Factors Associated With Infant Death After Apparent Life-threatening Event (alte)

Objective: To detect factors associated with greater risk of death in infants after an apparent life-threatening event (ALTE). Methods: This cross-sectional, retrospective, descriptive and analytic study evaluated infants younger than 12 months who had a sudden event of cyanosis, pallor, hypotonia or apnea and were seen in the emergency department of a tertiary university hospital. Forward stepwise logistic regression (Wald) was used to calculate and adjust odds ratios to evaluate associations. Results: Mean age of the 145 patients included in the study was 105 days (median = 65 days). Eleven (7.6%) died, and their mean age was 189 days (median = 218 days). Mean age of survivors was 98 days (median = 62 days) (p = 0.003). Activity before the event, prematurity and number of events were not associated with death. A significant association was found with pallor. Of the 11 infants, 3 had spontaneous resolution of ALTE, whereas 8 patients [27.6%; p < 0.001; OR = 14.3 (95%CI 3.51-58.3)] did not. The associations with respiratory or cardiovascular disease were also significant. In multivariate analysis, immediate spontaneous resolution [p = 0.015; OR = 6.06 (95%CI 1.02-35.94)] and diagnosis of cardiovascular disease [p = 0.047; OR = 164.27 (95%CI 7.34-3.673.78)] remained statistically significant. Conclusion: Infants who experienced an ALTE had a higher risk of subsequent death when their age was greater than 6 months and the event had a long duration, particularly when ALTE was associated with cardiovascular disease. Copyright © 2010 by Sociedade Brasileira de Pediatria.866515519National Institutes of Health Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986 (1987) Pediatrics, 79, pp. 292-299Davies, F., Gupta, R., Apparent life threatening events in infants presenting to an emergency department (2002) Emergency Medicine Journal, 19 (1), pp. 11-16Anjos, A.M., Nunes, M.L., Perfil epidemiológico de crianças com apparent life-threatening event (ALTE) e avaliação prospectiva da etiologia determinante do episódio (2009) Rev Bras Saude Matern Infant, 9, pp. 301-309Edner, A., Wennborg, M., Alm, B., Langercrantz, H., Why do ALTE infants not die in SIDS? (2007) Acta Paediatr, 96, pp. 191-194Dewolfe, C.C., Apparent life-threatening event: A review (2005) Pediatr Clin North Am, 52, pp. 1127-1146. , ixKiechl-Kohlendorfer, U., Hof, D., Peflow, U.P., Traweger-Ravanelli, B., Kiechl, S., Epidemiology of apparent life threatening event (2004) Arch Dis Child, 90, pp. 297-300Shah, S., Sharieff, G.Q., An update on the approach to apparent life-threatening events (2007) Current Opinion in Pediatrics, 19 (3), pp. 288-294. , DOI 10.1097/MOP.0b013e32815745a9, PII 0000848020070600000010Zuckerbraun, N.S., Zomorrodi, A., Pitetti, R.D., Occurrence of serious bacterial infection in infants aged 60 days or younger with an apparent life-threatening event (2009) Pediatr Emerg Care, 25, pp. 19-25Gibb, S.M., Waite, A.J., The management of apparent life threatening events (1998) Current Paediatrics, 8 (3), pp. 152-156Brand, D.A., Altman, R.L., Purtill, K., Edwards, K.S., Yield of diagnostic testing in infants who have had an apparent life-threatening event (2005) Pediatrics, 115, pp. 885-893McGovern, M.C., Smith, M.B., Causes of apparent life threatening events in infants: A systematic review (2004) Arch Dis Child, 89, pp. 1043-1048Rivarola, M.R., Nunes, M.L., Jenik, A., Follett, F., Borghini, M., Mazzola, M.E., Pinho, A.P.S., Kanopa, V., Consensus document for the clinical evaluation and follow up of infants with an apparent life threatening event (ALTE) and its differential diagnosis with first seizure (2007) Journal of Epilepsy and Clinical Neurophysiology, 13 (2), pp. 51-57. , http://www.scielo.br/pdf/jecn/v13n2/a03v13n2.pdfEtxaniz, J.S., Burruchaga, M.S., Hermosa, A.G., Serrano, R.R., Beobide, E.A., Mantín, M.I., Características epidemiológicas y factores de riesgo de los episodios aparentemente letales (2009) An Pediatr, 71, pp. 412-418. , BarcAl-Kindy, H.A., Gélinas, J.F., Hatzakis, G., Côté, A., Risk factors for extreme events in infants hospitalized for apparent life-threatening events (2009) J Pediatr, 154, pp. 332-337Altman, R.L., Li, K.I., Brand, D.A., Infections and apparent life-threatening events (2008) Clin Pediatr, 47, pp. 372-378. , PhilaClaudius, I., Keens, T., Do all infants with apparent life-threatening events need to be admitted? (2007) Pediatrics, 119, pp. 679-683Vellody, K., Freeto, J.P., Gage, S.L., Collins, N., Gershan, W.M., Clues that aid in the diagnosis of nonaccidental trauma presenting as an apparent life-threatening event (2008) Clin Pediatr, 47, pp. 912-918. , PhilaPitetti, R.D., Whitman, E., Zaylor, A., Accidental and nonaccidental poisonings as a cause of apparent life-threatening events in infants (2008) Pediatrics, 122, pp. e359-62Bonkowsky, J.L., Guenther, E., Filloux, F.M., Srivastava, R., Death, child abuse and adverse neurological outcome of infants after an apparent life-threatening event (2008) Pediatrics, 122, pp. 125-131Steinschneider, A., Richmond, C., Ramaswamy, V., Curns, A., Clinical characteristics of an Apparant Life-Threatening Event (ALTE) and the subsequent occurrence of prolonged apnea or prolonged bradycardia (1998) Clinical Pediatrics, 37 (4), pp. 223-230Geib, L.T., Nunes, M.L., The incidence of sudden death syndrome in a cohort of infants (2006) J Pediatr, 82, pp. 21-26. , Rio JSemmekrot, B.A., Van Sleuwen, B.E., Engelberts, A.C., Joosten, K.F., Mulder, J.C., Liem, K.D., Survillance study of apparent life-threatening events (ALTE) in the Netherlands (2010) Eur J Pediatr, 169, pp. 229-236Ramanathan, R., Corwin, M.J., Hunt, C.E., Lister, G., Tinsley, L.R., Baird, T., Silvestri, J.M., Keens, T.G., Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for SIDS (2001) Journal of the American Medical Association, 285 (17), pp. 2199-2207Duffty, P., Bryan, M.H., Home apnea monitoring in "near-miss" sudden infant death syndrome (SIDS) and in siblings of SIDS victims (1982) Pediatrics, 70, pp. 69-74De Piero, A.D., Teach, S.J., Chamberlain, J.M., ED Evaluation of Infants after an Apparent Life-Threatening Event (2004) American Journal of Emergency Medicine, 22 (2), pp. 83-86. , DOI 10.1016/j.ajem.2003.12.00

Protocolos De Triagem E Classificação De Risco Em Emergência Pediátrica

34324925

Gastric emptying of liquids in rats dehydrated by water deprivation

The gastric emptying of liquids was investigated in male Wistar rats (8 to 10 weeks old, 210-300 g) dehydrated by water deprivation. In this model of dehydration, weight loss, hematocrit and plasma density were significantly higher in the dehydrated animals than in the control groups after 48 and 72 h of water deprivation (P&lt;0.05). Three test meals (saline (N = 10), water (N = 10) and a WHO rehydrating solution containing in one liter 90 mEq sodium, 20 mEq potassium, 80 mEq chloride and 30 mEq citrate (N = 10)) were used to study gastric emptying following water deprivation for 24, 48 and 72 h. After 72 h, gastric emptying of the water (39.4% retention) and rehydrating solution (49.2% retention) test meals was significantly retarded compared to the corresponding control groups (P&lt;0.05, Mann-Whitney test). The 72-h period of deprivation was used to study the recovery from dehydration, and water was supplied for 60 or 120 min after 67 h of deprivation. Body weight loss, hematocrit and plasma density tended to return to normal when water was offered for 120 min. In the animals supplied with water for 60 min, there was a recovery in the gastric emptying of water while the gastric emptying of the rehydrating solution was still retarded (53.1% retention; P&lt;0.02, Kruskal-Wallis test). In the group supplied with water for 120 min, the gastric emptying of the rehydrating (51.7% retention) and gluco-saline (46.0% retention) solutions tended to be retarded (P = 0.04, Kruskal-Wallis test). In this model of dehydration caused by water deprivation, with little alteration in the body electrolyte content, gastric emptying of the rehydrating solution was retarded after rehydration with water. We conclude that the mechanisms whereby receptors in the duodenal mucosa can modify gastric motility are altered during dehydration caused by water deprivatio

Gastric Emptying And Metabolic Acidosis. Iii. Gastric Retention Of A Sodium Citrate Solution, Utilizing An Experimental Model Of Metabolic Acidosis In Rats [esvaziamento Gastrico E Acidose Metabolica. Iii. Estudo Da Retencao Gastrica De Uma Solucao De Citrato De Sodio, Utilizando Um Modelo Experimental De Acidose Metabolica Em Ratos]

[No abstract available]29310110

Acute Toxic Exposure In Children: An Overview

Objective: To review the literature on acute toxic exposure in children, excluding envenomations. Sources of data: MEDLINE review (emphasis on the past decade), including the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists' position statements and position papers (peer-reviewed information based on scientific evidence and broad consensus) on gastrointestinal decontamination, multiple-dose activated charcoal and urine alkalinization. Summary of the findings: Acute toxic exposure in children is a common event, mainly in children under six years of age. Death is rare. Although widely employed, there is no evidence that gastrointestinal decontamination and multiple-dose activated charcoal improve the outcome of poisoned patients. Very few efficient antidotes are used on a consistent basis, and some of them are very expensive and not available in Brazil. Conclusions: Ipecac syrup and cathartics should not be administered on a routine basis in acute toxic exposures in outpatient treatment. Excluding the contraindications, single-dose activated charcoal and gastric lavage may be considered within one hour of ingestion if a patient ingested a potentially toxic amount or a potentially lethal amount, respectively. Whole bowel irrigation, multiple-dose activated charcoal and urine alkalinization may be considered in a few situations. Fomepizole and octreotide are safe and efficient antidotes, which can be used in the treatment of alcohol (methanol and ethylene glycol) and sulfonylureas poisoning, respectively. Copyright © 2005 by Sociedade Brasileira de Pediatria.815 SUPPL.S212S222Watson, W., Litovitz, T.L., Klein-Schwartz, W., Rodgers, G.C., Youniss, J., Reid, N., 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System (2004) Am J Emerg Med, 22, pp. 335-404Liebelt, E.L., DeAngelis, C.D., Evolving trends and treatment advances in pediatric poisoning (1999) JAMA, 282, pp. 1113-1115Tenenbein, M., Recent advances in pediatric toxicology (1999) Pediatr Clin North Am, 46, pp. 1179-1188Riordan, M., Rylance, G., Berry, K., Poisoning in children 1: General management (2002) Arch Dis Child, 87, pp. 392-396Riordan, M., Rylance, G., Berry, K., Poisoning in children 2: Painkillers (2002) Arch Dis Child, 87, pp. 397-399Riordan, M., Rylance, G., Berry, K., Poisoning in children 3: Common medicines (2002) Arch Dis Child, 87, pp. 400-402Riordan, M., Rylance, G., Berry, K., Poisoning in children 4: Household products, plants, and mushrooms (2002) Arch Dis Child, 87, pp. 403-406Riordan, M., Rylance, G., Berry, K., Poisoning in children 5: Rare and dangerous poisons (2002) Arch Dis Child, 87, pp. 407-410Abbruzzi, G., Stork, C.M., Pediatric toxicologic concerns (2002) Emerg Med Clin North Am, 20, pp. 223-247(2002) Casos Registrados de Intoxicação Humana e Envenenamento, , www.fiocruz.br/sinitox/2002/brasil2002.htm, BrasilRodgers, G.B., The safety effects of child-resistant packaging for oral prescription of drugs. Two decades of experience (1996) JAMA, 275, pp. 1661-1665Poison treatment in the home (2003) Pediatrics, 112, pp. 1182-1185Krenzelok, E.P., McGuigan, M., Lheureux, P., AACT/EAPCCT position statement: Ipecac syrup (1997) J Toxicol Clin Toxicol, 35, pp. 699-709Vale, G.A., AACT/EAPCCT position statement: Gastric lavage (1997) J Toxicol Clin Toxicol, 35, pp. 711-719Chyka, P.A., Seger, D., AACT/EAPCCT position statement: Singledose activated charcoal (1997) J Toxicol Clin Toxicol, 35, pp. 721-741Barceloux, D., McGuigan, M., Hartigan-Go, K., AACT/EAPCCT position statement: Cathartics (1997) J Toxicol Clin Toxicol, 35, pp. 743-752Tenenbein, M., AACT/EAPCCT position statement: Whole bowel irrigation (1997) J Toxicol Clin Toxicol, 35, pp. 743-752Manoguerra, A.S., Krenzelok, E.P., McGuigan, M., Lheureux, P., AACT/EAPCCT position paper: Ipecac syrup (2004) J Toxicol Clin Toxicol, 42, pp. 133-143Lheureux, P., Tenenbein, M., AACT/EAPCCT position paper: Whole bowel irrigation (2004) J Toxicol Clin Toxicol, 42, pp. 843-854Kulig, K., Vale, J.A., AACT/EAPCCT position paper: Gastric lavage (2004) J Toxicol Clin Toxicol, 42, pp. 933-943Krenzelok, E.P., Vale, J.A., Chyka, P.A., Seger, D., AACT/EAPCCT position paper: Single-dose activated charcoal (2005) J Toxicol Clin Toxicol, 43, pp. 61-87Bond, G.R., Home syrup of ipecac use does not reduce emergency department use or improve outcome (2003) Pediatrics, 112, pp. 1061-1064Krenzelok, E.P., New developments in the therapy of intoxications (2002) Toxicol Letters, 127, pp. 299-305Manoguerra, A.S., Cobaugh, D.J., Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons (2005) Clin Toxicol, 43, pp. 1-10Krenzelok, E.P., Ipecac syrup-induced emesis. No evidence of benefit (2005) Clin Toxicol, 43, pp. 11-12Seger, D., Parallax view (2005) Clin Toxicol, 43, pp. 13-15Eddleston, M., Juszczac, E., Buckley, N., Does gastric lavage really push poisons beyond the pylorus? A systematic review of the evidence (2003) Ann Emerg Med, 42, pp. 359-364Seger, D., Single-dose activated charcoal-backup and reassess (2004) J Toxicol Clin Toxicol, 42, pp. 101-110Sitar, G.R., Tenenbein, M., Effect of anticholinergic drugs on the efficacy of activated charcoal (2004) J Toxicol Clin Toxicol, 42, pp. 267-272Spiller, H.A., Rodgers Jr., G.C., (2001) Evaluation of Administration of Activated Charcoal in the Home, 108 (6), pp. E100. , www.pediatrics.org/cgi/content/full/108/6/e100Scharman, E.J., Cloonan, H.A., Durback-Morris, L.F., Home administration of charcoal: Can mothers administer a therapeutic dose? (2001) J Emerg Med, 21, pp. 357-361Bond, G.R., Activated charcoal in the home: Helpful and important or simply a distraction? (2002) Pediatrics, 109, pp. 145-146James, L.P., Nichols, M.H., King, W.D., A comparison of cathartics in pediatric ingestions (1995) Pediatrics, 96, pp. 235-238AACT/EAPCCT position statement and practical guidelines on the use of multiple dose-activated charcoal in the treatment of acute poisoning (1999) J Toxicol Clin Toxicol, 37, pp. 731-751Tenenbein, M., Multiple-dose activated charcoal: Time for reappraisal II (2003) Ann Emerg Med, 42, pp. 597-598Dorrington, C.L., Johnson, D.W., Brant, R., The frequency of complications associated with the use of multiple-dose activated charcoal (2003) Ann Emerg Med, 41, pp. 370-377Eroglu, A., Kucuktulu, U., Ercyes, N., Turgutalp, H., Multiple doseactivated charcoal as a cause of acute appendicitis (2003) J Toxicol Clin Toxicol, 41, pp. 71-73Proudfoot, A.T., Vale, J.A., Krenzelok, E.P., Position paper on urine alkalinization (2004) J Toxicol Clin Toxicol, 42, pp. 1-26Higgins, R.M., Connolly, J.O., Hendry, B.M., Alkalinization and hemodialysis in severe salicylate poisoning: Comparison of elimination techniques in the same patient (1998) Clin Nephrol, 50, pp. 178-183Perry, H.E., Shannon, M.W., Diagnosis and management of opioid and benzodiazepine - Induced comatose overdose in children (1996) Curr Opin Pediatr, 8, pp. 243-247Naloxone dosage and route of administration for infants and children: Addendum to emergency drug doses for infants and children (1990) Pediatrics, 86, pp. 483-484Klein-Schwartz, W., Trends and toxic effects from pediatric clonidine exposures (2002) Arch Pediatr Adolesc Med, 156, pp. 392-395Liebelt, E.L., The use of naloxone for resuscitation of non-opioid toxicity (2003) Abstracts of the XXIII Congress of the European Association of Poison Centres and Clinical Toxicologists (EAPCCT), , May 20-23Roma- Italy: abstract n. 30Bucaretchi, F., Dragosavac, S., Vieira, J.R., Exposição aguda a derivados imidazolínicos em crianças (2003) J Pediatr, 79, pp. 519-524. , Rio JThe flumazenil in benzodiazepine intoxication Multicenter Study Group: Treatment of benzodiazepine overdose with flumazenil (1992) Clin Ther, 14, pp. 978-995Geller, E., Crome, P., Challer, M.D., Marchant, B., Risks and benefits of therapy with flumazenil (Lanexate) in mixed drug intoxications (1991) Eur Neurol, 31, pp. 241-250Seger, D.L., Flumazenil - Treatment or toxin (2004) J Toxicol Clin Toxicol, 42, pp. 209-216Harrison, P.M., Keays, R., Bray, G.P., Improved outcome of acetaminophen-induced fulminant hepatic failure by late administration of acetylcystine (1990) Lancet, 335, pp. 1572-1573Marzullo, L., An update of N-acetylcisteine treatment for acute acetaminophen toxicity in children (2005) Curr Opin Pediatr, 17, pp. 239-245Tenebein, M., Acetaminophen: The 150 mg/kg myth (2004) J Toxicol Clin Toxicol, 42, pp. 145-148Bond, R.G., Reduced toxicity of acetaminophen in children: It's the liver (2004) J Toxicol Clin Toxicol, 42, pp. 149-152Bucaretchi, F., Miglioli, L., Baracat, E.C., Madureira, P.R., De Capitani, E.M., Vieira, J.R., Exposição aguda à dapsona e metemoglobinemia em crianças: Tratamento com doses múltiplas de carvão ativado (2000) J Pediatr, 76, pp. 290-294. , Rio

Gastric emptying of liquids in rats dehydrated by water deprivation

The gastric emptying of liquids was investigated in male Wistar rats (8 to 10 weeks old, 210-300 g) dehydrated by water deprivation. In this model of dehydration, weight loss, hematocrit and plasma density were significantly higher in the dehydrated animals than in the control groups after 48 and 72 h of water deprivation (P&lt;0.05). Three test meals (saline (N = 10), water (N = 10) and a WHO rehydrating solution containing in one liter 90 mEq sodium, 20 mEq potassium, 80 mEq chloride and 30 mEq citrate (N = 10)) were used to study gastric emptying following water deprivation for 24, 48 and 72 h. After 72 h, gastric emptying of the water (39.4% retention) and rehydrating solution (49.2% retention) test meals was significantly retarded compared to the corresponding control groups (P&lt;0.05, Mann-Whitney test). The 72-h period of deprivation was used to study the recovery from dehydration, and water was supplied for 60 or 120 min after 67 h of deprivation. Body weight loss, hematocrit and plasma density tended to return to normal when water was offered for 120 min. In the animals supplied with water for 60 min, there was a recovery in the gastric emptying of water while the gastric emptying of the rehydrating solution was still retarded (53.1% retention; P&lt;0.02, Kruskal-Wallis test). In the group supplied with water for 120 min, the gastric emptying of the rehydrating (51.7% retention) and gluco-saline (46.0% retention) solutions tended to be retarded (P = 0.04, Kruskal-Wallis test). In this model of dehydration caused by water deprivation, with little alteration in the body electrolyte content, gastric emptying of the rehydrating solution was retarded after rehydration with water. We conclude that the mechanisms whereby receptors in the duodenal mucosa can modify gastric motility are altered during dehydration caused by water deprivation1363136

Antileukotrienes In The Treatment Of Asthma And Allergic Rhinitis

Objective: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment. Sources: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic Summary of the findings: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting β2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. Conclusion: Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II). Copyright © 2006 by Sociedade Brasileira de Pediatria.82SUPPL. 2S213S221Bisgaard, H., Szefler, S., Long-acting beta2 agonists and paediatric asthma (2006) Lancet, 367, pp. 286-288(2005) Global Strategy for Asthma Management and Prevention NHLBI/WHO Workshop Report, , http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=60, Updated Access: 17/09/2006British guideline on the management of asthma (2003) Thorax, 58 (SUPPL. 1), pp. i1-94. , British Thoracic SocietyScottish Intercollegiate Guidelines Network(1997) Guidelines for Diagnosis and Management of Asthma, , http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm, (NIH) National Asthma Education and Prevention Program. Publication No. 97-4051, Updated 2002. Access: 17/09/2006Salpeter, S.R., Ormiston, T.M., Salpeter, E.E., Cardiovascular effects of β-agonists in patients with asthma and COPD: A metaanalysis (2004) Chest, 125, pp. 2309-2321Bisgaard, H., Long-acting 2-agonists in management of childhood asthma: A critical review of the literature (2000) Pediatr Pulmonol, 29, pp. 221-234Bisgaard, H., Effect of long-acting 2-agonists on exacerbation rates of asthma in children (2003) Pediatr Pulmonol, 36, pp. 391-398Mann, M., Chowdhury, B., Sullivan, E., Nicklas, R., Anthracite, R., Meyer, R.J., Serious asthma exacerbations in asthmatics treated with high-dose formoterol (2003) Chest, 124, pp. 70-74Wooltorton, E., Long-acting B2 agonists in asthma: Safety concerns (2005) CMAJ, 173, pp. 1030-1031Nelson, H.S., Weiss, S.T., Bleecker, E.R., Yancey, S.W., Dorinsky, P.M., Is there a problem with inhaled long-acting b-adrenergic agonists? (2006) J Allergy Clin Immunol, 117, pp. 3-16. , SMART Study GroupNelson, H.S., Weiss, S.T., Bleecker, E.R., Yancey, S.W., Dorinsky, P.M., The salmeterol multicenter asthma research trial: A comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol (2006) Chest, 129, pp. 15-26. , SMART Study GroupMartinez, F.D., Safety of long-acting beta-agonists - An urgent need to clear the air (2005) N Engl J Med, 353, pp. 2637-2639Walia, M., Lodha, R., Kabra, S.K., Montelukast in pediatric asthma management (2006) Indian J Pediatr, 73, pp. 275-282Langlois, A., Ferland, C., Tremblay, G.M., Laviolette, M., Montelukast regulates eosinophil protease activity through a leukotriene-independent mechanism (2006) J Allergy Clin Immunol, 118, pp. 113-119Hay, D.W., Torphy, T.J., Undem, B.J., Cysteinyl leukotrienes in asthma: Old mediators up to new tricks (1995) Trends Pharmacol Sci, 16, pp. 304-309Zeidler, M.R., Kleerup, E.C., Goldin, J.G., Kim, H.J., Truong, D.A., Simmons, M.D., Montelukast improves regional air-trapping. due to small airways obstruction in asthma (2006) Eur Respir J, 27, pp. 307-315Spahn, J.D., Covar, R.A., Jain, N., Gleason, M., Shimamoto, R., Szefler, S.J., Effect of montelukast on peripheral airflow obstruction in children with asthma (2006) Ann Allergy Asthma Immunol, 96, pp. 541-549Nieto, A., Pamiesa, R., Olivera, F., Medinab, A., Caballeroa, L., Mazon, A., Montelukast improves pulmonary function measured by impulse oscillometry in children with asthma (Mio study) (2006) Respir Med, 100, pp. 1180-1185Pizzichini, E., Leff, J.A., Reiss, T.F., Hendeles, L., Boulet, L.P., Wei, L.X., Montelukast reduces airway eosinophilic inflammation in asthma: A randomized, controlled trial (1999) Eur Respir J, 14, pp. 12-18Laviolette, M., Malmstrom, K., Lu, S., Chervinsky, P., Pujet, J.C., Peszek, I., Montelukast added to inhaled beclomethasone in treatment of asthma (1999) Am J Respir Crit Care Med, 160, pp. 1862-1868. , Montelukast/Beclomethasone Additivity GroupLex, C., Zacharasiewicz, A., Payne, D.N., Wilson, N.M., Nicholson, A.G., Kharitonov, S.A., Exhaled breath condensate cysteinyl leukotrienes and airway remodeling in childhood asthma: A pilot study (2006) Respir Res, 7, p. 63O'Shaughnessy, K.M., Wellings, R., Gillies, B., Fuller, R.W., Differential effects of fluticasone propionate on allergen-evoked bronchoconstriction and increased urinary leukotriene E4 excretion (1993) Am Rev Respir Dis, 147, pp. 1472-1476Pavord, I.D., Ward, R., Woltmann, G., Wardlaw, A.J., Sheller, J.R., Dworski, R., Induced sputum eicosanoid concentrations in asthma (1999) Am J Respir Crit Care Med, 160, pp. 1905-1909Straub, D.A., Moeller, A., Minocchieri, S., Hamacher, J., Sennhauser, F.H., Hall, G.L., The effect of montelukast on lung function and exhaled nitric oxide in infants with early childhood asthma (2005) Eur Respir J, 25, pp. 289-294Bisgaard, H., Zielen, S., Garcia-Garcia, M.L., Johnston, S.L., Gilles, L., Menten, J., Montelukast reduces asthma exacerbations in 2-to 5-year-old children with intermittent asthma (2005) Am J Respir Crit Care Med, 171, pp. 315-322Knorr, B., Franchi, L.M., Bisgaard, H., Vermeulen, J.H., Lesouef, P., Santanello, N., Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years (2001) Pediatrics, 108, pp. E48Garcia, M.L., Wahn, U., Gilles, L., Swern, A., Tozzi, C.A., Polos, P., Montelukast, compared with fluticasone, for control of asthma among 6- To 14-year-old patients with mild asthma: The MOSAIC study (2005) Pediatrics, 116, pp. 360-369Ng, D., Salvio, F., Hicks, G., Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children (2004) Cochrane Database Syst Rev, (2), pp. CD002314Ducharme, F.M., Di Salvio, F., Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children (Cochrane Review) (2004) The Cochrane Database of Systematic Reviews, (1). , Art. No.: CD002314. DOI:10.1002/14651858.CD002314Szefler, S.J., Phillips, B.R., Martinez, F.D., Chinchilli, V.M., Lemanske, R.F., Strunk, R.C., Characterization of within-subject responses to fluticasone and montelukast in childhood asthma (2005) J Allergy Clin Immunol, 115, pp. 233-242Zeiger, R.S., Szefler, S.J., Phillips, B.R., Schatz, M., Martinez, F.D., Chinchilli, V.M., Childhood asthma research and education network of the National Heart, Lung, and Blood Institute. 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Heterogeneity in the correction of portfolios in the medicine course: student perception

Na Faculdade de Ciências Médicas da Unicamp, o portfólio foi implementado no Curso de Medicina em 2001, – é desenvolvido no quarto ano, quando os discentes atuam nas Unidades Básicas de Saúde. Cada portfólio é corrigido por um docente, e, após as considerações necessárias de cada tópico, atribui-se uma nota. O objetivo deste estudo foi compreender a percepção dos discentes sobre a correção do portfólio pelo grupo docente. Trata-se de um estudo descritivo, com análise qualitativa dos dados. Foram realizadas 31 entrevistas semiestruturadas, após a devolutiva dos portfólios. Os dados foram consolidados utilizando-se a análise de conteúdo proposta por Bardin. Os alunos consideraram que a avaliação por meio do portfólio necessita ser aprimorada com definição clara dos critérios de correção. Na percepção discente, destaca-se a heterogeneidade e a subjetividade dos docentes nessa correção.23The portfolios were implemented in the Medicine Course of the School of Medical Sciences of Unicamp in 2001; it is developed in the fourth year, when the students work in basic health units. Each portfolio iss corrected by a professor, and after the necessary considerations on each topic, a grade is awarded. This study aimed at understanding the perception of students regarding the correction of the portfolios by the teaching staff. It consisted of a descriptive study with qualitative data analysis. Thirty-one semi-structured interviews were conducted after the portfolios were returned. Data were consolidated with the use of the content analysis proposed by Bardin. The students considered that the assessment through the portfolio needs to be improved with a clear definition of the correction criteria. The heterogeneity and subjectivity of the professor in such correction is highlighted in the student perception

Risk Factors Of Death In Children With Diarrhea And Shock Admitted To The Intensive Care Unit [o óbito Em Crianças Com Diarréia Aguda E Choque Em Uti]

BACKGROUND. Describe clinical and epidemiological characteristics of pediatric patients diagnosed with acute diarrhea and shock, admitted to the pediatric intensive care unit, in order to compare the evolution of clinical data between the survival and non-survival groups, thereby identifying the risk factors of death. METHODS. In the Pediatric Intensive Care Unit of the Clinical Hospital at the State University of Campinas (UNICAMP), a non-controlled, descriptive and retrospective study was carried out from February 1994 to January 1998 The epidemiological and clinical/evolution data were analyzed and the groups of those who survived (56) and did not survive (15) were compared. For continuous variables, the Chi-Square test was used and for categorical variables, the Fisher's Exact test, for values lower than five. RESULTS. Seventy one children aged from 0.4 to 13.9 months were admitted, 15 of them died (21.2%). Low birth weight was found in 18.1% and the mean breast-feeding time was 1.1 months. The average length of stay was 5.6 days. 52/71 children needed mechanical ventilation, use of vasoactive drugs and sodium bicarbonate was necessary in 23/71 and 15/71, respectively. 93% of children were given antibiotics. The use of sodium bicarbonate, vasoactive drugs and mechanical ventilation showed an association with risk of death, but only vasoactive drugs (OR=18.56) and an age less than 3 months (OR=0.10) showed a statistically significant difference in multivariate analysis. Artigo recebido: 06/05/04 CONCLUSIONS. Acute diarrhea and shock occurred mainly in children under 3 months of age with a severe clinical/laboratorial condition. During clinical evolution, the high risk of death was related to the use of vasoactive drugs, a support therapy used in critical patients.514237240Claeson, M., Merson, M.H., Global progress in the control of diarrheal diseases (1990) Pediatr Infect Dis J, 9, pp. 345-355Berns, C., Martines, J., De Zoysa, I., Glass, R.I., The magnitude of the global problem of diarrhoeal disease: A ten-year update (1992) Bull World Health Org, 70, pp. 705-714Montarjemi, Y., Käferstein, F., Moy, G., Quevedo, F., Contamineted weaning food: A major risk factor for diarrhoea and associated malnutrition (1993) Bull World Health Org, 71, pp. 79-92Morais, T.B., Morais, M.B., Sigulem, D.M., Bacterial contamination of the lacteal contents of feeding bottles in metropolitan São Paulo, Brazil (1998) Bull World Health Org, 76 (2), pp. 173-181Bone, R.C., Balk, R.A., Cerra, F.B., Dellinger, R.P., Fein, A.M., Knaus, W.A., Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992) Chest, 101, pp. 1644-1655Tobin, J.R., Wetzel, R.C., Shock and multi-organ system dysfunction (1996) Textbook of Pediatric Intensive Care. 3rd Ed., pp. 555-606. , Rogers MC. Baltimore: Williams & WilkinsMitra, A.K., Khan, M.R., Alam, A.N., Complications and outcome of disease in patients admitted to the intensive care unit of a diarrhoeal diseases hospital in Bangladesh (1991) Trans R Soc Trop Med Hyg, 85, pp. 685-687Andrade, J.A., Oliveira, J.O., Fagundes Neto, U., Lethality in hospitalized infants with acute diarrhea: Risk factors associated with death (1999) Rev Assoc Med Bras, 45, pp. 121-127Teka, T., Faruque, A.S.G., Fuchs, G.J., Risk factors for deaths in under-age-five children attending a diarrhoea treatment centre (1996) Acta Paediatr, 85, pp. 1070-1075Griffin, P.M., Ryan, C.A., Nyaphisi, M., Hargrett-Bean, N., Waldman, R.J., Risk factors for fatal diarrhea: A case-control study of African children (1988) Am J Epidemiol, 128 (6), pp. 1322-1329Kilgore, P.E., Holman, R.C., Clarke, M.J., Glass, R.I., Trends do diarrheal disease-associated mortality in US children, 1968 through 1991 (1995) JAMA, 274, pp. 1143-1148Shukry, S., Zaki, A.M., Dupont, H.L., Shoukry, I., Tagi, M.E., Hamed, Z., Detection of enteropathogens in fatal and potentially fatal diarrhea in Cairo, Egypt (1986) J Clin Microbiol, 24, pp. 959-962Sweet, A.Y., Classificação do neonato de baixo peso (1990) Alto Risco Em Neonatologia, pp. 62-86. , Klauss MH, Fanaroff AA. Rio de Janeiro: Guanabara KooganVictora, C.G., Barros, F.C., Vaughan, J.P., Teixeira, A.M.B., Birthweight and infant mortality: A longitudinal study of 5914 Brazilian children (1987) Int J Epidemiol, 16, pp. 239-245Victora, C.G., Smith, P.G., Vaughan, J.P., Nobre, L.C., Lombardi, C., Teixeira, A.M.B., Influence of birth weight on mortality from infectious diseases: A case-control study (1988) Pediatrics, 81, pp. 807-811Post, C.L.A., Victora, C.G., Valente, J.G., Leal, M.C., Niobey, F.M.L., Sabroza, P.C., Fatores prognósticos de letalidade hospitalar por diarréia ou pneumonia em menores de um ano de idade. Estudo de caso e controle (1992) Rev Saúde Publica, 26, pp. 369-378Huttly, S.R.A., Morris, S.S., Pisani, V., Prevention of diarrhoea in young children in developing countries (1997) Bull World Health Org, 75, pp. 163-17