Evaluation of criteria for the diagnosis of asthma using an epidemiological questionnaire

OBJECTIVE: To evaluate criteria for the diagnosis of asthma in an epidemiological survey. METHODS: Adolescents (13-14 years of age) and legal guardians of schoolchildren (6-7 years of age) in the city of Santo André, Brazil, completed the International Study of Asthma and Allergies in Childhood (ISAAC) standard written questionnaire. Affirmative responses regarding wheezing within the last 12 months, asthma ever, bronchitis ever (question added at the end of the questionnaire), as well as the overall ISAAC score above the predefined cutoff points, were considered indicative of asthma. RESULTS: The legal guardians of 2,180 schoolchildren and 3,231 adolescents completed the questionnaires properly. Depending on the criterion adopted, the prevalence of asthma ranged from 4.9% to 26.8% for the schoolchildren and from 8.9% to 27.9% for the adolescents. The criteria with the lowest and highest prevalences were, respectively, physician-diagnosed asthma and physician-diagnosed bronchitis. When compared with other criteria, physician-diagnosed bronchitis showed concordance levels between 71.9% and 79.4%, positive predictive values between 0.16 and 0.63 and poor concordance (kappa: 0.21-0.46). Strong concordance levels were found only between wheezing within the last 12 months and the overall ISAAC score (kappa: 0.82 and 0.98). CONCLUSIONS: The prevalence of asthma varied significantly, depending on the criterion adopted, and there was poor concordance among the criteria. Wheezing within the last 12 months and the overall ISAAC score are the best criteria for the diagnosis of asthma, whereas the question regarding bronchitis ever did not improve the questionnaire. Modifications in this instrument can make it difficult to draw comparisons and should therefore be carefully evaluated.OBJETIVO: Avaliar critérios para o diagnóstico de asma em um estudo epidemiológico. MÉTODOS: Adolescentes (13-14 anos) e responsáveis por escolares (6-7 anos) do município de Santo André, São Paulo, responderam o questionário escrito padrão do International Study of Asthma and Allergies in Childhood (ISAAC). Respostas afirmativas quanto a ter sibilos nos últimos 12 meses, ter asma ou ter bronquite (pergunta adicionada ao final do questionário), assim como o escore global do ISAAC acima dos pontos de corte pré-definidos, foram consideradas como indicativo de asma. RESULTADOS: Os questionários foram adequadamente preenchidos por 2.180 responsáveis por escolares e 3.231 adolescentes. Dependendo do critério empregado, a prevalência de asma variou de 4,9% a 26,8% para os escolares, e de 8,9% a 27,9% para os adolescentes. Os critérios com as menores e maiores prevalências foram, respectivamente, diagnóstico médico de asma e diagnóstico médico de bronquite. A análise comparativa entre o diagnóstico médico de bronquite e os demais critérios mostrou níveis de concordância entre 71,9% e 79,4%, valores preditivos positivos entre 0,16 e 0,63 e concordância fraca (kappa: 0,21-0,46). Índices elevados de concordância foram observados entre sibilos nos últimos 12 meses e o escore global do ISAAC (kappa: 0,82 e 0,98). CONCLUSÕES: A prevalência de asma variou significantemente, de acordo com o critério diagnóstico adotado, e houve baixa concordância entre os critérios. Sibilos nos últimos 12 meses e o escore global do ISAAC são os critérios mais recomendados para se diagnosticar asma, ao passo que a pergunta bronquite alguma vez não demonstrou melhorar o questionário. Modificações nesse instrumento devem ser cuidadosamente avaliadas e podem dificultar comparações.Faculdade de Medicina do ABC Departamento de PediatriaUniversidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUNIFESP, Depto. de PediatriaSciEL

Queixas musculoesqueléticas no ombro: características dos usuários e dos atendimentos na atenção primária

A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.El dolor en el hombro representa la tercera principal queja musculoesquelética de la población. Acomete los factores físicos, psicológicos y económicos del individuo. La atención primaria a la salud es esencial para la eficacia del cuidado de los pacientes afectados. Este estudio de tipo observacional transversal obtuvo un perfil de los usuarios y de las consultas médicas en que había relato de dolor en el hombro durante un año en la atención primaria del municipio de Ribeirão Preto (SP). Se analizaron los registros de las consultas médicas programadas y sin programación previa. En estos registros se recolectaron los datos de los pacientes que se quejaban de dolor musculoesquelético en el hombro (sus datos sociodemográficos y las características de las consultas), los cuales fueron analizados de forma descriptiva y por la prueba chi-cuadrado de Pearson, por las razones de prevalencia y por la regresión logística múltiple. La frecuencia de consultas médicas por queja de dolor en el hombro fue del 9,2%. El perfil de los individuos que se quejaron de dolor en el hombro fue de mujeres, con edad avanzada, casadas, alfabetizadas y que se dedicaban a alguna actividad. Las consultas en su mayoría tuvieron retornos programados, ofrecimiento de orientaciones terapéuticas y pocos encaminamientos.Shoulder pain is the third most common musculoskeletal complaint of the world population. It affects the physical, psychological and financial situation of the individual. Primary care is essential to an effective health care for affected patients. This cross-sectional and observational study has the purpose of characterizing the profile of users of the primary health care service, and analyzing the medical records with shoulder pain reports over an one-year period in the primary care service of Ribeirão Preto – SP. Medical records of patients with scheduled and unscheduled medical consultations were analyzed. Data from patients with musculoskeletal shoulder pain – sociodemographic data and the consultation characteristics – were collected and analyzed descriptively and by Pearson’s Chi-squared test, Odds Ratio and Multiple Logistic Regression. The frequency of shoulder pain in the primary care was 9.2%. The profile of individuals who complained about shoulder pain was advanced age, married, literate and working women. Most consultations had scheduled follow-up consultations, therapeutic guidance and few referrals

Biochemical Aspects of a Serine Protease from Caesalpinia echinata Lam. (Brazilwood) Seeds: A Potential Tool to Access the Mobilization of Seed Storage Proteins

Several proteins have been isolated from seeds of leguminous, but this is the first report that a protease was obtained from seeds of Caesalpinia echinata Lam., a tree belonging to the Fabaceae family. This enzyme was purified to homogeneity by hydrophobic interaction and anion exchange chromatographies and gel filtration. This 61-kDa serine protease (CeSP) hydrolyses H-D-prolyl-L-phenylalanyl-L-arginine-p-nitroanilide (Km 55.7 μM) in an optimum pH of 7.1, and this activity is effectively retained until 50°C. CeSP remained stable in the presence of kosmotropic anions (PO4 3−, SO4 2−, and CH3COO−) or chaotropic cations (K+ and Na+). It is strongly inhibited by TLCK, a serine protease inhibitor, but not by E-64, EDTA or pepstatin A. The characteristics of the purified enzyme allowed us to classify it as a serine protease. The role of CeSP in the seeds cannot be assigned yet but is possible to infer that it is involved in the mobilization of seed storage proteins

Peginterferon still has a place in the treatment of hepatitis C caused by genotype 3 virus

Despite recent advances in therapy for chronic hepatitis C (CHC), the disease caused by genotype 3 virus (GEN3) is still considered a treatment challenge in certain patient subgroups. The aim of this retrospective study was to evaluate the effectiveness and safety of the peginterferon (Peg-IFN) and ribavirin (RBV) combination treatment for GEN3/CHC patients, and to evaluate sustained virological response (SVR) indicators and early treatment interruption due to serious adverse events (SAE). This was a retrospective observational study of GEN3/CHC patients, co-infected or not by HIV and treated with Peg-IFN/RBV in nine Brazilian healthcare centers. The study sample included 184 GEN3/CHC patients; 70 (38%) were co-infected with HIV. The overall SVR rate was 57.1% (95% CI 50-64). Among co-infected and mono-infected patients, the SVR rate was 51.4% (36/70) and 60.5% (69/114), respectively (p=0.241). Thirty-four (18.5%) patients experienced SAE and interrupted treatment. SVR was negatively associated with the use of Peg-IFN alpha 2b (PR 0.75; 95% CI 0.58-0.99; p=0.045) and to early treatment interruption due to SAE (PR 0.36; 95% CI 0.20-0.68; p=0.001). Early treatment interruption due to SAE was associated with age (PR 1.06; 95% CI 1.02-1.10;