Agenesia pulmonar em gêmeos monozigóticos: relato de caso / Pulmonary agenesis in monozygotic twins: case report

Agenesia pulmonar é uma anormalidade congênita extremamente rara com prevalência estimada de 24-34 casos por 1.000,000 nascidos vivos e estar frequentemente associada com outras malformações congênitas. Descrevemos um caso de agenesia pulmonar em gêmeos monozigóticos, no qual a ausência dos pulmões teve apresentação em espelho- o primeiro gemelar com agenesia de pulmão esquerdo e o segundo gemelar com agenesia de pulmão direito. Houve associação com fenda palatina e lábio leporino no primeiro gêmeo e no segundo gêmeo houve associação com polidactilia. Este diagnóstico foi feito ao nascimento. O diagnóstico de agenesia pulmonar e outras malformações congênitas podem ser realizados durante exame pré-natal por ultra-sonografia morfológica. É importante uma identificação precoce da malformação pulmonar para melhor assistência ao recém-nascido. (AU)

Pulmonary agenesis is a congenital anomaly extremely rare with estimated prevalence of 24-34 cases for each 1,000,000 live births and it is frequently associated with other congenital malformations. We describe a case of pulmonary agenesis in monozygotic twins, in which the absence of the lungs has a mirror presentation - the first twin with left lung agenesis and the second twin with right lung agenesis. There was association with cleft palate and cleft lip in the first twin and, in the second twin, there was association with polydactyly. This diagnosis was made to birth.The diagnosis of pulmonary agenesis and other congenital malformations can be made during prenatal exams by morphological ultrasonoghapy. Early identification of the pulmonary malformation is important for better care of the newborn. (AU)

Increased risk of allergic rhinitis among children delivered by cesarean section: a cross-sectional study nested in a birth cohort.

BACKGROUND: Few studies have evaluated the association between delivery by cesarean section (CS) and asthma, allergic rhinitis and chronic rhinitis and whether this association is different in children with and without a family history of asthma. This study aims to investigate whether children born by CS have a higher chance to develop asthma, allergic rhinitis and chronic rhinitis and to evaluate the influence of parental history of asthma on these associations. METHODS: This is a cross-sectional study of 672 children nested in a birth cohort evaluated at 6-years of age. Asthma and chronic/allergic rhinitis were identified by means of the mother's responses to the ISAAC questionnaire. The association between CS, asthma, chronic rhinitis and allergic rhinitis was evaluated by multivariable logistic regression. The evidence of effect modification of parental history of asthma on the association CS and outcomes was examined by introducing interactions terms in the logistic regression models adjusting for confounders. RESULTS: Asthma was not associated with birth by CS irrespective of parental history of asthma (odds ratio (OR) 1.03; 95 % CI 0.61-1.74). Chronic rhinitis and allergic rhinitis were both significantly associated with birth by CS but only in the subgroup of children with by parental history of asthma (OR 1.56; 95 % CI 1.04-2.34) and (OR 1.60; 95 % CI 1.01-2.55) respectively, after adjustment for confounders. The parental history of asthma was a effect modifier in the association between CS, chronic rhinitis and allergic rhinitis (p for effect modification = 0.10 and 0.02, respectively). CONCLUSION: CS increases the risk of chronic rhinitis and allergic rhinitis in children at 6 years of age with parental history of asthma. Health professionals must be alerted with regard to the increased risk of allergic rhinitis and made aware this is another reason to avoid unnecessary CS.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts.

OBJECTIVE: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. METHODS: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. RESULTS: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. CONCLUSIONS: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.

OBJETIVO: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. MÉTODOS: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. RESULTADOS: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. CONCLUSÕES: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts / Programas e centros de atenção a asmáticos no Brasil; uma oficina de trabalho: revisitando e explicitando conceitos

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. .

Objetivo: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. Métodos: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. Resultados: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. Conclusões: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado. .

