​Respirar is a free and open access electronic scientific journal. It is an official publication of the Asociación Latinoamericana de Tórax (ALAT). Its objective is to disseminate the scientific work carried out in Latin America in the area of respiratory pathology. This journal is aimed at health professionals. Quarterly: March, June, September and December. - - - - - - - - - - EDITORS IN CHIEF Dr. Francisco Arancibia (Instituto Nacional del Tórax, Santiago de Chile, Chile) https://orcid.org/0000-0001-5429-5420 Dr. Carlos Luna (Hospital de Clínicas, Ciudad Autónoma de Buenos Aires, Argentina) https://orcid.org/0000-0002-9288-096X ASSISTANT EDITORS Dra. Lorena Noriega- Aguirre (Universidad de Panamá, Facultad de Medicina; Ciudad de la salud de la Caja de Seguro Social; Investigadora Nacional I del SNI – SENACYT; Panamá, Panamá) https://orcid.org/0000-0003-1806-9797 Dr. Rogelio Pérez-Padilla (Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad de México, México) https://orcid.org/0000-0002-1132-5308 Dr. Carlos Arturo Torres-Duque (Centro Internacional de Investigación en Neumología y Salud Respiratoria (CINEUMO); Fundación Neumológica Colombiana; Universidad de La Sabana; Bogotá, Colombia) https://orcid.org/0000-0003-0004-8955 Dr. Gustavo Zabert (Universidad Nacional del Comahue, Facultad de Ciencias Médicas (FACIMED), Rio Negro, Argentina) https://orcid.org/0000-0001-9937-4464 Editorial Coordinator- Editorial Secretary: Lic. Mercedes Cavallero
Asociación Latinoamericana de Tórax (ALAT)
Professional Profile and Areas of Opportunity for Teachers in Respiratory Medicine in Latin America
Copyright (c) 2026 Respirar https://creativecommons.org/licenses/by/4.0
For a childhood and infancy free of tobacco and nicotine
Pleuropulmonary Ultrasound: Relationship of Findings with Histological Types in Lung Cancer
Introduction: Thoracic ultrasound is an accessible tool for evaluating consolidations with suspected malignancy; however, the histologic classification of malignant tumors is not fully described. Objective: To evaluate ultrasonographic findings in lung cancer and correlate them with histological type. Methods: Prospective study of 26 patients with consolidations suspicious for malignancy at Dr. José Ignacio Baldó Hospital, January – August 2022. Two observers evaluated the ultrasonographic characteristics of consolidations in B-mode and Doppler, blinded to histologic results, which were obtained by the standard hematoxylin-eosin staining method. Chi – squared tests were used for associations and the Kappa coefficient for interobserver agreement. Results: The examined consolidations appeared heterogeneous with deep, fragmented borders and absence of air bronchograms. Adenocarcinoma was the prevalent histologic type (65,4%). Doppler uptake was observed in 96,2% of tumors, with monophasic spectra in 69,2% and low resistance in 61,5%. A significant association was found between squamous cell carcinoma and pleural thickening > 10 mm (p = 0.048), and interobserver agreement was excellent. Conclusions: Thoracic ultrasound is a reproducible tool for local characterization of lung cancer. Pleural thickening associated with squamous carcinoma and absence of air bronchogram may improve noninvasive diagnostic accuracy. Further studies are needed to validate these findings.
ALAT-SEPAR Consensus on Asthma Exacerbations: the Answer to an Unmet Need
Latin American Registry of Patients with Post-Tuberculosis Lung Disease: Analysis of Clinical Conditions, Pulmonary Function, Quality of Life, and Rehabilitation. Multicenter Study
Introduction: Tuberculosis (TB) is a communicable disease included in the Pan American Health Organization’s Initiative for the Elimination of Diseases in the Americas. In Latin America, unlike other regions, the World Health Organization has reported a sustained increase in TB incidence in recent years. In parallel, Post-Tuberculosis Pulmonary Disease (PTPD) has emerged as a relevant clinical entity, associated with respiratory, functional, and psychosocial sequelae that negatively impact quality of life and generate substantial catastrophic health costs. However, the burden and clinical characteristics of PTPD in Latin America remain poorly defined. Objective: To describe the demographic, clinical, functional, radiological, and quality-of-life characteristics of patients with PTPD in Latin America through a standardized registry, in order to generate evidence to support recommendations for timely diagnosis and management in the region. Methods: A multicenter registry was developed using a standardized shared medical record model available on the REDCap (Research Electronic Data Capture) platform of the Latin American Thoracic Association (ALAT). Relevant clinical data, pulmonary function tests, radiological imaging, quality-of-life assessments, and the use and impact of pulmonary rehabilitation will be collected from patients with PTPD across participating Latin American countries. Conclusions: This registry will allow estimation of the burden of PTPD in Latin America and provide a comprehensive characterization of affected patients. The generated data will support strategies aimed at improving diagnosis, treatment, and rehabilitation, promoting an integrated approach to reduce disability and catastrophic health costs associated with this condition.
