Increased exhalation of hydrogen peroxide in healthy subjects following cigarette consumption

CONTEXT: Increased hydrogen peroxide has been described in the expired breath condensate (H2O2-E) of several lung conditions, such as acute respiratory distress syndrome, chronic obstructive pulmonary disease and asthma. This technique has been advocated as being a simple method for documenting airway inflammation. OBJECTIVE: To evaluate H2O2-E in healthy cigarette smokers, and to determine the acute effects of the consumption of one cigarette on H2O2-E levels. TYPE OF STUDY: Prospective, controlled trial. SETTING: A pulmonary function laboratory in a University Hospital. PARTICIPANTS: Two groups of healthy volunteers: individuals who had never smoked (NS; n=10; 4 men; age = 30.6 ± 6.2 years) and current cigarette smokers (S; n=12; 7 men; age = 38.7 ± 9.8). None of the volunteers had respiratory symptoms and all showed normal spirometric tests. INTERVENTION: Expired air was collected from all volunteers through a face mask and a plastic collecting system leading into a flask with dry ice and pure ethanol. Samples from the group S were collected twice, before and half an hour after the combustion of one cigarette. MAIN MEASUREMENTS: Expired hydrogen peroxide using the Gallati and Pracht method. RESULTS: The S and NS groups showed comparable levels of H2O2-E at basal conditions [NS = 0.74 muM (DP 0.24) vs. S = 0.75 muM (DP 0.31)]. The smokers showed a significant increase in H2O2-E levels half an hour after the consumption of only one cigarette [0.75 muM (DP 0.31) vs. 0.95 muM (DP 0.22)]. CONCLUSION: The present results are consistent with the concept that smokers increase oxidative stress with elevated production of reactive oxygen species, contributing to the development of smoking-related disorders.CONTEXTO: Elevações do peróxido de hidrogênio exalado (H2O2-E) tem sido descritas em diversas doenças pulmonares tais como a síndrome do desconforto respiratório agudo, doença pulmonar obstrutiva crônica e asma. Essa técnica tem sido preconizada como um método simples capaz de refletir inflamação ao nível das vias aéreas. OBJETIVO: Avaliar os níveis de H2O2-E em indivíduos normais e determinar os efeitos agudos do consumo de um cigarro sobre seus valores. TIPO DE ESTUDO: Ensaio clínico, prospectivo, controlado. LOCAL: Laboratório de função pulmonar de um Hospital Universitário. PARTICIPANTES: Dois grupos de voluntários sadios: indivíduos que nunca fumaram [NS; n = 10; 4 homens; idade = 30,6 anos (DP 6,2)] e indivíduos fumantes atuais [S; n = 12; 7 homens; idade = 38,7 anos (DP 9,8)]. Todos os voluntários não apresentavam sintomas respiratórios e exibiam testes espirométricos dentro da normalidade. INTERVENÇÃO: Ar expirado foi coletado de todos os voluntários utilizando-se uma máscara facial e um sistema colocado em um frasco com gelo seco e etanol absoluto. Amostras do grupo S foram coletadas duas vezes, antes e meia hora após o consumo de um cigarro. VARIÁVEIS ESTUDADAS: Peróxido de hidrogênio expirado utilizando-se o método de Gallati e Pracht. RESULTADOS: Ambos os grupos mostraram níveis comparáveis de H2O2-E em condições basais [NS = 0,74 miM (DP 0,24) vs. S = 0,75 miM (DP 0,31)]. Os fumantes mostraram um aumento significante dos níveis de H2O2-E meia hora após o consumo de apenas um cigarro [0,75 miM (DP 0,31) vs. 0,95 miM (DP 0,22)]. CONCLUSÃO: Os resultados obtidos estão de acordo com o conceito de que o consumo de cigarros aumenta o estresse oxidativo com produção elevada de espécies reativas do oxigênio (ROS) contribuindo para o desenvolvimento de doenças relacionadas ao tabagismo.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Pulmonary DivisionUniversity of São Paulo Medical School of Ribeirão Preto Department of MedicineUNIFESP, EPM, Pulmonary DivisionSciEL

Occurrence of influenza among patients hospitalized for suspicion of influenza A (H1N1) infection in 2010 at a sentinel hospital in São Paulo, Brazil

In 2010, 96 patients suspected of being infected with the influenza A (H1N1) virus were hospitalized at the Hospital São Paulo, located in the city of São Paulo, Brazil. Of those 96 patients, 4 (4.2%) were found to be infected with influenza A virus-3 with influenza A (H1N1) and 1 with seasonal influenza A-and 2 patients (2.1%) were found to be infected with influenza B virus. Most (63.5%) of the suspected cases occurred in children, as did half of the positive cases. The second wave of influenza A (H1N1) infection was weaker in São Paulo. The decrease in the number of hospitalizations for H1N1 infection in 2010 might be attributable to vaccination.Em 2010, 96 pacientes com suspeita de infecção por influenza A (H1N1) foram hospitalizados no Hospital São Paulo, na cidade de São Paulo (SP). Desses, 4 pacientes (4,2%) foram diagnosticados com influenza A - 3 com influenza A (H1N1) e 1 com influenza sazonal - e 2 pacientes (2,1%) foram diagnosticados com influenza B. A maioria dos casos suspeitos (63,5%) e metade dos casos positivos ocorreram em crianças. A segunda onda de influenza A (H1N1) foi mais fraca em São Paulo. A vacinação pode ter contribuído para a redução das internações devido a essa infecção em 2010.Universidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina Unidade de Doenças InfecciosasUNIFESP, Depto. de Medicina Unidade de Doenças InfecciosasSciEL

Comparison of the direct fluorescence assay and real-time polymerase chain reaction for the detection of influenza virus A and B in immunocompromised patients

OBJECTIVE: This study evaluated the diagnostic performance of two methods for the detection of influenza virus in immunocompromised transplant patients. METHODS: A total of 475 respiratory samples, 236 from patients in a hematopoietic stem cell transplantation program and 239 from kidney transplant patients, were analyzed by a direct fluorescence assay and the Centers for Disease Control real-time polymerase chain reaction protocol for influenza A and B detection. RESULTS: Influenza detection using either method was 7.6% in the hematopoietic stem cell transplant group and 30.5% in the kidney transplant patient group. Influenza detection by real-time polymerase chain reaction yielded a higher positive rate compared with fluorescence than that reported by other studies, and this difference was more pronounced for influenza A. The fluorescence assay sensitivity, specificity, positive and negative predictive values, and kappa coefficient were 17.6%, 100%, 1, 0.83, and 0.256, respectively, and lower detection rates occurred in the kidney transplant patients. CONCLUSIONS: The real-time polymerase chain reaction performance and the associated turnaround time for a large number of samples support the choice of this method for use in different routine diagnostic settings and influenza surveillance in high-risk patients.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)FAPESPFederal University of São Paulo Medicine Department Infections Disease UnitUNIFESP, Medicine Department Infections Disease UnitSciEL

Respiratory viral coinfection among hospitalized patients with H1N1 2009 during the first pandemic wave in Brazil

Influenza A coinfections with other respiratory viruses were investigated in 25.8% (41/159) of the samples from patients hospitalized in 2009 at our University Hospital. Out of the 41 influenza A cases, nine cases (21.9%) were coinfected with other viruses, with a similar frequency among children and adults (p = 0.47), and seasonal influenza cases were more prevalent than H1N1 2009 influenza virus. Adenovirus was the most frequently detected (4/9) among coinfected cases. Coinfection was not associated with higher morbidity or mortality (p = 0.75)

A survey strategy for human respiratory syncytial virus detection among haematopoietic stem cell transplant patients: epidemiological and methodological analysis

Human respiratory syncytial virus (HRSV) causes severe infections among children and immunocompromised patients. We compared HRSV infections among Haematopoietic Stem Cell Transplant program (HSCT) patients and children using direct immunofluorescence (DFA), point-of-care RSV Bio Easy® and a polymerase chain reaction (PCR) assay. Overall, 102 samples from HSCT patients and 128 from children obtained positivity rate of 18.6% and 14.1% respectively. PCR sensitivity was highest mainly on samples collected after five days of symptoms onset. A combination of both DFA and reverse transcriptase-PCR methods for HSCT high-risk patients is the best diagnostic flow for HRSV diagnosis among these patients