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Lung ultrasound teaching in medical education: a pilot study at a Brazilian medical school. 医学教育中的肺部超声教学:巴西一所医学院的试点研究。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230382
Gabrielle Turnes Pereira Demetrio, Ana Cristina Burigo Grumann, Mariângela Pimentel Pincelli, Leonardo Jonck Staub

Objective: To evaluate cognitive learning, ability to perform and interpret lung ultrasound exams, and self-perception of learning among medical students after a short pedagogical intervention at a medical school in Brazil.

Methods: An experimental pilot study was conducted with medical students at different stages of their education (basic cycle, clinical cycle, and medical internship). The participants underwent a cognitive test before and after the intervention, a practical test, a test to recognize lung ultrasound pathologies, and a qualitative evaluation test at the end of the intervention. Statistical analysis was performed using a significance level of p < 0.05.

Results: A total of 42 students were included in the study, with a median age of 23 years and a predominance of males. The mean score of the pre-intervention cognitive test was 2.97 ± 0.87, and that of the post-intervention test was 6.57 ± 1.41, showing significant improvement (p < 0.001). The score of the practical test and that of the recognition of pathologies test also showed significant improvement after the intervention. There was no significant difference in execution time between the groups. Students in the clinical cycle had a better self-perception of learning.

Conclusions: Theoretical teaching and practical training of lung ultrasound in a short pedagogical intervention can improve cognitive performance, practical skills, and interpretation of the exam. The level of learning achievement was higher among more advanced students in medical education. Additionally, the students in the clinical cycle had a better perception of their learning.

目的在巴西一所医学院进行短期教学干预后,评估医学生的认知学习、执行和解释肺部超声检查的能力以及自我学习感知:对处于不同教育阶段(基础阶段、临床阶段和医学实习阶段)的医学生进行了实验性试点研究。参与者在干预前后接受了认知测试、实践测试、肺部超声病理识别测试,并在干预结束后接受了定性评估测试。统计分析的显著性水平为 p < 0.05:共有 42 名学生参与了研究,年龄中位数为 23 岁,男性居多。干预前认知测试的平均得分为 2.97 ± 0.87,干预后测试的平均得分为 6.57 ± 1.41,有显著改善(p < 0.001)。干预后,实践测试和病理识别测试的得分也有显著提高。两组学生在执行时间上没有明显差异。结论:在短期教学干预中进行肺部超声的理论教学和实践训练可以提高认知能力、实践技能和对检查的解释能力。在医学教育中,高年级学生的学习成绩水平更高。此外,临床周期的学生对自己的学习有更好的认识。
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引用次数: 0
Lung function and quality of life one year after severe COVID-19 in Brazil. 巴西严重 COVID-19 一年后的肺功能和生活质量。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230261
Tarciane Aline Prata, Arnaldo Santos Leite, Valéria Maria Augusto, Daniel Cruz Bretas, Bruno Horta Andrade, Jaqueline das Graças Ferreira Oliveira, Aline Priscila Batista, George Luiz Lins Machado-Coelho, Eliane Mancuzo, Carolina Coimbra Marinho

Objective: To evaluate symptoms, lung function, and quality of life of a cohort of patients hospitalized for severe COVID-19 12 months after hospital admission.

Methods: This was a cross-sectional study. We included severe COVID-19 survivors hospitalized in one of three tertiary referral hospitals for COVID-19 in the city of Belo Horizonte, Brazil. Participants were submitted to lung function and six-minute walk tests and completed the EQ-5D-3L questionnaire.

Results: The whole sample comprised 189 COVID-19 survivors (mean age = 59.6 ± 13.4 years) who had been admitted to a ward only (n = 96; 50.8%) or to an ICU (n = 93; 49.2%). At 12 months of follow-up, 43% of patients presented with dyspnea, 27% of whom had a restrictive ventilatory disorder and 18% of whom presented with impaired DLCO. There were no significant differences in FVC, FEV1, and TLC between the survivors with or without dyspnea. However, those who still had dyspnea had significantly more impaired DLCO (14.9% vs. 22.4%; p < 0.020) and poorer quality of life.

