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Introduction: coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: there was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: block presents less aerolization than intravenous lidocaine in extubation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the respiratory symptoms in women from Paipa, Colombia, who have been exposed to wood smoke. MATERIALS AND METHODS: Observational study, single cohort with analytical phase. Women over 18 years of age exposed to wood smoke, who resided in the area of direct influence of the thermal plant, were included in the study. Data was collected from January 23 to November 22, 2019; they consisted of a consultation with two doctors belonging to the research, in which they were inquired about the research variables by applying a data collection sheet and later spirometry was performed. RESULTS: One hundred seven women exposed to wood smoke were included; all participants had respiratory symptoms. The average age was 53.14 years, 68.3% had some degree of overweight; 48.6% had dyspnea, 38.3% cough, 21.5% expectoration and on auscultation 7.5% had rhonchi, 4.7% had wheezing and 1.9% rales. CONCLUSIONS: Women in rural areas are at high risk of exposure to wood smoke and all patients presented respiratory symptoms, which is associated with these exposure factors. In addition, people who stop smoking are likely to reduce respiratory symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Post-COVID-19 Syndrome has been the most coined terminology for the diagnosis of sequelae that persist for more than 3 months following SARS-CoV-2 virus infection. Objective: To determine the prevalence of post-COVID-19 diagnosis. Methodology: Descriptive, cross-sectional, retrospective, and observational study. The universe consists of all hospitalized patients of legal age who required oxygen therapy at the Centro Integral de Atención Provisional para Pacientes Moderados COVID-19 (FIGALI) during the first quarter of 2021. Demographic data, comorbidities, main persistent symptoms, and attendance to Post-COVID Clinics are described. Results: Predominantly those older than 50 years (66%), with an average stay of 10 days, most (79%) requiring low-flow oxygen therapy (moderate COVID-19), with equal distribution of sex and most respondents had a minimum of 5 months of discharge. The main comorbidities reported were hypertension (57%) and diabetes mellitus (31%). The prevalence of post-COVID-19 Diagnosis was 74% (131/177), with fatigue, cough and dyspnea being the main symptoms reported (45%, 32%, 29%) respectively. In the neuro-psychiatric aspect, anxiety was evident with 18% and depression in 14% of the patients surveyed. Conclusions: three out of four patients who required oxygen therapy persisted with at least one symptom more than 5 months after hospitalization, with fatigue being the predominant symptom. Despite the high prevalence described in this study, only one out of four patients reported having attended Post-COVID Clinics. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a pathological entity characterized by a series of persistent physical manifestations such as cough, fatigue, dyspnea and sputum production; symptoms that generate discomfort in the patient from the moment of diagnosis and that, being an irreversible disease due to the tissue damage it causes, progressively has a negative impact on quality of life. On the other hand, the presence of psychological symptoms such as depression, insecurity, anxiety and emotional disturbances has been reported in patients diagnosed with COPD. Likewise, patients with this diagnosis tend to develop behaviors that alter their family and work social relationships, as they tend to isolate themselves due to the symptoms, especially physical. This situation generates the need to develop a research work with the objective of recognizing the cluster of physical, psychological and social symptoms of patients diagnosed with COPD, and to identify if a palliative care approach is proposed. The study was developed through a systematic literature review in which 1,776 articles were identified, of which 41 were evaluated for the identification of the symptom cluster. The binomial dyspnea and cough, fatigue and expectoration were identified as the physical symptom cluster; depression and anxiety constitute the psychological symptom cluster, and the impact on quality of life and the perception of isolation or social exclusion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Brick kiln workers exposed to smoke and dust have an increased risk of developing respiratory diseases. OBJECTIVE: To identify respiratory symptoms and their characteristics in brick workers of Tunja Boyacá, Colombia. MATERIALS AND METHODS: A cross-sectional descriptive study was done applying a questionnaire on respiratory symptoms, which met the reliability and validity criteria of brick kiln workers in the city of Tunja, based on inclusion and exclusion criteria previously established, in 2017. RESULTS: There were included 82 workers. There was evidence of respiratory symptoms, particularly waking up due to cough, whistling and problems with breathing. There is an important relationship between the sociodemographic variable position in the brickyard and the lack of air after exercise (p = 0.003); years of work in the brickyard with expectoration day and night in winter (p = 0.004) and the age of the brick maker with expectoration day and night in winter (p = 0.001). CONCLUSIONS: Respiratory symptoms are present in brickworkers; An important relationship is found between the respiratory symptoms referred by the population and certain sociodemographic variables [ABSTRACT FROM AUTHOR]

Introduction: pneumonia, named by Sir William Osler "the captain of the hosts of men's death", represents one of the main health problems in the world. Both the incidence and the mortality rate increase with age because in the geriatric patient there are diseases that increase the risk of pneumonia. In addition, due to their own health conditions and immune senescence, the probability of dying from this cause is very high. Objective: to study the main characteristics of pneumonia in the elderly and mainly the increased risk factors for developing it. Methods: a prospective quantitative-qualitative research was carried out in 950 patients aged 60 years or older with a diagnosis of community-acquired pneumonia admitted to the "Arnaldo Milián Castro" Hospital, in Villa Clara Province, from January 2016 to December 2018 with the aim of determining the risk factors of community-acquired pneumonia in the elderly. Results: the most frequent clinical manifestations were: fever, cough, decay, tachypnea and tachycardia, in various combinations. Smoking, chronic obstructive pulmonary disease, bronchial asthma, heart failure, diabetes mellitus and alcoholism were risk factors. Age was an independent prognostic factor associated with higher mortality, longer hospital stay and longer recovery time. Conclusions: the most frequently found risk factors were smoking, alcoholism, chronic obstructive pulmonary disease, cancer, diabetes mellitus and heart failure. [ABSTRACT FROM AUTHOR]

We present the case of a comorbid patient with Chronic Obstructive Pulmonary disease who developed a pulmonary herniation secondary to a coughing episode. He complained of severe and invalidating somatic pain in the herniation area, pain score was 4 out of 10 in the Verbal Numeric Scale (VNS) at rest, that worsened with cough to 9 out of 10. Buprenorphine and acetaminophen were initiated with only slight improvement in pain. Surgical reparation was discarded. An erector spinae plane nerve block (ESP block) was performed with improvement in the VNS to 0 out of 10 at rest and 6 out of 10 with cough. After the procedure, the patient only needed acetaminophen as analgesic for pain relief, and the improvement was maintained in time. The ESP block was described in 2016, and since then there has been growing evidence of its safety and efficacy in post-operative analgesia for breast, thoracic and abdominal surgery. The main ESP block benefits compared to similar blocks are the relative less incidence of pneumothorax, less systemic absorption of local anaesthetics and the simplicity of its performance. Although there is less evidence in chronic pain, it has been described in the treatment of post thoracotomy chronic pain with good results. This case is described because of the great clinical improvement in an uncommon and very symptomatic disease. [ABSTRACT FROM AUTHOR]

Introduction: thymic cyst is a condition that sits in the thymus gland. It can be congenital or acquired. Case report: It is presented a male patient who started about a year ago with a wet cough, accompanied by mucous expectoration. In the study performed, a mediastinal cystic lesion was detected and interpreted radiologically as a pleuropericardial cyst; he was operated and the lesion was completely resected by right thoracotomy. The anatomopathological diagnosis reported multilocular thymic cyst. The patient evolved satisfactorily and was discharged on the third post-operative day. Conclusions: cystic lesions of the anterior mediastinum are many times a finding because there are no symptoms until they reach great size. They must be treated surgically, with total resection, to avoid complications inherent to growth and compression and to arrive at a histopathological diagnosis. [ABSTRACT FROM AUTHOR]

El articulo discute el estudio de caso de un hombre de 28 años con clínica de dos meses de tos y dolor torácico intermitent y que consultó a urgencias, luego Se tomó biopsia por fibrobroncoscopia y se hizo diagnóstico de tumor de células germinales. Se inició quimioterapia y fue dado de alta para continuar ambulatoriamente.

The article discusses pharmaceutical assessment of patient with cough. It notes that cough is the most common symptom of the patient with disorders of the respiratory system. It adds that it is an expiratory maneuver explosive and brusque that tries to remove the sputum of the airway. It states that cough protects the lung from aspiration, with the different types of stimuli that can generate cough explaining the differences in the sounds and patterns of it.

Introduction: arterial hypertension is a health problem with high prevalence worldwide, considered one of the main cardiovascular risk factors, being a very frequent reason for consultation, both in primary care and in emergency services. Objective: to determine the Therapeutic effectiveness of two homeopathic remedies in the treatment of Hypertensive Urgency and the comparison of these remedies. Method: quasi-experimental study of 60 patients with Hypertensive Urgency in the Emergency Department of the José Martí Cast of the "Marta Abreu" polyclinic, between January 2018 and December 2018. Patients with characteristics from the homeopathic point of view of Lachesis and Aconitum were chosen and they were also randomly divided into each of the remedies in a study group that applied the homeopathic remedy to the (200CH); 5 sublingual drops every 10 minutes and another control with Captopril (25 mg) 1 tablet in both cases the blood pressure was taken systematically. Results: the ages of 50 to 60 years and the female sex predominated, in addition in both remedies the BP was reduced fundamentally at 45 minutes in both the study group and the control group, the adverse effect in the study groups that prevailed was burning in the tongue and cough in the control groups. Conclusions: it was evidenced that the homeopathic remedies studied are effective in the Treatment of Hypertensive Urgency, lowering blood pressure as well as Captopril with minimal undesirable effects in relation to conventional treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the association between the respiratory symptomatic status and sleep disturbance in Peru's inhabitants over 15 years of age. MATERIAL AND METHOD: Secondary analysis of the Demographic and Family Health Survey (ENDES) 2015. A person with respiratory symptomatic status was one who reported having cough and phlegm for more than 14 days. A person with sleep disturbance was one who reported sleep disorders, fatigue and lack of concentration for more than 11 days in the last 14 days. The proposed association was evaluated using a generalized linear model. RESULTS: Data from 34,583 individuals were analyzed, evidencing a frequency of sleep disturbance and respiratory symptomatic status of 1.8% (590/33,478) and 2.8% (921/33,298), respectively. It was observed that participants with respiratory symptomatic status had sleep disturbances at a frequency of 1.54 times compared to those who did not have this characteristic, after adjusting for variables of interest. There was no significant difference in the frequency of sleep disturbances in relation to the duration of the respiratory symptomatic status (p = 0.992). CONCLUSIONS: There is enough evidence to suggest the possible relationship between the variables of interest, establishing that some or all the diseases associated with the respiratory symptomatic status are related to sleep disturbance. [ABSTRACT FROM AUTHOR]

The cough reflex is a protective mechanism of the airway; it avoids bronchoaspiration and its complications and, when it is altered, it can appear as a hypersensitivity syndrome; cough per se is the most common symptom for which medical consultation is sought. Chronic cough represents a public health problem with a high degree of morbidity; It represents a syndrome by itself, regardless of the underlying condition. Recent evidence suggests an abnormal and altered neurophysiologic process. Recent literature and new therapeutic mechanisms were reviewed. We are in the process of understanding the cough syndrome. [ABSTRACT FROM AUTHOR]

This article presents distinctive and essential features in the transformations of the Cuban health system that have allowed the eradication and reduction of the incidence rates of some communicable diseases at levels lower than 0.1 per 100 000 inhabitants. The results obtained are a consequence of the importance given to the prevention and control, as well as to the risks and potential damages, of these diseases. The structure and functioning of the hygiene and epidemiology subsystem and its interrelations with the rest of the system, based on the different models of service provision, have been permanent integration scenarios for decision making. Diseases such as poliomyelitis, malaria, diphtheria, whooping cough, rubella, mumps, post-mumps meningitis, measles, yellow fever, cholera, severe forms of tuberculosis, human rabies transmitted by canines, leishmaniasis, Chagas disease, vertical transmission of HIV, congenital syphilis and clinical forms such as neonatal tetanus and congenital rubella syndrome were eliminated. Some communicable diseases are analyzed in more detail and, in particular, the social response developed against tuberculosis, leprosy, AIDS and vector- borne diseases. However, the current health context presents challenges for the sustainability of the achievements made in the country. Assuring the maintenance of universal coverage with access of the Cuban population to health services will always be a principle of Cuban public health. [ABSTRACT FROM AUTHOR]

Pulmonary tuberculosis (PT) is a public health problem, it is estimated that patients with PT developed one complication during life with bronchiectasis being the most frequent. Objectives: Ton describe clinical and epidemiologic features of patients with bronchiectasis secondary to PT in a general hospital in Lima. Methods: A cross-sectional study was conducted in which medical reports of patients with bronchiectasis secondary to PT were reviewed. Results: 69% of patients were female; 40% were elder. Most frequent clinical manifestations were cough in 66.6%, expectoration in 56.0% and hemoptysis in 49.2%. Saccular tomographic pattern was observed in 43%. Bronchodilators were prescribed for 53%, 41% received inhaled bronchodilators, 33 received antibiotics and 16% mucolytic medications. Mean time from diagnosis of PT to development of bronchiectasis was 16.76 ± 11.94 years. Conclusions: Bronchiectasis secondary to PT were more common in females and in the elder population. The most common clinical manifestations were cough, expectoration and hemoptysis. The most common pattern at CT scan was the saccular and bronchodilators were the most common drugs used. [ABSTRACT FROM AUTHOR]

Objective: To identify the clinical characteristics of patients diagnosed with Pertussis like Syndrome at the Hospital General Liborio Panchana Sotomayor. Materials and methods: This was a descriptive and retrospective study in infant patients diagnosed with Pertussis like Syndrome of the mentioned hospital during the period from June 2015 to May 2017, the clinical data of the medical histories found in the medical records department. Results: Out of the 45 patients evaluated, 57.8% were male, the most frequent age group was 2-6 months (68.9%), in-hospital management was performed in 53.1% of them, the presence of leukocytosis with lymphocytosis was the most frequent laboratory finding (37.8%), the majority received treatment with macrolides (82.2%) and only 39.1% had complications (n=9) of the admitted patients. Conclusion: there is a high frequency of Pertussis like Syndrome in our children population with a predominance in male sex, with ages between 2-6 months, leukocytosis with lymphocytosis as the most frequent laboratory finding and use of macrolides as the main antimicrobial agent. [ABSTRACT FROM AUTHOR]

Pneumomediastinum is the presence of air in the mediastinal space, originated in bronchi, alveoli or esophageal rupture, which runs through the vascular tissue pods and towards the mediastinal space. Pneumomediastinum is classified as spontaneous or traumatic. Secondary pneumomediastinum is considered an unusual entity in children, with very variable incidence. It is associated with acute asthma airway infections, trauma, vomiting, intense efforts, anxiety with hyperventilation and drug use. This is a case report of a previously healthy, 4 year old female toddler with secondary pneumomediastinum, without trauma or thoracic procedures or instrumentation in child's pathophysiology associated with cough, with communityacquired pneumonia. It was confirmed by chest and neck radiographs. The pathology was of short duration and required treatment during a short time in the hospital. According to the chest CT scan performed at admission, air was observed migrating from the perivascular bronchial sheaths to the mediastinum ("Macklin effect"). [ABSTRACT FROM AUTHOR]

