Risk factors associated with wheezing in infants

OBJECTIVE: to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil. METHODS: this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46). CONCLUSIONS: the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.OBJETIVO: identificar possíveis fatores de risco associados à sibilância em lactentes (12 a 15 meses) no estado de Mato Grosso, Brasil. MÉTODOS: estudo transversal, utilizando o questionário escrito padronizado do Estudio Internacional de Sibilancia en Lactantes (EISL) - fase 3. Pais e/ou responsáveis pela criança foram entrevistados em Unidades Básicas de Saúde quando as procuravam para imunização de rotina ou durante visitas nos domicílios de crianças matriculadas nos programas de saúde da família, no período de agosto de 2009 a novembro de 2010. Fatores associados à sibilância foram avaliados utilizando análise bivariada e multivariada e expressos como odds ratio (OR) e intervalo de confiança 95% (IC95%). RESULTADOS: ao todo, um mil e sessenta (n = 1.060) pais e/ou responsáveis responderam o questionário escrito. Os fatores de risco para sibilância foram: história familiar de asma [mãe (OR = 1,62; IC95%= 1,07-2,43); pai (OR = 1,98; IC95% = 1,22-3,23); irmãos (OR = 2,13; IC95% = 1,18-3,87)]; história prévia de pneumonia (OR = 10,8; IC 95% = 4,52-25,77); ter mais de seis infecções de vias aéreas superiores (IVAS) (OR = 2,95; IC95% = 2,11-4,14) e a primeira IVAS antes dos três meses de idade (OR = 1,50; IC95% = 1,04-2,17); residir em local com moderada poluição (OR = 1,59; IC95% = 1,08-2,33); uso de paracetamol por IVAS (OR = 2,13; IC95% = 1,54-2,95); e uso de antibiótico por infecção na pele (OR = 2,29; IC 95% = 1,18-4,46). CONCLUSÕES: o estudo dos fatores de risco para sibilância no primeiro ano de vida é importante para auxiliar na identificação, entre os lactentes sibilantes, aqueles de alto risco para desenvolver asma, e para o desenvolvimento de estratégias de prevenção por políticas pública de saúde visando minimizar a morbidade da sibilância na infância.Universidade Federal de Mato Grosso Departamento de PediatriaUniversidad de Santiago Hospital CRS El PinoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Prevalência e características clínicas da sibilância emcrianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactante (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infant were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity.OBJETIVO: Determinar a prevalência e as características clínicas da sibilância em lactente (12-15 meses) residentes em Cuiabá (MT). MÉTODOS: Pais e/ou responsáveis pela criança foram entrevistados e responderam ao questionário escrito padronizado do Estudio Internacional de Sibilanciaen Lactantes (EISL) - fase 3, em unidades básicas de saúde por ocasião da vacinação de rotina ou durante visitas nos domicílios de criança matriculadas nos programas de saúde da família no período de agosto de 2009 a novembro de 2010. RESULTADOS: 1060 pais e/ou responsáveis responderam ao questionário escrito, sendo 514 (48,5%) lactentes do sexo masculino. Dos lactentes, 294 (27,7%) tiveram pelo meno um episódio de sibilância no primeiro ano de vida, com início aos 5,8±3,0 meses e predomínio em meninos. A prevalência de sibilância ocasional (<3 episódios de sibilância) foi 15% e a recorrente (≥3 episódios) foi 12,7%. Entre estes, o uso de broncodilatador inalado, corticosteroide oral, antileucotrieno, presença de sintomas noturnos, dificuldade para respirar e internação por sibilância foram significantemente mais frequentes. Diagnóstico médico de asma foi evidenciado em 28 (9,5%) dos lactentes sibilantes. Dos lactentes sibilantes, 80 (27,7%) relataram ocorrência prévia de pneumonia, sendo que 33 (11,2%) necessitaram internação para tratamento, porém não houve diferença entre os grupos de sibilantes. CONCLUSÃO: A prevalência de sibilância recorrente em lactentes foi mais baixa em comparação a outros estudos brasileiros, assim como o diagnóstico médico de asma. Sibilância recorrente teve início precoce e alta morbidade.Universidade Federal de Mato GrossoUniversidade de SantiagoUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

RELATO DE CASO: DOENÇA DE KAWASAKI

 A Doença de kawasaki foi descrita, em 1967, por um pediatra japonês, chamado Tomisaku Kawasaki. Definida como uma vasculite sistêmica aguda, o que significa que existe uma inflamação das paredes dos vasos sanguíneos, que pode evoluir para dilatação (aneurismas), principalmente, das artérias coronárias. A causa da doença é incerta, embora se suspeite que haja uma origem infecciosa. Os critérios diagnósticos incluem: febre que persiste além de cinco dias, congestão ocular bilateral não exsudativa, ressecamento de lábios e hiperemia de orofaringe com proeminência das papilas linguais, exantema polimorfo não vesicular que se inicia no tronco e se estende para membros, eritema e edema de mãos e pés que evolui para descamação periungueal, linfadenopatia cervical aguda não supurativa uni ou bilateral superior a 1,5 cm de diâmetro. Os critérios "completos" são: febre acima de cinco dias associada a quatro dos cinco critérios restantes ou a presença de febre e aneurisma coronariano associado a três dos demais critérios. O tratamento consiste no uso imunoglobulina, 2 g/kg em infusão contínua, e ácido acetil salicílico na dose de 100 mg/kg/dia, até o desaparecimento da febre e, a partir daí, 3 a 5 mg/kg/dia para manter o do efeito anti-trombótico até a normalização das plaquetas

Influence of strains and environmental cultivation conditions on the bioconversion of ergosterol and vitamin D 2 in the sun mushroom

The fungus Agaricus subrufescens is grown commercially in China, the USA, Brazil, Taiwan and Japan, among others. However, each country adopts a cultivation system that significantly influences the agronomical parameters and chemical composition of the harvested mushrooms. In this study, the influence of the cultivation process on the content of ergosterol and vitamin D2 was evaluated. RESULTS: Four commercial strains of A. subrufescens (ABL 04/49, ABL CS7, ABL 18/01 and ABL 19/01) and two environmental cultivation conditions (in the field and a controlled chamber with the absence of sunlight) were used. Infield cultivation, ABL CS7 and ABL 19/01 strains presented better agronomic parameters, whereas in a protected environment ABL 19/01, ABL 04/49 and ABL 18/01 demonstrated better performance, respectively. The highest biological efficiency value (64%) was provided by ABL 19/01 strain in a controlled environment. CONCLUSION: The highest content in ergosterol (990 mg kg−1) and vitamin D2 (36.8 mg kg−1) were observed in mushrooms obtained in the field from strain ABL 04/49, which presents reasonable agronomic parameters for cultivation.This research was funded by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP No. 2017/22501-2 for CVS, 2019/12605-0 for DMMS and 2018/21492-2 for DCZ, 19/00419-8 for WGVJ). The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES to CIMO (UIDB/00690/2020); national funding by FCT, PI, through the institutional scientific employment program contracts for A Fernandes and L Barros. This work is funded by the European Structural and Investment Funds (FEEI) through the Regional Operational Program North 2020, within the scope of Project Mobilizador ValorNatural®.info:eu-repo/semantics/publishedVersio

Biphasic positive airway pressure minimizes biological impact on lung tissue in mild acute lung injury independent of etiology

Abstract\ud \ud \ud \ud Introduction\ud Biphasic positive airway pressure (BIVENT) is a partial support mode that employs pressure-controlled, time-cycled ventilation set at two levels of continuous positive airway pressure with unrestricted spontaneous breathing. BIVENT can modulate inspiratory effort by modifying the frequency of controlled breaths. Nevertheless, the optimal amount of inspiratory effort to improve respiratory function while minimizing ventilator-associated lung injury during partial ventilatory assistance has not been determined. Furthermore, it is unclear whether the effects of partial ventilatory support depend on acute lung injury (ALI) etiology. This study aimed to investigate the impact of spontaneous and time-cycled control breaths during BIVENT on the lung and diaphragm in experimental pulmonary (p) and extrapulmonary (exp) ALI.\ud \ud \ud \ud Methods\ud This was a prospective, randomized, controlled experimental study of 60 adult male Wistar rats. Mild ALI was induced by Escherichia coli lipopolysaccharide either intratracheally (ALIp) or intraperitoneally (ALIexp). After 24 hours, animals were anesthetized and further randomized as follows: (1) pressure-controlled ventilation (PCV) with tidal volume (Vt) = 6 ml/kg, respiratory rate = 100 breaths/min, PEEP = 5 cmH2O, and inspiratory-to-expiratory ratio (I:E) = 1:2; or (2) BIVENT with three spontaneous and time-cycled control breath modes (100, 75, and 50 breaths/min). BIVENT was set with two levels of CPAP (Phigh = 10 cmH2O and Plow = 5 cmH2O). Inspiratory time was kept constant (Thigh = 0.3 s).\ud \ud \ud \ud Results\ud BIVENT was associated with reduced markers of inflammation, apoptosis, fibrogenesis, and epithelial and endothelial cell damage in lung tissue in both ALI models when compared to PCV. The inspiratory effort during spontaneous breaths increased during BIVENT-50 in both ALI models. In ALIp, alveolar collapse was higher in BIVENT-100 than PCV, but decreased during BIVENT-50, and diaphragmatic injury was lower during BIVENT-50 compared to PCV and BIVENT-100. In ALIexp, alveolar collapse during BIVENT-100 and BIVENT-75 was comparable to PCV, while decreasing with BIVENT-50, and diaphragmatic injury increased during BIVENT-50.\ud \ud \ud \ud Conclusions\ud In mild ALI, BIVENT had a lower biological impact on lung tissue compared to PCV. In contrast, the response of atelectasis and diaphragmatic injury to BIVENT differed according to the rate of spontaneous/controlled breaths and ALI etiology.The authors express their gratitude to Andre Benedito da Silva for animal care, Ana Lucia Neves da Silva for help with microscopy, Moira Elizabeth Schottler and Claudia Buchweitz for assistance in editing the manuscript and MAQUET for providing technical support. This study was supported by Centers of Excellence Program (PRONEX-FAPERJ), Brazilian Council for Scientific and Technological Development (CNPq), Rio de Janeiro State Research Supporting Foundation (FAPERJ), São Paulo State Research Supporting Foundation (FAPESP), National Institute of Science and Technology of Drugs and Medicine (INCT-INOFAR), Coordination for the Improvement of Higher Level Personnel (CAPES), and the European Community’s Seventh Framework Programme (TARKINAID, FP7-2007-2013)

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil.METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010.RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found.CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity