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La auscultación pulmonar es parte fundamental del examen físico para el diagnóstico de las enfermedades respiratorias. La estandarización que ha alcanzado la nomenclatura de los ruidos respiratorios, sumado a los avances en el análisis computacional de los mismos, han permitido mejorar la utilidad de esta técnica. Sin embargo, el rendimiento de la auscultación pulmonar ha sido cuestionado por tener una concordancia variable entre profesionales de la salud. Aun cuando la incorporación de nuevas herramientas diagnósticas de imágenes y función pulmonar han revolucionado la precisión diagnóstica en enfermedades respiratorias, no existe tecnología que permita reemplazar la técnica de auscultación pulmonar para guiar el proceso diagnóstico. Por una parte, la auscultación pulmonar permite seleccionar a aquellos pacientes que se beneficiarán de una determinada técnica diagnóstica, se puede repetir cuantas veces sea necesario para tomar decisiones clínicas, y frecuentemente permite prescindir de exámenes adicionales que no siempre son fáciles de realizar o no se encuentran disponibles. En esta revisión se presenta el estado actual de la técnica de auscultación pulmonar y su rendimiento objetivo basado en la nomenclatura actual aceptada para los ruidos respiratorios, además de resumir la evidencia principal de estudios de concordancia de auscultación pediátrica y su análisis objetivo a través de nueva tecnología computacional.

Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.

This article states that the incorporation of ethical issues such as bioethics and principles of good practice, facilitates the academic management in a Faculty of Medicine. It presents some interesting aspects necessary to carry out a quality academic management that serves the university mission and its educational and research project. It underlines good practices regarding not only professional relations but also organizational aspects. It includes an analysis of academic management and its association with quality and leadership, it reflects on the ethical values of quality work and on the theory of functional or interactional leadership, a key element to boost the development of a university health institution.

This article states that the incorporation of ethical issues such as bioethics and principles of good practice, facilitates the academic management in a Faculty of Medicine. It presents some interesting aspects necessary to carry out a quality academic management that serves the university mission and its educational and research project. It underlines good practices regarding not only professional relations but also organizational aspects. It includes an analysis of academic management and its association with quality and leadership, it reflects on the ethical values of quality work and on the theory of functional or interactional leadership, a key element to boost the development of a university health institution.

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Catolica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comite Nacional de Acreditacion de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.

The work environment of an organization has to do with a set of permanent qualities that are experienced by its members.To assess the work environment perception of faculty members of a Medical School in two different periods (2005 and 2007).A standardized survey was applied to faculty members and Department chairs of the academic units of our Medical School. The survey used the Likert scale from 1 to 5 and included 59 items, distributed in 8 factors. Additionally, there were two groups of statements, indicating the priorities for the School and for the academic departments.In the study performed in year 2005, the survey was answered by a total of 399 faculty members (68%) and in year 2007, it was answered by 408 members (68%). The global climate perceptions were 66% and 68% in 2005 and 2007, respectively (ns). Among the dimensions evaluated, communications (p =0,62) and physical conditions (p =0,008) improved in the two years period.The applied instrument was stable and useful to knowing the requirements of the faculty members and for improving the organizational climate.

An important challenge for medical schools is to recognize and stimulate the academic career of its clinical faculty. These professionals are mainly dedicated to teaching activities and play a role in the modeling of its students. Therefore, they contribute to the development of medical education. The aim of this paper is to analyze the main features of this particular kind of academics and to stimulate physicians to embrace the teaching career. The development channels of teaching academic activity are direct teaching, curricular innovation and administration, counseling, clinical investigation, education administration, leadership and assessment of the learning process. We define each of these activities, giving examples of the activities that can be carried out and how to assess them.

Background: The work environment of an organization has to do with a set of permanent qualities that are experienced by its members. Aim: To assess the work environment perception of faculty members of a Medical School in two different periods (2005 and 2007). Material and methods: A standardized survey was applied to faculty members and Department chairs of the academic units of our Medical School. The survey used the Likert scale from 1 to 5 and included 59 items, distributed in 8 factors. Additionally, there were two groups of statements, indicating the priorities for the School and for the academic departments. Results: In the study performed in year 2005, the survey was answered by a total of 399 faculty members (68%) and in year 2007, it was answered by 408 members (68%). The global climate perceptions were 66% and 68% in 2005 and 2007, respectively (ns). Among the dimensions evaluated, communications (p =0,62) and physical conditions (p =0,008) improved in the two years period. Conclusions: The applied instrument was stable and useful to knowing the requirements of the faculty members and for improving the organizational climate.

Studies on Mycoplasma pneumoniae infection are scarce in Chile.To describe clinical characteristics associated with M. pneumoniae in children requiring hospitalization.All children with a respiratory infection requiring hospitalizations between 2000-2005, whom had a M. pneumoniae specific IgMor = 1:32, were analyzed.Fifty children meeting study criteria were identified with an average length of hospitalization of 4 days (range: 1-10); mean age was 5.4 years (46% were younger than 5 years). Common clinical features were cough (92%), fever (82%), malaise (74%) and respiratory distress (72%). At admission 40/45 children had hypoxemia. Chest-X ray showed interstitial pattern (69.3%), consolidation (51%) and hyperinsuflation (28.5%). Six patients had pleural effusion. Eighty four percent of patients had a favorable clinical outcome; eight children required admission to the PICU all of whom recovered.Respiratory infections associated with M. pneumoniae in our series of children had a highly variable and non-specific clinical spectrum. Chest-X rays showed different pattern in concordance with previous publications.

Introducción: La infección por Mycoplasma pneumoniae es una condición respiratoria poco estudiada en nuestro medio. Objetivo: Describir las características clínicas de los niños hospitalizados porM. pneumoniae. Materiales y Métodos: Se analizaron todos los pacientes hospitalizados por infecciones respiratorias durante el 2000-2005, con IgM específica; se utilizó como diagnóstico de enfermedad por M. pneumoniae la presencia de fluorescencia verde manzana 2 a 3 positivo en títulos ≥ 1:32 diluciones. Resultados: Se analizaron 50 hospitalizaciones, con estadía promedio de 4 días (rango: 1-10); la edad promedio fue 5,4 años (46% bajo 5 años). Los síntomas más frecuentes fueron tos (92%), fiebre (82%), compromiso del estado general (74%) y dificultad respiratoria (72%). Al momento del ingreso 40/45 presentaron hipoxemia. La radiografía de tórax (RT) reveló infiltrado intersticial (69,3%), foco de consolidación (51%) e hi-perinsuflación (28,5%). Seis presentaron efusión pleural asociada. En 84% la evolución fue favorable; sin embargo, 8 niños ingresaron a la Unidad de Paciente Critico para monitorización. No hubo decesos Conclusiones: La infección respiratoria asociada aM. pneumoniae en niños produjo manifestaciones inespecíficas y variables de un caso a otro. La RT reveló una variedad de presentaciones similar a lo mostrado en la literatura médica.

An important challenge for medical schools is to recognize and stimulate the academic career of its clinical faculty. These professionals are mainly dedicated to teaching activities and play a role in the modeling of its students. Therefore, they contribute to the development of medical education. The aim of this paper is to analyze the main features of this particular kind of academics and to stimulate physicians to embrace the teaching career. The development channels of teaching academic activity are direct teaching, curricular innovation and administration, counseling, clinical investigation, education administration, leadership and assessment of the learning process. We define each of these activities, giving examples of the activities that can be carried out and how to assess them.

Hace treinta anos, Abrahamson describio los principales problemas de los planes curriculares de la carrera de pregrado de Medicina, haciendo una analogia con diversas enfermedades. En base a nuestra experiencia y conocimiento, proponemos la existencia de otra enfermedad: la “ Curriculitis autoinmune ”. Esta enfermedad se origina en los propios estudiantes, quienes “inflaman” el curriculo, aumentando en forma exagerada su participacion en multiples actividades, tanto intra como extra-murales, compitiendo por mejorar su rendimiento academico en forma desmedida. A diferencia de las otras enfermedades curriculares, esta impacta directamente en la vida personal y en la salud de los estudiantes, especialmente si su comienzo es precoz. En la genesis de esta enfermedad, participarian principalmente dos aspectos fundamentales de la formacion medica: el denominado curriculo oculto, presente en las diversas instituciones encargadas de dicho proceso, y el sistema de seleccion para los programas de postgrado en Chile. Lamentablemente, esta enfermedad curricular amenaza con aumentar su prevalencia y gravedad, debido al importante crecimiento de alumnos de pregrado de Medicina en Chile, sin un correspondiente aumento en programas de postgrado. Por sus caracteristicas, parece dificil pensar que se pueda erradicar, para ello se requerira una senal clara por parte de los comites de seleccion al postitulo, respecto de los atributos considerados mas relevantes para seleccionar a los candidatos a beca, desincentivando la recoleccion desmedida de antecedentes curriculares. Por otra parte, se necesita de un grupo de estudiantes que sean fieles a sus propios intereses y que cultiven en profundidad aquello que les hace mas sentido.

Antecedentes: La prevalencia de asma se encuentra mundialmente en aumento, especialmente en paises en desarrollo. Objetivos: Determinar la prevalencia de asma en escolares de Santiago, estudiando la influencia del nivel socioeconomico (NSE) y describir su evolucion en un periodo de 6 anos. Material y metodos: Estudio transversal en poblacion escolar de la Region Metropolitana. Se encuesto a 4.561 escolares de 6-7 y 13-14 anos provenientes de establecimientos publicos de la comuna de Santiago y de colegios particulares pagados ubicados en el sector oriente de la ciudad. Las variables estudiadas fueron diagnostico de asma (DA), sibilancias en los ultimos 12 meses (SIB12) y frecuencia de episodios de sibilancias (FES). Mediante modelos de regresion se calcularon odds ratios para la ocurrencia de estas variables segun la exposicion a diversas variables independientes. Resultados: La prevalencia de DA en el grupo completo de escolares fue mayor en escolares varones respecto de mujeres (13,2% vs . 10,8%) (p = 0,016), siendo estadisticamente mayor en escolares de 13-14 anos respecto del grupo de 6-7 anos (13,8%: vs .10,1%). (p -4 ). Se encontro una asociacion inversa significativa entre NSE y SIB12. Un mayor nivel de educacion materna se asocio a menor prevalencia de SIB12 en ambos grupos de edad y de FES en ninos de 6-7 anos. Un mayor nivel de instruccion paterna determino un incremento en DA entre los mas pequenos. Incrementos significativos en la prevalencia de SIB12 y FES fueron observados entre 1994 y 2000 unicamente en escolares de 6-7 anos de Santiago Centro. Conclusion: Se encontro asociacion significativa entre NSE y el diagnostico y sintomatologia del asma en escolares de Santiago, asi como un incremento de su prevalencia y severidad en el grupo de 6-7 anos en el periodo 1994–2000.

Influenza cause high hospitalization rates and complications in children.To describe clinical and epidemiological characteristics of influenza infection in hospitalized children.In Universidad Católica Hospital, all hospitalizations due to influenza in children aged 15 days to 14 years, occurring between January 2001 and December 2005 were reviewed.Of a total of 3570 admissions associated with a respiratory illness, 124 (3.5%) were due to influenza, of which 75% presented between the months of April and June. Median age was 20.5 months (60% younger than 2 years) and 24% had an underlying risk factor. Most common symptoms were fever (94%) and dry cough (61%) and 75% of the children required oxygen. The most frequent complication was pneumonia (53%). The mean duration of hospitalization and oxygen use were 4.4 and 2.5 days respectively. Fifty two children (49.1%) received an antibiotic and nine children were admitted to intensive care unit. No deaths were recorded.Influenza virus cause serious complications and affects mostly healthy children younger than 2 years.

Introducción: El virus influenza produce elevadas tasas de hospitalización y complicaciones en niños. Objetivo: Describir el perfil clínico-epidemiológico de los niños hospitalizados por influenza en un hospital universitario. Pacientes y Métodos: Estudio descriptivo de las hospitalizaciones respiratorias y por influenza entre enero 2001 y diciembre 2005 en el Hospital Clínico de la Pontificia Universidad Católica. Resultados: Se hospitalizaron 3.570 niños por alguna causa respiratoria, 124 (3,5%) correspondieron a influenza confirmada, 75% ocurrieron entre abril y junio. La edad promedio fue 20,5 meses (60%) < 2 años), 24% tenían algún factor de riesgo identificado. Los síntomas más frecuentes fueron: fiebre (94%) y tos seca (61%). El 75%) presentó hipoxemia, siendo la complicación más frecuente la neumonía (53%). El promedio (días) de hospitalización y oxígeno fue 4,4 y 2,5; respectivamente. En 52/109 se indicaron antibacterianos, 9 niños ingresaron a cuidados intensivos. No hubo fallecidos. Conclusión: La hospitalización por influenza se asoció a serias complicaciones y afecta especialmente a niños sanos menores de 2 años

Developing a School of Medicine involves being aware of the changes that have taken place in the past years, particularly those concerning the characteristics of students and young faculty, their main motivations and the research, teaching and professional practice scenarios that are being offered by Chilean medical schools and clinical sites. Inspired by these challenges, and from the viewpoint of the generational differences, this article discusses the present development of an academic career founded on humanistic and university values, the tutorial teaching model, academic medicine, and the concept of professionalism.

Cystic fibrosis (CF) is the most common lethal autosomic recessive disease among Caucasians. In Chile, its incidence is estimated in 1/4,000 newborns and it is possibly underestimated.To analyze CF mortality in Chile during the period 1997-2003.Demographic and CF mortality data reported by the National Institute of Statistics during the period 1997-2003 were recorded, according to sex and age. Overall mortality rate for each year was estimated, as well as the average mortality rate during the same period in patients younger than 1 year, 1-4 years, 5-9 years, 10-14 years and older than 15 years.One hundred and three deaths (56 females) due to CF occurred during 1997-2003. Sixty-eight deaths corresponded to patients younger than 15 years (66.0%). Overall mortality rate ranged from 0.82 to 1.33 per 10(6) inhabitants in 1997 and 1999, respectively. Average mortality rate ranged from 0.46 to 9.81 per 10(6) inhabitants among patients older than 15 years and younger than 1 year, respectively.Most CF deaths occurred in the pediatric age group.