Copyright (c) 2025 Respirar https://creativecommons.org/licenses/by/4.0
Humanization in Primary Care for Patients with Tuberculosis
Introduction: The humanization provided by health personnel in primary health care to patients with tuberculosis is crucial for their satisfactory evolution. Objective: To explore the opinions of the staff of the basic health teams in the health areas of the municipality of Habana Vieja on the humanization of patients treated for tuberculosis. A descriptive, exploratory study was conducted using a Likert scale for a comprehensive sample of 23 healthcare personnel who care for patients in treatment, from December 2023 to June 2024. Sociodemographic variables, frequencies and percentages were used. Opinions were explored using seven statements. A position index was calculated for each item (-totally disagree, -disagree, -no idea about it, -agree and -totally agree) with a 95% confidence interval. Results: 21/23 respondents were under 65 years of age and 65.22% were female. 19/23 had been in the program for more than 10 years. The majority of respondents agreed with the first three statements, regarding population stigma and lack of knowledge (PI = 0.674, 0.543, and 0.750), respectively. From the fourth to the seventh statement about the gaps in humanized care, they were between strongly disagree and disagree, with (IP= 0.272; 0.467; 0.370 and 0.489), respectively. Conclusion: The opinions of health professionals in the municipality of Habana Vieja showed that there is an adequate performance for the humanized care of TB patients. However, educational activities should be increased for professionals, patients and civil society regarding knowledge of the disease.
New Era in the Management of Early-Stage Lung Adenocarcinoma: a 3-Year Observational Follow-Up Study
Background: Lung cancer is frequently diagnosed in advanced stages and is currently the leading cause of cancer-related mortality worldwide. A multidisciplinary approach is crucial to optimize diagnosis, treatment and improve patient survival. Methods: A retrospective cohort analytical study over two time periods, including patients over 18 years old with early-stage lung adenocarcinoma treated at a high-complexity oncology center in Colombia. The exposure group (2021-2023) received multidisciplinary care, while the non-exposure group (2018-2020) was managed conventionally by individual specialists. The study aimed to compare clinical outcomes and treatment times between both groups. Statistical analysis was based on the distribution of variables. Results: A total of 34 patients were included. The multidisciplinary approach enabled earlier diagnosis of lung adenocarcinoma, increasing early-stage identification from 30% to 61% between 2018 and 2022. Additionally, the multidisciplinary group had a higher proportion of asymptomatic cases (54% vs. 32%) and a lower relapse rate (7% vs. 52%) compared to conventional management. Treatment initiation times were significantly reduced from 3.2 to 2.2 months (p < 0.05), and the time from pathology to treatment decreased to 30 days in the multidisciplinary group versus 85 days in the conventional group. Conclusions: The multidisciplinary approach reduced waiting times for the initiation of cancer treatment, increased treatment adherence and improved clinical outcomes.
Demographic Characterization of Patients with Pulmonary Arterial Hypertension Group 1 and Group 4 at Fundación Santa Fe de Bogotá from 2017 to 2024: Our Real Life Experience
Introduction: Pulmonary hypertension is a potentially fatal condition; it is considered a public health concern due to its clinical impact. Therapeutic options are available in our setting, however, the lack of diagnostic standardization is undeniable. Objective: To determine the clinical and demographic characteristics of patients diagnosed with pulmonary arterial hypertension in group 1 or group 4. Methods: This is an observational, cross-sectional study. Patients over 18 years of age diagnosed with pulmonary arterial hypertension in group 1 or associated with chronic thromboembolic pulmonary hypertension, confirmed by right heart catheterization, and treated at Fundación Santa Fe de Bogotá between January 2017 and April 2024 were included. Descriptive statistics were applied to characterize and describe the variables. Results: A total of 42 patients were included, with 81% belonging to group 1 and 19% to group 4. 90.4% were women, with a mean age of 62 years. Nearly 70% of the patients were receiving some type of specific vasodilator therapy, either as monotherapy (48%) or in combination therapy (22%). In the differentiation by etiological group, there were statistically significant differences in LVEF (62 ± 0.09% in group 1 vs. 66 ± 0.16% in group 4) (p = 0.02), as well as in terms of SvO2 (64 ± 0.19% vs. 79 ± 0.26%, respectively) (p = 0.003). Conclusions: In patients with pulmonary arterial hypertension, the distribution by sex, age, clinical characteristics, hemodynamic profile, and treatment status was comparable to that reported in international registries outside of Latin America.
