Association Between Oxygenation And Ventilation Index With The Time On Mechanical Ventilation In Pediatric Intensive Care Patients [relação Entre índice De Oxigenação E Ventilação Com O Tempo Em Ventilação Mecânica De Pacientes Em Terapia Intensiva Pediátrica]

Objective: To correlate the oxygenation index (OI) and the ventilation index (VI) with the time of invasive mechanical ventilation (IMV) in pediatric patients. Methods: This prospective and observational study enrolled patients from 28 days to 14 years of age, admitted in the Pediatric Intensive Care Unit of a university hospital. The values of age, weight, pH, partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), OI and VI were measured from day one to the day five and they were correlated with the time on IMV. The total time on mechanical ventilation was divided into: <7 days and ≥7 days. Results: 28 patients were studied. The time spent on IMV showed a significant negative correlation with the pH on the fourth day and with the PaO 2 on the fifth day. The time on IMV showed a positive correlation with the OI on the third and fourth days and with the VI on the third, fourth and fifth days. There were significant differences in the age and pH on the fourth and fifth days and in the VI from the second to fifth days between the group that remained less than seven days and those that remained seven days or more on IMV. Conclusions: VI, OI, pH and PaO 2 measured during the first five days of IMV were associated with prolonged IMV, reflecting the severity of the initial ventilatory disturb.293348351Farias, J.A., Frutos, F., Esteban, A., Flores, J.C., Retta, A., Baltodano, A., What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study (2004) Intensive Care Med, 30, pp. 918-925Torres, A., Gatell, J.M., Aznar, E., El-Ebiary, M., de la, B.P.J., Gonzalez, J., Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation (1995) Am J Respir Crit Care Med, 152, pp. 137-141Almeida-Júnior, A.A., da Silva, M.T., Almeida, C.C., Jacomo, A.D., Nery, B.M., Ribeiro, J.D., Association between ventilation index and time on mechanical ventilation in infants with acute viral bronchiolits (2005) J Pediatr (Rio J), 81, pp. 466-470Khan, N., Brown, A.R., Venkataraman, S.T., Predictors of extubation success and failure in mechanically ventilated infants and children (1996) Crit Care Med, 24, pp. 1568-1579Paret, G., Ziv, T., Barzilai, A., Ben-Abraham, R., Vardi, A., Manisterski, Y., Ventilation index and outcome in children with acute respiratory distress syndrome (1998) Pediatr Pulmonol, 26, pp. 125-128Peters, M.J., Tasker, R.C., Kiff, K.M., Yates, R., Hatch, D.J., Acute hypoxemic respiratory failure in children: Case mix and the utility of respiratory severity indices (1998) Intensive Care Med, 24, pp. 699-705Trachsel, D., McCrindle, B.W., Nakagawa, S., Bohn, D., Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure (2005) Am J Respir Crit Care Med, 172, pp. 206-211Venkataraman, S.T., Khan, N., Brown, A., Validation of predictors of extubation success and failure in mechanically ventilated infants and children (2000) Crit Care Med, 28, pp. 2991-2996Aggarwal, R., Downe, L., Use of high frequency ventilation as a rescue measure in premature babies with severe respiratory failure (2000) Indian Pediatr, 37, pp. 522-526Goldman, A.P., Tasker, R.C., Hosiasson, S., Henrichsen, T., Macrae, D.J., Early response to inhaled nitric oxide and its relationship to outcome in children with severe hypoxemic respiratory failure (1997) Chest, 112, pp. 752-758Relvas, M.S., Silver, P.C., Sagy, M., Prone positioning of pediatric patients with ARDS results in improvement in oxygenation if maintained > 12 h daily (2003) Chest, 124, pp. 269-274Wessel, D.L., Adatia, I., van Marter, L.J., Thompson, J.E., Kane, J.W., Stark, A.R., Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn (1997) Pediatrics, 100, pp. E7Yapicioǧlu, H., Yildizdaş, D., Bayram, I., Sertdemir, Y., Yilmaz, H.L., The use of surfactant in children with acute respiratory distress syndrome: Efficacy in terms of oxygenation, ventilation and mortality (2003) Pulm Pharmacol Ther, 16, pp. 327-33

Obesity increases eosinophil activity in asthmatic children and adolescents

A clear relationship between asthma and obesity has been reported, but the mechanisms remain unclear. The aim of this study was to evaluate the influence of obesity on eosinophil activity (chemotaxis and adhesion) in asthmatic children and adolescents compared with cells from healthy volunteers. Methods: Asthmatic obese (AO), asthmatic non-obese (ANO), non-asthmatic obese (NAO) and non-asthmatic non-obese (NANO) individuals were included in the present study. The chemotaxis of eosinophils after stimulation with eotaxin (300 ng/ml), platelet-activating factor (10 mu M; PAF) and RANTES (100 ng/ml) was performed using a microchemotaxis chamber. The eosinophil peroxidase activity was measured to determine the adhesion activity of eosinophils cultivated on fibronectin-coated plates. The serum leptin, adiponectin, TNF-alpha and IgE levels were quantified using ELISA assays. Results: The serum IgE levels and eosinophil counts were significantly higher in asthmatic (obese and non-obese) individuals compared with non-asthmatic individuals (obese and non-obese). Spontaneous eosinophil chemotaxis was greater in the AO group compared with either the ANO or NANO groups. The activation of eosinophils using eotaxin and PAF increased eosinophil chemotaxis in the AO group. RANTES treatment increased eosinophil chemotaxis in the NAO group compared with the NANO or ANO groups. The activation of eosinophils using eotaxin significantly increased eosinophil adhesion in the AO group compared with other groups. The serum leptin and TNF-alpha levels were higher in obese subjects (asthmatic and non-asthmatic), whereas the levels of adiponectin did not significantly differ among these groups. Conclusion: This study is the first to show increased eosinophilic activity (chemotaxis and adhesion) associated with high serum leptin and TNF-alpha levels in atopic asthmatic obese children and adolescents compared with non-obese healthy volunteers133

Correlation Between Acoustic Rhinometry, Computed Rhinomanometry And Cone-beam Computed Tomography In Mouth Breathers With Transverse Maxillary Deficiency

To provide clinical information and diagnosis in mouth breathers with transverse maxillary deficiency with posterior crossbite. Numerous exams can be performed; however, the correlation among these exams remains unclear. Objective: To evaluate the correlation between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency. Methods: A cross-sectional study was conducted in 30 mouth breathers with transverse maxillary deficiency (7-13 y.o.) patients with posterior crossbite. The examinations assessed: (i) acoustic rhinometry: nasal volumes (0-5. cm and 2-5. cm) and minimum cross-sectional areas 1 and 2 of nasal cavity; (ii) computed rhinomanometry: flow and average inspiratory and expiratory resistance; (iii) cone-beam computed tomography: coronal section on the head of inferior turbinate (Widths 1 and 2), middle turbinate (Widths 3 and 4) and maxilla levels (Width 5). acoustic rhinometry and computed rhinomanometry were evaluated before and after administration of vasoconstrictor. Results were compared by Spearman's correlation and Mann-Whitney tests (α = 0.05). Results: Positive correlation was observed between: (i) flow evaluated before administration of vasoconstrictor and Width 4 (Rho = 0.380) and Width 5 (Rho = 0.371); (ii) Width 2 and minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho = 0.380); (iii) flow evaluated before administration of vasoconstrictor and nasal volumes of 0-5. cm (Rho = 0.421), 2-5. cm (Rho = 0.393) and minimum cross-sectional areas 1 (Rho = 0.375); (iv) Width 4 and nasal volumes of 0-5. cm evaluated before administration of vasoconstrictor (Rho = 0.376), 2-5. cm evaluated before administration of vasoconstrictor (Rho = 0.376), minimum cross-sectional areas 1 evaluated before administration of vasoconstrictor (Rho = 0.410) and minimum cross-sectional areas 1 after administration of vasoconstrictor (Rho = 0.426); (v) Width 5 and Width 1 (Rho = 0.542), Width 2 (Rho = 0.411), and Width 4 (Rho = 0.429). Negative correlation was observed between: (i) Width 4 and average inspiratory resistance (Rho = -0.385); (ii) average inspiratory resistance evaluated before administration of vasoconstrictor and volume of 0-5. cm (Rho = -0.382), and average expiratory resistance evaluated before administration of vasoconstrictor and minimum cross-sectional areas 1 (Rho = -0.362). Conclusion: There was correlation between acoustic rhinometry, computed rhinomanometry, and cone-beam computed tomography in mouth breathers with transverse maxillary deficiency. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial

Increase in ghrelin levels after weight loss in obese Zucker rats is prevented by gastric banding.

Obes Surg. 2007 Dec;17(12):1599-607. Epub 2007 Nov 30. Increase in ghrelin levels after weight loss in obese Zucker rats is prevented by gastric banding. Monteiro MP, Ribeiro AH, Nunes AF, Sousa MM, Monteiro JD, Aguas AP, Cardoso MH. Department of Anatomy and UMIB (Unit for Multidisciplinary Biomedical Research) of ICBAS (Abel Salazar Institute for the Biomedical Sciences), University of Porto, 4099-003 Porto, Portugal. [email protected] Abstract BACKGROUND: Gastric banding is thought to decrease appetite in addition to the mechanical effects of food restriction, although this has been difficult to demonstrate in human studies. Our aim was to investigate the changes in orexigenic signals in the obese Zucker rat after gastric banding. METHODS: Obese Zucker rats (fa/fa) were submitted to gastric banding (GBP), sham gastric banding fed ad libitum (sham), or sham operation with food restriction, pair-fed to the gastric banding group (sham-PF). Lean Zucker rats (fa/+) were used as additional controls. Body weight and food intake were daily recorded for 21 days after surgery when epididymal fat was weighed and fasting ghrelin and hypothalamic NPY mRNA expression were measured. RESULTS: Gastric banding in obese Zucker rats resulted in a significant decrease of cumulative body weight gain and food intake. Furthermore, gastric banded rats were leaner than Sham-PF, as expressed by a significantly lower epididymal fat weight. Ghrelin levels of gastric banded rats were not increased when compared to sham-operated animals fed ad libitum and were significantly lower than the levels of weight matched sham-PF rats (1116.9 +/- 103.3 g GBP vs 963.2 +/- 54.3 g sham, 3,079.5 +/- 221.6 sham-PF and 2,969.9 +/- 150.9 g lean rats, p < 0.001); hypothalamic NPY mRNA expression was not increased in GBP when compared to sham-operated rats. CONCLUSION: In obese Zucker rats, GBP prevents the increase in orexigenic signals that occur during caloric deprivation. Our data support the hypothesis that sustained weight loss observed after gastric banding does not depend solely on food restriction

Spirometry And Volumetric Capnography In Lung Function Assessment Of Obese And Normal-weight Individuals Without Asthma

To analyze and compare lung function of obese and healthy, normal-weight children and adolescents, without asthma, through spirometry and volumetric capnography. Methods: Cross-sectional study including 77 subjects (38 obese) aged 5-17 years. All subjects underwent spirometry and volumetric capnography. The evaluations were repeated in obese subjects after the use of a bronchodilator. Results: At the spirometry assessment, obese individuals, when compared with the control group, showed lower values of forced expiratory volume in the first second by forced vital capacity (FEV1/FVC) and expiratory flows at 75% and between 25 and 75% of the FVC (p &lt;0.05). Volumetric capnography showed that obese individuals had a higher volume of produced carbon dioxide and alveolar tidal volume (p &lt;0.05). Additionally, the associations between dead space volume and tidal volume, as well as phase-3 slope normalized by tidal volume, were lower in healthy subjects (p &lt;0.05). These data suggest that obesity does not alter ventilation homogeneity, but flow homogeneity. After subdividing the groups by age, a greater difference in lung function was observed in obese and healthy individuals aged &gt;11 years (p &lt;0.05). Conclusion: Even without the diagnosis of asthma by clinical criteria and without response to bronchodilator use, obese individuals showed lower FEV1/FVC values and forced expiratory flow, indicating the presence of an obstructive process. Volumetric capnography showed that obese individuals had higher alveolar tidal volume, with no alterations in ventilation homogeneity, suggesting flow alterations, without affecting lung volumes. © 2017 Sociedade Brasileira de Pediatria

Cystic Fibrosis At A Brazilian Center Of Excellence: Clinical And Laboratory Characteristics Of 104 Patients And Their Association With Genotype And Disease Severity

Objective: To identify the clinical, laboratory and radiographic characteristics of the cystic fibrosis patients under care at Universidade Estadual de Campinas (UNICAMP) in the last decade of the twentieth century, and to investigate the association of these characteristics with genotype and severity of the disease as measured by the Shwachman score. Methods: Descriptive, retrospective and cross-sectional study of the patients assisted at UNICAMP hospital's Cystic Fibrosis Clinic from July 1990 to July 2000. Results: One hundred and four patients were studied; 53.8% male; 93.3% Caucasian; 89.4% presented with respiratory symptoms; 59.6% presented with digestive symptoms; 5.8% had meconium ileus; 4.8% had diabetes. The mean age at onset of symptoms was 3 months, and the mean age at diagnosis was 2 years and 4 months. At diagnosis, 69.9 and 56.6% of the patients had weight and height below 10th percentile, respectively; in 10.6%, sweat chloride was < 60 mEq/l. Staphylococcus aureus was found in 80.2%, Pseudomonas aeruginosa in 76.0%, and Burkholderia cepacia in 5.2%. ΔF508 homozygosis was observed in 18.75%, whereas 62.50% of the patients were ΔF508 heterozygous. A moderate/severe Shwachman score was found in 15.7%. Eighteen patients died in that period (17.3%). The mean age at death was 7 years and 8 months; median survival after diagnosis was 18 years and 4 months. Patients who have at least one ΔF508 mutation have more frequent alterations in fecal fat levels when compared to patients who do not have this mutation (p < 0.05). There were no differences in any parameter between ΔF508 homozygous and heterozygous patients. Conclusions: The clinical and laboratory characteristics of the 104 patients studied were similar to the characteristics described for patients in other countries. Exceptions are the higher age at diagnosis and lower survival. Our results support the recommendation for early diagnosis and the need for more treatment opportunities in the population of cystic fibrosis patients. 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New York: McGraw-HillKerem, E., Corey, M., Kerem, B., Rommens, J.M., Markiewicz, D., Levison, H., The relationship of the most common mutation ΔF508 (1990) N Engl J Med, 323, pp. 1517-1522Borgo, G., Mastella, G., Gasparini, P., Zoranello, A., Doro, R., Pignatti, P.F., Pancreatic function and genetic ΔF508 in cystic fibrosis (1990) J Med Genet, 27, pp. 665-669Santis, G., Osborne, L., Knight, R.A., Hodson, M.E., Independent genetic determinants of pancreatic and pulmonary status in cystic fibrosis (1990) Lancet, 336, pp. 1081-1084Campbell III, P.W., Phillips III, J.A., Krishnamani, M.R., Maness, K.J., Hajinski, T.A., Cystic fibrosis: Relationship between clinical status and ΔF508 deletion (1991) J Pediatr, 118, pp. 239-241Johansen, H.K., Nir, M., Hoib, Y.N., Koch, C., Schwartz, M., Severity of cystic fibrosis in patients homozygous and heterozygous for ΔF508 mutation (1991) Lancet, 337, pp. 631-634McKone, E.F., Emerson, S.S., Edwards, K.L., Aitken, M.L., Effect of genotype on phenotype and mortality in cystic fibrosis: A retrospective cohort study (2003) Lancet, 361, pp. 1671-1676(1997) Clinical Practice Guidelines for Cystic FibrosisPark, R.W., Grand, R.J., Gastrointestinal manifestations of cystic fibrosis: A review (1981) Gastroenterology, 81, p. 1143Finkelstein, S.M., Wielinski, C.L., Elliott, G.R., Diabetes mellitus associated with cystic fibrosis (1988) J Pediatr, 112, p. 373Rosenecker, J., Eichler, I., Kuhn, L., Harms, H.K., Von De Hardt, J., Genetic determination of diabetes mellitus in Danish CF patients: Prevalence and late diabetic complications (1994) Acta Paediatr, 83, pp. 72-77Bargon, J., Rickmann, J., Jacobi, V., Straub, R., Arnemann, J., Wagner, T.O., Cystic fibrosis: Initial diagnosis in a 39 year-old patient (2000) Med Klin, 95, pp. 697-700Mitcell-Heggs, P., Mearns, M., Batten, J.C., Cystic fibrosis in adolescents and adults (1976) Quarter J Med New Series, 45, pp. 479-504Maróstica, P.J.C., (1995) Avaliação Pneumológica de Pacientes Portadores de Fibrose Cística: Sua Relação Com Grupos Genéticos, , [tese]. Porto Alegre, Universidade Federal do Rio Grande do SulDomec Espinoza, M.P.S., (1998) Fibrose Cística Em Jovens e Adultos Do Hospital Das Clínicas Da Unicamp, , [dissertação]. Campinas, Universidade Estadual de Campinas;Tauber, E., Eichler, I., Gartner, C., Halmerbauer, G., Gotz, M., Rath, R., Improvements of lung function in cystic fibrosis (2002) Pediatr Pulmonol, 33, pp. 263-268Wang, S.S., O'Leary, L.A., Fitzsimmons, S.C., Khoury, M.J., The impact of early cystic fibrosis on pulmonary function in children (2002) J Pediatr, 141, pp. 804-810Wagener, J.S., Headley, A.A., Cystic fibrosis: Current trends in respiratory care (2003) Respir Care, 48, pp. 234-245Emerson, J., Rosenfeld, M., McNamara, S., Ramsey, B., Gibson, R.L., Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis (2002) Pediatr Pulmonol, 34, pp. 91-100Bush, A., Decisions facing the cystic fibrosis clinician at the first isolation of Pseudomonas aeruginosa (2002) Paediatr Respir Rev, 3, pp. 82-88Merelle, M.E., Nagelkerke, A.F., Lees, C.M., Dezateaux, C., Newborn screening for cystic fibrosis (2001) Cochrane Database Syst Rev, 3, pp. CD001402Farrell, P.M., Li, Z., Kosorok, M.R., Laxova, A., Green, C.G., Collins, J., Bronchopulmonary disease in children with cystic fibrosis after early or delayed diagnosis (2003) Am J Respir Crit Care Med, 168, pp. 1100-1108Lee, D.S., Rosenberg, M.A., Peterson, A., Makholm, L., Hoffman, G., Laessig, R.H., Analysis of the costs of diagnosing cystic fibrosis with a newborn screening program (2003) J Pediatr, 142, pp. 617-623Siret, D., Bretaudeau, G., Branger, B., Dabadie, A., Dagorne, M., David, V., Comparing the clinical evolution of cystic fibrosis screened neonatally to that of cystic fibrosis diagnosed from clinical symptoms: A 10-year retrospective study in a French region (Brittany) (2003) Pediatr Pulmonol, 35, pp. 342-349West, S.E., Zeng, L., Lee, B.L., Kosorok, M.R., Rock, M.J., Splaingard, M.J., Respiratory infections with Pseudomonas aeruginosa in children with cystic fibrosis: Early detection by serology and assessment of risk factors (2002) JAMA, 287, pp. 2958-2967Oliveira, M.C., Reis, F.J., Oliveira, E.A., Colosimo, E.A., Monteiro, A.P., Penna, F.J., Prognostic factors in cystic fibrosis in a single center in Brazil: A survival analysis (2002) Pediatr Pulmonol, 34, pp. 3-10Maclusky, I., Levison, H., Cystic fibrosis (1990) Kendig's Disorders of the Respiratory Tract in Children, pp. 692-729. , Chernick V, Boat TE. Philadelphia: SaundersKerem, E., Reisman, J., Corey, M., Canny, G.J., Levison, H., Prediction of mortality in patients with cystic fibrosis (1992) N Engl J Med, 326, pp. 1187-1191Bolyard, D.R., Sexuality and cystic fibrosis (2001) Am J Matern Child Nurs, 26, pp. 39-41Kulich, M., Rosenfeld, M., Goss, C.H., Wilmott, R., Improved survival among young patients with cystic fibrosis (2003) J Pediatr, 142, pp. 631-636Doull, I.J., Recent advances in cystic fibrosis (2001) Arch Dis Child, 85, pp. 62-66Reis, F.J.C., Camargos, P.A.M., Rocha, S.F., Survival analysis for cystic fibrosis in Minas Gerais State, Brazil (1998) J Trop Pediatr, 44, pp. 329-331Farrell, P.M., Kosorok, M.R., Laxova, A., Shen, G., Nutritional benefits of neonatal screening for cystic fibrosis (1997) N Engl J Med, 337, pp. 963-969Zemel, B.S., Jawad, A.F., FitzSimmons, S., Stallings, V.A., Longitudinal relationship among growth, nutritional status and pulmonary function in children with cystic fibrosis: Analysis of the Cystic Fibrosis Foundation National Patient Registry (2000) J Pediatr, 137, pp. 374-380Schechter, M.S., Shelton, B.J., Margolis, P.A., Fitzsimmons, S.C., The association of socioeconomic status with outcomes in cystic fibrosis in the United States (2001) Am J Respir Crit Care Med, 163, pp. 1331-1337O'Connor, G.T., Quinton, H.B., Kahn, R., Robichaud, P., Maddock, J., Lever, T., Case-mix adjustment for evaluation of mortality in cystic fibrosis (2002) Pediatr Pulmonol, 33, pp. 99-105Huff, D.S., Huang, N.N., Arey, J.B., Atypical cystic fibrosis of the pancreas with normal levels of sweat chloride and minimal pancreatic lesions (1979) J Pediatr, 94, p. 237Stewart, B., Zabner, J., Shuber, A.P., Welsh, M.J., Mccray Jr., P.B., Normal sweat chloride values do not exclude the diagnosis of cystic fibrosis (1995) Am J Respir Crit Care Med, 151, pp. 899-903Desmarquest, P., Feldman, N., Tamalat, A., Boule, M., Fauroux, B., Tournier, G., Genotype analysis and phenotypic manifestations of children with intermediate sweat chloride test results (2000) Chest, 118, pp. 1591-1597Lebecque, P., Leal, T., De Boeck, C., Jaspers, M., Cuppens, H., Cassiman, J., Mutations of the cystic fibrosis gene and intermediate sweat chloride levels in children (2002) Am J Respir Crit Care Med, 165, pp. 757-761Rosentein, B.J., Cuting, G.R., The diagnosis of cystic fibrosis: A consensus statement (1998) J Pediatr, 132, pp. 589-595. , Cystic Fibrosis Foundation Consensus PanelRosentein, B.J., What is a cystic fibrosis diagnosis? (1998) Clin Chest Med, 19, pp. 423-441Ratjen, F., Döring, G., Cystic fibrosis (2003) Lancet, 361, pp. 681-689Burns, J.L., Gibson, R.L., Mcnamara, S., Yim, D., Emerson, J., Rosenfeld, M., Longitudinal assessment of Pseudomonas aeruginosa in young children with cystic fibrosis (2001) J Infect Dis, 183, pp. 444-452Dornelas, E.C., Fernandes, M.I.M., Galvão, L.C., Silva, G.A., Estudo do quadro pulmonar de pacientes com fibrose cística (2000) J Pediatr, 76, pp. 295-299. , Rio JSoni, R., Marks, G., Henry, D.A., Robison, M., Moriaty, C., Parsons, S., Effects of Burkholderia cepacia infection in the clinical course of patients with cystic fibrosis: A pilot study in a Sydney clinic (2002) Respirology, 7, pp. 241-245Jones, A.M., Dodd, M.E., Webb, A.K., Burkholderia cepacia: Current clinical issues, environmental controversies and ethical dilemmas (2001) Eur Respir J, 17, pp. 295-301Lewin, L.O., Byard, P.J., Davis, P.B., Effect of Pseudomonas cepacia colonization on survival and pulmonary function of cystic fibrosis patients (1990) J Clin Epidemiol, 43, pp. 125-131Speert, D.P., Henry, D., Vandamme, P., Corey, M., Mahenthiralingam, E., Epidemiology of Burkholderia cepacea complex in patients with cystic fibrosis, Canada (2002) Emerg Infec Dis, 8, pp. 181-187Raskin, S., Philips III, J.A., Krishnamani, M.R.S., Jones, C., Parker, R.A., Rozov, T., DNA analysis of cystic fibrosis in Brazil by direct PCR amplification from guthrie cards (1993) Am J Med Gen, 46, pp. 665-669Cystic Fibrosis Genetic Analysis Consortium - Population variation of common cystic fibrosis mutations (1994) Human Mutation, 4, pp. 167-177Guilloud-Batalie, M., De Crozes, D., Rault, G., Degioanni, A., Feingold, J., Cystic fibrosis mutations: Report from the French Registry (2000) Hum Hered, 50, pp. 142-145. , The Clinical Centers of the CFSaleh, M.C., Botelli, A., Melano De Botelli, M., Rezzonico, C.A., Argaraña, C.E., Cystic fibrosis: Frequency of delta F508 and G542X mutations in Cordoba, Argentina (1996) Medicina, 56, pp. 14-16. , B. 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Assessment Of The Body Posture Of Mouth-breathing Children And Adolescents [avaliação Da Postura Corporal Em Crianças E Adolescentes Respiradores Orais]

Objective: To investigate associations between mouth breathing (MBr), nose breathing (NBr) and body posture classification and clinical variables in children and adolescents, by comparing patients with mouth breathing syndrome with a control group of similar age. Methods: This was an observational, analytical, controlled, crosssectional study conducted at a university hospital. Children aged 5 years or more were recruited to one of two groups: healthy controls (NBr) or an MBr group. The MBr group comprised patients with a diagnosis of mouth breathing syndrome confirmed by clinical examination by a physician plus nasal endoscopy. The control group comprised healthy volunteers of the same age, with NBr confirmed by medical examination. All participants underwent postural assessment. Data were analyzed using the Mann- Whitney nonparametric test, the chi-square test and Fisher's exact test, to a significance level of 0.05%. Results: A total of 306 MBr and 124 NBr were enrolled. Mouth breathers were more likely to be male (p = 0.0002), have more frequent and more severe nasal obstruction and larger tonsils (p = 0.0001) than NBr. Mouth breathers also exhibited higher incidence rates of allergic rhinitis (p = 0.0001), of thoracic respiratory pattern (p = 0.0001), high-arched palate (p = 0.0001) and unfavorable postural classifications (p = 0.0001) with relation to the control group. Postural classification scores were directly proportional to nasal obstruction (p = 0.0001) and male sex (p = 0.0008). Conclusions: Postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome. 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Pulsed Direct And Constant Direct Currents In The Pilocarpine Iontophoresis Sweat Chloride Test

Background: The classic sweat test (CST) is the golden standard for cystic fibrosis (CF) diagnosis. Then, our aim was compare the production and volume of sweat, and side effects caused by pulsed direct current (PDC) and constant direct current (CDC). To determine the optimal stimulation time (ST) for the sweat collection. To verify the PDC as CF diagnosis option. Methods: Prospective study with cross-sectional experimental intervention. Experiment 1 (right arm): PDC and CDC. ST at 10 min and sweat collected at 30 min. Currents of 0.5; 0.75; 1.0 and 1.5 mA and frequencies of 0, 200, 1,000 and 5,000 Hz applied. Experiment 2 (left arm): current of 1.0 mA, ST at 5 and 10 min and sweat collected at 15 and 30 min with frequencies of 0; 200; 1,000 and 5,000 Hz applied Experiments 1 and 2 were performed with current density (CD) from 0.07 to 0.21 mA/cm2. Experiment 3: PDC was used in typical CF patients with two CFTR mutations screened and or with CF diagnosis by rectal biopsy and patients with atypical CF. Results: 48 subjects (79.16% female) with average of 29.54 ± 8.87 years old were enrolled. There was no statistical difference between the interaction of frequency and current in the sweat weight (p = 0.7488). Individually, positive association was achieved between weight sweat and stimulation frequency (p = 0.0088); and current (p = 0.0025). The sweat production was higher for 10 min of stimulation (p = 0.0023). The sweat collection was better for 30 min (p = 0.0019). The skin impedance was not influenced by ST and sweat collection (p &gt; 0.05). The current frequency was inversely associated with the skin impedance (p &lt; 0.0001). The skin temperature measured before stimulation was higher than after (p &lt; 0.0001). 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