Introducción: La fibrosis quística (FQ) exhibe un deterioro progresivo de la función pulmonar (FP) asociada a infecciones recurrentes. Objetivo: Evaluar la FP en sujetos con FQ mediante espirometría, saturometría y pletismografía (PG) determinando alguna relación matemática. Pacientes y Métodos: Se identificaron 10 pacientes capaces de realizar CVF, CRF, VR, CPT, VEF1, y FEF25-75 %; comparándose con los valores de Zapletal y de 33 controles sanos. Resultados: Edad promedio 13,6 años (rango: 9-20). Sa0(2)y VEF1fueron normales en 10 y 5 sujetos, respectivamente (4 tenían VEF1entre 65-80%). La PG mostró 4 pacientes con VR/CPT > 30%, 3 con aumento de CRF y VR/CPT, sólo uno tuvo PG normal. Los promedios de CPT y VR fueron superiores a valores de referencia y controles (p < 0,05). Se encontró una relación inversa entre VEF1y VR/CPT (r = -0,642, p < 0,05) y entre FEF25-75 y VR/CPT (r = -0,803, p < 0,01). Conclusiones: Este estudio sugiere un incremento significativo de los volúmenes pulmonares en pacientes con FQ aún teniendo espirometría normal; así como una relación matemática inversa entre VEF1, FEF25-75 y VR/CPT.

Cystic fibrosis (CF) is the most common lethal autosomic recessive disease among Caucasians. In Chile, its incidence is estimated in 1/4,000 newborns and it is possibly underestimated. Aim: To analyze CF mortality in Chile during the period 1997-2003. Material and methods: Demographic and CF mortality data reported by the National Institute of Statistics during the period 1997-2003 were recorded, according to sex and age. Overall mortality rate for each year was estimated, as well as the average mortality rate during the same period in patients younger than 1 year, 1-4 years, 5-9 years, 10-14 years and older than 15 years. Results: One hundred and three deaths (56 females) due to CF occurred during 1997-2003. Sixty-eight deaths corresponded to patients younger than 15years (66.0%). Overall mortality rate ranged from 0.82 to 1.33 per 10(6) inhabitants in 1997 and 1999, respectively. Average mortality rate ranged from 0.46 to 9.81 per ^inhabitants among patients older than 15 years and younger than 1 year, respectively. Conclusions: Most CF deaths occurred in the pediatric age group

Developing a School of Medicine involves being aware of thechanges that have taken place in the past years, particularly those concerning thecharacteristics of students and young faculty, their main motivations and the research,teaching and professional practice scenarios that are being offered by Chilean medical schoolsand clinical sites. Inspired by these challenges, and from the viewpoint of the generationaldifferences, this article discusses the present development of an academic career founded onhumanistic and university values, the tutorial teaching model, academic medicine, and theconcept of professionalism (Rev Med Chile 2008; 136: 261-6).(

Ciliary dyskinesia (CD) is a low incidence genetic illness, that presents with a wide clinical spectrum. Also, there are transitory conditions that present with ciliary anomalies, secondary to infectious diseases of the airways.To descube clinical and ultrastructural findings and clinical and therapeutic evolution of these patients.Retrospective review of medical records and electron microscopy findings of 33 patients (aged 1 to 21 years, 14 females) with ultrastructural diagnosis of CD. To obtain follow up information, a telephone survey was done.In 30 patients (90%) the inner dynein arm (IDA) was absent in 50 or more percent of the cilia. Twenty two (66%) had absence of the outer dynein arm. Before diagnosis of CD, 19 patients (57%) presented recurrent otitis media, 25 patients (77%), three or more episodes of rhinosinusitis and 18 patients (56%) had recurrent pneumonia. Middle ear ventilation tubes were placed in 19 patients (57%), and during its use, 12 (68%) remained without othorrea. Sixteen patients (48%) with recurrent episodes of rhinosinusitis required adenoidectomy Seven (21%) required a functional endoscopic sinus surgery (FESS), and 6 (86%) improved after FESS.Our patients with CD presented recurrent infections in different airway locations. In those with a diagnosis of CD and recurrent otológica! and rhinosinusal infections, IDA was absent in a high percentage of cilia. FESS and the use of ventilation tubes may have a beneficial role in a subgroup of patients with CD.

Introduccion: El empiema pleural (EP) es una complicacion grave de la neumonia adquirida en la comunidad (NAC). Objetivos: Describir las caracteristicas de los pacientes hospitalizados por EP en el Servicio de Pediatria del Hospital de la Universidad Catolica durante el periodo 2000-2005. Se identificaron 86 hospitalizaciones por NAC con efusion pleural, practicandose en 59 (70%), al menos una toracocentesis. Se considero EP a la presencia de pus, tincion de Gram con bacterias, cultivo positivo o pH < 7,10 en el liquido pleural, siendo las efusiones para-neumonicas los controles. Resultados: Se analizaron 24 EP y 25 controles [promedio 2,9 anos (rango: 8 meses - 14,3 anos)], 78% de edad inferior a 5 anos con diferencia entre los grupos EP y controles [1,6 vs 3,3 anos, respectivamente (p = 0,01)]. El promedio global (dias) de sintomas previo al ingreso en los EP fue 7 (rango: 2-21), siendo los mas frecuentes fiebre (100%) y tos (96%). Se identifico algun microorganismo en 15/24 EP, Streptococcus pneumoniae fue el mas frecuente (n: 9). En 48 ninos, el manejo inicial fue conservador, requiriendose cuatro rescates quirurgicos luego del cuarto dia. El promedio (dias) de hospitalizacion fue significativamente superior en el grupo EP vs controles [15 (rango: 5-38) vs 9 (rango: 3-16) (p < 0,01)]. Requirieron drenaje pleural 83% del grupo EP y 36% de los controles (p = 0,002). No hubo diferencia en el numero de dias de empleo de oxigeno [6 vs 4,5 (p = 0,36)] o drenaje pleural [3 vs 2,5 (p = 0,29)]. No se registraron fallecidos. Conclusion: El EP en ninos fue una condicion respiratoria aguda que se asocio a estadias hospitalarias prolongadas, especialmente en los de menor edad, no requiriendose, en la mayoria, una intervencion quirurgica de rescate

Human parainfluenza viruses (hPIV) are a common cause of respiratory illness of children but published data on clinical characteristics of hPIV infection in South America is scarce.To review the clinical presentation and epidemiological features of hPIV in a series of hospitalized children in Chile.Retrospective review of clinical charts from all pediatric admissions with a diagnosis of respiratory disease (between January 2001 to December 2004) at the Catholic University Hospital, Santiago, Chile. Nasopharyngeal secretions were tested for hPIV in children admitted with suspected respiratory viral infections.A total of 3,043 respiratory admissions were recorded during the study period; 64 children (2.1%) were hPIV positive. Average age was 13 months (range: lm to 12y) and 77%were younger than 2 years. HPIV-2 was the most common type identified (47%). A seasonal trend was noted for serotypes hPIV-2 and 3. Acute wheezing (40%o) and pneumonia (30%) were the most common clinical diagnosis in hPIV positive children and 17%hPIV positive children (44%for hPIV-1) were associated with laryngitis. All hPIV positive bronchiolitis were due to serotypes hPIV-2 and 3.hPIV can cause respiratory disease requiring hospitalization; serotypes hPIV-2 and 3 displayed a seasonal trend. Although hPIV is an uncommon cause of severe respiratory infecion requiring hospitalization in children, it should be considered in the differential diagnosis of laryngitis, bronchiolitis and pneumonia, especially in younger children.