Correlation of Cardiac Output by Blood Gas Analysis and Echocardiography in Critical Care Medicine at very High Altitude
Introduction: Cardiac output (CO) is a marker to determine the global hemodynamic state. Its determination by Fick's principle has been used by invasive and non-invasive methods such as simple blood gas analysis (GA), the latter has been displaced by more modern methods. Transthoracic echocardiography (TTE) is a validated and reliable method to determine CO. The objective of this study is to determine if there is a linear relationship between the CO by GA through theoretical formulas and the GC obtained by TEE. Material and Methods: Observational, descriptive, cross-sectional and single-center study. Patients admitted to the Adult Intensive Care Unit of the Hospital del Norte in the city of El Alto at 4,150 meters above sea level were included. The data was tabulated in Excel. Normality tests, Bravais-Pearson correlation, Bland-Altman test were performed with the SPSS Statistics v 29 program; the White test for heteroskedasticity was performed in XLSTAT. The Hospital Bioethics committee approved the study protocol. Results: The Bravais-Pearson r coefficient was 0.60 (95% CI: 0.18 to 0.82; p value 0.007). This relationship increased when we used the formula proposed by this study with r 0.64 (95% CI: 0.23 to 0.84; p value 0.003). We found a linear relationship between stroke volume (SV) and arterial O2 concentration (CaO2) with r 0.8 (95% CI: 0.5 to 0.9; p 0.001). Conclusion: There was a linear correlation of CO by both methods in patients.
Respiratory Function Tests in Alveolar Hypoventilationand Ventilatory Support
The ventilatory pump is responsible for alveolar ventilation (respiratory centers, nerve conduction pathways, neuromuscular joint, respiratory muscles and rib cage). A drop in alveolar minute ventilation is inversely related to arterial values of CO2, so hypoventilation is the cause of hypercapnia. Failure of the ventilatory pump determines hypoventilation and the need for mechanical respiratory assistance (invasive or non-invasive). The use of respiratory functional tests facilitates the correct interpretation of alveolar hypoventilation and making therapeutic decisions. Respiratory function allows prediction of the need for ventilatory support before obvious hypercapnia appears. Likewise, properly interpreted information can offer the clinician bedside keys to making differential diagnoses and may allow a prognostic prediction. This review contributes to understand the respiratory functional disorders linked to hypoventilation, focusing on the interrelation between the indicators of respiratory functional examination tests and the treatment modalities using ventilatory support.
Redefining the Severity of Asthma Exacerbations: Implications and Limitations of the ALAT-SEPAR Consensus
Knowledge, Attitudes and Practices Regarding Sleep-Related Breathing Disorders: a Cross-Sectional Study among General Public
Introduction: Sleep-related breathing disorders (SRBD) are common underdiagnosed conditions with significant health consequences, including cardiovascular complications and impaired quality of life. Globally, disorders such as obstructive sleep apnea affect a substantial proportion of adults and are expected to rise with increasing risk factors like obesity, while remaining largely unrecognized. Objective: To evaluate knowledge, attitudes, and practices (KAP) regarding SRBD among the general population. Methods: A cross-sectional study was conducted over four months (June–September 2024) at Bangalore Medical College and Research Institute, including 250 participants aged ≥18 years. Data were collected using a validated 30-item semi-structured questionnaire assessing KAP domains and analyzed using IBM SPSS Statistics (Version 29.0). Results: Among participants, 56.4% had heard of SRBD, yet 58% did not consider it serious and only 42% recognized its health impact. Knowledge gaps were evident, with 52.4% unaware of diagnostic methods and 48.4% unaware of treatment options. Regarding attitudes, 47.2% would seek medical care and 41.2% were open to treatment, but only 17.6% were willing to undergo polysomnography. In practice, 55.2% avoided risk factors, while 73.2% had never discussed sleep concerns with a healthcare provider. Mean KAP scores showed moderate knowledge, mildly positive attitudes, and poor practices. Conclusion: Significant gaps persist in awareness and health-seeking behaviour related to SRBD. Targeted education, improved screening, and primary care training are essential to enhance early diagnosis and management.
Pleuroscopy as a Diagnostic Method in Patients with Previous Closed Pleural Biopsy without Conclusive Results
Introduction: Pleuroscopy is a minimally invasive technique that explores the pleural cavity and allows taking targeted biopsies of the parietal pleura. It is a highly cost-effective diagnostic method for unexplained exudative pleural effusion (PE). There is little evidence on its use in our region. Material and Methods: This is a retrospective, descriptive study conducted between June 1, 2024, and January 31, 2025. Adult patients hospitalized for pleural effusion with negative cytochemical and cytological studies, and non diagnostic closed pleural biopsy with an Abrams needle were included. Analysis included patients’ demographic data, type of tube used, time until tube removal, and post-procedure discharge, histopathological results, and complications. Results: Fifteen pleuroscopies were performed. A specific histopathological diagnosis was established in 86% (13/15) of the patients in the study, 77.7% (7/9) of the patients with forceps biopsy, and 100% (6/6) of the patients with cryoprobe biopsy. The histopathological diagnoses were malignant neoplasia (8/15), inflammatory/infectious (5/15), and undiagnosed (2/15). One patient with chest wall seroma and one patient with post-procedural respiratory failure were recorded as complications. Conclusions: Pleuroscopy allows taking parietal pleural biopsies under direct vision through a trocar, using forceps and cryoprobes. In this study, we demonstrated that it is a cost-effective and safe diagnostic alternative in patients whose previous fluid analysis and closed pleural biopsy were inconclusive.
Silent Catastrophe: Severe Pulmonary Tuberculosis in Immunocompetent Young Adults – Case Report
Introduction: Pulmonary tuberculosis (TB) remains endemic in Uruguay (37/100,000; mortality 4.2/100,000), and is strongly associated with social vulnerability, overcrowding, and malnutrition. Over the past year, an increase in severe clinical presentations has been observed among young immunocompetent patients, which is unusual in the local epidemiological context. Methods: A retrospective case series was conducted including patients ≤40 years of age, without previous comorbidities, hospitalized for pulmonary TB with severe complications between 2023 and 2024 at Hospital Maciel (Montevideo). Sociodemographic characteristics, prior healthcare consultations, nutritional status, complications, interventions, and clinical outcomes were collected. Results: Eight patients were included (mean age 24 years), all with low socioeconomic status and limited educational attainment. All presented advanced forms of pulmonary TB without resistance to first-line antituberculous drugs. Complications included severe respiratory failure, life-threatening hemoptysis, pyopneumothorax, and pleurocutaneous fistula. Patients required high-complexity procedures such as arterial embolization, pleural drainage, Heimlich valve placement, and pleural window. Two patients died due to severe malnutrition and/or severe respiratory failure. Discussion and Conclusions: Severe pulmonary TB in young immunocompetent patients represents an uncommon clinical profile in Uruguay. Diagnostic delay, social vulnerability, and malnutrition were associated with increased morbidity and mortality, underscoring the need to strengthen early clinical suspicion, improve access to diagnostic tools, and promote health education and social support strategies.
Measuring Sleep: the Role of BMI, Neck Circumference and Sex in the Severity of Obstructive Sleep Apnea
Introduction: Obstructive sleep apnea (OSA) is a respiratory disorder associated with cardiovascular, metabolic complications and impairment of the quality of life. Body mass index (BMI), neck circumference (WC) and sex have been directly related to the risk and severity of the disease. However, in the Dominican Republic there is little information describing these associations in its population. Objective: To evaluate the relationship between BMI, CC and sex with OSA severity as determined by the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). Methods: A cross-sectional study was conducted in adults with suspected OSA, evaluated with home polysomnography. Sociodemographic, anthropometric data and sleep parameters were collected. Pearson correlation analysis and logistic regression models were used to determine associations between variables. Results: The mean age of the participants was 54 years, predominantly male (68.8%), and severe OSA (39.1%). A moderate positive correlation was found between BMI and AHI at 3% (r=0.433, p<0.001) and 4% (r=0.419, p<0.001). CC showed a weaker positive correlation. For each unit increase in BMI, the risk of severe OSA increased by 12% (p<0.001). Sex differences were observed, with higher prevalence of severe OSA in men. Conclusions: BMI constitutes a relevant predictor of severity in OSA, especially in its severe forms, in the Dominican population.
Does COPD and its Exacerbations Truly Impact Cardiovascular and Cerebrovascular Health? Is this Impact Modifiable?
