Prevalence and Severity of Asthma, Rhinitis, and Atopic Eczema in 13- to 14-Year-Old Schoolchildren from Southern Brazil

The objective of this study was to investigate the prevalence and severity of asthma, rhinitis, and atopic eczema in schoolchildren from southern Brazil. A cross-sectional study was carried out with the International Study of Asthma and Allergies in Childhood phase III written questionnaire. The questionnaire was self-applied by 2,948 randomly selected schoolchildren aged 13 to 14 years. The lifetime prevalence rates of symptoms were as follows: wheezing, 40.8%; rhinitis, 40.7%; eczema, 13.6%; self-reported asthma, 14.6%; rhinitis, 31.4%; eczema, 13.4%. Rhinitis was reported by 55% of adolescents with current asthma (60% females vs 46.9% males). Girls 13 to 14 years of age had higher prevalence rates of asthma, rhinitis, and eczema than boys had. Atopic eczema was reported by 42.7% of girls and 31.4% of boys with asthma. The prevalence rates were statistically significant for symptoms of asthma, rhinitis, and atopic eczema in females. However, there were no statistically significant differences between the sexes in regard to reported asthma and bronchospasm induced by exercise

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Prevalência de asma, rinite e eczema atópico em escolares de 13 e 14 anos de idade no município de Passo Fundo, Rio Grande do Sul

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Prevalência de asma, rinite e eczema atópico em escolares de 13 e 14 anos de idade no município de Passo Fundo, Rio Grande do Sul

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Fatores de risco para asma e rinite alérgica em população de escolares na cidade de Passo Fundo, RS

Introdução: nas últimas décadas, tem havido aumento na prevalência das doenças alérgicas, como também na sensibilização a aeroalérgenos ou alimentos, fenômenos caracterizados como “epidemia das doenças alérgicas”. Objetivo: determinar os fatores de risco associados a sintomas de asma (sibilância) e rinoconjuntivite, descrevendo a prevalência desses sintomas em crianças escolares do município de Passo Fundo, RS. Método: estudo transversal realizado em alunos de oito a doze anos de idade matriculados em escolas públicas e particulares do ensino fundamental, moradores da zona urbana de Passo Fundo, RS. A amostra representativa dessa população foi escolhida aleatoriamente, e seus pais ou responsáveis responderam questionário escrito padrão do International Study of Asthma and Allergies in Childhood (ISAAC), acrescido de perguntas sobre fatores de risco pessoais, familiares e ambientais (ISAAC fase II). Dessa população inicial, separou-se, aleatoriamente, um subgrupo de crianças (n=878), para realizar testes cutâneos de hipersensibilidade imediata (TCHIs) com alérgenos ambientais e coletar amostras de fezes para exame protoparasitológico. As crianças também foram pesadas, tendo sua estatura aferida e seu índice de massa corporal (IMC) calculado. Resultados: a prevalência de asma ativa foi de 31,2%; de asma diagnosticada, de 16,3%; de asma induzida por exercício, de 14,1%; de asma grave, de 7,4%; de crise aguda severa de asma, de 5,6%. A prevalência de rinite ativa foi de 53%; rinoconjuntivite, 37,6%; rinite diagnosticada, 35%; rinite polínica (hay fever), 27,9%; rinite moderada a grave, 14,7%. A prevalência de eczema ativo foi de 17,8%; de eczema em dobras, 16,8%; de eczema grave, 2,7%. Eram atópicos 487/878 (55,5%), independentemente de serem asmáticos ou não; desses, 84,4% eram polissensibilizados. A maioria (70,2%) dos que tinham asma atual era atópica, sendo somente 9% monossensibilizados. Da mesma maneira, a maioria (83,1%) dos com asma ativa também era atópica (OR = 3,16; IC95%=4,4-7,6). Além disso, os asmáticos atópicos tinham asma mais grave em relação aos não atópicos (OR = 2,39; IC95% = 2,60-7,60). Os fatores de risco siginificativamente associados à asma ativa foram: história materna de asma (OR = 1,75, IC 95%= 1,05-2,87), rinite ativa (OR = 2,07, IC 95%=1,42-3,01), compartilhar quarto no primeiro ano de vida (OR = 2,03, IC 95%= 1,36-3,04), ser atópico (OR = 1,82, IC 95%=1,26-2,50), ter contato com gato intradomiciliar no primeiro ano de vida (OR = 1,73, IC 95%=1,07-2,78), usar paracetamol mais de 12× ao ano nos últimos doze meses (OR=1,68, IC 95= 1,20-2,31)), usar antibiótico com ≤6 meses de vida (OR = 1,57, IC 95%= 1,13-2,17), ter tido bronquiolite com ≤2 anos de vida (OR = 3,11, IC 95%=2,23-4,33), ter nascido de parto prematuro (OR = 1,60, IC 95%=1,02-2,50). Em relação à rinoconjuntivite, os fatores de risco foram: história de eczema no pai (OR = 3,50, IC 95%= 1,05-10,70), rinite no pai (OR= 1,73, IC 95%=1,06-2,82), residência com mofo (OR = 2,09, IC 95%=1,16-3,74), ter morado em casa úmida no primeiro ano de vida (OR = 2,05, IC 95%=1,20-3,48), ter eczema ativo (OR = 1,97, IC 95%=1,16-3,56), ter sensibilidade alérgica a Lolium perenne (OR = 14,03, IC 95%=7,75-25,40), ter sensibilidade a ácaros da poeira doméstica (OR = 2,82, IC 95%=1,77-4,52), ter tido bronquiolite com ≤2 anos idade (OR = 1,78, IC 95%=1,10-2,90). Compartilhar quarto foi fator de proteção para rinoconjuntivite (OR = 0,50, IC 95%=0,32-0,79). Os questionários foram respondidos pelas mães em 83,9%, das quais 42% tinham baixa escolaridade (≤8 anos completos). Cerca de 25% das famílias das crianças tinham renda mensal ≤1 salário mínimo (SM) vigente na época, e 4,4%, renda ≥10 SMs. Um terço dessa população era exposto a mãe fumante, tendo 15% delas afirmado que fumaram durante a gravidez e 18%, durante o primeiro ano de vida da criança. Nasceram de parto cesariano 48,0%; 15,0% eram prematuros e 20,0% da amostra tinham baixo peso (<2,500 g) ao nascer, tendo 2% pesado <1,500 g. Um terço mamou no peito menos de seis meses. Tiveram contato com cachorro dentro de casa no primeiro ano de vida 30%, e somente 12%, com gato intradomicílio. Apenas 7,5% das crianças tiveram contato com animais de fazenda no primeiro ano de vida. Conclusões: a prevalência de asma e rinoconjuntivite está acima da média mundial relatada pelos centros do projeto ISAAC fase II e acima da média nacional medida pelo projeto ISAAC fase III, Brasil. Houve uma importante associação entre asma ativa com a história materna de asma e de antecedentes pessoais atópicos (rinite ativa e atopia). Ter tido bronquiolite com <2 anos de idade foi forte fator de risco para asma ativa aos dez anos de idade. Ao contrário de algumas proposições da hipótese da higiene, contato com animais (gato) dentro de casa e compartilhar dormitório no primeiro ano de vida foram fatores de risco para asma ativa, e não de proteção. Em relação à rinoconjuntivite, igualmente, houve um forte componente genético (familiar) como fator de risco, ao lado do fator ambiental (moradia úmida e com mofo). Ter sensibilidade ao pólen de Lolium perenne mostrou-se forte fator de risco para rinoconjuntivite. Por outro lado, compartilhar quarto se mostrou fator de proteção para rinoconjuntivite na faixa etária de oito a doze anos de idade.Introduction: over the last decades the prevalence of allergic diseases has increased, as well as the sensitization to aeroallergens or food, phenomena characterized as "allergic diseases epidemic". Objective: to determine the risk factors associated to asthma symptoms (wheezing) and rhinoconjunctivitis and to describe the prevalence of these symptoms in schoolchildren from the city of Passo Fundo, RS. Method: cross sectional study performed in students from ages nine to twelve, enrolled in public and private elementary schools, residents of the urban zone of Passo Fundo, RS. The sample representing this population was randomly selected. Their parents or responsible persons answered a written questionnaire standard to the International Study of Asthma and Allergies in Childhood (ISAAC), with the addition of questions about personal, familial and environmental risk factors (ISAAC phase II). From this initial population, a subgroup of children (n=878) was selected to perform skin prick tests (SPT) with environmental allergens and to collect stool samples for the protoparasitological exam. The children were also weighed, their height was assessed, and their body mass index (BMI) was calculated. Results: the prevalence of current asthma was 31.2%; diagnosed asthma 16.3%; exercise induced asthma 14.1%; severe asthma 7.4%; severe acute asthma attack 5.6%. The prevalence of current eczema was 17.8%; eczema in folds 16.8%; severe eczema 2.7%. Regardless of being asthmatic or not, 487/878 (55.5%) were atopic; 84.4% of these were polysensitized. Most of the children (70.2%) who had current asthma were atopic and only 9% were monosensitized. Similarly, most of the children (83.1%) with active asthma were also atopic (OR = 3.155; CI 95% = 4.40-7,60). Moreover, the atopic asthmatic children presented more severe asthma compared to the non-atopic ones (OR = 2.39; CI 95% = 2.602-7.603). The factors significantley associated to current asthma were: history of maternal asthma (OR = 1.75, IC 95%=1.05-2.87), current rhinitis (OR = 2.07; IC 95%=1.42-3.0), bedroom sharing during the first year of life (OR = 2.03; IC95%=1.36-3.04), atopy (OR = 1.82; IC 95%=1.26-2.50), indoor contact with cats during the first year of life (OR = 1.73; IC 95%=1.07-2.78), paracetamol use >12× per year over the last twelve months (OR = 1.68; IC 95%=1.20-2.31), antibiotic use ≤6 months of age (OR= 1.57; IC 95%=1.13-2.17), history of bronchiolitis in the first 2 years of life (OR = 3.11; IC 95%=2.23-4.33) and premature birth (OR = 1.60; IC 95%=1.02-2.50). Regarding rhinoconjunctivitis, the risk factors were: history of paternal eczema (OR = 3.35; IC 95%=1.05-10.70), paternal rhinitis (OR = 1.73; IC 95%=1.06-2.82), house with mold (OR = 2.09; IC 95%=1.16-3.75), having lived in a humid house during the first year of life (OR = 2.05; IC 95%=1.21-3.48), having current eczema (OR = 1.97; IC 95%=1.16-3.36), allergic sensitivity to Lolium perenne (OR = 14.0; IC 95%=7.75-25.40), sensitivity to house dust mites (OR = 2.82; IC 95%=1.77-4.52), history of bronchiolitis in the first two years old (OR = 1.78; IC 95%=1.78; IC 95%=1.10-2.90). Sharing a bedroom was a protective factor to rhinoconjunctivitis (OR = 0,50; IC 95%=0.32-0.79). A total of 84.0% of the mothers answered the questionnaires, 42% of which had a low education level (≤eight years of school completed). About 25% of families had a monthly income of ≤1 national minimum wage (NMW) at the time, while 5.0%, had an income of ≥10 NMW. One third of these children were exposed to smoking mothers. Approximately 15% of the mothers affirmed to have smoked during pregnancy, and 18% during the child‟s first year. A total of 48.0% born from C-sections; 15.0% were premature, and 20.0% of the sample had low weight (<2,500 g) upon birth, where 2% weighed <1,500 g. One third was breastfed for less than six months. A total of 30% the individual had contact with dogs inside the house during the first year of life, and only 12% had contact with indoor cat over the same period. Only 7.5% had contact with farm animals during the first year of life. Conclusions: the prevalence of asthma and rhinoconjunctivitis in Passo Fundo is above the world average measured by the ISAAC phase II, and above the national average measured by the ISAAC phase III, Brazil. There is an important association between current asthma with history of maternal asthma and personal atopic background (current rhinitis and atopy). A history of bronchiolitis during the first two years of life was a strong risk factor to current asthma at ten years old. Unlike some proposals of the hygiene hypothesis, the contact with animals (cat) inside the house and sharing a bedroom during the first year of life were risk factors for current asthma, and not protective factors. Concerning rhinoconjunctivitis, there was also a strong genetic component (family) as a risk factor, as well as an environmental component (humid house with mold). Sensitivity to Lolium perenne polen represented a strong risk factor to rhinoconjunctivitis. On the other hand, sharing a bedroom represented a protective factor to rhinoconjunctivitis at eight to twelve years old

Protocolo para transporte intra-hospitalar de pacientes da Unidade de Terapia Intensiva do Hospital Universitário Walter Cantídio

Em Unidades de Terapia Intensiva (UTI) temos pacientes graves e com necessidade de transferências para hospitais de maior complexidade ou transporte intra-hospitalar para realizar exames e procedimentos externos ao setor de origem. O transporte pode gerar instabilidade e grandes riscos para o paciente. Este trabalho objetivou organizar e propor um protocolo para transporte intra-hospitalar dos pacientes da UTI do Hospital Universitário Walter Cantídio. Foram utilizados protocolos citados em artigos e adotados em serviços hospitalares de vários países, com adaptações à realidade do serviço e à disponibilidade de corpo técnico e de equipamentos. Um checklist foi desenvolvido, tentando garantir ao máximo a segurança no transporte dos pacientes. O protocolo conta também com lista de perguntas para revisão ativa das condições clínicas do paciente e dos equipamentos necessários à ação. O cuidado intensivo do paciente grave durante transporte deve ser assegurado como na Unidade de Terapia Intensiva. Esse protocolo assistencial busca padronizar e sistematizar a conduta do serviço, melhorar o atendimento ao paciente e minimizar a variação da prática. Aquisição de conhecimento pela equipe, melhoria da comunicação entre membros, coordenação do cuidado e monitoramento dos resultados são estimulados através desse protocolo proposto

Laboratory screening test with inhalant and food allergens in atopic Brazilian children and adolescents : a performance

The Phadiatop Infant (R)) is a panel developed to assess allergic sensitization (immunoglobulin E [IgE]) in children aged &lt;5 years and combines inhalant and food allergens. The test has not been evaluated outside Europe. This is a cross-sectional study conducted at 11 pediatric allergy centers to evaluate PhInf as an allergic disease screening method in Brazilian children. Children as controls and patients (aged 6 months-18 years) were grouped according to their primary disease and age group. PhInf and specific serum IgE (sIgE) screening was performed for Dermatophagoides pteronyssinus (DP), cat and dog epithelia, a mix of grasses and pollens, eggs, cow's milk, peanuts, and shrimp. Values &gt;= 0.35 kU (A)/L (or PAU/L) were considered positive. A total of 470 children and adolescents, which included 385 patients and 85 controls, participated in the study (47.7% boys, average age: 6.3 years). In all, 72.6% of the participants had positive PhInf test (n = 341), with a higher proportion of those having food allergy (92.6%), atopic dermatitis (91.9%), and those aged &gt;13 years having allergy (95%). The PhInf and sIgE agreement between patients (Kappa = 0.94, P &lt; 0.001) and controls (Kappa = 0.84, P &lt; 0.001) was high. PhInf and DP agreement in patients aged &gt;13 years was excellent (Kappa = 0.936, P &lt; 0.001). Compared with sIgE dosage, PhInf had high sensitivity (97%) and specificity (93%). Positivity of PhInf test in this population was high and had an excellent correlation with the allergens comprising the panel. It is a useful method for screening children suspected of having allergic diseases in a non-European country

Allergic sensitization pattern of patients in Brazil

Objective: Allergic sensitization is one of the key components for the development of allergies. Polysensitization seems to be related to the persistence and severity of allergic diseases. Furthermore, allergic sensitization has a predictive role in the development of allergies. The aim of this study was to characterize the pattern of sensitization of atopic patients treated at different pediatric allergy referral centers in Brazil. Methods: A nation-wide transversal multicenter study collected data on patients attended in Brazil. Peripheral blood samples were collected to determine the serum levels of allergen-specific IgE. If allergen-specific IgE was higher than 0.1 kUA/L, the following specific components were quantified. Results: A total of 470 individuals were enrolled in the study. Mite sensitization was the most frequent kind in all participants. A high frequency of sensitization to furry animals and grasses featured in the respiratory allergies. Regarding components, there was a predominance of sensitization to Der p 1 and Der p 2. It has been verified that having a food allergy, atopic dermatitis, or multimorbidity are risk factors for the development of more severe allergic disease. Conclusion: Studies on the pattern of allergic sensitization to a specific population offer tools for the more effectual prevention, diagnosis, and treatment of allergic diseases. Sensitization to dust mites house was the most prevalent in the evaluated sample. High rates of sensitization to furry animals also stand out. Patients with food allergy, atopic dermatitis, or multimorbidity appear to be at greater risk for developing more severe allergic diseases

O conhecimento de pediatras sobre alergia alimentar: estudo piloto Pediatricians' knowledge on food allergy: pilot study

OBJETIVO: Avaliar o conhecimento de pediatras sobre alergia alimentar. MÉTODOS: Dados obtidos de questionário padronizado, postado e respondido por pediatras filiados à Sociedade Brasileira de Pediatria (SBP). Digitação dos dados em planilha Excel e análise de freqüência de respostas afirmativas em porcentagem. RESULTADOS: Foram analisados 895 questionários preenchidos por pediatras de todo o país, com predomínio da região Sudeste (61,6%). Segundo os pediatras entrevistados, as manifestações diagnósticas de alergia alimentar são: respiratórias, cutâneas e sistêmicas, em iguais proporções. Ainda segundo estes pediatras, leite de vaca (98,9%), clara de ovo (58,7%) e amendoim (50,9%) são os principais alimentos associados a essas manifestações. Embora 74,8% dos respondedores tivessem identificados os corantes e aditivos alimentares como responsáveis pela alergia alimentar, apenas 19,4% conheciam o código de identificação da tartrazina. CONCLUSÕES: Os dados apresentados reforçam a necessidade de ampliação dos conhecimentos dos profissionais de saúde sobre o diagnóstico e tratamento da alergia alimentar, com o objetivo de garantir o uso de critérios diagnósticos e terapêuticos mais adequados.<br>OBJECTIVE: To evaluate the knowledge of Brazilian pediatricians about food allergy. METHODS: Data was obtained from a sent back posted written questionnaire. It was filled in by Brazilian pediatricians, affiliated to the Brazilian Society of Pediatrics. Data was transcript to an Excel spread sheet and the frequency of affirmative responses was reported as percentages. RESULTS: Data from 895 written questionnaire of pediatricians from all over Brazil, (mainly from the southeastern region - 61.6%), were analyzed. The main clinical expressions of food allergy determined by the pediatricians were: respiratory, cutaneous and systemic symptoms (equal proportions). According to these pediatricians, cow's milk (98.9%), egg white (58.7%) and peanuts (50.9%) were the main allergens related to food allergy symptoms. Although 74.8% of the responders have indicated food dyes and food additives as associated to food allergies, only 19.4% of them knew the identification code of tartrarzine. CONCLUSIONS: The presented data reinforce the need to improve the pediatricians' knowledge about the diagnosis and treatment of food allergy, in order to assure the use of appropriate diagnostic and treatment criteria