​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. Carlos Luna (Hospital de Clínicas, Ciudad Autónoma de Buenos Aires, Argentina) https://orcid.org/0000-0002-9288-096X Dr. Francisco Arancibia (Instituto Nacional del Tórax, Santiago de Chile, Chile) https://orcid.org/0000-0001-5429-5420 ASSISTANT EDITORS Dr. Rogelio Pérez-Padilla (Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Ciudad de México, México) https://orcid.org/0000-0002-1132-5308 Dr. Adrián Rendón (Universidad Autónoma de Nueva León, Hospital Universitario de Monterrey, Nueva León, México) https://orcid.org/0000-0001-8973-4024 Dr. Gustavo Zabert (Universidad Nacional del Comahue, Facultad de Ciencias Médicas (FACIMED), Rio Negro, Argentina) https://orcid.org/0000-0001-9937-4464 Editorial Secretary: Lic. Mercedes Cavallero Edition: Daniel Pereira
Asociación Latinoamericana de Tórax (ALAT)
Letter to the Editor: "Respiratory Incentive Should Still Be in Use? Narrative Review"
Copyright (c) 2025 Respirar https://creativecommons.org/licenses/by/4.0
A Firm Step toward Coordinated Management of COPD in Latin America
Fever as the First Clue: an Atypical Case of Occult Brown Tumor
A 46-year-old asian male presented with throat pain, hoarseness, dry cough and persistent high-grade fever unresponsive to antibiotics. Imaging showed left upper lobe consolidation and bronchoscopy revealed no infectious cause. Although the patient initially improved with intravenous antibiotics, fever recurred post-discharge, prompting further evaluation. Imaging identified multiple lytic bone lesions, initially suggestive of malignancy. However, bone biopsy revealed osteitis fibrosa cystica (Brown tumor), indicating metabolic bone disease. Laboratory tests showed markedly elevated parathyroid hormone (PTH) levels with high-normal serum calcium, confirming primary hyperparathyroidism. PET-CT and parathyroid scintigraphy localized a left inferior parathyroid adenoma. Surgical resection of the adenoma led to normalization of PTH levels and resolution of systemic symptoms, including fever. This case highlights fever as an atypical presentation of primary hyperparathyroidism and underscores the importance of considering endocrine disorders in cases of pyrexia of unknown origin, especially when conventional infectious and malignant causes are excluded.
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.
Addressing the Challenges of COPD in Latin America: Questions and Answers Based on the GRADE Methodology
Introduction: Chronic obstructive pulmonary disease (COPD) represents a major public health challenge in Latin America, contributing substantially to morbidity and mortality. This document seeks to provide evidence-based recommendations for the diagnosis and treatment of COPD in Latin America, tailored to the specific needs and resources of the region. Its purpose is to serve as a guide for healthcare professionals in their efforts to improve the quality of life of people with COPD. Methods: An executive committee for the recommendations was established, consisting of four pulmonologists from the COPD Department of ALAT and two clinical epidemiologists. Representatives of national pulmonology societies and representatives of ALAT scientific departments formulated clinical questions, and twelve questions were selected based on their relevance to the Latin American context. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to evaluate the available evidence and formulate recommendations. Results: Recommendations were obtained in 12 PICO questions divided into four sections: secondary prevention, prognosis I, prognosis II and therapeutics. Conclusions: The objective of this document is to provide recommendations for the diagnosis and treatment of COPD relevant to Latin America, applicable to specialists and primary care physicians, with the goal of reducing the healthcare impact and costs associated with the disease.
EBUS-L in a Latin American Interventional Respiratory Endoscopy Center: Diagnostic Performance, Correlation with PET SUV and Lymph Node Size. A Real-Life Study
Introduction: This study presents the experience with linear endobronchial ultrasound (EBUS-L) in the Interventional Respiratory Endoscopy Unit of Hospital Maciel from November 2019 to February 2023. Methods: A total of 122 procedures were analyzed, with the primary objective of EBUS being the staging and diagnosis of bronchopulmonary cancer, which accounted for 49.1% of the cases. Results: The analysis focused on the correlation between malignant etiology and two main variables: the size of the lymphadenopathy and its standardized uptake value (SUV). Notably, a high rate of adequate samples (98.4%) was achieved and a statistically significant relationship was found between lymphadenopathy ≥ 15 mm, an SUV in PET-CT ≥ 3.75, and malignant etiology. Conclusion: The findings indicate that EBUS-L is an effective tool for the staging and diagnosis of bronchopulmonary cancer, particularly in cases with larger lymphadenopathy and elevated SUV values.
Idiopathic Follicular Bronchiolitis Presenting as Diffuse Cystic Lung Disease: Case Report
Idiopathic follicular bronchiolitis (FB) is a rare entity, whose manifestation as diffuse cystic lung disease is unusual. This case highlights the importance of its recognition in the differential diagnosis. We present the case of a 48-year-old, non-smoking, immunocompetent woman with chronic cough and progressive dyspnea. High resolution computed tomography revealed multiple pulmonary cysts, ground glass and mosaic attenuation. Functional tests showed severe obstruction with no bronchodilator response. Autoimmune diseases, immunodeficiencies and infections were ruled out by microbiological, serological and autoimmune studies. A surgical biopsy confirmed follicular bronchiolitis. Treatment with mycophenolate mofetil, prednisone and inhaled corticosteroids with long-acting beta-2 agonists was initiated, with clinical improvement. This case highlights the importance of including FB in the differential diagnosis of diffuse cystic lung diseases and the relevance of surgical biopsy to avoid misdiagnosis and optimize management. More evidence is needed on its evolution and response to immunosuppression in adults.
Clinical-Epidemiological Characterization, Radiological, Functional, Bronchoscopic, Cytological and Microbiological Findings of Patients with Bronchopulmonary Anthracosis, Honduras
Introduction: Bronchopulmonary anthracosis is the presence of black pigment in the bronchi and lung parenchyma, which can cause destruction, deformity, symptoms and alterations in lung function. The objective of this study is to describe the clinical and imaging findings of a series of patients with bronchoscopic findings of anthracosis. Methods: A descriptive cross-sectional study was conducted from August 2022 to July 2023. All adult patients with anthracosis on bronchoscopy had their medical records collected, including sociodemographic variables, symptoms, and radiological and spirometric patterns. Bronchopulmonary anthracosis was classified as mild, moderate, and severe. Microbiological and pathological studies of bronchial aspirates were performed. Results: A total of 133 patients were studied, 75 (56.4%) of whom were women, predominantly aged 51 to 70 years, and 63 (47.4%) were housewives exposed to biomass smoke. Chronic cough and dyspnea were the main symptoms, occurring in 118 (88.7%) and 114 (85.7%) patients, respectively. A reticular radiological pattern was found in 63 (47.4%) patients, and spirometry revealed the most frequent abnormal patterns: obstructive 18 (28.6%) and suggestive of restriction 11 (17.4%) patients. Tuberculosis was diagnosed in 36 (27.1%) patients and pulmonary neoplasia in 3 (2.2%) patients. Conclusion: In this group of patients with bronchopulmonary anthracosis, chronic exposure to biomass smoke was the most likely causal factor, manifesting with chronic respiratory symptoms and variable radiological and functional respiratory patterns. Tuberculosis was a common finding, so it is necessary to investigate the effect of anthracosis on local defense mechanisms and the lung microbiome.
