Immune and Inflammatory Response in Atopic Elite Endurance Athletes.

The present study aimed to compare the immune and inflammatory responses between atopic (n=20) and non-atopic (n=39) elite endurance athletes. Fifty-nine elite runners and triathletes were assessed for the following measurements: Th1, Th2 and lymphocyte phenotyping and plasma levels of cortisol, chemokines, inflammatory cytokines and specific immunoglobulin E (IgE). Levels of salivary IgA, allergic symptoms and training data were also evaluated. No difference was observed in baseline lymphocyte levels. However, the Th1 lymphocytes of atopic athletes presented a lower response after activation. In contrast to this result, levels of salivary IgA and CXCL9 chemokine were higher in the atopic athletes. It was observed that the volume of training per week was linearly associated with Th1 levels, allergic symptoms and IgE levels. In addition, linear multiple regression analysis demonstrated that the volume of training was the only factor associated with allergic symptoms in atopic athletes (r=0.53; p=0.04). These results suggest that compared to non-atopic athletes, atopic athletes present a reduced Th1 response and higher levels of salivary IgA. Training volume is associated with the immune response and allergic symptoms, which suggests that they may play a role in the atopy in elite endurance athletes.

Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age.

OBJECTIVE: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. METHODS: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. RESULTS: The prevalence of asthma symptoms in the last 12 months was 11.5%, and 327 (29.4%) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7%) reported having ever been treated: the most common "treatment" was swimming (in 37.3%), and only 12.7% used inhaled corticosteroids. Of the 254 participants (22.7%) with airflow obstruction, only 52 (20.5%) reported having asthma symptoms. CONCLUSIONS: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.

Ocorrência de sintomas asmáticos e de distúrbio obstrutivo em nadadores amadores de 8 a 17 anos de idade / Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age

OBJETIVO: Analisar a prevalência de sintomas asmáticos e de obstrução ao fluxo aéreo em nadadores amadores de 8-17 anos de idade e avaliar a conscientização sobre asma e tratamento de asma entre nadadores, seus pais e treinadores. MÉTODOS: Uma amostra com 1.116 nadadores amadores respondeu a uma versão modificada do questionário escrito do International Study of Asthma and Allergies in Childhood, ao qual questões sobre as razões de início da natação e sobre gerenciamento de asma foram adicionadas. Os participantes realizaram espirometria antes de uma prova de natação. RESULTADOS: A prevalência de sintomas de asma nos últimos 12 meses foi de 11,5 por cento, e 327 participantes (29,4 por cento) relataram sibilos no passado. Dos 223 nadadores que relataram asma ou bronquite na vida, somente 102 (45,7 por cento) relataram algum tipo de tratamento: natação foi o "tratamento" mais frequente (37,3 por cento), e somente 12,7 por cento utilizavam corticosteroides inalatórios. Dos 254 participantes (22,7 por cento) com obstrução ao fluxo aéreo, somente 52 (20,5 por cento) relataram sintomas de asma. CONCLUSÕES: Os sintomas de asma estão presentes em nadadores amadores, e muitos deles têm obstrução ao fluxo aéreo sem sintomas, o que sugere uma subestimação da asma nessa população. É preocupante que os nadadores diagnosticados previamente com asma não utilizassem os tratamentos recomendados para asma. As implicações clínicas desses achados enfatizam a importância da implementação de medidas educacionais para nadadores amadores, pais e treinadores para auxiliá-los no reconhecimento dos sintomas de asma e de seus riscos no ambiente esportivo a fim de permitir o diagnóstico e a intervenção clínica precoce.

OBJECTIVE: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. METHODS: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. RESULTS: The prevalence of asthma symptoms in the last 12 months was 11.5 percent, and 327 (29.4 percent) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7 percent) reported having ever been treated: the most common "treatment" was swimming (in 37.3 percent), and only 12.7 percent used inhaled corticosteroids. Of the 254 participants (22.7 percent) with airflow obstruction, only 52 (20.5 percent) reported having asthma symptoms. CONCLUSIONS: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.

Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers.

OBJECTIVE: To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. METHODS: The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. RESULTS: The overall incidence of asthma symptoms (ISAAC score > 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score > 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids. CONCLUSIONS: The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores / Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers

OBJETIVO: Investigar a frequência de sintomas de asma entre crianças e adolescentes nadadores amadores e descrever o tratamento clínico entre as crianças asmáticas em um clube esportivo privado na cidade de São Paulo. MÉTODOS: Foram incluídos no estudo 171 nadadores amadores de 6 a 14 anos de idade. Todos os participantes ou seus responsáveis foram solicitados a responder o questionário International Study of Asthma and Allergies in Childhood (ISAAC), e 119 realizaram prova de função pulmonar em repouso. RESULTADOS: A frequência geral de sintomas de asma (ISAAC > 6 pontos) entre os nadadores foi de 16,8 por cento. Entre os 119 nadadores que realizaram a espirometria, 39 (32,7 por cento) apresentaram alterações espirométricas (VEF1/CVF < 0,75). Entre os sujeitos com escore ISAAC > 6, 10 (31,2 por cento) alegaram não realizar nenhum tipo de tratamento para a doença. Daqueles que afirmaram realizar tratamento medicamentoso, 24 por cento faziam uso de broncodilatadores mas não de corticosteroides. CONCLUSÕES: A frequência de sintomas de asma e de alterações da função pulmonar em nadadores amadores de 6 a 14 anos foi elevada. Além disso, uma proporção considerável destes atletas não recebia tratamento.

OBJECTIVE: To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. METHODS: The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. RESULTS: The overall incidence of asthma symptoms (ISAAC score > 6) among the swimmers was 16.8 percent. Of the 119 swimmers submitted to spirometry, 39 (32.7 percent) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score > 6, there were 10 (31.2 percent) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24 percent made use of bronchodilators but not of corticosteroids. CONCLUSIONS: The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.

Asma e exercício / Asthma and exercise

De acordo com os dados brasileiros publicados em 2006, a asma atinge 24 por cento das nossas crianças e adolescentes, sendo uma das doenças mais freqüentes nessa idade. Mesmo assim, todos os anos, centenas de atletas asmáticos participam com sucesso de eventos esportivos das mais variadas modalidades. Crianças que praticam atividades esportivas competitivas desde muito cedo passam muito mais tempo com seus técnicos do que com seus pais. E é também durante o exercício que os sintomas da asma são mais observados. Portanto, cabe ao técnico a responsabilidade de saber reconhecer tais sintomas e também auxiliar no tratamento. A asma não deve ser um obstáculo ao bom desempenho esportivo. Atletas asmáticos bem controlados competem em igualdade com os demais.(AU)

According to Brazilian data published in 2006, asthma affects 24 percent of our children and adolescents, being one of the most frequent diseases in that age. Even so, every year, hundreds of asthmatic athletes successfully participate in sport events of varied modalities. Children who practice competitive sport activities since early childhood spend more time with their coaches than with their parents. And it is also during the exercise that the asthma symptoms are more frequently observed. Therefore, the coach is responsible for knowing how to recognize such symptoms and also for helping with treatment. Asthma should not be an obstacle to good sport performance. Well-controlled asthmatic athletes compete in equal terms with the others.(AU)

Functional implications of BAL in the presence of restrictive or obstructive lung disease.

Most of the complications associated to bronchoscopy are related to changes of the respiratory function during or after its performance. Prevention of complications should be achieved by understanding the effects of bronchoscopic procedures and their relation to the pulmonary function deterioration. Previous studies regarding the functional impairment caused by bronchoalveolar lavage (BAL) were mostly limited by the presence of interferent factors such as sedative drugs. Furthermore, it is not clear whether or not patients with different ventilatory disturbances present the same functional response to bronchoscopy and BAL. The aim of this study was to determine the additional effects of BAL over the respiratory function deterioration related to bronchoscopy in patients with different respiratory function profiles (normal, restrictive and obstructive). Forty patients submitted to bronchoscopy without premedication were divided into four groups: group I-normal pulmonary function submitted to basic bronchoscopy; group II-bronchoscopy in combination with BAL, subdivided according to pulmonary function: group IIa (normal function), group IIb (restrictive ventilatory disturbances) and group IIc (obstructive ventilatory disturbances). Spirometry was made before and after the bronchoscopic procedure. Baseline hemoglobin saturation was compared to the lowest level during the procedure. Functional worsening caused by the procedure was observed with a decrease in forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and Hemoglobin saturation in all groups. Comparison between groups showed no significant difference regarding the changes in FVC (P=0.8324), FEV(1) (P=0.6952) and hemoglobin saturation (P=0.5044). We conclude that standardized BAL, like the one used in our study, does not result in an increased risk for ventilatory impairment compared to bronchoscopy itself, independently of the presence of previous respiratory disease.

Associated tumors of the upper aerodigestive tract: the role of staging and endoscopic follow-up in early detection

A incidência aumentada de segunda neoplasia associada aos carcinomas escamosos de cabeça e pescoço e documentada desde 1860, sendo o tabagismo e o alcoolismo, além de fatores geneticos implicados como fatores causais. Sabendo-se que o encontro de segunda neoplasia associada, com certeza, acarretara alteraçöes no planejamento terapeutico da doença inicial e ainda que o diagnóstico precoce destes tumores permanece como fator primordial no sucesso do tratamento, o objetivo deste estudo e avaliar o estadiamento e seguimento endoscopico dos portadores de carcinoma epidermoide do esofago na detecçäo de tumores associados das vias aereas e digestivas superiores...

Insuficiencia renal como complicacao do tratamento da paracoccidioidomicose pulmonar / Kidney failure as complication of the pulmonary paracoccidioidomycosis treatment

A sulfadiazina ainda ocupa posicao privilegiada no tratamento da paracoccidioidomicose. As complicacoes no seu uso sao incomuns e resumem-se a reacoes cutaneas, irritacoes gastrointestinais e raramente leucopenia e ictericia. A cristaluria pode ocorrer. Apresentamos o caso de um paciente com paracoccidioidomicose pulmonar tratado com sulfadiazina (6g/dia) com boa resposta. No decimo segundo dia de tratamento apresentou dor abdominal intensa e diminuicao do volume urinario. A ultra-sonografia diagnosticou calculose em todo trato urinario. Submetido a dialise peritonial, hidratacao adequada e alcalinizacao urinaria, houve normalizacao da funcao renal. Este caso ilustra a importancia de se garantir ao paciente que esta recebendo sulfadiazina, balanco hidrico adequado, sendo esta uma medida simples na prevencao de complicacao incomum, porem de alta morbidade.