Introduction: Cough at the time of extubation may trigger anaesthesia-related adverse events. A technique that has been found to limit cough during this stage of the anaesthesia procedure is the use of remifentanil. Objective: To compare cough frequency and intensity at the time of extubation with two different plasma concentrations of remifentanil, 3-4 ng/ml and 2-3 ng/ml, using target controlled anaesthesia. Materials and methods: Randomised controlled clinical trial carried out at the Institute for Blind and Deaf Children in Valle del Cauca, in patients taken to elective ear surgery. Patients were randomly assigned to one of two groups. The first group (T) received an infusion of remifentanil at a plasma concentration of 3-4 ng/ml (n = 50). The second group (U) received an infusion of remifentanil at a plasma concentration of 2-3 ng/ml (n = 51). Data were analysed using the Student t test and the non-parametric Mann Whitney U test; the Chi square test was used for determining associations. Results: Cough intensity and frequency were less in group T compared to group U (OR: 3.73; 95% CI: 1.3-10.7), and there was no difference between the two groups regarding emergence from anaesthesia. Conclusions: The presence of at least one cough episode during extubation is less with plasma concentrations of remifentanil of 3-4 ng/ml than 2-3 ng/ml. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate the prevalence of symptomatic respiratory (SR) cases in the Peruvian population aged 15 years and over between 2013 and 2015. A secondary analysis of the Demographic and Family Health Survey (ENDES) was carried out. The subjects of the study were people aged 15 years and over who answered these interview questions: Do you currently have a cough with phlegm? How long have you had a cough with phlegm? People who had had a cough and phlegm for 15 days or more were defined as having SR. The prevalence of SR was 3.3% in 2013 (95% confidence interval [95% CI]: 2.8-3.9%), 3.8% in 2014 (95% CI: 3.5-4.1%), and 3.3% in 2015 (95% CI: 3.0-3.6%). The prevalence of SR was greater than 5% in people aged 60 years and over, in people in the poorest quintile, and in residents of rural areas. We conclude that 3-4% of Peruvian people aged 15 years and over report cough with phlegm for =15 days. The proportion with SR varies according to the region of the country. It is recommended that the expected number of symptomatic SR cases be assessed and that Peruvian healthcare be adjusted as necessary. [ABSTRACT FROM AUTHOR]

Objectives. To classify the study population in the Argentinian National Health Surveillance System framework, determine the proportion of infection by Bordetella pertussis and Bordetella parapertussis, and identify factors associated with the cases of suspected whooping cough attended to in the city of Mar del Plata and its outskirts during the period 2011-2015. Materials and Methods. An observational and descriptive study was carried out. Clinical cases with suspicion of whooping cough were diagnosed by laboratory. The laboratory studies consisted of culture, PCR, and serology using the ELISA technique. Results. A total of 572 cases were evaluated. The female sex was the most frequent (51.9%). The most frequent age range was 2 to 17 moths (51.1%; 290/568), which was also the group with the most confirmed cases. Only 47.8% (155/324) of the population studied had complete vaccination for their age. Whooping cough due to B. pertussis was confirmed in 15.5% (89/572) of cases and one case with B. parapertussis. Those cases that had contact with a coughing relative were significantly associated with the confirmation of Bordetella spp. by the laboratory (odds ratio: 3.3; 95% confidence interval: 1.9-5.4). Conclusions. The results show the need to suspect whooping cough and diagnose it early in children, adolescents, and adults in order to better control the disease. Likewise, continuing prevention and containment measures are fundamental in decreasing the circulation of the causal agent. [ABSTRACT FROM AUTHOR]

It describe the clinical case of a possible resistance to fenbendazole in a Jersey calf infested by Dictyocaulus viviparous described. In the municipality of Entrerrios (Antioquia, Colombia) a female Jersey breed of 6 months of age, presented serious sings of bronchopneumonia. which did not improve with the application of fenbendazole and enrofloxacin as maintenance therapy. At the necropsy, a large number of live parasites compatible with Dictyocaulus viviparus were observed, determining a verminous bronchitis. This nematode, which is routinely treated with fenbendazole in Colombian dairy farms, has been proved resistance when is trated with some benzimidazoles. This specific case shows the possible causes of the Dictyocaulus viviparus resistance in Jersey calf. [ABSTRACT FROM AUTHOR]

The nontuberculous mycobacteria are rarely recognized today in the world, being increased their prevalence about to departure of their suspicion in chronic illnesses such as inmunocompromised patients and cystic fibrosis. We present a case with diagnosis of syndrome of Lady Windermere about to departure of a square of chronic cough. Computed tomography was performed where bilateral bronchiectasis is observed in the left lingual segment and right upper lobe. In the Bronchoscopy was isolated complex Mycobacterium avium-intracellulare. The lack of suspicion of nontuberculous mycobacteria in patient without risk factors, with a square of chronic cough leads to the delay in the diagnosis and the patient's clinical deterioration. [ABSTRACT FROM AUTHOR]

The aim of this article is to study the two phases of the poliomyelitis' vaccination campaign in the years 1963 and 1964, with the Sabin oral vaccine, in the city of Jerez de la Frontera (Cádiz). We also expound some data about the vaccination campaign in 1965 against polio, diphtheria, whooping cough and tetanus in the same city. We have used, in our study, original documents sources from Municipal Archives of Jerez, other archives and libraries of the province, as well as local, regional and national press, which have provided us some information on the mentioned vaccination campaigns. [ABSTRACT FROM AUTHOR]

Objective: To characterize children under 5 years diagnosed with acute respiratory infections who were admitted to the Regional Hospital of Coronel Oviedo for the period 2012-2013. Materials and Methods: observational, descriptive cross-sectional study with non probabilistic sampling of consecutive cases of patients under 5 years old with acute respiratory infections admitted to the Regional Hospital of Coronel Oviedo - Paraguay from January 2012 to December 2013. Results: 150 medical records of children under 5 who are aged between 0 and 60 months were included, of which 60% were men and 55.3% were from urban areas. The most common symptoms were cough (75%) and fever (70%). The most common diagnosis was pneumonia in 33% of cases and 56% of cases have the condition at discharge with outpatient treatment. Conclusion: The most common disease was pneumonia, over 50% came from the urban area. In most patients, the presented symptoms were fever and cough. [ABSTRACT FROM AUTHOR]

Background: Bordetella pertussis infection remains a public health problem in several developed and developing we describe the epide-miological syndrome cases subsystem special surveillance of whooping cough from 1992 to 2011 at a population with social security. Methods: We obtained special cases subsystem Pertussis surveillance of 1992-2011. Univariate analysis was made of rates, ratios and proportions. Wilson was determined test for proportions to an alpha of 0.05, t-test for mean difference. Results: We appreciate epidemic cycles every three to five years, the average baseline incidence, excluding epidemic years, 0.1 is considered confirmed cases per 100 000 beneficiaries assigned to family medicine, the highest incidence was recorded in 1997 and 2009. The most affected were children under 1 year of age and in outbreaks, the disease occurred at older ages. Conclusions: During the period observed intermediate epidemic cycles 5 and 3 years of age presentation is consistent in other countries. [ABSTRACT FROM AUTHOR]

A retrospective analysis of the epidemiological situation of whooping cough in Venezuela from 1990 to 2012 was made. In spite of a significant decline in cases in the 80s and 90s, with the introduction of the expanded program of immunization, increase in incidence was seen since 2nd half of the last decade, with a peak of 4.5 cases x 100,000 in 2007. The apparent decline in cases in the years 2009 and 2010, does not correspond with regional reports of others Latin American countries. Incidence in 2011 was 217% greater than 2012. The most susceptible group are children below 1 year, but a consistent number of cases occur in older than 5 years, including adolescents and adults, being a source of transmission for most susceptible group. The decreased lethality observed does not correlate with a parallel rise of disease incidence. Of note, vaccine coverage of DPT3 is low and vaccine boosting doses are not contemplated for teenagers. The death toll from B. pertussis in Venezuela might be higher than recorded since more sensitive techniques, as PCR and DIF, are not used for surveillance [ABSTRACT FROM AUTHOR]

Background: Cough and laryngotracheal pain are caused when tracheal pain receptors are activated. The purpose of applying continuously a local anesthetic to block these nociceptive block these nociceptive receptors would be a logic attempt to reduce its incidence. Objective: The aim of this body of work (study) is to determine whether or not the flush of the endotracheal tube cuff with alkalized lidocaine reduces the postoperative cough and laryngotracheal pain. Material and methods: Two groups, of thirty four (34) patients each, were studied. Within the first group, the endotracheal tube cuff was flushed using alkalinized lidocaine; while in the second group, the endotracheal tube cuff was flushed using a saline solution. Using a time frame: starting at the 0 hour, then 1 hour, 6 hours and 12 hours after the procedure, the cough incidence and laryngotracheal pain were evaluated. Results: There was a direct association between the presence of cough, laryngotracheal pain and the use of a saline solution, which demonstrated a protective effect when using lidocaine. Conclusion: The use of alkalized lidocaine into the endotracheal tube cuff has a protective effect/result, which diminishes cough and laryngotracheal in the interim between the extubation and twelve hours after surgery in patients under general anesthesia. [ABSTRACT FROM AUTHOR]

Bordetella pertussis is the causal agent of whooping cough (pertussis), a highly contagious respiratory illness. This organism produces a group of virulence factors between which is possible to find to the adenylate cyclase toxin-hemolysin (CyaA) and pertactin (Prn). The first allows the bacteria inhibit phagocytosis and inflammatory response in the host, whereas the second is an adhesin that is frequently included as a component in acellular vaccines against B. pertussis. The objective of this work was to obtain Bordetella pertussis LPA311 mutants lacking adenylate cyclase toxin - hemolysin and largest producers of pertactin 2 with vaccinal purposes. The results revealed that in the seven mutants obtained the cyaA gene has been replaced by the prn2 gene. Additionally, one-way ANOVA showed that the levels of production of Prn in five of the mutants were significantly higher to the levels produced by the control (p < 0.05). These results showed that the strategy of replacement of the gene cyaA by the prn2 gene on B. pertussis LPA311, allows eliminating the CyaA expression and increasing the Prn production. [ABSTRACT FROM AUTHOR]

The adenylate cyclase - hemolysin toxin (ACT) is one of the main virulence factors in Bordetella pertussis. It was discovered in 1973 by Wolff and Cook as a contaminant in vaccine formulations against this microorganism. It belongs to the family of toxins that form pores at the plasma membrane of target cells and reaches the highest expression during the virulent phase of the bacteria. This toxin has 1706 aminoacid residues and is composed of two domains: the N-terminal domain, with calmodulin-sensitive adenylate cyclase activity and the C-terminal domain that promotes the formation of pores at the membrane of target cells. Furthermore, the integrins type αMβ2 molecules are natural receptors for the toxin, which binds to the N-glycosylated extracellular portion. ACT allows the bacteria to inhibit phagocytosis, activation of type 1 T-helper cells and cytotoxic T cells as well as gamma interferon production by macrophages. Despite of its toxic effects, the inactivated form of the toxin has been used in delivering immunogenic epitopes to antigen-presenting cells, in the identification of proteins secreted by the type III secretion system and in protein-protein interactions studies. [ABSTRACT FROM AUTHOR]

Pertussis is an endemic disease in our population. Every 3 to 4 years, pertussis has an epidemic pattern even in countries with good health conditions. Antipertussis vaccine first dose is administered at the age of 2 months; a second and third dose are given at 4 and 6 months of age. This vaccine has an 8 to 10 year protective effect, for which reason it is suggested that pregnant women in the third trimester should be vaccinated in order to prevent pertussis in newborns. It should also be administered to older people to avoid turning them into asymptomatic carriers. Clinic manifestations are easily identifiable due to respiratory symptoms, especially to the particular characteristics of the cough. The diagnosis is supported by the presence of leukocytosis (predominantly lymphocytes) and by certain thoracic radiologic findings. The diagnosis is confirmed with a positive culture for Bordetella pertussis or with a polymerase chain reaction (PCR). In a non complicated clinic course macrolides are still the best therapeutic choice. Nonetheless clinic observation is highly recommended in order to avoid complications. Redefinition of vaccine programs against Bordetella pertussis in Mexican population is recommended and also to notify the presence of the disease to the corresponding health authorities. [ABSTRACT FROM AUTHOR]

El artículo discurre sobre el aislamiento y la purificación de la toxina de bordetella pertussis y la tosferina. Los autores comentan sobre la producción de las vacunas antipertúsicas, la separación de las proteínas y electroforesis. Otros temas incluyen Western blotting y la detección de los anticuerpos.

Conventional vaccines are based on the application of diverse biochemical, microbiological and immunological methods over causal agents of diseases. Despite of success reached in vaccines for controlling and preventing a lot of infectious pathologies, in some other instances the results have not been rather fruitful, so that exploring new approaches and possibilities is imposed. The development and increase of the molecular biology means a revolution for designing new vaccines against a great variety of pathogenic microorganisms causing diseases that affect mankind and animals. From knowledge on whole genome sequences of these microorganisms in combination with new advanced technologies such as bioinformatics, DNA microarrays and proteomics it has been possible to identify new important antigens for the development of new vaccine candidates. The combination genomics - proteomics has rendered great advances in discovering "target" sites of vaccines against pathogenic bacteria. The ideal vaccine must be pathogen - specific, harboring conserved antigens in each strain, therefore having a universal cover, with the minimal number of antigens. Based on that knowledge, all antigens in silico may be predicted a priori, without growing the microorganism in vitro. This new approach has been successfully applied to identifying new antigens in Bordetella pertussis as well, which may be evaluated further for vaccine purposes, therefore representing a serious global effort, just to face whooping-cough or pertussis reemergence. [ABSTRACT FROM AUTHOR]

Despite vaccination against pertussis, there are still a large number of pertussis deaths worldwide. Waning vaccine-induced immunity and the gradual increase in reported incidence among adolescents and adults have supported the role of these age groups in the transmission. Several countries have implemented a booster vaccination in order to reduce transmission and clinical significance. Pertussis is a current public health problem in Mexico. The clinical suspicion in toddlers, adolescents and adults, delayed or incomplete vaccination series and diagnosis confirmation are the most important challenges for pertussis control. The introduction of new vaccination strategies in adults and adolescents as well as pregnant women should improve disease control. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the health care workers' knowledge about some aspects of pertussis disease and its prevention by vaccination Methods: Surveys were conducted in 136 health professionals and medical students at the Clínica Razetti and Hospital Pediatrico "Agustin Zubillaga" of Barquisimeto. Results:A total of 136 surveys were conducted. 95.6% of the persons who were interviewed work in direct contact with infants and older children, 87% (95% CI: 80.7 to 92.8%) of respondents are aware that pertussis not only affects children, 55.8 % thought that the immunity conferred by pertussis continues throughout life. 73.5% felt that there is no need to apply boosters against pertussis after application of the childhood schedule, 64% were unaware that a vaccine against pertussis is available for adolescents and adults. 81% of those surveyed responded affirmatively that they would vaccinate against pertusis. Conclusion: The study provides data suggesting that health personnel in this study, in its majority, have knowledge of the importance of pertussis in small children; as well as the potential for infection of the adolescent and adult population. However, their knowledge about protection through immunization and its duration, is scarce; furthermore, since they have a good disposition towards prevention of the disease, educative efforts should be directed towards this population to help implement the diverse strategies of vaccination for a better control of the disease. [ABSTRACT FROM AUTHOR]

Objective: To review the existent literature regarding chronic rhinosinusitis in children. Material and method: PubMed search using the keywords: chronic sinusitis, chronic rhinosinusitis, chronic cough in children, persistent cough, gastroesophageal reflux in children, cystic fibrosis, ciliary diskinesia. Articles were selected based on their relevance to this review. Results: Chronic rhinosinusitis in children and adults appear to have different etiology and therefore different diagnostic and treatment strategies. It is becoming more apparent that adult chronic rhinosinusitis has a relatively greater inflammatory component whereas childhood chronic rhinosinusitis has a relatively greater infectious component. This is secondary to immaturity of the pediatric immune system, the increased incidence of viral upper respiratory tract infections, the smaller ostia of the sinuses and adenoidal hypertrophy. Concentrations of eosinophils in adult mucosa are greater than those noted in children. There is a greater degree of collagen deposition and expansion of submucosal mucous glands in the adult sinus indicating more tissue remodeling and potentially greater irreversible scarring. Immune deficiencies, cystic fibrosis, and ciliary dyskinesia are more likely to occur in children. Conclusions: Careful history and physical examination, together with appropriate investigations, enable the clinician to make a correct diagnosis in the majority of cases of chronic rhinosinusitis. For the difficult cases the referral to a pediatric specialist in allergy, clinical immunology and respiratory diseases is warranted. [ABSTRACT FROM AUTHOR]

Objectives. To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives. Material and Methods. The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualiied personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under ive were taken from the Children's Health Epidemiology Reference Group of WHO (CHERG). Results. The regional trend in the rate of mortality for children under ive (MDG-4) in the last 18 years shows an annual reduction of 4.2%, signiicantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal. Conclusion. Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under ive years but insuficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulill the acquired commitments to eradicate poverty. [ABSTRACT FROM AUTHOR]

Introduction. Asthma is the most common chronic disease in children. It is characterised by coughing, wheezing and breathlessness. Symptoms, seasonality and triggering factors differ for each individual. Objective. To describe the clinical and spirometric characteristics of Mexican asthmatic children, as well as triggering factors, use of rescue therapy, seasonality and allergic sensitization. Method. Medical history, clinical evaluation, spirometric tests, and skin prick tests were performed in children attending an allergy outpatient clinic for the first time, with symptoms suggestive of asthma in the last year. Asthma severity was classified according to GINA 2002. Results. A total of 104 patients between 7 and 18 years old (10.1±2.79) were included. Male gender predominated with a 1.3:1 ratio. 58.7% had mild asthma; 29.8% mild to moderate asthma, and 11.5% moderate to severe asthma. Coughing, wheezing and nocturnal asthma were the predominant symptoms. Forced expiratory volume in one second (FEV1) (%) was between 80 and 117% (92.1±7) in the first group; between 80 and 105% (90±7.4) in the second group; and between 72 and 89% (79.2±4.8) in the third group. 58.2% of the patients had received bronchodilators in the last year (average 1.3 times/week). Most children (89.4%) were sensitized to at least one allergen. Conclusions. Asthma symptoms, triggering factors, as well as FEV1 vary individually according to asthma severity. [ABSTRACT FROM AUTHOR]

Introduction. From long time back it has been tried by several methods to mitigate the haemodynamic changes and the cough during intubation like in the tracheal extubation, being this it completes the one of but interest by the complexity that represents the drug combination to suppress to the haemodynamic changes and the cough, having the described schemes from calcium channel bloc-ker, local anesthetics to the extubation still anesthetized, with the purpose of to maintain without haemodynamic changes to the patient during the tracheal extubation. Material and methods. One hundred five patients divided in three groups of the following way: an experimental group (Group 1, n = 35) handled with 0.5 mg/kg of endotracheal lidocaine 15 minutes previous to the extubation and 0.5 mg/kg intravenous route 3-7 minutes previous to the extubation, an experimental group (Group 2, n = 34) handled with 0.5 mg/kg of endotracheal lidocaine 15 minutes previous to the extubation and 1.0 mg/kg of previous intravenous lidocaina 3-7 minutes to the extubation, and the group control (n = 36) to which minister saline solution by both routes, to simulate the placebo effect. Results. Was a suitable suppression of the cough in both experimental groups (p < 0.001), the control of the tachycardia and hypertension were mitigated following the dose (p < 0.05), and I am not observed delay in waking up in any of the groups (p = 0.364). Conclusions. We concluded that the lidocaine in low doses, combining the routes intravenous and endotracheal reduces to the cough and haemodynamic changes during the tracheal extubation. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical presentation of 48 cases and the risk factors associated with mortality. Study Design: Transversal, descriptive, between January 2009 and March 2010. Materials y Methods: Two groups were compared for the descriptive analysis: group 1; patients who passed away, group 2, patients who survived. The selected variables were: Age, sex, cough characteristics, vaccination history, leukocytosis, X-ray, antimicrobial treatment and mortality. The statistic significance was evaluated by Student T test, Pearson Χ² test and Fisher's Exact Test. Results of p <.05 were considered significant. Results: Positive samples to patients in 18 cases (38%), positive samples to relatives in 5 cases (10%). Positive samples group 1; 7 cases (100%), positive samples group 2, 11 cases (61%). Apneas: group 1; 7 cases, group 2: 5 cases; 42% when p = 0.001 (significant). Pneumonias: group 1; 7 cases, group 2; 25 cases, when p= 0.0001 (significant). Starting leucocytes (average) group1; 74,457 mm3. Group 2 51,667 mm3, p = 0.0177. Leukocytosis on day 4; group 1 80,014. Group 2 20,428 mm3, when p = 0.0001. Mortality 15%. Conclusions: Presence of apnea, leukocytosis and pneumonia can be considered as a risk factor considering they were significantly higher in G1 in comparison to G2. [ABSTRACT FROM AUTHOR]

Objective: To review and to analyze the existing literature regarding chronic cough in children. Material and methods: We searched published articles in PubMed using the key words: cough, chronic cough, chronic cough in children, persistent cough, gastroesophageal reflux in children. Results: Cough in children is common; the majority of cases reflect respiratory infections. Cough is rarely associated to a serious disorder. All children with cough persisting for more than 8 weeks should be evaluated. A careful history, physical examination, chest x-ray, and spirometry (in an able child) are recommended for all children with chronic cough. If a diagnosis is no evident (nonspecific cough), then an approach based on characterizing the cough as “wet” or “dry” is helpful. In each case, specific etiology-based treatment is recommended when possible; otherwise, a therapeutic trial is indicated with inhaled corticosteroids (ICS) for children with dry cough (for possible asthma) and antibiotics for wet cough (for possible protracted bacterial bronchitis [PPB] or sinusitis). The treatment should be reviewed within the specified time frame for normal response. If no effect is obvious, the treatment should be stopped and alternative diagnosis considered. Multiple etiologies may need to be treated concomitantly. Every effort should be made to identify the underlying cause. Data suggests potential harmful effects of medications used for symptomatic relief of acute or chronic cough in children. Conclusions: Medical history and physical examination, together with appropriate investigations allow the correct diagnosis of chronic cough. The diagnostic approach is summarized in Figures 1 and 2. Most cases can be managed with this algorithm. For the difficult, complex and rare cases referral to a Pediatric specialist in Allergy, Clinical Immunology and Respiratory Diseases is warranted. [ABSTRACT FROM AUTHOR]

Objective: To know the local epidemiology of the lower respiratory tract infections by viruses in children under two. Material and Methods: A prospective, transversal, observational and descriptive study was designed, which included years under two. They had lower tract infection between September 15, 2008 and July 15, 2009 demonstrated by direct immunofluorescence. Results will be presented in a statistical descriptive manner, conveniently displayed in charts and graphs. Results: 164 samples were sent to the Sonora's State Public Health Laboratory, from which two were rejected because of inappropriate identification, hence 161 samples were included. In 71 samples the viral agent was properly identified, 87% were respiratory syncytial virus (RSV); Influenza A 8.4%; adenovirus 2.5%; parainfluenza virus 1.3%. From 62 infected patients with RSV, 42 (74.2%) were infants under 6 months, this increased up to 95% at the end of the year. Clinical presentation of RSV infection was pneumonia, followed by bronchiolitis and pertussis like syndrome. Conclusions: knowledge of local epidemiological data, will allow us to use antibiotics judiciously, and to design studies that evaluate novel therapies in patients with severe evolution, allowing us to improve patient care. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory disorder of the airway pathways characterized by an obstruction of airflow, which may be completely or partially reversed with or without specific therapy. Airway inflammation is the result of interactions between various cells, cellular elements and cytokines. In susceptible individuals, airway inflammation may cause recurrent or persistent broncho spasm, which causes symptoms including wheezing, breathlessness, chest tightness, and cough. Childhood asthma includes several different clinical phenotypes with different management strategies. The diagnosis of asthma in children requires a careful review of the child's current and past medical history, family history and a physical examination. Specialized testing is sometimes needed to diagnose asthma and to rule out other possible causes. [ABSTRACT FROM AUTHOR]

Bordetella pertussis is the causal agent of whooping cough (pertussis), a highly contagious respiratory illness. Although the initial vaccines against the disease consisted of killed cells, nowadays many countries use acellular variants less reactogenic and more efficacious. Pertactin (Prn) is one of the B. pertussis's antigens implicated in protective immunity of most of these acellular vaccines. Prn is a polymorfic autotransporter protein of around 60 kD and 13 different variants have been described so far; Prn1 and Prn2 are two of the most studied variants. For obtaining acellular vaccine components it is necessary to develop high-levels antigen expression systems. With this purpose, one of the strategies followed is increasing the rate of transcription for these protein's genes and their number of copies in the cell. In this work prn1 and prn2 genes were inserted into the broad-host-range plasmid pMMB67EH under the regulation of fhaB and tac promoters. As a result it was obtained B. pertussis strains capable of expressing between 11 and 23 times more Prn than analyzed wild ones. It was also obtained E. coli strains in which Prn was detected in association with the cellular surface. The detection and quantification of pertactin antigen was performed by ELISA. [ABSTRACT FROM AUTHOR]

Asthma is a disorder defined by its clinical, physiological and pathological conditions. The predominant characteristic of the medical history are the episodes of breathing difficulty, particularly at night, and frequently accompanied by cough. Factors that influence the risk of developing asthma can be divided into those that cause the development of asthma and those that precipitate asthma exacerbations. Now asthma is considered a controllable disease with a combination of appropriate therapeutic and health education to the family and the patient with asthma. This education is geared primarily toward avoiding risk factors identified in each patient and the proper adherence to established treatment. [ABSTRACT FROM AUTHOR]

High Altitude pulmonary edema is a type of acute pulmonary edema, non cardiogenic, whose causes are unknown. The risk of catching the disease is higher among those who live at greater altitudes; specially children returning back home after spending 7 to 10 days at sea-level zones. It generally occurs between 24 and 96 hours alter the ascent. Subjects prone to the disease display a ventilation response to the reduced hypoxia. The case of a 10 year-old girl arriving to the emergency room with acute symptoms of breathing problems, hacking cough and chest pain has been reported. [ABSTRACT FROM AUTHOR]