Regarding Rare Conditions: Pulmonary Hernias
Introduction: Pulmonary hernia is the abnormal protrusion of lung parenchyma through a defect in the chest wall. It is a rare entity; approximately 300 cases have been reported since its first description. It represents a diagnostic-therapeutic challenge and a correct understanding will allow providing an adequate approach to this entity. Methodology: A narrative review of the literature was carried out through the PubMed search engine of the Medline database, using the terms pulmonary hernia, lung herniation and chestwall hernias. From the results obtained, the abstracts of the related documents were analyzed and a total of 38 references were selected, from which the information for this manuscript was extracted. Results: Lung hernias are classified according to their location and etiology; etiology can also be classified as spontaneous, traumatic or pathological. There are different risk factors that predispose patients to this entity, such as anatomical defects of the chest wall or pathologies that increase intrathoracic pressure. Therapeutic options include expectant management with follow-up and surgical management, which seeks a definitive correction of the hernia defect by using different suturing or tissue coping techniques, as well as the use of materials such as meshes. Conclusions: Pulmonary hernias, despite being rare, do exist, which is why thoracic surgeons play a fundamental role in the prevention, diagnostics and management of this entity. The limited literature found recommends surgical management over conservative management, even in asymptomatic patients, and in our opinion, we agree with this statement.
Yield of Cutting Needles versus Abrams Needles in Ultrasound-Assisted Pleural Sampling in Patients with Pleural Effusion under Study. Case Series
Introduction: Pleural biopsies are of great diagnostic utility for the study of pleural pathology. Abrams needles continue to be widely used. However, a higher profitability of cutting needles is described, due to technical differences in sample collection. The objective of our study is to compare the profitability of pleural tissue collection by cutting needles versus ecologically assisted Abrams needles. Material and Methods: We conducted a retrospective, observational study comparing the cost-effectiveness of pleural tissue collection using sharp needles versus traditional Abrams needles, all assisted by ultrasound. Pleural biopsies performed during 2023 by a single operator trained in both techniques were selected. Sixty-nine patients with exudative pleural effusion who required pleural biopsies as part of the diagnostic procedure were included. 19 were sharp needle biopsies and 50 were Abrams needle biopsies. A descriptive study of the results was conducted. Results: Pleural needle biopsies obtained pleural tissue in 79% of cases and Abrams needle biopsies obtained 68%. The most frequent diagnoses obtained with the sharp needle were: neoplasia (20%), TB (26.6%) and nonspecific chronic inflammatory disease (53.3%). The most frequent diagnoses obtained with the Abrams needle were: neoplasia (55.8%), TB (17.6%) and nonspecific chronic inflammatory disease (26.4%). Chi-square test (P = 0.38) showed no statistically significant difference. Conclusions: There was no significant difference between the two techniques, thus presenting a valid alternative to ultrasound-assisted closed pleural biopsies without affecting our diagnostic yield.
Diagnostic Value of PUMA E-Tool in Prospective Case Finding of COPD in Primary Care: A Real-World Implementation Analysis
Background COPD is a major cause of morbidity and mortality worldwide. Underdiagnosis is frequently reported since spirometry is not widely available in primary care settings. Therefore, a simple and accessible questionnaire-based strategy to select individuals for mandatory spirometry is desirable. Methods: A cross-sectional study was performed to determine COPD prevalence among high-risk patients in five primary care facilities in Argentina and to assess the utility of PUMA score embedded in an electronic tool. Sample size was estimated between 683 to 893 cases for a prevalence of 20- 30% (with a CI of 95%), respectively. Results: Over a 3-month period, a total of 866 patients were surveyed, with 836 meeting the inclusion criteria. The PUMA score was ≥ 5 in 503 patients and 440 patients underwent spirometry. Sixty-three patients were excluded (52 did not attend spirometry, 8 refused to participate and 3 for safety reasons). Spirometry diagnosed 120 cases of COPD, representing a COPD prevalence of 27.3% in the study population and 23.5% in the subgroup of patients with a PUMA score ≥ 5. Conclusion: The PUMA score embedded in an electronic tool performed appropriately to select cases to diagnose COPD by spirometry in a primary care setting.
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.