In Argentina, tobacco consumption causes over 47,000 deaths annually, primarily due to cancer, cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), pneumonia, and stroke (CVA). Nearly 7,000 people die from COPD in Argentina each year. It affects 14.5% of Argentinians over 40, with a concerning rate of underdiagnosis. A narrative review of the main scientific databases was conducted between 1996 and 2025. This article aims to analyze why COPD and its exacerbations are risk factors for CVD and CVA, and the preventive strategies that have shown to reduce these risks. Patients with COPD have a higher prevalence of CVD, and its severity correlates with an increased risk of cardiovascular and overall mortality. Acute respiratory infections, such as influenza, respiratory syncytial virus (RSV), SARS-CoV-2, and Streptococcus pneumoniae, associated with COPD exacerbations "per se", significantly increase the risk of cardiovascular and cerebrovascular events. COPD exacerbations drastically raise cardiovascular and cerebrovascular morbidity and mortality for up to a year after the event. To prevent cardiovascular and cerebrovascular impact in patients with COPD, several interventions are crucial. Smoking cessation is the most cost-effective intervention, reducing mortality. Respiratory rehabilitation and regular physical activity (over 10,000 steps daily) improve health and decrease overall, cardiovascular, and respiratory mortality. Vaccination against influenza and pneumococcus significantly reduces the risk of major cardiovascular events and mortality. Finally, inhaled triple therapy in frequent COPD exacerbator patients with >300 eosinophils/µl has shown to reduce mortality and cardiovascular events.
Economic Profile of Asthma in the Dominican Republic
Introduction: Asthma is the most common respiratory pathology worldwide, causing more than 455,000 deaths in 2019. The high cost of treatment is one of the barriers preventing its control. Over 50% of asthma-related costs are due to the 5%-10% of patients with severe disease. This study aims to estimate the current state of asthma in the Dominican Republic, based on its cost. Materials and methods: An observational cross-sectional study was conducted at the Clínica Unión Médica del Norte from February to April 2023. It included patients over 18 years old with asthma treated for at least 12 months who attended the emergency department or pneumology consultation. Results: 34.8% of the patients reported discontinuing medication purchases due to cost. On the other hand, patients with “non-significant” exacerbations had significantly higher medication costs (USD 129) compared to patients with more exacerbations (USD 55.2) (p = 0.046). Conclusions: The economic burden and challenges of asthma management in the Dominican population are revealed, considering the global increase in the disease and its impact on healthcare systems.
Documentary Review of Tuberculosis in the Elderly in Cuba During the Period 1971 - 2020
Introduction: Tuberculosis (TB) persists as a global health problem, with high incidence, prevalence, and mortality in adults over ≥65 age. In Cuba, this group is considered vulnerable by the National TB Control Program. Objective: To analyze the frequency of studies on TB in the elderly in specialty, master's, and doctoral theses in Cuba (1971–2020). Method: A cross-sectional study was conducted based on a narrative review of 67 thesis retrieved from repositories of the "Pedro Kourí" Institute of Tropical Medicine, the Benéfico Jurídico Pneumological Hospital of Havana, and Infomed. Thesis were classified according to whether or not they addressed TB in the elderly. The analysis included absolute/relative frequencies (univariate) and comparison of proportions (χ² test, p < 0.05). Results: 46.3% (31/67) corresponded to specialty degrees, 44.8% (30/67) to master's degrees, and 9.0% (6/67) to doctoral degrees. 62.2% (23/37) of specialty thesis dealt with TB in the elderly, compared to 32.4% (12/37) in master's degrees and 5.4% (2/37) in doctoral degrees. 89.6% (60/67) were developed by physicians, and 100% of those addressing the elderly. Only 27.5% (17/67) were published, with a lower rate in geriatric topics (10.8%, 4/37). 70% (47/67) were developed between 1994–2020, with no significant association between period and focus on the elderly (p > 0.05). Conclusion: Research on TB in the elderly predominates in specialty thesis, with scarce publication and participation of non-physicians. The need to encourage studies and dissemination in this vulnerable population is evident, especially in non-medical postgraduate programs and master's/doctoral degrees.
Lymphatic Vessel Embolization in a Case of Plastic Bronchitis in a Patient with Ebstein´s Anomaly: Therapeutic Resolution of a Complex Case
Introduction: Plastic bronchitis is a rare condition characterized by the formation and expectoration of bronchial casts composed of fibrin, glycoproteins, and cellular debris, which can obstruct the airways and cause recurrent atelectasis. Although most frequently associated with chronic pulmonary diseases, it has also been described in patients with congenital heart disease, particularly after corrective surgery that disrupts lymphatic drainage, such as Ebstein’s anomaly. Recent advances have introduced lymphatic embolization as a promising interventional therapeutic alternative. Case presentation: A 36-year-old woman with chronic heart failure (NYHA III) and Ebstein’s anomaly surgically corrected during childhood presented with productive cough, dyspnea, orthopnea, occasional hemoptysis, and expectoration of bronchial casts. On admission, oxygen saturation was 75%, and chest radiography revealed complete left lung atelectasis. Two bronchoscopies were performed for cast removal, and biochemical analysis confirmed plastic bronchitis. Due to persistent atelectasis, intrapulmonary percussive ventilation was initiated as an airway clearance technique. Lymphangiography demonstrated lymphatic leakage into the left bronchial tree, and selective lymphatic vessel embolization was performed, resulting in complete clinical resolution without recurrence of casts. Discussion and conclusion: Plastic bronchitis in patients with congenital heart disease may arise from lymphatic alterations secondary to prior cardiac surgery. Lymphatic embolization is an effective and minimally invasive therapeutic strategy, positioning itself as an innovative alternative in refractory cases. This case highlights the value of a multidisciplinary approach and supports embolization as a relevant intervention capable of modifying the clinical course of this complex disorder.
Pulmonary Cavities Due to Bladder Cancer
A 69-year-old male patient with a history of high blood pressure and active smoking. He was diagnosed 11 years ago with localized urothelial bladder cancer with invasion of the lamina propria (T1) and without invasion of the muscularis layer. Multiple local interventions were performed, the last one 5 years ago with disease-free follow-up. He consulted in February of this year for a cervical tumor, a computed tomography scan of the neck was requested, showing an infected thyroglossal cyst and right supraclavicular and lower right paratracheal lymphadenopathy. The study was complemented with a computed tomography scan of the chest, abdomen and pelvis, also revealing bilateral pulmonary cavities with thick walls and irregular internal borders. A biopsy of the right supraclavicular lymph node was performed, which was positive for urothelial carcinoma metastasis. The presence of multiple pulmonary cavitary lesions should raise suspicion of metastasis. Cavitation is estimated to occur in approximately 4% of pulmonary metastases, and is most often caused by squamous cell carcinoma. Rarely, low-grade superficial bladder tumors progress directly to metastatic disease without prior evidence of muscle invasion. The development of cavitary lesions in a patient with transitional cell carcinoma of the bladder should raise suspicion of metastatic disease.
Approach to Tobacco Use in Children and Adolescents: Diagnosis, Prevention and Treatment
Introduction: The use of ENDS (Electronic Nicotine Delivery Systems) among children and adolescents has become one of the most relevant emerging threats to public health. Their spread, driven by marketing strategies and appealing flavors, has encouraged a mistaken perception of safety. Evidence shows that early exposure to nicotine and toxic aerosols affects lung development, increases vulnerability to infections, alters neural reward circuits and facilitates the transition to conventional smoking. In Latin America, where regulatory frameworks are weak and surveillance limited, this phenomenon poses challenges for pediatrics, public health and health policies. Methods: A critical analysis of scientific and regulatory evidence was conducted through a structured review of original articles, technical documents and international guidelines, emphasizing recommendations adaptable to the Latin American context. Results: E-cigarette use among adolescents shows a sustained increase. It is associated with early respiratory symptoms, lower academic performance and a higher risk of nicotine dependence. In clinical settings, a comprehensive approach includes: (1) early detection using validated questionnaires, (2) brief motivational counseling, (3) youth-adapted cognitive behavioral therapy and (4) coordination with schools and families. From a regulatory perspective, evidence supports restricting advertising, limiting points of sale and banning appealing flavors for minors. Conclusions: The use of ENDS in adolescents is not a safe alternative to tobacco but an emerging addictive phenomenon threatening to reverse progress in tobacco control.
Report of the First Case of Childhood Pulmonary Tuberculosis Diagnosed by the Xpert® MTB/RIF Ultra in Stool
Introduction: Childhood tuberculosis (TB) is not a health problem in Cuba. However, in recent years, a slight increase in case notifications has been observed. Diagnosis in young children is challenging due to the paucibacillary nature of the samples and the invasive nature of specimen collection. The World Health Organization recommends the Xpert® MTB/RIF Ultra stool test as the initial test for the diagnosis of the disease in this age group. Objective: Presentation of the first case of childhood TB in stool using the molecular assay. Case presentation: A 1.5-year-old asymptomatic female patient with paternal contact with pulmonary TB (drug-sensitive), hyperergic Mantoux syndrome, and retrocardiac radiopacity on chest X-ray. A stool sample was tested using the molecular assay at the National Reference Laboratory for Tuberculosis, Pedro Kourí Institute, with a positive result (traces) for Mycobacterium tuberculosis complex and undetermined resistance to rifampicin. Shortened treatment was initiated with good tolerance, weight gain, and radiological resolution, successfully completing the treatment. Conclusions: Early detection of pulmonary TB allowed healthcare personnel to initiate rapid and targeted treatment, prevent serious complications, and prevent disease spread. A confirmatory diagnosis was obtained for the first time in Cuba in a child under 2 years of age. The usefulness of stool samples for diagnosing childhood TB using the Xpert® MTB/RIF Ultra assay is confirmed, without the need for invasive procedures.
Goodpasture's disease, an alternative diagnosis
Introduction: Goodpasture's disease is an autoimmune disease mediated by anti-glomerular basement membrane (GBM) antibodies. It primarily affects the kidneys and/or lungs. It is rare and can be severe and even fatal if not diagnosed early. Case presentation: A patient with febrile syndrome associated with a dry cough and asthenia received outpatient antibiotic therapy without improvement. Multiple chest CT scans revealed migratory nodular images and a negative rheumatologic profile. Bronchoalveolar lavage revealed no germ development, and percutaneous puncture and video-assisted thoracoscopic biopsy revealed an inflammatory pattern in the sample, without atypia. The patient developed hemoptysis. Anti-glomerular basement membrane antibodies were requested, which were positive, interpreting the condition as Goodpasture's disease. Discussion: Goodpasture's disease is a rare entity. Anti-GBM antibodies can affect both the kidneys, causing rapidly progressive glomerulonephritis, and the lungs, primarily causing alveolar hemorrhage. Between 60% and 80% of patients have clinically evident manifestations of lung/kidney disease, and less than 10% have disease limited to the lungs. Conclusion: Goodpasture's disease, which affects only the lungs, is a rare entity and can mimic other pathologies and become a challenge. Because it is relatively uncommon, the time to diagnosis is longer, leading to a delay in targeted treatment.
Epidemiological Analysis of Infant Deaths from Respiratory Infections and the Influence of Socioeconomic Factors
Objective: To analyze the epidemiological profile of deaths from respiratory infections and detect correlations with socioeconomic factors in Brazil. Methods: This is an analytical ecological epidemiological study of child deaths from respiratory infections between 2014 and 2023 in Brazil. The data was obtained from the Mortality Information System. Death incidence rates, multinomial logistic regressions, and Pearson and Spearman correlations were calculated. Results: A total of 25,729 deaths were detected, the majority caused by unspecified pneumonia. Higher incidences of death were found in breastfeeding infants, in males, in mixed ethnic groups and in children of mothers aged between 20 and 29 years and with a primary level of education. Correlations were found between deaths from acute bronchiolitis in Brazil and the human development index (R = 0.916), the Gini index (R = 0.883) and human resources (R = 0.988) in the pre-pandemic period. High odds ratios of death from influenza and pneumonia were observed among black children (OR: 2.23) and indigenous children (OR: 1.45) during the COVID-19 pandemic, respectively. Conclusions: In Brazil, most deaths from respiratory infections were not confirmed by complementary tests. In addition, the predominance of deaths, especially in vulnerable pediatric populations, may indicate that the deaths were influenced by socioeconomic factors.
Cost Analysis of Hospitalization due to Invasive Pneumococcal Disease (IPD) in a Public Hospital in Buenos Aires
Introduction: There are no direct cost studies of hospitalization for invasive pneumococcal disease (IPD) in Argentina. Objectives: To determine the direct cost structure for patients hospitalized with IPD at a public hospital in City of Buenos Aires in 2022. Methods: We evaluated adult patients hospitalized with IPD in 2022 at a public hospital. Diagnosis was confirmed by positive blood cultures for Streptococcus pneumoniae or CSF. Direct costs were determined from the funder's perspective, based on the hospitalization cost model from the Government of the City of Buenos Aires as of June 2024, using an official exchange rate of 918 pesos per dollar. Results: Of 24 patients with IPD, 83% had pneumonia and 17% had meningitis. The median age was 72 years (IQR 67.5-75); 54% were male; 85% were smokers; and 8.3% had a complete pneumococcal vaccination. A high prevalence of comorbidities was found (median Charlson comorbidity index 6, IQR 5-8). The median length of stay in the emergency room was 1 day (IQR 0.5-1) and 7 days on the ward (4-20). The direct cost was $3,795.91 per patient. The non-modulated direct cost was 25.65% of the total (24.1% for medications; 75.09% for tests). Conclusion: Patients hospitalized with IPD were mostly men over 70 years old with a high burden of comorbidities. Less than 10% had full vaccine coverage. The direct cost from the funder's perspective was $3,795.9 per patient. A quarter of the cost was not modulated. Measures should be intensified to ensure greater vaccine coverage for the at-risk population.
