diagnóstico , Broncopatias/epidemiologia , Criança , Pré-Escolar , Erros de Diagnóstico , Testes Diagnósticos de Rotina/estatística & dados numéricos , Dispneia/etiologia , Emergências , Feminino , Humanos , Lactente , Laringite/diagnóstico , Laringite/epidemiologia , Masculino , Oximetria/estatística & dados numéricos , Paraguai/epidemiologia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Transtornos Respiratórios/classificação , Transtornos Respiratórios/epidemiologia , Taxa Respiratória , Estudos Retrospectivos , Estado Asmático/diagnóstico , Estado Asmático/epidemiologia , Fatores de Tempo , Triagem/estatística & dados numéricosAssuntos
Humanos , Lactente , Pré-Escolar , Bronquite/diagnóstico , Bronquite/epidemiologia , Laringite/diagnóstico , Laringite/epidemiologia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Bronquite/terapia , Chile , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Influenza Humana/terapia , Laringite/terapia , Medicina Baseada em Evidências , Pneumonia/terapia , Coqueluche/terapiaRESUMO
The presence of antibodies against human parainfluenza viruses type 2 and 3 was studied in 1 793 sera from an infantile population under 14 years old. The hemagglutination inhibition technique was used for screening the clinical samples. Of the total of analyzed sera, 1 382 (77.1%) were positive. The presence of antibodies against type 2 was confirmed in 320 of them (17.8%), and against type 3 in 334 (18.6%). The simultaneous seropositivity predominated in 805 (44.9%). The circulation of human parainfluenza viruses was corroborated during all the months of the year and in all the analyzed age groups. It was observed an increase in the positivity percentages with age.
Assuntos
Crupe/epidemiologia , Laringite/epidemiologia , Vírus da Parainfluenza 2 Humana/isolamento & purificação , Vírus da Parainfluenza 3 Humana/isolamento & purificação , Traqueíte/epidemiologia , Adolescente , Fatores Etários , Anticorpos Antivirais/análise , Criança , Pré-Escolar , Crupe/virologia , Cuba/epidemiologia , Testes de Inibição da Hemaglutinação , Humanos , Lactente , Recém-Nascido , Laringite/virologia , Vírus da Parainfluenza 2 Humana/imunologia , Vírus da Parainfluenza 3 Humana/imunologia , Vigilância da População , Estudos Retrospectivos , Estações do Ano , Estudos Soroepidemiológicos , Traqueíte/virologiaRESUMO
In a total of 1,003 children (805 inpatients and 198 outpatients) with acute lower respiratory infections (ALRI), clinical, social, and environmental data were analyzed. The major clinical entities were bronchiolitis, pneumonia, bronchitis, and laryngitis. The first two of these predominated in inpatients; pneumonia and bronchitis were more common in older children, while bronchiolitis was observed in infants. Respiratory rates of > 50/min. were more common in younger children and in cases with bronchiolitis and bronchitis. Retractions showed markedly less age-dependent variations and were present in all severe cases with different clinical diagnoses. Retractions alone or associated with cyanosis were the best indicators for severity of ALRI. Among outpatients, fever and wheezing were more common; inpatients were younger, more frequently malnourished, and from a lower socioeconomic level; family history of chronic bronchitis, crowding, and parental smoking also prevailed in this group. Family asthma and exposure to domestic aerosols was more common among outpatients. Prematurity rate (17 and 15%) of all ALRI cases was twice that of the general pediatric population and a significant difference existed between in- and outpatients under 6 months of age when perinatal respiratory pathologies predominated among inpatients. It is suggested to consider the need for assessing personal, family, and environmental risk factors in addition to clinical signs and symptoms when severe cases of ALRI are evaluated.
Assuntos
Bronquiolite/epidemiologia , Bronquite/epidemiologia , Pacientes Internados , Laringite/epidemiologia , Pacientes Ambulatoriais , Pneumonia/epidemiologia , Doença Aguda , Fatores Etários , Argentina/epidemiologia , Bronquiolite/diagnóstico , Bronquite/diagnóstico , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Laringite/diagnóstico , Masculino , Anamnese , Pneumonia/diagnósticoRESUMO
OBJECTIVE: To evaluate demographic and clinical correlates of laryngotracheobronchitis (LTB) as a complication of measles during a community-wide epidemic. DESIGN: Retrospective review of medical records. SETTING: Childrens Hospital Los Angeles, a large urban pediatric facility, during a regional epidemic of measles studied January through June 1990. PATIENTS: All patients identified at our hospital who met Centers for Disease Control criteria for measles. MEASUREMENTS AND RESULTS: Of 440 patients with measles, 82 also had LTB (18.6%). Patients in whom LTB developed were significantly younger (mean +/- SD: 14.7 +/- 8.2 months) than the cohort (24.8 +/- 30.1 months) (p less than 0.001) and more likely to require hospitalization (91.5%) than the cohort (44.3%) (p less than 0.001). Thirteen patients (17.3%) required intensive care, including 9 (11%) who required endotracheal intubation for a mean of 8.3 +/- 7.1 days. Pulmonary function testing of five patients with an endotracheal tube in place, including three not clinically assessed as having pneumonia, indicated the presence of concomitant lower respiratory tract disease. CONCLUSION: Laryngotracheobronchitis was a frequent and often severe complication of measles. The likelihood that LTB would develop was inversely related to age, generally required inpatient care, and necessitated endotracheal intubation in severely affected patients.
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Bronquite/etiologia , Laringite/etiologia , Sarampo/complicações , Traqueíte/etiologia , Adolescente , Adulto , Bronquite/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Laringite/epidemiologia , Los Angeles , Masculino , Sarampo/epidemiologia , Estudos Retrospectivos , Traqueíte/epidemiologia , Saúde da População UrbanaRESUMO
This paper summarizes the first study on clinical, etiologic, and epidemiologic features of acute lower respiratory tract infection (ALRI) in children in Argentina. A total of 1,003 children less than 5 years of age (805 inpatients and 198 outpatients) presenting with ALRI were studied during a 40-month period. Nasopharyngeal aspirate (NPA), blood, urine, and throat-swab samples were collected when each child was first seen for care. Virologic studies were performed on the NPA by means of indirect immunofluorescence and isolation of virus in cell culture. Bacteriologic studies primarily were done by means of culture of blood or pleural fluid (when available); Bordetella pertussis and Mycoplasma pneumoniae, however, were searched for by the use of immunofluorescence and complement-fixation testing, respectively, in paired sera. Respiratory syncytial virus was the most commonly isolated virus, followed by adenovirus, parainfluenza virus, and influenza virus. Streptococcus pneumoniae was the most frequently isolated bacterium, followed by B. pertussis and Haemophilus influenzae type b. Overall, the patient fatality rate was 3.8% among inpatients with pneumonia or bronchiolitis.