Comparison of Oxygen Saturation Values between Apple Watch Ultra® and Conventional Commercial Oximeters in Pediatric Patients with Cardiopulmonary Disease Treated at Mario Catarino Rivas Hospital, January–June 2024
Introduction: Accurate monitoring of oxygen saturation (SpO2) and heart rate (HR) is essential in the management of pediatric patients with cardiopulmonary diseases. While commercial pulse oximeters are the standard for noninvasive monitoring, wearable devices such as the Apple Watch Ultra® have gained popularity as potential alternatives. Objective: This study aims to compare the accuracy of oxygen saturation (SpO2) and heart rate (HR) measurements between the Apple Watch Ultra® and conventional commercial pulse oximeters in pediatric patients with cardiopulmonary diseases. Methods: A cross-sectional analytical study was conducted in 137 pediatric patients (1 month to 17 years of age) diagnosed with cardiopulmonary diseases. Measurements were obtained using both the Apple Watch Ultra® and a Masimo SET® pulse oximeter. Lin's concordance correlation coefficient (CCC) and Spearman/Pearson correlation were used to assess agreement and correlation. Results: The CCC for SpO2 measurements was 0.88, indicating high agreement between devices. The CCC for heart rate was 0.99, with a strong correlation (r = 0.986). There were no significant differences in SpO2 values ​​between devices (p = 0.67). Conclusion: Apple Watch Ultra® provides reliable heart rate and SpO2 measurements, making it a reliable alternative in the absence of a pulse oximeter.
Availability and Access to Respiratory Vaccines in Latin America: Report of the Latin American Forum of Respiratory Societies 2024
Introduction: Latin America faces a high burden of preventable respiratory diseases, with influenza, COVID-19, respiratory syncytial virus and pneumococcal being the main causes of morbidity and mortality. While many countries have implemented immunization programs, coverage varies, reflecting disparities in access to vaccines. Material and Methods: The Asociación Latinoamericana de Tórax (ALAT) and FOLASOR sent a survey to all member societies asking about access, availability, guidelines used, financing of respiratory vaccines, coverage, cold chain control and the role of pulmonology societies in decision-making in National Immunization Programs. A representative of each member society presented the information collected during the ALAT Congress in July 2024. Results: 14 of 19 member societies presented situational information for each country. Vaccination schedules do not vary much between countries by adapting PAHO/WHO or ACIP/CDC guidelines in their programs, but the availability and coverage of different respiratory vaccines varies significantly. Most respiratory vaccines are available and their financing is the direct or indirect responsibility of the state, although in many countries it is through private practice. The control of the cold chain is the responsibility of the state. Pulmonary societies are not taken into account in decision-making. Conclusions: Access to and availability of respiratory vaccines is adequate in the region, but there is heterogeneity in their coverage. The active participation of pulmonology societies in decision-making on respiratory vaccines is necessary.
Systemic Impact of Prolonged Corticosteroid Therapy in Asthma Patients: a Case Series
Objectives: To determine, in patients with bronchial asthma and prolonged use of systemic corticosteroids (CS), the endocrinological impact on the hypothalamic-pituitary-adrenal axis and the clinical impact on target organs. Methods: Retrospective analysis of medical records of asthmatic patients treated with systemic CS and referred to pulmonology clinics. They were evaluated by an endocrinologist to assess the clinical and endocrinological impact. Conventional statistical methods were used. Results: A total of 12 patients were included (66.6% female, median age 41 years), of which 66.6% had childhood-onset asthma and 33% were smokers. Only 8% had controlled asthma with a median ACT score of 13. CS use averaged 24 months, with baseline cortisol abnormalities in 100% of patients. The adrenal axis recovered in 75% of cases after 12 months. Three patients (25%) did not recover adrenal function. Clinically, there was pyrosis/reflux (66.6%), hypertension (41.6%), osteopenia/osteoporosis (33.3%), obesity (33%), and diabetes, glucose intolerance, or cataracts in 8%. Conclusion: Prolonged CS use in poorly controlled asthmatic patients led to adrenal insufficiency in all cases, with recovery in 75% after one year. Significant clinical impacts were observed in cardiovascular, bone and gastrointestinal systems. It is recommended to educate patients and healthcare providers about the deleterious effects of CS, to improve adherence to preventive treatment and consult endocrinology when considering discontinuing it.
Cutaneous Metastasis as First Manifestation of Lung Adenocarcinoma: Case Report
Introduction: Lung adenocarcinoma is a neoplasm whose main types of dissemination are bone, hilar, brain and adrenal. Cutaneous metastasis occurs in 0.7-12% and generally has a more aggressive clinical course and poor short and long-term prognosis. Clinical case: A 62-year-old male with a 1-year history of clinical symptoms characterized by a progressive increase in the size of a 2x2 cm pearly tumor in the right nostril, with no other associated symptoms, whose biopsy describes metastatic adenocarcinoma of probable pulmonary origin. After 5 months, he begins to lose 34% of total body weight, cough with hemoptoic sputum, dysphonia and cervical adenopathy. Discussion: The skin is an unusual site of neoplasia metastasis, although within these the lung represents 24% of cutaneous metastases in the male sex. In these cases, it is usually associated with advanced stages of the disease and the appearance of the lesions can mimic benign lesions, particularly if it is a single lesion, with the most common manifestation being a firm, painless nodule. Conclusion: Cutaneous metastasis of lung cancer is an indicator of poor prognosis, with an estimated overall survival of 12-18 months without treatment, however, new therapies targeting mutations such as the identification of the deletion of exon 19 of Epidermal Growth Factor Receptor (EGFR) and the use of Osimertimib have changed the survival paradigm up to 38 months.
Pulmonary Fibrosis and the Antisynthetase Syndrome: a Case Report
Antisynthetase syndrome is a rare disease that usually presents with different degrees of muscle, skin, joint and lung involvement depending on the profile of autoantibodies involved in its pathogenesis. Lung involvement can be serious and have a progressive fibrosing pattern with important prognostic and therapeutic implications, so its early detection through timely screening based on high-resolution chest tomography and respiratory functional study is essential. The clinical case of a patient with a diagnosis of anti-Jo1 positive inflammatory myopathy refractory to multiple immunosuppressive treatments that establish subacute respiratory failure is presented, leading to the diagnosis of fibrosing interstitial lung disease and presenting a good response to treatment with nintedanib.
Quantification and Association of Electronic Cigarette Use with Mental Health in the Dominican Republic: a Cross-Sectional Study.
Introduction: Electronic cigarettes (ECs) were invented to reduce risks for smokers; however, they have gained popularity among populations that previously did not smoke. This, combined with their effects on physical health, has led to studying the long-term consequences for consumers, including impacts on mental health. Methods: A cross-sectional study was designed using a non-parametric snowball sampling method. Data was collected between December 2023 and June 2024 in the Dominican Republic using a mixed survey approach: in-person and online. Results: A sample of 501 participants who had used ECs in the past 90 days was obtained. Of these, 63% were men, with a median age of 22. Participants with a history of mental illness showed higher consumption intensity compared to those without a history (66.7% vs. 62.0%, p = 0.019, OR = 1.66). Similarly, higher suicidal ideation (62% vs. 38%, p = 0.011, OR = 2.22) was observed among those with high-intensity consumption compared to low-intensity users. Conclusion: There is a clear association between EC use intensity and mental health outcomes. Longitudinal studies are recommended to establish causality and develop policies to reduce EC use in the Dominican Republic.
Effect of OM-85 in Reducing Pediatric Recurrent Respiratory Infections in a Real-World Setting
Introduction: Acute respiratory infections (ARI) represent an important health problem in the pediatric population. Possible preventive strategies include the use of bacterial lysates. The efficacy of the lyophilized bacterial extract OM-85 has been reported in several clinical studies, but little real-world data are available. Our objectives were to verify the effectiveness of OM-85 in reducing the number of visits for ARI and antibiotic use, and to compare the results in terms of recurrent respiratory infections (rRTI: ≥ 6/year) with a control cohort. Methods: From a database of 13229 pediatric patients, 108 children treated with 3 complete cycles of OM-85 were identified. By stratified sampling, a control group with similar baseline characteristics was formed. Results: The median number of visits for ARI was significantly reduced from 5 (interquartile range [IQR]: 2.75-7) before OM-85 administration to 1 visit (IQR: 0-2), independent of sex, age group or exclusive breastfeeding (EBF). The number of courses of antibiotics was significantly reduced from 1.63/patient to 0.71/patient, independent of sex, age or history of EBF. The prevalence of rRTI was significantly reduced from 39.81% to 4.62%, while it remained stable in the control cohort (48.14%). Conclusion: In real pediatric practice settings in Peru, OM-85 was associated with reduced incidence of ARI, antibiotic use and rate of patients with recurrent ARI. The reduction of rRTI rate in this population is especially highlighted.
Severe Asthmatic Crisis in the Intensive Care Unit: Clinical, Epidemiological and Evolutionary Characteristics.
Introduction: Asthma is a chronic inflammatory disease that causes respiratory exacerbations that can be life threatening. Knowing the characteristics and triggers of patients with severe attacks is essential for proper management. Methods: This retrospective, observational and descriptive study included patients over 18 years old who were admitted to the Intensive Care Unit of Maciel Hospital (Montevideo, Uruguay) with a diagnosis of severe asthma crisis between June 1, 2016, and May 31, 2023. Results: 61 patients were included, with a mean age of 47.8 ± 16.5 years. 92% had prior emergency consultations and 55.7% had previously required admission to intensive care. 93,4% were not immunized and 80.3% had no prior pulmonary follow-up. All patients required ventilatory support, 48 (78.7%) invasively and 13 (21.3%) non-invasively. Infections were the main cause of decompensation in 49.3% of cases, with viruses being the most common etiology (63.3%). The main complications were infections (13.1%), followed by hypokalemia (11.5%), cardiorespiratory arrest (8.2%), quadriparesis (4.9%) and pneumothorax (4.9%). The median length of stay was 5 days, with only 1 patient dying (mortality rate of 1.6%). 16.4% required readmission to intensive care within 6 months. Conclusions: Most patients are young, with few follow-ups during stable phases and low immunization rates. They have high ventilatory support requirements but a short ICU stay and low mortality. Achieving adequate control and treatment adherence during stable phases is essential to prevent severe crises.
Volume of Pleural Effusion Measured by Ultrasound and Tomography: Are there Differences?
Introduction: Pleural effusion (DP) is the accumulation of fluid in the pleural space. Computed tomography (TAC) is considered the standard for its quantification; however, lung ultrasound (USP) is presented as a viable alternative. Objective: To compare the measurement of DP volume obtained by USP and CT in hemodynamically stable patients without mechanical ventilation. Methods: A descriptive, cross-sectional and observational study was performed in 24 patients at Hospital Militar Central No. 1 of La Paz, Bolivia. DP volume was evaluated with Balik technique for USP and the Hazlinger technique for TAC. Correlation and concordance between both methods was analyzed using Pearson's correlation test and Bland-Altman diagram. Results: Mean age was 60.08 years, with a male predominance (66.7%). Systemic arterial hypertension was the most frequent comorbidity (50.0%), bacterial pneumonia was the main etiology (50.0%). The mean DP volume measured with USP was 861.8 mL and the mean volume measured with CT was 697 mL. Pearson's correlation revealed a significant correlation (p < 0.001), with a high positive correlation (r = 0.796), however, Bland-Altman analysis indicated a lack of perfect agreement. Conclusion: The Balik technique by LUS is reliable for estimating DP volume in hemodynamically stable patients without mechanical ventilation.