A Not-So-Stray Disease: Pleuroparenchymal Fibroelastosis, a Challenging Diagnosis
Pleuroparenchymal fibroelastosis (PPFE) is a rare disease within the spectrum of diffuse interstitial lung diseases, classified as a rare idiopathic interstitial pneumonia by the American Thoracic Society (ATS) and the European Respiratory Society (ERS). Histologically, it is characterized by fibrosis of the visceral pleura associated with fibroelastic changes in the subpleural lung parenchyma, predominantly in the upper lobes. Its real incidence is unknown, due to underdiagnosis and the lack of standardized diagnostic criteria. This article reports two clinical cases diagnosed with advanced PPFE in a medical center in Montevideo, Uruguay. This condition presents a diagnostic challenge, and its early recognition is crucial as it might be more prevalent than perceived. PPFE should be suspected in patients with pleural thickening associated with upper lobes interstitial involvement, which justifies prompt referral to specialized centers. Given its progressive behavior, negative impact on quality of life, and high mortality, PPFE treatment remains the main challenge for this entity.
ALAT-SEPAR Consensus on the Definition and Classification of Asthma Exacerbations by Severity: a Move toward International Standardization
Asthma exacerbation is a significant clinical event that occurs with varying severity, yet a set of universally accepted standardized definitions is still needed. The aim of this consensus developed by ALAT and SEPAR was to fill this gap with a validated proposal for classifying asthma exacerbations into levels of severity: non-severe, severe, and very severe. The consensus was based on an in-depth review of the literature conducted by the scientific committee to identify key parameters for each level of severity, including worsening symptoms, respiratory function changes, and the need for specific medical interventions. A total of 67 publications were analyzed to generate a questionnaire on the defining elements of asthma exacerbations, and this was put to the vote. Twenty-eight international experts participated in the validation of characteristics and definitions of exacerbation severity following Delphi methodology. The resulting definitions clearly distinguish non-severe exacerbations (requiring minor adjustments in treatment) from severe exacerbations (requiring more intensive interventions, including longer systemic corticosteroid use or hospitalization) and very severe exacerbations (life-threatening events requiring intensive care). These definitions provide a standardized framework that facilitates comparison between clinical trials and optimizes patient care. This consensus lays the foundation for unifying management criteria in global clinical practice and fostering research on the efficacy of asthma treatments. It also underlines the importance of accurate classification in improving clinical outcomes and reducing the overall burden of disease.
Current Strategies for Assessing Lung Function and Managing Respiratory Dysfunction in Amyotrophic Lateral Sclerosis: a Scoping Review
Introduction: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects the motor neurons of the central nervous system. Respiratory failure is the main cause of death in these patients. Objective: To map the recently used strategies (2019–2024) for assessing pulmonary function and managing respiratory dysfunctions in individuals with ALS, identifying emerging advances and their alignment with current clinical guidelines. Methods: A scoping review was conducted following the recommendations of the Joanna Briggs Institute (JBI) and the PRISMA-ScR extension for scoping reviews. The PubMed, Scopus, and Web of Science databases were searched up to March 2024. Original studies published between 2019 and 2024 were included. Results: Of 4,427 records, 28 studies met the inclusion criteria. The most frequent strategies were spirometry, maximal respiratory pressures, capnography/blood gas analysis, non-invasive ventilation (NIV), and cough-assist techniques. Emerging tools such as calculated maximal voluntary ventilation (cMVV), diaphragmatic ultrasound, and pressure at 0.1 second (P0.1) measurement showed clinical potential but require validation. The use of telemonitoring stood out as a complement to home-based NIV management. Conclusions: Although options for respiratory assessment and management in ALS have expanded, international guidelines continue to recommend established methods as the foundation of care. The incorporation of new techniques should be cautious and supported by robust evidence.
Diffuse Cystic Lung Disease. A case report
Lung cysts consist of thin walled, less than 2 millimeters thickness, hyperlucent round lesions with a clear distinction from the surrounding lung parenchyma. Diffuse cystic lung diseases (DCLDs) are classified as multicystic, in the presence of at least ten cysts, and paucicystic if five to nine cysts. The described tomographic pattern is mainly related with lymphoid interstitial pneumonia, lymphangioleiomiomatosis, pulmonary Langerhans cell histiocytosis and Birt-Hogg-Dubé Syndrome.