Cesariana e risco para asma e rinite: revisão sistemática / Delivery cesarean and risk of asthma and rhinitis: systematic review

JUSTIFICATIVA E OBJETIVOS: A associação entre cesariana,asma e rinite ainda é uma questão controversa com dadosconflitantes na literatura. Esta revisão tem como objetivo reuniros resultados dos trabalhos mais importantes acerca do tema.MÉTODOS: Base de dados Medline, Lilacs e SciELO foramconsultadas no período de janeiro de 2000 a julho de 2013 utilizandoas palavras chaves delivery cesarean and asthma; deliverycesarean and rhinitis. Foram incluídos artigos escritos em línguainglesa, portuguesa e espanhola e estudos epidemiológicosanalíticos em seres humanos em qualquer faixa etária. Foramexcluídos os artigos publicados em outras línguas e não relacionadosao tema estudado. RESULTADOS: Foram identificados33 artigos, de acordo o delineamento, 25 estudos foram longitudinais,5 foram transversais e 3 estudos de caso-controle.A cesariana esteve associada à asma em 18 estudos e 1 estudoesteve associado a sibilância recorrente. Dez estudos avaliaramos sintomas de rinite com cesariana, nove avaliaram conjuntamentea asma, 4 encontraram associação entre cesariana e rinitee 6 estudos não demonstraram associação. CONCLUSÃO: Aassociação entre cesariana, asma e rinite permanece ainda controversadevido ao potencial de confundimento de vários outrosfatores determinantes da asma. Cesariana de emergência esteveassociada à asma em alguns estudos e esta associação não podeser explicada pela hipótese da higiene.(AU)

BACKGROUND AND OBJECTIVES: The association betweencaesarean, asthma and rhinitis is still a controversial issue withconflicting data in the literature. This review aims to bringtogether the results of the most important studies about thesubject published in recent years. METHODS: Medline,LILACS and Scielo databases were consulted from January 2000to July 2013 using the keywords asthma and cesarean delivery,cesarean delivery and rhinitis. We included articles written inEnglish, Portuguese and Spanish and analytical epidemiologicalstudies in humans at any age. We excluded studies published inother languages and not related to the theme. RESULTS: 33articles were identified. 25 studies were prospective cohorts; 5were sectional studies; 3 were case-control studies. Caesareanwas associated with asthma in 18 studies. One study foundassociation between recurrent wheezing and Caesarean. Tenstudies evaluated the symptoms of rhinitis with caesarean.Nine evaluated the association between asthma, rhinitis andcaesarean. Four studies found an association between Caesareanand rhinitis. Six studies did not find an association betweencaesarean and rhinitis. CONCLUSION: The association betweencaesarean, rhinitis and asthma remains controversial due topotential confounding of several other determinants of asthma.Emergency caesarean was associated with asthma in somestudies and this association can not be explained by the hygienehypothesis.(AU)

Fatores preditores de hospitalização por asma em crianças e adolescentes participantes de um programa de controle da asma / Predictors of hospital admission due to asthma in children and adolescents enrolled in an asthma control program

OBJETIVO: Determinar as características clínicas e os fatores preditores para hospitalizações por asma em crianças e adolescentes sob tratamento em um centro de referência para asma. MÉTODOS: Estudo de coorte retrospectiva com 151 crianças e adolescentes com asma, provenientes do Sistema Único de Saúde, recebendo tratamento gratuito e acompanhados durante 12 meses no centro de referência do Programa de Controle da Asma e Rinite Alérgica de Feira de Santana, em Feira de Santana (BA) Brasil. O teste do qui-quadrado foi utilizado para determinar a associação entre as variáveis estudadas e a ocorrência de hospitalizações, enquanto o teste de Mann-Whitney foi utilizado para a comparação entre os grupos de pacientes hospitalizados e não hospitalizados. O nível de significância adotado foi de p < 0,05. A análise univariada com regressão logística foi realizada para determinar os fatores preditores de hospitalização. RESULTADOS: Dos 151 pacientes do estudo, 8 (5,2 por cento) foram hospitalizados com um total de 12 internações. O único fator preditor encontrado na análise univariada foi maior gravidade da asma (OR = 13,3; IC95 por cento: 2,55-70,1). CONCLUSÕES: Devido ao fato de que, em nossa amostra, o principal fator preditor de hospitalização foi a maior gravidade da asma, essa condição requer atenção especial no cuidado a esses pacientes.

OBJECTIVE: To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. METHODS: A retrospective cohort study comprising 151 children and adolescents with asthma, referred from the Unified Health Care System and enrolled in the Asthma and Allergic Rhinitis Control Program in the city of Feira de Santana, Brazil, followed for a period of 12 months and receiving asthma medication at no cost. The chi-square test was used in order to determine the associations between the studied variables and the occurrence of hospital admissions, whereas the Mann-Whitney test was used for the comparison between the groups of hospitalized patients and nonhospitalized patients. The level of significance was set at p < 0.05. Univariate analysis with logistic regression was performed in order to determine the predictors of hospital admission. RESULTS: Of the 151 patients evaluated, 8 (5.2 percent) were hospitalized, in a total of 12 hospital admissions. In the univariate analysis, the only variable found to be a predictive factor was greater asthma severity (OR = 13.3; 95 percent CI: 2.55-70.1). CONCLUSIONS: The fact that, in our study sample, the principal predictor of hospital admission was greater asthma severity, calls for special attention being given to the care of these patients.

Predictors of hospital admission due to asthma in children and adolescents enrolled in an asthma control program.

OBJECTIVE: To determine the clinical characteristics and the predictors of hospital admission due to asthma among children and adolescents with asthma under treatment at a referral center. METHODS: A retrospective cohort study comprising 151 children and adolescents with asthma, referred from the Unified Health Care System and enrolled in the Asthma and Allergic Rhinitis Control Program in the city of Feira de Santana, Brazil, followed for a period of 12 months and receiving asthma medication at no cost. The chi-square test was used in order to determine the associations between the studied variables and the occurrence of hospital admissions, whereas the Mann-Whitney test was used for the comparison between the groups of hospitalized patients and nonhospitalized patients. The level of significance was set at p < 0.05. Univariate analysis with logistic regression was performed in order to determine the predictors of hospital admission. RESULTS: Of the 151 patients evaluated, 8 (5.2%) were hospitalized, in a total of 12 hospital admissions. In the univariate analysis, the only variable found to be a predictive factor was greater asthma severity (OR = 13.3; 95% CI: 2.55-70.1). CONCLUSIONS: The fact that, in our study sample, the principal predictor of hospital admission was greater asthma severity, calls for special attention being given to the care of these patients.

Fatores de risco para visitas à emergência por exacerbações de asma em pacientes de um programa de controle da asma e rinite alérgica em Feira de Santana, BA / Risk factors for ER visits due to asthma exacerbations in patients enrolled in a program for the control of asthma and allergie rhinitis in Feira de Santana, Brazil

OBJETIVO: Determinar os fatores de risco para atendimentos de emergência por exacerbações da asma em pacientes acompanhados em um centro de referência. MÉTODOS: Estudo de coorte prospectiva de 253 crianças e adultos com asma e monitorados por 12 meses no Centro de Referência do Programa de Controle da Asma e Rinite Alérgica de Feira de Santana, BA. RESULTADOS: As exacerbações foram frequentes, e 36,5 por cento dos pacientes buscaram assistência em serviços de emergência no período de 12 meses. Os fatores de risco associados às exacerbações foram idade > 20 anos (OR = 1,34; IC95 por cento: 1,06-1,70); residência em zona urbana (OR = 1,19; IC95 por cento: 1,06-1,33); baixa escolaridade (OR = 1,53; IC95 por cento: 1,00-2,39); asma grave (OR = 1,65; IC95 por cento: 1,24-2,18); e rinite crônica (OR = 2,20: IC95 por cento: 1,00-4,80). CONCLUSÕES: Ter de rinite crônica, asma mais grave e baixa escolaridade foram os principais fatores de risco para atendimentos de emergência por exacerbações da asma nesta coorte. Esses resultados são semelhantes àqueles descritos para pacientes com asma sem tratamento regular.

OBJECTIVE: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. METHODS: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. RESULTS: Exacerbations were common, and 36.5 percent of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95 percent CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95 percent CI: 1.06-1.33); having a low level of education (OR = 1.53: 95 percent CI: 1.00-2.39); having severe asthma (OR = 1.65; 95 percent CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95 percent CI: 1.00-4.80). CONCLUSIONS: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment.

Hospitalizations for asthma: impact of a program for the control of asthma and allergic rhinitis in Feira de Santana, Brazil.

OBJECTIVE: To evaluate the impact of the Programa de Controle da Asma e Rinite Alérgica em Feira de Santana (ProAR-FS, Program for the Control of Asthma and Allergic Rhinitis in Feira de Santana) on the frequency of hospitalizations for asthma in patients monitored at a referral center for one year. METHODS: This was a historical control study involving 253 consecutive patients with asthma, ages ranging from 4 to 76 years. We compared the frequency of hospital admissions and visits to the emergency room (ER) in the 12 months prior to and after their admission to the ProAR-FS. During the program, patients received free treatment, including inhaled medications and education on asthma. Demographic and socioeconomic aspects were also assessed. RESULTS: There was a significant reduction in the number of hospitalizations (465 vs. 21) and of visits to the ER (2,473 vs. 184) after their admission to ProAR-FS (p < 0.001 for both). Of the 253 patients who had been hospitalized and had had ER visits within the year prior to the admission to ProAR-FS, only 16 were hospitalized and 92 visited the ER during the follow-up year, representing a reduction of 94% and 64%, respectively. CONCLUSIONS: Implementing a referral center for the treatment of asthma and rhinitis in the Unified Health Care System, with the free distribution of inhaled corticosteroids and the support of an education program, is a highly effective strategy for the control of asthma.

Hospitalizações por asma: impacto de um programa de controle de asma e rinite alérgica em Feira de Santana (BA) / Hospitalizations for asthma: impact of a program for the control of asthma and allergic rhinitis in Feira de Santana, Brazil

OBJETIVO: Avaliar o impacto do Programa de Controle da Asma e Rinite Alérgica em Feira de Santana (ProAR-FS) na frequência de hospitalizações por asma em pacientes acompanhados por um ano em um centro de referência. MÉTODOS: Estudo de controle histórico de 253 pacientes com asma, entre 4 e 76 anos idade, e admitidos consecutivamente. Comparou-se a frequência de internações e de atendimentos em emergência nos doze meses anteriores e posteriores à sua inclusão no ProAR-FS. Durante o programa, os pacientes receberam atendimento gratuito, incluindo medicação inalatória e educação em asma. Os aspectos demográficos e socioeconômicos também foram avaliados. RESULTADOS: Houve redução significativa no número de internações (463 vs. 21) e de atendimentos em emergência (2.473 vs. 184) após a matrícula no ProAR-FS (p < 0,001 para ambos). Dos 253 pacientes internados e atendidos na emergência no ano anterior à participação no ProAR-FS, apenas 16 foram novamente internados e 92 foram atendidos na emergência durante o ano de acompanhamento, correspondendo a uma redução de 94 por cento e 64 por cento, respectivamente. CONCLUSÕES: A implementação de um ambulatório de referência para o tratamento de asma e rinite no Sistema Público de Saúde, com o fornecimento de corticoide inalatório e o suporte de um programa de educação, é uma estratégia muito efetiva para o controle da asma.

OBJECTIVE: To evaluate the impact of the Programa de Controle da Asma e Rinite Alérgica em Feira de Santana (ProAR-FS, Program for the Control of Asthma and Allergic Rhinitis in Feira de Santana) on the frequency of hospitalizations for asthma in patients monitored at a referral center for one year. METHODS: This was a historical control study involving 253 consecutive patients with asthma, ages ranging from 4 to 76 years. We compared the frequency of hospital admissions and visits to the emergency room (ER) in the 12 months prior to and after their admission to the ProAR-FS. During the program, patients received free treatment, including inhaled medications and education on asthma. Demographic and socioeconomic aspects were also assessed. RESULTS: There was a significant reduction in the number of hospitalizations (465 vs. 21) and of visits to the ER (2,473 vs. 184) after their admission to ProAR-FS (p < 0.001 for both). Of the 253 patients who had been hospitalized and had had ER visits within the year prior to the admission to ProAR-FS, only 16 were hospitalized and 92 visited the ER during the follow-up year, representing a reduction of 94 percent and 64 percent, respectively. CONCLUSIONS: Implementing a referral center for the treatment of asthma and rhinitis in the Unified Health Care System, with the free distribution of inhaled corticosteroids and the support of an education program, is a highly effective strategy for the control of asthma.

Risk factors for ER visits due to asthma exacerbations in patients enrolled in a program for the control of asthma and allergie rhinitis in Feira de Santana, Brazil..

OBJECTIVE: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. METHODS: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. RESULTS: Exacerbations were common, and 36.5% of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95% CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95% CI: 1.06-1.33); having a low level of education (OR = 1.53: 95% CI: 1.00-2.39); having severe asthma (OR = 1.65; 95% CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95% CI: 1.00-4.80). CONCLUSIONS: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment.