Avaliação das funções orofaciais do sistema estomatognático nos níveis de gravidade de asma

PURPOSE: To compare the orofacial functions (chewing, swallowing and speech) in children with asthma and healthy children. METHODS: A cross sectional study including 54 children of both genders with ages between 7 and 10 years was conducted. Twenty-seven of these subjects composed the experimental group, and were subdivided into two severity levels of asthma: Group I - mild intermittent and persistent asthma; Group II - persistent moderate to severe asthma. Twenty-seven healthy children were included in the control group (Group III). Speech-language pathology evaluation used the adapted Orofacial Myofunctional Assessment Protocol. Adaptation consisted in the exclusion of the structural part of the test, since this was not the aim of the study. The structural part was excluded because it was not the aim of this study. RESULTS: It was found alterations in oral functions, with significant differences between the three groups. These alterations showed no correlation with asthma severity, since the highest rate of alterations was found in Group I (mild asthma). CONCLUSION: Regardless of the severity level, children with asthma have altered patterns of chewing, swallowing and speech.OBJETIVO: Avaliar as funções orofaciais de mastigação, deglutição e fala em crianças asmáticas e crianças saudáveis. MÉTODOS: Estudo de corte transversal com 54 crianças, com idades entre 7 e 10 anos completos, de ambos os gêneros. Do total, 27 compuseram o grupo experimental e foram subdivididas em dois níveis de gravidade de asma: Grupo I - asma intermitente ou persistente leve; Grupo II - asma persistente moderada ou grave. Fizeram parte do grupo controle (Grupo III) 27 crianças saudáveis. Para a avaliação fonoaudiológica foi utilizado o Protocolo de Avaliação Miofuncional Orofacial adaptado. A adaptação constituiu na exclusão da parte estrutural, já que esta não fazia parte do objetivo do estudo. RESULTADOS: Alterações nas funções orofaciais foram encontradas, com diferenças entre os três grupos estudados. Essas alterações não tiveram relação com a gravidade da asma, visto que o maior índice de alterações foi encontrado no Grupo I (asma leve). CONCLUSÃO: Independentemente do nível de gravidade da doença, crianças asmáticas apresentam padrões alterados de mastigação, deglutição e fala.11912

Evaluation Of Oral Functions Of The Stomatognathic System According To The Levels Of Asthma Severity.

To compare the orofacial functions (chewing, swallowing and speech) in children with asthma and healthy children. A cross sectional study including 54 children of both genders with ages between 7 and 10 years was conducted. Twenty-seven of these subjects composed the experimental group, and were subdivided into two severity levels of asthma: Group I - mild intermittent and persistent asthma; Group II - persistent moderate to severe asthma. Twenty-seven healthy children were included in the control group (Group III). Speech-language pathology evaluation used the adapted Orofacial Myofunctional Assessment Protocol. Adaptation consisted in the exclusion of the structural part of the test, since this was not the aim of the study. The structural part was excluded because it was not the aim of this study. It was found alterations in oral functions, with significant differences between the three groups. These alterations showed no correlation with asthma severity, since the highest rate of alterations was found in Group I (mild asthma). Regardless of the severity level, children with asthma have altered patterns of chewing, swallowing and speech.24119-2

Functional performance on the six-minute walk test in patients with cystic fibrosis

OBJECTIVE: To compare patients with cystic fibrosis and healthy individuals in terms of their functional performance on the six-minute walk test (6MWT). METHODS: A prospective, cross-sectional study involving healthy individuals and patients with cystic fibrosis treated at a referral university hospital in the city of Campinas, Brazil. The 6MWT was administered in accordance with the American Thoracic Society guidelines, and it was repeated after a 30-min rest period. For all of the participants, RR, HR, SpO2, and Borg scale scores were obtained. For the cystic fibrosis patients, nutritional status and spirometric values were determined. Patients with pulmonary exacerbation were excluded. Spearman's correlation coefficient and repeated measures ANOVA were used. RESULTS: The cystic fibrosis group comprised 55 patients, and the control group comprised 185 healthy individuals. The mean ages were 12.2 ± 4.3 and 11.3 ± 4.3 years, respectively. The six-minute walk distance (6MWD) was significantly shorter in the cystic fibrosis group than in the control group for both tests (547.2 ± 80.6 m vs. 610.3 ± 53.4 m for the first and 552.2 ± 82.1 m vs. 616.2 ± 58.0 m for the second; p < 0.0001 for both). The 6MWD correlated with age, weight, and height only in the cystic fibrosis group. During the tests, SpO2 remained stable, whereas HR and RR increased. CONCLUSIONS: In our sample, functional performance on the 6MWT was poorer among the cystic fibrosis patients than among the healthy controls in the same age bracket, and we found immediate repetition of the test to be unadvisable.OBJETIVO: Comparar pacientes com fibrose cística e indivíduos saudáveis quanto ao desempenho funcional no teste de caminhada de seis minutos (TC6). MÉTODOS: Estudo transversal e prospectivo, com indivíduos saudáveis e com fibrose cística de um hospital universitário de referência na cidade de Campinas (SP). O TC6 foi aplicado de acordo com as normas da American Thoracic Society e repetido após 30 min de repouso. Foram determinados FR, FC, SpO2 e escore da escala de Borg em todos os participantes, assim como o status nutricional e valores espirométricos para os pacientes com fibrose cística. Excluíram-se pacientes em exacerbação pulmonar. Foram utilizados coeficientes de correlação de Spearman e ANOVA para medidas repetidas. RESULTADOS: Foram incluídos 55 pacientes no grupo fibrose cística e 185 indivíduos saudáveis no grupo controle, com médias de idade de 12,2 ± 4,3 anos e 11,3 ± 4,3 anos, respectivamente. A distância percorrida no TC6 (DTC6) foi significativamente menor no grupo fibrose cística que no grupo controle em ambos os testes (547,2 ± 80,6 m vs. 610,3 ± 53,4 m no primeiro e 552,2 ± 82,1 m vs. 616,2 ± 58,0 m no segundo; p < 0,0001 para ambos). A DTC6 se correlacionou com idade, peso e altura somente no grupo fibrose cística. A SpO2 manteve-se estável durante o teste, com aumento da FC e da FR. CONCLUSÕES: Nesta amostra, os pacientes com fibrose cística apresentaram um menor desempenho funcional no TC6 quando comparados a indivíduos saudáveis de mesma faixa etária, sem a necessidade de repetição imediata do teste.73574

Lack Of Association Between Nutritional Status And Change In Clinical Category Among Hiv-infected Children In Brazil.

Malnutrition is common among HIV-infected children. Our objective was to study the occurrence of malnutrition and its relationship with changes in clinical category among HIV-infected children. Longitudinal study, at the Pediatrics Department and Pediatrics Investigation Center (CIPED), Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp). We reviewed the hospital records of 127 vertically HIV-infected children. Anthropometric measurements were obtained at the beginning of follow-up, at clinical category change and five months later. These were converted to z-scores of weight/age, height/age and weight/height. Data were presented as means, standard deviations, frequency counts and percentages. The Wilcoxon and Kruskal-Wallis tests and odds ratios were used in the analysis. We found that 51 (40.2%) were undernourished and 40 (31.5%) were stunted, with higher risk of being included in clinical category C. There was an association between nutritional condition and the clinical categories of the Centers for Disease Control classification (1994), and with age at symptom onset (except for height z-score). During follow-up, 36 patients (28.4%) changed their clinical category, which occurred early among the undernourished patients. The group that changed its clinical category maintained the same z-score distribution for weight, height and weight/height throughout follow-up. Aids manifestation severity was associated with nutritional status and with age at symptom onset, but change in clinical category was not followed by worsening of nutritional status.12362-

Linear growth in asthmatic children

Asthma is the most frequent chronic inflammatory disease in childhood, and its prevalence has increased remarkably over the last decades. Therefore, the scientific community became interested in studying the growth of the affected children. The relationship between asthma and growth suffers the influence of the clinical picture, of therapeutics, but the different study methods make it difficult to distinguish the factors responsible for the growth retardation detected by some authors. This review has the purpose of providing an overall outlook on this matter.364

Hepatotoxicity In Hiv-infected Children And Adolescents On Antiretroviral Therapy.

Adverse drug reactions are a significant problem in patients on antiretroviral therapy (ART). We determined liver enzyme elevation frequencies in HIV-infected children and adolescents receiving ART, and their association with risk factors. Cross-sectional study, at the Pediatrics Immunodeficiency Division, University Hospital, Universidade Estadual de Campinas. Medical records of 152 children and adolescents (54.6% male; median age 7.48 years) were analyzed, with a mean of 2.6 liver enzyme determinations per patient. Clinically, patients were classified in categories N (6), A (29), B (78) and C (39). Serum levels of aspartate aminotransferase and alanine aminotransferase were evaluated. Hepatotoxicity was scored as grade 1 (1.1-4.9 times upper limit of normality, ULN), grade 2 (5.0-9.9 times ULN), grade 3 (10.0-15.0 times ULN) and grade 4 (> 15.0 times ULN). To assess hepatotoxicity risk factors, odds ratios (OR) and adjusted odds ratios (aOR) for age, gender, TCD4+ cell count, viral load and medication usage were calculated. We observed grade 1 hepatotoxicity in 19.7 % (30/152) patients. No cases of grade 2, 3 or 4 were detected. There was a significant association between hepatotoxicity and use of sulfonamides (OR, 3.61; 95% confidence interval (CI), 1.50-8.70; aOR, 3.58; 95% CI, 1.44-8.85) and antituberculous agents (OR, 9.23; 95% CI, 1.60-53.08; aOR, 9.05; 95% CI, 1.48-55.25). No toxicity was associated with ART. One fifth of patients experienced mild hepatotoxicity, attributed to antituberculous agents and sulfonamides. Our results suggest that ART was well tolerated.125205-

Alterações pulmonares em crianças infectadas pelo virus da imunodeficiencia humana do tipo 1

Orientador: Maria Marluce dos Santos VilelaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Depois do sistema imunológico, o pulmão é o órgão mais acometido em pacientes com a síndrome da imunodeficiência pediátrica, causada pelo vírus HIV-l. O objetivo deste estudo foi avaliar as manifestações clínicas e de imagens do trato respiratório inferior em crianças infectadas pelo HIV-l, por transmissão vertical considerando: a) a evolução da doença pulmonar e identificação, quando possível, da sua etiologia; b) as alterações radiográficas e a correlação anatomopatológica; c) a categoria clínico-imunológica da infecção pelo HIV-1 e a manifestação da doença pulmonar. O presente estudo foi realizado com um grupo de 48 pacientes da faixa etária pediátrica (entre O e 13 anos de idade ), os quais faziam seguimento no Ambulatório de Imunodeficiência Pediátrica . do Hospital das Clínicas da Faculdade de Medicina da Unicamp, no período entre dezembro de 1994 à outubro de 1998, e que apresentaram em algum momento doença pulmonar. Esses pacientes fazem parte de uma coorte de 304 crianças e adolescentes menores de 14 anos, nascidos de mães infectadas pelo vírus da imunodeficiência humana do tipo um (HIV -1), matriculadas no Serviço de Imunodeficiência Pediátrica do HC -Unicamp, desde janeiro de 1989 até 31 de julho de 1998. Pneumonia aguda de provável etiologia bacteriana foi diagnosticada em 42 (87,5%) pacientes, mediante critérios clínicos e radiológicos, sendo que 10 (20,8%) destes com apenas um episódio de pneumonia, 8 (16,6%) com dois e 24 (5001Ó) com três ou mais. Dentre todos eles, 39 (92,8 %) apresentaram melhora clínica e radiológica e apenas um mostrou imagem mantida de pneumatocele com resolução no final de um ano de seguimento. Dos 42 pacientes com pneumonia resgatou-se o tratamento em 100 episódios, e 97% deles apresentaram tratamento efetivo para as bactérias mais freqüentes de acordo com a faixa etária pediátrica. Dentre os trinta e um pacientes ,?om imagem radiológica mantida (opacidade heterogênea) por mais de três meses, vinte e sete realizaram tomografia de tórax de alta resolução (TCAR). Em sete pacientes foram encontradas linfonodomegalia mediastinal na TCAR. As alterações pulmonares vistas na TCAR das crianças desse estudo foram: opacidades em vidro fosco em 3; opacidades retículo-nodulares em 8; reticulares em 3; nodulares em 6; consolidação em espaços aéreos em 7; aprisionamento de ar em um e cistos pulmonares em 2. A biópsia pulmonar foi realizada em vinte pacientes. Dezessete crianças com patologia pulmonar crônica e três com quadro pulmonar agudo. A média de idade na data da biópsia foi 4 anos e 6 meses e a mediana 3 anos e 6 meses. Segundo os critérios clínicos e imunológicos, do Centers for Disease Control dos Estados Unidos da América, esses pacientes foram classificados em: B2, seis (300.10); B3, quatro (20%); C2, dois (10%) e C3, oito (40)%. Os achados histopatológicos obtidos em dezessete pacientes que realizaram biópsia pulmonar por imagem mantida no radiograma de tórax e confirmada pela tomografia foram: pneumonia intersticial linfocítica (PIL) em 5 pacientes, hiperplasia linfóide em 9, tuberculose em 1, pneumonia intersticial não PIL em 2. Três pacientes foram submetidos a biópsia durante quadro agudo infeccioso, para auxílio no diagnóstico, com os seguintes resultados: pneumonia necrosante em 1, pneumonia intersticial crônica não PIL com focos de bronco pneumonia em 1, processo inflamatório crônico nodular rico em histiócitos em outro. Em apenas um dentre todos, o material foi obtido de necrópsia: dano alveülar difuso e avançado em organização. A cultura do material de biópsia mosu:ou em dois dos pacientes, com diagnóstico histopatológico de hiperplasia linfóide: O)'l!tbccocos neoformans e Mycobacterium tuberculosis, respectivamente. Portanto, nessa casuística, os pacientes apresentaram pneumonia de possível etiologia bacteriana com o mesmo aspecto clínico e radiológico, já descrito em crianças não infectadas pelo vírus HIV-I, respondendo ao tratamento padrão, estabelecido para tal patologia. Pacientes com imagem pulmonar manti.da se beneficiaram da biópsia, a qual auxiliou na indicação terapêuticaAbstract: The respiratory tract is affected in AIDS , second only to the imune system. The aim of this study was to evaluate the role of the Iung and how it contributes to the development of the mv infection. From a cohort of 304 children, 48, infected with mv by vertical transmission were selected, who had developed some pulmonary disease. Those children were folIowed up in the Immunodeficiency Clinic, ITom December, 1994, to October, 1998. The patients were assessed according to their clinicaI, radiologicaI and histopathological aspects and TCD3, TCD4 and TCD8 counts. The decision to make a lung biopsy was taking after noticing a persistent heterogeneous nodular pattem on chest radiographs, for more than three months, confirmed by high-resolution CT (HRCT). Forty two patients (87,5%) had at sometime bacteriaI pneumonia. The HRCT findings incIuded : ground-glass pattem 3, reticular pattem 3, nodular pattem 3, air-trapping 1, pulmonary air cysts 2, reticulonodular pattem 8, air-space consolidation 7. Twenty patients were submitted to Iung biopsy. The pathologic diagnoses incIuded: lymphoid interstitial peumonitis in 5 patients, pulmonary limphoid hiperplasia in 9, tuberculosis in 1, interstitial pneumonia in 4, difuse alveolar damage in 1, necrotizing pneumonia 1. Two differeht patients had Criptococos Neoformmls and Mycobacterium Tuberculosis, isolated ITom their pulmonary tis sue cultures. In this study, patients with an undiagnosed persistent Iocalized nodular infiltrate might have a signifcant benefit ITom an invasive diagnostic procedure due to similar radiologic imagesMestradoMestre em Pediatri

Lipoid pneumonia in a 40-day-old infant

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