Los virus parainfluenza del ser humano (VPIh) son patógenos importantes de enfermedad respiratoria en niños; pese a ello, existe escasa información publicada en Sudamérica dirigida a caracterizar esta infección. Objetivo: Describir las manifestaciones clínicas y epidemiológicas específicas de los VPIh en niños hospitalizados. Pacientes y Métodos: Se revisaron todas las hospitalizaciones respiratorias (HR) efectuadas en el Hospital de la Pontificia Universidad Católica, Santiago, Chile, durante el período 2001-2004 y sus respectivos estudios virales obtenidos de secreciones nasofaríngeas en aquellos con sospecha de infección viral. Resultados: Se identificaron 3.043 HR siendo 64 (2,1%) VPUrh La edad promedio fue 13 meses (rango: 1 m-12 a) siendo 77%) de edad inferior a dos años. VPIh-2 fue el serotipo prevalente (47%), observándose una tendencia estacional para los serotipos 2 y 3. Las presentaciones más frecuentes fueron sibilancias asociadas a virus (40%o) y neumonía (30%). Todas las bronquiolitis se presentaron asociadas a VPIh serotipos 2 y 3. Sólo 17% de los hospitalizados por VPIh+ (44% VPIh-1) desarrollaron laringitis. Conclusión: Virus parainfluenza humano puede ser responsable de HR en niños, mostrando una tendencia estacional VPIh-2 y el serotipo 3. Aunque son poco frecuentes como causa de HR, confirmamos su participación como etiología específica de laringitis, bronquiolitis y neumonía, especialmente en niños pequeños

Background: Ciliary dyskinesia (CD) is a low incidence genetic illness, that presents with a wide clinical spectrum. Also, there are transitory conditions that present with ciliary anomalies, secondary to infectious diseases of the airways. Aim: To describe clinical and ultrastructural findings and clinical and therapeutic evolution of these patients. Patients and Methods: Retrospective review of medical records and electron microscopy findings of 33 patients (aged 1 to 21 years, 14 females) with ultrastructural diagnosis of CD. To obtain follow up information, a telephone survey was done. Results: In 30 patients (90%) the inner dynein arm (IDA) was absent in 50 or more percent of the cilia. Twenty two (66%) had absence of the outer dynein arm. Before diagnosis of CD, 19 patients (57%) presented recurrent otitis media, 25 patients (77%), three or more episodes of rhinosinusitis and 18 patients (56%) had recurrent pneumonia. Middle ear ventilation tubes were placed in 19 patients (57%), and during its use, 12 (68%) remained without othorrea. Sixteen patients (48%) with recurrent episodes of rhinosinusitis required adenoidectomy. Seven (21%) required a functional endoscopic sinus surgery (FESS), and 6 (86%) improved after FESS. Conclusions: Our patients with CD presented recurrent infections in different airway locations. In those with a diagnosis of CD and recurrent otological and rhinosinusal infections, IDA was absent in a high percentage of cilia. FESS and the use of ventilation tubes may have a beneficial role in a subgroup of patients with CD (Rev Med Chile 2007; 135: 1147-52). (Key words: Ciliary motility disorders; Otitis; Rhinitis; Sinusitis)

Introducción:El asma es una enfermedad heterogénea con prevalencia descrita en aumento. En Chile, existen escasos estudios en que se describa las características clínicas de los pacientes pediátricos hospitalizados. Objetivos: Describir las características clínicas de los niños hospitalizados por episodios de crisis asmáticas. Pacientes y Método: Estudio descriptivo, restrospectivo en niños con asma entre 6 y 15 años, hospitalizados en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, entre los años 1998 y 2004. Resultados: De un total de 317 fichas clínicas que correspondían a pacientes asmáticos hospitalizados, se pudo acceder sólo a 188, de las cuales 113 cumplían con los criterios de inclusión. Sesenta y ocho fichas correspondían a niños (61%), setenta y cinco niños iniciaron cuadros obstructivos antes de los 3 años (66%), el desencadenante más frecuente fueron los virus respiratorios en 53 casos (47%), el 93% (105 casos) requirió FiO2 < 0,5%, y 60 pacientes (53%) tenían antecedentes de atopía. Conclusión: La mayoría de los pacientes hospitalizados presentó crisis leves o moderadas, sin requerir ingreso a la unidad de paciente crítico. La atopía fue un antecedente frecuente. Es importante realizar un estudio prospectivo que evalúe el tipo y adherencia a tratamiento en relación a la evolución clínica del asma en niños Background: Asthma is a heterogeneous disease with arising prevalence. There are few studies in Chile that describe clinical characteristics of pediatric hospitalized patients. Objective: To describe clinical characteristics of patients hospitalized due to asthma attacks. Method: Descriptive-retrospective study in asthmatic children between 6 and 15 years-old, hospitalized in the Pediatric Service at the Clinical Hospital of Pontificia Universidad Católica of Chile between 1998 and 2004. Results: From a total of 317 asthmatic clinical charts, we reviewed 188 (61%), from which 113 met inclusion criteria. Sixty eight patients were male (61%), 75 cases (66%) presented acute exacerbations before 3 years-old, the most frequent trigger was respiratory virus infections in 53 cases (47%), 93% (105 patients) required FiO2 < 50% and atopy was present in 60 patients (53%). Conclusion: The majority of hospitalized patients presented mild or moderate crisis and did not need management on intensive critical units. Atopy was a frequent finding. It is important to develop a prospective study that evaluates type and adherence to asthma treatment, in order to achieve clinical influence in asthma evolution

The prevalence of asthma and allergic rhinitis experienced a steady increase in the last years, probably associated to changes in lifestyles.To assess the prevalence of allergic rhinitis, to evaluate changes over time (1994-2000), and to describe risk factors.The International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire, with questions added about socioeconomic status (SES), was applied to 4594 children between 6-7 years old and 13-14 years old during october-december 2000. Attendance to public or private schools was also used a SES proxy. The results were compared with those of a similar survey in 5281 children, performed in 1994. Rhinitis symptoms (ever) (SR), rhinitis symptoms within last 12 months (SR12) and medical diagnosis of rhinitis (DR) were assessed.There was a significant increase in the prevalence of SR, SR 12 and DR in both age groups in 2000, compared to 1994. SR older children showed a higher prevalence of SR compared with the youngest group (p=0.003). No age differences were observed in the prevalence of SR12 and DR. Both SR and SR12 were more prevalent at schools of medium and low-medium SES (p=0.003 and p=0.002 respectively). DR was significantly more prevalent among children of high SES. A better mother educational level was associated to higher prevalence of SR and SR12 (p=0.03 and p=0.04). Father educational level was associated to DR (p=0.007). The prevalence of SR12 was higher in households with carpets (p=0.017). The prevalence of DR was higher in houses with smokers (p=0.03) and gas heating (p=0.005). None of the three variables were related to gender.The prevalence of SR, SR12 and DR increased significantly in a short time period (6 years). Our results support a positive association between DR and high SES.

La definición de ALTE (Apparent Life Threatening Event) corresponde a un evento que pone en riesgo la vida de un lactante, caracterizado por cianosis, hipotonía o apnea, y que requiere de maniobras para su recuperación. Objetivo: Evaluar las causas de ALTE en nuestro centro, para estandarizar el enfrentamiento diagnóstico y de tratamiento en nuestros pacientes. Pacientes y Método: Estudio retrospectivo que enroló a 71 pacientes hospitalizados con diagnóstico de ALTE. Resultados: Las causas principales de ALTE fueron idiopático (36%), infección respiratoria viral (29%), síndrome convulsivo (12%), mala técnica de alimentación (14%). Los exámenes que con mayor frecuencia contribuyeron al diagnóstico fueron: inmunofluorescencia (IFD) viral, electroencefalograma (EEG), polisomnograma. Un 49% repitió un ALTE durante su hospitalización. Se realizó educación en reanimación a 71,4% de los padres. Al 42% se les indicó monitor cardiorrespiratorio al alta. Conclusiones: Las causas de ALTE encontradas son similares a lo publicado, destacando la alta frecuencia de ALTE idiopático. Basados en nuestros datos se propone un algoritmo de estudio, tratamiento e indicaciones de monitor cardiorrespiratorio para lactantes con diagnóstico de ALTE. Es necesario realizar un estudio controlado, prospectivo de estudio y tratamiento de esta entidad para poder afirmar y soportar adecuadamente este algoritmo

La influenza es una enfermedad respiratoria aguda con elevada tasa de morbilidad y mortalidad anual. Todos los niños, tanto sanos como aquellos de alto riesgo son susceptibles a la infección. La vacuna anti-influenza es eficaz en prevenir síntomas asociados a influenza, infección demostrada por laboratorio, hospitalizaciones y muertes y ha demostrado ser una medida costo-efectiva. No se han observado claras diferencias entre las vacunas inactivadas y las nuevas vacunas elaboradas con virus vivo atenuado. Por la elevada tasa de hospitalización que los afecta, algunos países han resuelto recomendar la vacunación universal de los lactantes sanos entre 6 y 24 meses de edad. Considerando que esta medida de salud pública también ha sido incorporada en Chile, serían necesarios estudios locales que evalúen su real impacto en nuestro medio

Influenza is an acute respiratory illness that year to year causes considerable morbidity and mortality. . All children, healthy or at high risk, are susceptible to this infection. Influenza vaccine seems to be effective in preventing influenza-like illness, laboratory-confirmed infection, and hospitalizations and deaths, demonstrating cost-effectiveness. Inactivated and live-attenuated vaccines have a similar efficacy profile. . Due to high influenza associated hospitalization rates in children, some countries have recommended incorporating influenza vaccination into the universal immunization program for healthy infants between 6-24 months of age. Considering that this public-health policy has been incorporated in Chile, local studies assessing its impact are needed.

The increased survival of patients with cystic fibrosis (CF) resulted in the appearance of new pulmonary and non-pulmonary complications. Even though subjects with CF present with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocus aureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression of pulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist, patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage. Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and of greater survival. Successful management will depend on the timely selection of adequate antimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratory physiotherapy. The transition from pediatric care to adult care must occur according to development of each patient. This timing must be flexible and there should be a constant communication and coordination within the different specialists in internal medicine. Thus, it is crucial to recognize the disease progression as a continuous process, giving the appropriate physiologic support and evaluating the needs of the patient and close relatives.

Background: The prevalence of asthma and allergic rhinitis experienced a steady increase in the last years, probably associated to changes in lifestyles. Aim: To assess the prevalence of allergic rhinitis, to evaluate changes over time (1994-2000), and to describe risk factors. Material and Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire, with questions added about socioeconomic status (SES), was applied to 4594 children between 6-7 years old and 13-14 years old during october-december 2000. Attendance to public or private schools was also used a SES proxy. The results were compared with those of a similar survey in 5281 children, performed in 1994. Rhinitis symptoms (ever) (SR), rhinitis symptoms within last 12 months (SR12) and medical diagnosis of rhinitis (DR) were assessed. Results: There was a significant increase in the prevalence of SR, SR 12 and DR in both age groups in 2000, compared to 1994. SR older children showed a higher prevalence of SR compared with the youngest group (p=0.003). No age differences were observed in the prevalence of SR12 and DR. Both SR and SR12 were more prevalent at schools of medium and low-medium SES (p=0.003 and p=0.002 respectively). DR was significantly more prevalent among children of high SES. A better mother educational level was associated to higher prevalence of SR and SR12 (p=0.03 and p=0.04). Father educational level was associated to DR (p=0.007). The prevalence of SR12 was higher in households with carpets (p=0.017). The prevalence of DR was higher in houses with smokers (p=0.03) and gas heating (p=0.005). None of the three variables were related to gender. Conclusions: The prevalence of SR, SR12 and DR increased significantly in a short time period (6 years). Our results support a positive association between DR and high SES (Rev Med Chile 2006; 134: 456-64).

Introduccion: La espirometria es el metodo mas utilizado para evaluar la funcion pulmonar. Estudios previos han demostrado la factibilidad de realizar estas pruebas en la edad pre-escolar. Objetivos: Describir los valores espirometricos obtenidos en preescolares derivados al laboratorio de funcion pulmonar. Material y Metodos: Se analizaron en forma retrospectiva las curvas de volumen/tiempo, flujo/volumen, tiempo espiratorio, CVF y VEF1, de las espirometrias realizadas entre 1996-2004 en 180 preescolares. Se utilizo un espirometro Schiller SP100. Se analizo el coeficiente de variacion para CVF y VEF1. Resultados: Se realizaron espirometrias en 180 menores de 6 anos, con edad promedio de 5,4 ± 0,39 anos, 53% hombres. La principal indicacion de la espirometria fue asma 172/180 (90%). 10% de los pacientes realizaron 1 maniobra aceptable, 55% 2 maniobras y 35% 3 maniobras reproducibles y aceptables. Considerando el tiempo espiratorio, hubo 43 curvas de < 3 s (24,4%), 116 de 3 a 6 s (66%) y 17 sobre 6 s (9,6%). Comparando los grupos menores y mayores de 5 anos, se encontro una diferencia significativa solo en el tiempo espiratorio: 3,1 ± 0,49 s en el primer grupo y 4,1 ± 0,13 en el segundo (p < 0,018). Al evaluar variabilidad de VEF1 en 162 pacientes que realizaron 2 o 3 maniobras aceptables se encontro que un 67% mostraba variabilidad