Strategies for Assessing Adherence to Inhalation Therapy. State of the Art on Health Care Utilization and Economic Costs
Inhalation therapy (IT) has significantly progressed in recent decades thanks to technological developments and research. This intervention is a key pillar in the comprehensive management of symptoms of obstructive diseases such as chronic obstructive pulmonary disease and asthma. Like any treatment, IT faces several threats that can undermine its benefits. Poor adherence, as well as inadequate drug administration techniques, are aspects that need to be monitored and corrected to promote the positive effects of IT. In this review, we addressed the potential impact of low adherence to IT on health expenditures, mentioning the different methodologies used to measure adherence.
Breathing, Heart and Positioning: the Complex World of Kartagener Syndrome in a Clinical Case from Ecuador
Kartagener syndrome is an autosomal recessive disease that affects approximately 1 in 10,000 to 30,000 individuals worldwide. It is part of the primary ciliary dyskinesia spectrum, characterized by the classic triad of situs inversus, bronchiectasis, and chronic sinusitis, due to the dysfunction of cilia responsible for mucus transport and proper organ positioning during embryonic development. Patients present with chronic respiratory symptoms from infancy, such as recurrent infections in the sinuses and lungs, persistent cough and respiratory difficulties. Diagnosis is based on clinical symptoms and genetic or microscopic tests confirming ciliary dysfunction. Management is symptomatic, focusing on controlling infections and improving quality of life through respiratory physiotherapy and antibiotics. A case is presented of a 31-year-old male diagnosed a year ago at Monte Sinai General Hospital. Throughout his life, the patient experienced recurrent respiratory infections and was diagnosed with bronchiectasis and a positive culture for Pseudomonas aeruginosa. In April 2024, he was admitted with complicated pneumonia and respiratory failure, passing away within 72 hours due to complications such as sepsis and multiple organ failure. This case highlights the severity and complications associated with Kartagener syndrome, emphasizing the need for comprehensive medical care.
Diagnostic Performance of Genexpert Ultra in Bronchoalveolar Lavage for Pulmonary Tuberculosis, Hospital Luis Uría de la Oliva
Introduction: Genexpert ultra as a molecular biology method provides rapid and early diagnosis in tuberculosis (TB) by identifying resistance to rifampicin. The culture has high sensitivity with slow growth of mycobacteria delaying early diagnosis of TB. Objectives: Demonstrate the diagnostic performance of Genexpert ultra in bronchoalveolar lavage (BAL) in patients with pulmonary TB and compare with the TB culture in BAL at the Luis Uría de la Oliva Hospital. Material and methods: Prospective study, carried out between January and December 2023; 43 samples from patients with suspected active TB disease were analyzed, BAL was performed for TB detection by Genexpert MTB / RIF ultra and BAL culture in Ogawa solid medium. Results: Of 43 patients who underwent flexible bronchoscopy, Genexpert ultra on BAL detected TB in 42 samples (97.7%) and did not detect TB in 1 sample (2.3%); in BAL culture, 32 samples (74.4%) were positive and 11 (25.6%) were negative with a p:0.5. Comparing Genexpert ultra on BAL with BAL culture, there is a sensitivity (S) of 97.6% with a Positive Predictive Value (PPV) of 100% of diagnostic performance for Genexpert MTB/RIF ultra on BAL. Conclusion: Genexpert ultra on BAL has a better diagnostic performance for pulmonary TB compared to Ogawa solid medium culture on BAL, with S 97.6% PPV 100%, compared to BAL culture S 74.4%, PPV:100%.
EQ-5D as a Tool to Evaluate Quality of Life of Rib Osteosynthesis
Objective: Rib fixation for flail chest has been shown to improve in-hospital outcome, but little is known about the treatment of multiple rib fractures and long-term outcome is poor. The objective of this study was to describe the safety and long-term quality of life after rib fixation. Methods: A prospective study was conducted that included all adult patients with blunt chest trauma who underwent rib fixation for flail chest or multiple rib fractures between March 2021 and March 2024 in the chest surgery service. Results: Of the 140 patients admitted with multiple rib fractures or flail chest, 69 (49.2%) underwent rib fixation; 14 patients with unstable chest (rib volet) and 55 patients with multiple rib fractures with an ISS of 29 and 22, respectively; 71 (50.7%) patients remained in the control group. The EQ-5D of the operated group was 0.87 compared to the control group, which was 0.71. Three (4.3%) patients had implant-related complications and 3 (4.3%) had their prosthesis removed. Conclusions: We demonstrated that rib fixation is a safe procedure and that patients reported a higher long-term quality of life in the operated group compared to the control.
Factors Associated with Successful Closure of Postpneumonectomy Bronchopleural Fistula in Patients with Empyema in a Hospital in Lima, Peru
Objective: To evaluate the factors associated with the closure of the postpneumonectomy bronchopleural fistula in patients with empyema. Methods: Analytical observational study in which 28 medical records of patients undergoing surgical management of post-pneumonectomy bronchopleural fistula (BPF) were evaluated. Results: The mean age was 43 years ± 12, the male sex was the most frequent (85.7%). The association of the right BPF and failure to close showed a Chi2 of 6.25 (p= 0.01); and regarding the association of the length of the bronchial stump greater than or equal to 1.5 cm and the success in closing the BPF, a Chi2 of 9.17 was obtained (p= 0.002). Conclusions: The type of surgical management, the length of the bronchial stump and the left location of the BPF were factors associated with successful closure of the postpneumonectomy BPF in this study.
Surgery Following Induction (Neoadjuvant) Therapy with Pembrolizumab in Lung Adenocarcinoma with High PD-L1 Expression
A case of a patient with lung adenocarcinoma with high PD-L1 expression initially not eligible to surgery due to advanced stage is reported. After induction with pembrolizumab, bilateral surgery was perfomed. Invasive staging is necessary to define the clinical stage and is particularly important in the case of proceeding to post-induction surgery due to the high rate of false negatives of imaging methods. Molecular study including mutations and membrane expression molecules of biopsies is of utmost importance to offer patients the best treatments. The use of targeted therapies instead of conventional chemotherapy has improved survival in lung cancer. Surgery should be initially considered in strategic treatment planning.
Respiratory Incentive Should Still Be in Use? Narrative Review
The respiratory incentive therapy (RI) is frequently prescribed as an adjunct to pulmonary rehabilitation (PR). Although it is known that this device lacks solid evidence to justify its prescription, it is constantly used in clinical practice. This has led to inappropriate use with poor practices that lack evidence. Therefore, a paradigm shift is required regarding its routine prescription. In this narrative review, we update the evidence on the practice of RI in different pulmonary conditions. We describe from the scientific evidence, the most important effects and the clinical impact. Flow-oriented RI does not generate significant effects. Conventional therapy appears to be sufficient in terms of prevention and rehabilitation of pulmonary complications.
Clinical Practice Guideline of Severe Asthma, ALAT 2024
Asthma affects millions of people around the world, including Latin America. Severe asthma is often underdiagnosed, with difficulty in both access to appropriate treatment and access to quality health services and there is a low level of education on its management; this has a significant impact on morbidity and mortality and quality of life of patients. In the year 2020 we elaborated the ALAT Severe Asthma GUIDE, considering the need to update and develop new recommendations, we present this document based on the best available evidence to the year 2024. In this new Guideline 2024, the recommendations have been based on the best available evidence and have been agreed upon by a group of experts representing most of the Latin American medical societies that are members of ALAT. The modified Delphi panel was used to achieve an appropriate level of consensus for each of the recommendations included in this CPG. Six new topics were included, such as the role of inhaled triple therapy in the definition of severe asthma, the new concepts of asthma remission and treatment failure, the identification of risk factors for exacerbations, the efficacy and safety of biologics in the treatment of adults with severe corticosteroid-dependent asthma and, finally, the efficacy and safety of anti-TSLP antibodies (tezepelumab). A specific guideline for the management of severe asthma is essential to improve diagnosis, standardize treatments, reduce inequalities in care and strengthen health systems by making more efficient use of available resources.