Conclusions: After one year, survivors of severe COVID-19 in a middle-income country still present with high symptom burden, restrictive ventilatory changes, and loss of quality of life. Ongoing follow-up is needed to characterize long COVID-19 and identify strategies to mitigate its consequences.

目的:评估重症 COVID-19 患者入院 12 个月后的症状、肺功能和生活质量:评估一组因严重 COVID-19 而住院的患者在入院 12 个月后的症状、肺功能和生活质量:这是一项横断面研究。我们纳入了在巴西贝洛奥里藏特市三家 COVID-19 三级转诊医院之一住院的重症 COVID-19 幸存者。参与者接受了肺功能和六分钟步行测试,并填写了 EQ-5D-3L 问卷:整个样本包括189名COVID-19幸存者(平均年龄为59.6 ± 13.4岁),他们只住过病房(96人,占50.8%)或住过重症监护室(93人,占49.2%)。随访12个月时,43%的患者出现呼吸困难,27%的患者出现限制性通气障碍,18%的患者出现DLCO受损。有无呼吸困难的幸存者在 FVC、FEV1 和 TLC 方面没有明显差异。然而,仍有呼吸困难的幸存者的 DLCO 受损程度明显更高(14.9% 对 22.4%;P < 0.020),生活质量也更差:结论:在一个中等收入国家,严重 COVID-19 的幸存者在一年后仍有较高的症状负担、限制性通气变化和生活质量下降。需要持续进行随访,以了解长期 COVID-19 的特征,并确定减轻其后果的策略。
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引用次数: 0
Clinical remission after biologic therapy discontinuation in pediatric patients with severe asthma: a case series from a tertiary center. 儿科重症哮喘患者停用生物制剂治疗后的临床缓解:来自一家三级医疗中心的系列病例。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-27 DOI: 10.36416/1806-3756/e20230405
Giovana De Marchi Castelli, Frederico Friederich, Anasthácia Ferreira Wiemann, Giovana Dos Santos, Paulo Márcio Pitrez
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引用次数: 0
Asthma in the Brazilian Unified Health Care System: an epidemiological analysis from 2008 to 2021. 巴西统一医疗系统中的哮喘:2008 年至 2021 年流行病学分析。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230364
David Halen Araújo Pinheiro, João Victor Hermógenes de Souza, Alberto Fernando Oliveira Justo, Regina Maria Carvalho-Pinto, Fabiano Francisco de Lima, Celso R F Carvalho

Objective: To analyze the number of hospitalizations, the length of hospital stay, and mortality due to asthma, as well as the costs to the Unified Health Care System in Brazil between 2008 and 2021.

Methods: This was a cross-sectional epidemiological study using data from the Information Technology Department of the Brazilian Unified Health Care System. Proportional hospitalization and death rates were estimated per 100,000 population by age, microregion, and year.

Results: The number of hospitalizations and deaths due to asthma decreased from 2008 to 2021 (205,392 vs. 55,009 and 822 vs. 327, respectively). In addition, a between-sex difference was observed in asthma-related hospitalizations in 2008, and more men were hospitalized in 2021 (51.8%). Asthma mortality rates were similar for both sexes (50.0% each) in 2008, and a slight increase was observed in women's deaths in 2021 (52.9%). Even so, approximately one death/day and more than 55,000 hospitalizations were observed yearly, with a mean length of hospital stay of three days. Additionally, the Southeast region allocated more financial resources to asthma-related hospitalizations.

Conclusions: Our results showed that the number of deaths and hospitalizations due to asthma substantially declined during the study period.

摘要分析 2008 年至 2021 年期间因哮喘住院的人数、住院时间和死亡率,以及巴西统一医疗系统的成本:这是一项横断面流行病学研究,使用的数据来自巴西统一医疗系统信息技术部。按年龄、微型地区和年份估算了每 10 万人的住院率和死亡率:结果:2008 年至 2021 年,因哮喘住院和死亡的人数均有所下降(分别为 205,392 对 55,009 和 822 对 327)。此外,2008 年与哮喘相关的住院人数出现了性别差异,2021 年男性住院人数更多(51.8%)。2008 年男女哮喘死亡率相似(均为 50.0%),2021 年女性死亡率略有上升(52.9%)。尽管如此,每年仍有约 1 人/天死亡,超过 55 000 人次住院,平均住院时间为 3 天。此外,东南部地区为哮喘相关住院治疗分配了更多的财政资源:我们的研究结果表明,在研究期间,因哮喘而死亡和住院的人数大幅下降。
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引用次数: 0
Management of pediatric pleural empyema: a national survey of pediatric surgeons in Brazil. 小儿胸腔积液的处理:巴西全国小儿外科医生调查。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-27 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230318
Felippe Flausino, Luiza Maes Manara, Bruna Baioni Sandre, Gilson Nagel Sawaya, Rosemeri Maurici

Objective: To identify how pediatric surgeons manage children with pneumonia and parapneumonic pleural effusion in Brazil.

Methods: An online cross-sectional survey with 27 questions was applied to pediatric surgeons in Brazil through the Brazilian Association of Pediatric Surgery. The questionnaire had questions about type of treatment, exams, hospital structure, and epidemiological data.

Results: A total of 131 respondents completed the questionnaire. The mean age of respondents was 44 ± 11 years, and more than half (51%) had been practicing pediatric surgery for more than 10 years. The majority of respondents (33.6%) reported performing chest drainage and fibrinolysis when facing a case of fibrinopurulent parapneumonic pleural effusion. A preference for video-assisted thoracic surgery instead of chest drainage plus fibrinolysis was noted only in the Northeast region.

Conclusions: Chest drainage plus fibrinolysis was the treatment adopted by most of the respondents in this Brazilian sample. There was a preference for large drains; in contrast, smaller drains were preferred by those who perform chest drainage plus fibrinolysis. Respondents would rather change treatment when facing treatment failure or in critically ill children.

目的确定巴西小儿外科医生如何处理肺炎和副肺性胸腔积液患儿:通过巴西小儿外科协会对巴西的小儿外科医生进行了在线横断面调查,共提出 27 个问题。调查问卷包括治疗类型、检查、医院结构和流行病学数据等问题:共有 131 名受访者完成了问卷调查。受访者的平均年龄为 44±11 岁,超过半数(51%)的受访者已从事小儿外科工作 10 年以上。大多数受访者(33.6%)表示在遇到纤维蛋白脓性气胸旁胸腔积液时会进行胸腔引流和纤维蛋白溶解。只有东北地区的受访者倾向于使用视频辅助胸腔手术,而不是胸腔引流加纤维蛋白溶解术:结论:在这一巴西样本中,胸腔引流加纤维蛋白溶解是大多数受访者采用的治疗方法。受访者更倾向于使用大号引流管;相比之下,使用胸腔引流加纤维蛋白溶解术的受访者更倾向于使用小号引流管。当治疗失败或患儿病情危重时,受访者更愿意改变治疗方法。
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引用次数: 0
Methylprednisolone intravenous pulse therapy for pediatric patients with post-infectious bronchiolitis obliterans: an update. 对感染后阻塞性支气管炎儿科患者的甲基强的松龙静脉脉冲疗法:最新进展。
IF 2.7 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-05-13 DOI: 10.36416/1806-3756/e20230373
Silvia Onoda Tomikawa, Joaquim Carlos Rodrigues, Cleyde Miryam Aversa Nakaie, Luiz Vicente Ribeiro Ferreira da Silva Filho
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引用次数: 0
Diagnosis and treatment of asthma in childhood: an overview of guidelines. 儿童哮喘的诊断和治疗:指南概览。
IF 2.9 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-03-25 DOI: 10.36416/1806-3756/e20240051
Laissa Harumi Furukawa, Laura de Castro E Garcia, Marina Puerari Pieta, Miguel Ângelo de Castro, Leonardo Araújo Pinto, Paulo M Pitrez
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引用次数: 0
Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger. 对 24 个月或以下儿童进行视频荧光屏吞咽研究前后的临床结果。
IF 2.9 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-03-22 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230290
Fabiola Luciane Barth, Deborah Salle Levy, Marisa Gasparin, Cláudia Schweiger, Denise Manica, Camila Dalbosco Gadenz, Paulo José Cauduro Maróstica

Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD).

Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS.

Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002).

Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

目的评估视频荧光屏吞咽检查(VFSS)和治疗性喂养与吞咽干预对口咽吞咽困难(OPD)患儿临床疗效的综合影响:这是一项非对照纵向分析研究,对口咽吞咽困难患者在VFSS前后的情况进行评估。研究对象包括在临床环境中被诊断为口咽吞咽困难(OPD)且年龄小于 24 个月的儿童,他们都接受了 VFSS,以便对 OPD 进行检查和治疗。研究参与者在接受 VFSS 后接受治疗性喂养和吞咽干预,并在儿科吞咽困难门诊接受随访,以监测喂养和吞咽困难。对VFSS前后的呼吸和喂养结果进行了比较:61%的 VFSS(n = 72)观察到穿刺/吸入事件,97%的研究参与者被建议采取治疗性喂养和吞咽干预措施。进行 VFSS 后,接受抗生素治疗的几率降低(OR = 0.007),抗生素治疗持续时间缩短(p = 0.014),住院几率降低(p = 0.024),住院时间缩短(p = 0.025)。口服和肠内喂养相结合比单独口服或肠内喂养更常见(p = 0.002):结论:很高比例的参与者在 VFSS 中表现出渗透/吸入。VFSS后的治疗性喂养和吞咽干预似乎与降低该人群的呼吸系统发病率有关。
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引用次数: 0
Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging. 巴西的肺癌筛查:巴西胸外科学会、巴西胸腔协会以及巴西放射学和诊断成像学院的建议。
IF 2.9 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-03-22 eCollection Date: 2024-01-01 DOI: 10.36416/1806-3756/e20230233
Luiz Fernando Ferreira Pereira, Ricardo Sales Dos Santos, Daniel Oliveira Bonomi, Juliana Franceschini, Ilka Lopes Santoro, André Miotto, Thiago Lins Fagundes de Sousa, Rodrigo Caruso Chate, Bruno Hochhegger, Artur Gomes Neto, Airton Schneider, César Augusto de Araújo Neto, Dante Luiz Escuissato, Gustavo Faibischew Prado, Luciana Costa-Silva, Mauro Musa Zamboni, Mario Claudio Ghefter, Paulo César Rodrigues Pinto Corrêa, Pedro Paulo Teixeira E Silva Torres, Ricardo Kalaf Mussi, Valdair Francisco Muglia, Irma de Godoy, Wanderley Marques Bernardo

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

尽管肺癌(LC)是最常见、最致命的肿瘤之一,但只有 15%的患者能在早期确诊。85%以上的肺癌患者仍是吸烟所致。通过低剂量 CT(LDCT)进行肺癌筛查可将肺癌相关死亡率降低 20%,如果通过 LDCT 进行肺癌筛查并同时戒烟,死亡率可降低 38%。在过去十年中,许多国家已将基于人群的低剂量 CT 作为一项公共卫生建议。尽管仍处于起步阶段,但巴西对这一主题的讨论正变得越来越广泛和必要。为了增加对 LCS 的了解并促进相关讨论,巴西胸外科学会、巴西胸腔镜协会和巴西放射诊断成像学院召集了一个专家小组,为巴西的 LCS 准备建议。本报告中的建议基于对文献的叙述性综述,重点是基于人群的大型研究、系统性综述和国际指南的建议,并经过专家小组的广泛讨论后制定。回顾了以下主题:筛查的原因;吸烟的一般考虑;LC 的流行病学;资格标准;偶然发现;肉芽肿病变;概率模型;LDCT 的最低要求;容积采集;筛查的风险;多学科团队的最低结构和作用;肺 CT 筛查报告和数据系统的实践;筛查的成本与收益;以及 LCS 的未来展望。
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引用次数: 0
Randomized controlled trials: advantages and pitfalls when studying causality. 随机对照试验:研究因果关系时的优势和陷阱。
IF 2.9 4区 医学 Q2 RESPIRATORY SYSTEM Pub Date : 2024-03-22 DOI: 10.36416/1806-3756/e20240052
Diego Caruso, Juliana C Ferreira
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引用次数: 0
期刊
Jornal Brasileiro De Pneumologia
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