The increased survival of patients with cystic fibrosis (CF) resulted inthe appearance of new pulmonary and non-pulmonary complications. Even though subjects with CFpresent with inflammatory pulmonary changes at birth, several pathogens such as Staphyloccocusaureus, Haemophilus influenzae and Pseudomona aeruginosa contribute to the progression ofpulmonary injury. Clinical presentations vary according to patient age; even though mild forms exist,patients with severe forms, develop respiratory insufficiency and end-stage disease at an early stage.Today, new diagnostic and therapeutic tools, increase the possibility of an early diagnosis and ofgreater survival. Successful management will depend on the timely selection of adequateantimicrobials, the use of pancreatic enzyme supplementation and early institution to respiratoryphysiotherapy. The transition from pediatric care to adult care must occur according to developmentof each patient. This timing must be flexible and there should be a constant communication andcoordination within the different specialists in internal medicine. Thus, it is crucial to recognize thedisease progression as a continuous process, giving the appropriate physiologic support andevaluating the needs of the patient and close relatives (Rev Med Chile 2006; 134: 365-71).(

Introduction: During the past three decades there has been increasing interest in the anti-inflammatory effects of macrolides. Objective: To review current data about anti-inflammatory mechanisms of these drugs, and to examine their effect on modulation of the inflammatory pathways, neutrophil function, bronchoconstriction, and Pseudomonas biofilm. Methods: A systematic review considering original papers and review articles at the National Library of Medicine (MEDLINE/Pubmed), using as key words macrolides, azithromycin, clarithromycin, immunomodulating, antiinflammatory, airway, cystic fibrosis, asthma, sinusitis and children, were performed. Results: Low-dose macrolide therapy has dramatically increased survival in patients with diffuse panbronchiolitis. This has led to further investigation into the potential use of macrolides in chronic lung diseases with an inflammatory component such asthma, cystic fibrosis and bronchiectasis. However, the current evidence to guide this approach, should be considered as only recommendations. Conclusion: The anti-inflammatory effects of these drugs have been under extensive investigation, but randomized and controlled clinical trials in children with respiratory condition are just beginning. The benefits and potential side effects need to be determined before routine use can be advised.

Aiming to join academic excellence and an ethical and Christian approach to medical profession, the Medical School of the Pontifical Catholic University of Chile initiated its activities in 1930. Since then, the associated Health Care Network has incorporated all the technological breakthroughs in medicine and developed all the specialties. Undergraduate teaching is oriented to promote creativity and innovation. There is also a special concern about humanity of Medicine, throught the Program of Humanistic Medical Studies and the Bioethics Center. Post graduate education is also an important activity of the School, through specialty training, Master and Doctorate programs. Researchers have also obtained important grants and generated a great number of publications in high impact journals. Our University is defined as «complex», meaning that we must take important challenges, be creative and lead knowledge generation. We must also improve ourselves to serve in the best possible way our students and the Country. Paraphrasing the words of our founder, Monsignor Carlos Casanueva, we must train physicians that will serve our community not only with science but also with humanity (Rev Méd Chile 2005; 133: 1229-32)

Los avances en torno al conocimiento de la proteína de regulación de transmembrana de la fibrosis quística (CFTR) han permitido entender mejor la fisiopatología de ésta enfermedad y la compleja relación genotipo-fenotipo. Los diversos fenotipos clínicos están influenciados no sólo por la clase de mutación registrada, sino también por factores ambientales y probablemente otros genes reguladores. CFTR regula la composición y cantidad de líquido en el epitelio de la vía aérea, primariamente por su acción sobre el cloro, pero también regula diferentes canales y transporta otras moléculas. Además, CFTR regula una respuesta inflamatoria frente a bacterias como Pseudomona aeruginosa y Staphylococcus aureus. Es probable que todos estos factores influyen en la historia natural de la FQ de cada paciente. El entendimiento de los aspectos básicos y sus implicancias clínicas podría brindar futuras y nuevas aproximaciones terapeúticas

Introducción: Laringotraqueobronquitis (LTB) es una condición frecuente en niños, con escasos estudios publicados en la literatura nacional. Objetivo: Caracterizar los episodios de LTB en nuestra institución. Método: Estudio retrospectivo descriptivo del 2001 al 2003. Resultados: 68 pacientes sufrieron 72 episodios de LTB. La edad promedio fue 16,5 meses, 62% eran varones. La mayoría de los ingresos ocurrieron en otoño (65%). El número de días promedio de síntomas previo al ingreso fue 2, siendo los más frecuentes estridor (85%), tos seca (78%) y fiebre (72%). La estadía promedio duró 1 día. Se identificó virus Parainfluenza en 12 de 23 inmunofluorescencias. La terapia incluyó adrenalina (100%), corticoides (96%), oxígeno (15%), salbutamol (11%) y antibióticos (11%). Las complicaciones fueron neumonía (3%) y traqueitis bacteriana (2%). Conclusión: En nuestra serie, LTB fue más frecuente en varones y menores de 2 años, con clara estacionalidad, estadías hospitalarias cortas y un bajo riesgo de complicaciones Laryngotracheobronchitis in hospitalized children: Clinical features Introduction: Laryngotracheobronchitis or croup is a frequent respiratory condition in children younger than 5 years-old, although there are few studies published in national literature. Objective: Characterise croup episodes in our institution. Methods: A retrospective and descriptive study during 2001-2003. Results: 78 children were admitted during this period, identifying 72 croup events. Most patients were admitted in autumn (65%), 62% were males and the mean age was 16,5 months, with 80% cases younger than 2 years-old. Symptoms prior admission had a mean duration of 2 days (interval 1-10), presenting stridor (85%), barking cough (78%) and fever (72%). Mean hospitalization was one day (interval 1-11). Parainfluenza virus was identified in half of 23 indirect inmunoflurescence studies. Patients received racemic epinephrine (100%), systemic steroids (96%), oxygen (15%), salbutamol (11%) and antibiotics (11%). Complications were infrequent and include pneumonia (3%) and bacterial tracheitis (2%). Conclusions: Our study showed that croup was a frequent condition in males younger than 2 years-old. Most patients present symptoms in autumn and winter, with short-period hospitalizations and low risk of complications

Interstitial lung diseases are uncommon in children, and can be idiopathic or secondary to known causes, sharing common pathological findings. We report a girl with progressive respiratory insufficiency secondary to interstitial pneumonia and pulmonary fibrosis, with risk factors such as bronchopulmonary dysplasia and respiratory infections (respiratory syncytial virus and suspected Mycoplasma pneumoniae), that may have had an additive effect. Nasal bi-level Positive Airway Pressure was used in the last period of her disease. She died due to global respiratory failure at the age of 14 years.

Background: Skin prick test (SPT) of immediate hypersensitivity is a main instrument in the diagnosis of allergy. Aim: To demonstrate the applicability of skin prick test in different age groups. Patients and Methods: We studied children and adolescents with the diagnosis of allergy in the Pediatric Respiratory Laboratory of the Catholic University of Chile, from January 2001 to March 2002. The SPT was performed using a standardized technique. The allergens were applied on the volar surface of the forearm in children older than 4 years of age and in younger children it was applied on their back. For study purposes we separated them into three age groups: GI ≤2 years and 11 months, GII from 3 to 4 years and 11 months, GIII ≥5 years. Results: We studied 408 children, aged between 8 months and 15 years. The SPT was applied to all patients with no adverse effects of any kind. There was a positive reaction in 57.7% of children. The reaction was positive in 37% in G1, 39% in GII and 65% in GIII (p

Interstitial lung diseases are uncommon in children, and can be idiopathic or secondary to known causes, sharing common pathological findings. We report a girl with progressive respiratory insufficiency secondary to interstitial pneumonia and pulmonary fibrosis, with risk factors such as bronchopulmonary dysplasia and respiratory infections (respiratory syncytial virus and suspected Mycoplasma pneumoniae), that may have had an additive effect. Nasal bi-level Positive Airway Pressure was used in the last period of her disease. She died due to global respiratory failure at the age of 14 years (Rev Méd Chile 2005; 133; 82-88)

Introducción: La bronquiolitis aguda (BA) es una de las patologías más prevalentes en la práctica pediátrica habitual. Objetivos: Comparar las características epidemiológicas de dos grupos de pacientes hospitalizados por BA en centros hospitalarios con diferencias demográficas y evaluar el manejo clínico y su evolución intrahospitalaria (IH). Material y Método: Se realizó una encuesta en forma prospectiva desde Mayo a Octubre 2002 a los padres de pacientes con diagnósticos de ingreso de BA hospitalizados en los Servicios de Pediatría UC (HUC) y Sótero del Río (HSR), incluyendo datos generales, epidemiológicos y antecedentes de patología previa. Junto con esto se registraron los datos de la presentación clínica y evolución IH. Resultados: Se encuestaron 130 pacientes del HSR y 93 del HUC. El promedio de edad fue de 2,5 ± 0,2 meses para el HSR y 6,6 para el HUC (p < 0,0001). Hubo diferencia en la educación de los padres (19,2% básica, 70% media, 10,7% superior en HSR y 2,1% básica 37,6% media y 60,2% superior en HUC p < 0,0001). En cuanto a los factores ambientales se encontró diferencias en la asistencia a sala cuna (2,3% en HSR vs 16,1% en HUC p < 0,0001). La contaminación intradomiciliaria demostró diferencias en el uso de parafina (46,1% en HSR vs 8,6 en HUC p < 0,001), el tabaquismo alcanzó diferencia significativa (38% HSR vs 22% HUC p < 0,02). Respecto al manejo IH, se observó mayor uso de adrenalina en HSR 81,5% vs 44% en HUC (p < 0,001) y la kinesioterapia respiratoria se utilizó en el 86% de los pacientes del HSR y en un 54% de los pacientes UC (p < 0,0001). No hubo diferencias en las complicaciones IH en ambos grupos. Conclusiones: La diferencia de edad y en el nivel SE de los pacientes hospitalizados en ambos centros, no se refleja en la presencia de complicaciones Introduction: Acute bronchiolitis (AB) is a frequent respiratory disease in infants. Objectives: To compare epidemiological characteristics of two groups of patients hospitalized due to AB in two hospitals with different SE conditions and to evaluate clinical management and hospital evolution. Methods: We performed a prospective clinical questionnaire between May and October 2002 to parents of infants younger than 2 years admitted with diagnosis of AB at the Pediatric Services of Universidad Católica (HUC) and Sótero del Río (HSR), including general information, epidemiological and previous disease. Clinical presentation and hospital evolution were recorded. Results: A total of 130 questionnaires were done in HSR and 93 in HUC. Mean age was 2,5 ± 0,2 months in HSR vs 6,6 ± 0,6 in HVC (p < 0,0001), with a predominance in males in both centers. Parental education was different (19,2% primary, 70% secondary and 10,7% university in HSR vs 2,15 primary, 37,6% secondary and 60.2 university in HUC p < 0,0001). Day care attendance was different (2,3% in HSR vs 16,1% in HUC, p < 0,0001). Kerosene heating was present in 46,1% in HSR vs 8,6% in HUC (p < 0,001), passive tabacco smoke was 38% in HSR vs 22% in HUC (p < 0,02). Clinical management showed significant differences in several aspects, such as: days of admission (mean of 5,2 days, 4 in HSR vs 4,4 days, in HUC p < 0,001). Adrenaline was given to 81,5% patients in HSR vs 44% in HUC (p < 001) and chest physiotherapy to 86% infants in HSR and 54% in HUC (p < 0,0001). Clinical complications were not different in both groups. Conclusions: Acute bronchiolitis can affect infants independent of their SE conditions. Despite of different SE status, clinical evolution and complications were not different

Introduccion: Los estudios epidemiologicos sugieren que la presencia de tos es un mal indicador de asma. Objetivo: Revision en torno a la presencia de tos persistente como unico sintoma respiratorio y su eventual relacion con asma en ninos. Material y Metodos: Se realizo una busqueda bibliografica considerando revisiones o articulos originales que evaluen la presencia de tos persistente en ninos, brindando un modelo de manejo para esta condicion. Resultados: Las vias de la tos y de la broncoconstriccion no son las mismas, por lo que no es un sintoma confiable para establecer el diagnostico de asma en ninos. La mayoria de veces obedece a un problema no especifico que se resuelve de manera espontanea. Debe eliminarse la exposicion a alergenos como tabaco. En ocasiones se emplean descongestionantes o antihistaminicos por periodos cortos y eventualmente antibioticos orales. Se recomienda medir la funcion pulmonar en aquellos casos, que se pueda. No existe evidencia que guie el uso de esteroides inhalados, sin embargo, en ocasiones se recomiendan iniciar dosis moderadamente altas por 8-12 semanas; si no hay mejoria, el diagnostico de asma es razonablemente improbable. Conclusiones: La mayoria de ninos con tos persistente no desarrollaran asma por lo que no se beneficiaran de la administracion de corticoides inhalados. El termino asma necesita ser interpretado con cuidado a la luz de los distintos fenotipos de asma en la infancia

Introducción: El estridor es un ruido respiratorio musical, que se presenta predominantemente durante la inspiración y que resulta del paso de un flujo turbulento por una zona de obstrucción parcial de la vía aérea. En reportes previos, la laringomalacia es su principal causa (65 a 75%) y se ha encontrado asociación de dos o más anomalías de la vía aérea en un promedio del 15% de los casos. En la literatura nacional existen escasas publicaciones en relación al tema. Objetivo: Revisar nuestra experiencia de 10 años en el estudio de pacientes con estridor. Pacientes y métodos: Entre marzo 1993 y julio 2003 se realizaron 806 fibrobroncoscopías flexibles (FBC) con un fibrobroncoscopio Olympus BF3C20 y BF3C30. La indicación del estudio por estridor se presentó en 133 pacientes (16,5%). Todos recibieron sedación, oxígeno por cánula nasal y monitorización continua cardio-respiratoria. Resultados: La edad promedio fue 10,6 meses (rango entre 5 días y 71 meses), 74 casos eran de sexo masculino (55,6%). El estridor fue congénito en 104 casos (78,2%) y las principales anomalías de la vía aérea fueron laringomalacia en 95 pacientes (71,4%), estenosis subglótica en 13 casos (9,8%) y traqueomalacia en 10 pacientes (7,5%). De los 95 casos de laringomalacia, 19 (20%) presentaron asociación con otra lesión de la vía aérea en forma concomitante, dentro de las que se incluyen bronquio traqueal, traqueomalacia y parálisis de cuerdas vocales entre otras. Nuestros hallazgos son comparables con los descritos previamente en la literatura internacional. Conclusión: El estudio de un paciente con estridor debe incluir la evaluación de la vía aérea superior e inferior Introduction: Stridor is a musical respiratory sound, appearing predominantly during inspiration and caused by a partial obstruction of the respiratory passages that results in turbulant airflow in the airway. Laringomalacia is the commonest cause of stridor (65-75%) and is associated with 2 or more anomalies of the airway in 15% of cases. There is little information in the Chilean literature on this topic. Objective: We reviewed our experience of flexible brochoscopy (FB) in the diagnosis of stridor during a 10 year period. Patients and Methods: 806 FB were performed between march 1993 and july 2003, with a fiber-optic FB Olympus BF3C20 and BF3C30. In 133 (16,5%) cases the indication was for stridor. All patients received sedation, oxygen via nasal canula and had continuous cardio-respiratory monitoring. Results: The average age was 10,6 months (range 5 days to 71 months), there were 74 males (55,6%), stridor was congenital in 104 (78,2%) of cases. Laryngomalacia was the cause in 95 cases (71,4%), subglottic stenosis in 13 (9,8%) and tracheomalacia in 10 (7,5%). Of the 95 cases of laryngomalacia, 19 (20%) were associated with other lesions of the airway, that included tracheal bronchus, tracheomalacia and vocal cord paralysis. Our findings are comparable with previously decribed finding in the international literature. Conclusion: children with stridor should have a complete investigation of their airways

Los episodios de pausas respiratorias y de respiración periódica son normales en los lactantes, conformando un patrón de sueño normal con el crecimiento. El objetivo de este trabajo fue evaluar un grupo de lactantes con sospecha de apnea, en quienes se encontraron, mediante polisomnografía (PSG1), evidencias de inmadurez del centro respiratorio, indicándose educación en reanimación cardiopulmonar, monitor cardiorespiratorio (MCRP) y control de polisomnografía (PSG2). Pacientes y Método: Se incluyeron 34 lactantes entre mayo 1997 y mayo 2001. Apnea fue definida como la ausencia de respiración por 20 segundos (central) y 10 segundos (obstructiva y mixta); pausas respiratorias como ausencia de respiración > 6 < 20 seg (central) y > 6 < 10 seg (obstructiva). Resultado: En todos se incluyó MCRP y se realizó un estudio inicial (PSG1) y final (PSG2); se evaluó las características de la PSG1 y se compara la evolución entre los 2 estudios. La muestra incluyó 22 hombres (65%), la edad promedio de la serie fue de 2,7 ± 2,3 meses ( ± DS), rango 0,3-9 meses. Los diagnósticos de referencia fueron apnea: (n = 27), RGE (n = 2) y cianosis (n = 4). Los eventos respiratorios promedio mostraron un índice total de pausas respiratorias de 14,1/hora, con predominio de centrales, y un porcentaje de respiración periódica de 4,5%. El examen fue anormal en 32 casos por presentar desaturación arterial (n = 23), apneas (n = 8), pausas centrales (n = 19), obstructivas (n = 9) y RGE patológico (n = 5). En relación al segundo examen (PSG2), la edad fue de 11,5 ± 4,5 (rango 6-24 meses). Al comparar PSG1 vs PSG2, hubo diferencias significativas en índice total de pausas (p < 0,01), pausas centrales (p < 0,05) y respiración periódica (p < 0,05). Se concluye que la mayoría de los pacientes con inmadurez del centro respiratorio normalizan sus parámetros al año de vida, y que en éstos, un adecuado uso del monitor cardio-respiratorio es de utilidad Introduction: Episodes of central pauses and periodic breathing are normal in infants and decrease with age and growth. Objective: to evaluate a group of infants that had a polysomnography (PSG) performed due to an episode of apnoea, with elevated immature sleep characteristics and who required home cardiorespiratory monitoring (HCRM) and further control PSGs. Methods: 34 patients, 22 (65%) were male, mean age 27 ± 2 months (PSG1), range 0,3-9 years, were studied between May 1997 and May 2001. Along with the first PSG (PSG1) a second was performed (PSG2) prior to the suspension of HCRM. Apnoea was defined as the absence of respiration for more than 20 sec (central) or more than 10 sec (obstructive and mixed); respiratory pauses as the absence of respiration for more than 6 sec and less than 20 sec (central) or more than 6 sec and less than 10 sec (obstructive). Results: The main indications for PSG were apnoea (27 pts), cyanosis (4 pts) and gastro-oesophageal reflux (GER)in 2. Respiratory events showed mean respiratory pauses of 14.1/hr, mostly central and periodic breathing during 4,5% of the total sleep time (TST). PSG1 was abnormal in 32 cases, with desaturation in 23, apnoea in 8, central pauses in 19, obstructive pauses in 9 and GER in 5. PSG2 was performed at a mean age of 11,5 ± 4 months, range 6-24 months. The comparision of PSG1 vs PSG2 showed significant differences in the total respiratory index (p < 0.01), central pauses (p < 0.05) and periodic breathing (p < 0.05), being always lower in the PSG2. We conclude that the majority of patients with episodes of apnoea and immature sleep patterns normalized their sleep pattern in the first year of life. In this group the correct use of HCRM is indicated

La parálisis diafragmática (PD) es poco frecuente en pediatría y su adecuado manejo es importante por el potencial compromiso respiratorio. La PD es sospechada por la radiografía de tórax y confirmada por la ultrasonografía. Últimamente la electromiografía (EMG) ha mostrado utilidad en la evaluación funcional del diafragma y del nervio frénico (NF), en especial a lo que se refiere a su pronóstico y reversibilidad. Objetivo: Reportar la utilidad de la EMG en 3 pacientes con PD. Pacientes y Método: Caso 1, lactante con PD bilateral secundaria a enfermedad neuromuscular adquirida y distrés respiratorio, la EMG mostró denervación y se indicó ventilación permanente. Caso 2: lactante con PD derecha secundaria a cirugía del plexo braquial, el seguimiento electromiográfico permitió tratamiento conservador. Caso 3: preescolar portadora de cardiopatía compleja, PD bilateral post cirugía cardíaca y dependencia de ventilación mecánica (VM), se realizó plicatura diafragmática bilateral, presentó recidiva, necesitó nueva plicatura izquierda por amplitud muy disminuida en la respuesta diafragmática al estudiar conducción de NF. Conclusión: La EMG determinó la disfunción del NF y permitió una conducta conservadora en estos pacientes evitando la cirugía. Sugerimos que la EMG es una herramienta útil en el estudio de pacientes con PD y en la determinación de su conducta terapéutica