Exploiting cyclodextrins as artificial chaperones to enhance enzyme protection through supramolecular engineering.

We report a method of enzyme stabilisation exploiting the artificial protein chaperone properties of ß-cyclodextrin (ß-CD) covalently embedded in an ultrathin organosilica layer. Putative interaction points of this artificial chaperone system with the surface of the selected enzyme were studied in silico using a protein energy landscape exploration simulation algorithm. We show that this enzyme shielding method allows for drastic enhancement of enzyme stability under thermal and chemical stress conditions, along with broadening the optimal temperature range of the biocatalyst. The presence of the ß-CD macrocycle within the protective layer supports protein refolding after treatment with a surfactant.

Impact of first chemotherapy exposure on follicle activation and survival in human cryopreserved ovarian tissue.

STUDY QUESTION: Does chemotherapy exposure prior to ovarian tissue cryopreservation (OTC) impact the signaling pathways governing follicle activation and survival for prepubertal and postpubertal patients? SUMMARY ANSWER: Chemotherapy exposure prior OTC increases follicle apoptosis rates but not follicular activation, although the PI3K/AKT/mTOR and Hippo signaling pathways were modified in the cortex. WHAT IS KNOWN ALREADY: OTC is currently the only available fertility preservation procedure for children and for patients who have already started their treatment. While previous studies have not observed harmful impacts of first chemotherapy exposure on OTC outcomes, the consequences of treatment on follicle activation and survival need to be further investigated. To address this question, we evaluated signaling pathway modifications induced by chemotherapy exposure according to pubertal status. STUDY DESIGN, SIZE, DURATION: Cryopreserved ovarian tissues from postpubertal (12-29 years old, n = 8) and prepubertal (3-10 years old, n = 8) cancer patients donated for research were thawed and cultured for 24 h. Analyses of the survival of the follicles and stroma, and of the PI3K/AKT/mTOR and Hippo signaling pathways, were conducted at thawing and after culture. Ovarian fragments exposed to chemotherapy before collection were compared to non-exposed controls. PARTICIPANTS/MATERIALS, SETTING, METHODS: Histological investigations were performed to assess the distribution of the follicles, stroma fibrosis, vessel integrity, and apoptosis levels. It included follicular counting, collagen staining, immunostaining on CD31 and gH2AX, as well as TUNEL staining. To explore follicle activation in the different groups, the PI3K/AKT/mTOR and Hippo signaling pathways were investigated by gene expression analyses of isolated follicles and protein analyses on whole fragments through western blots and immunostaining. MAIN RESULTS AND THE ROLE OF CHANCE: We first assessed the impact of a first exposure to chemotherapy on the collagen density and vessels in ovarian tissues at thawing and after culture. While no differences in collagen density were observed according to age or previous treatment, the vascularization area (CD31+) was significantly lower in tissue from previously exposed patients compared to non-treated ones. Apoptosis analyses (TUNEL) revealed an acute deleterious impact on follicle survival after chemotherapy exposure without affecting the follicular density. Surprisingly, leukemic patients had a significantly higher percentage of gH2AX-positive follicles, indicating a DNA damage response, compared to the other patients. The proportion of activated follicles appeared to decrease following exposure to chemotherapy, suggesting that it at least did not increase activation process. Stable KIT LIGAND gene and protein expression and cKIT protein levels were observed among the groups, confirming the absence of activation. Analysis of the PI3K pathway did not reveal a difference in the AKT phosphorylation level between the groups, but pRPS6 was significantly higher in tissue from patients previously exposed to chemotherapy compared to that from non-exposed patients. Finally, protein and gene analyses on Hippo pathway signaling showed a higher LATS1 protein level in the cortex after chemotherapy exposure. LIMITATIONS, REASONS FOR CAUTION: The heterogeneity of the human fragments, and the limited number of patients included in the cohort have to be considered as important study limitations. Moreover, this study did not explore the long-term consequences of chemotherapy on follicular development. Therefore, the results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: These results underscore the deleterious effect of previous chemotherapeutic treatment on follicle survival. Although follicular density was not reduced, these data suggested that exposure to chemotherapy impacts follicular apoptosis and the DNA damage response. Chemotherapy-induced activation was not observed despite the impact on mTOR and Hippo signaling pathways in the whole cortex. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by an Excellence of Science (EOS) Grant (ID: 30443682) and was supported by Fonds Erasme. I.D. and M.-M.D. are associate researchers at Fonds National de la Recherche Scientifique de Belgique (FNRS). There are no competing interests. TRIAL REGISTRATION NUMBER: N/A.

Metagenomic Mining for Esterases in the Microbial Community of Los Rueldos Acid Mine Drainage Formation.

Acid mine drainage (AMD) systems are extremely acidic and are metal-rich formations inhabited by relatively low-complexity communities of acidophiles whose enzymes remain mostly uncharacterized. Indeed, enzymes from only a few AMD sites have been studied. The low number of available cultured representatives and genome sequences of acidophiles inhabiting AMDs makes it difficult to assess the potential of these environments for enzyme bioprospecting. In this study, using naïve and in silico metagenomic approaches, we retrieved 16 esterases from the α/ß-hydrolase fold superfamily with the closest match from uncultured acidophilic Acidobacteria, Actinobacteria (Acidithrix, Acidimicrobium, and Ferrimicrobium), Acidiphilium, and other Proteobacteria inhabiting the Los Rueldos site, which is a unique AMD formation in northwestern Spain with a pH of ∼2. Within this set, only two polypeptides showed high homology (99.4%), while for the rest, the pairwise identities ranged between 4 and 44.9%, suggesting that the diversity of active polypeptides was dominated not by a particular type of protein or highly similar clusters of proteins, but by diverse non-redundant sequences. The enzymes exhibited amino acid sequence identities ranging from 39 to 99% relative to homologous proteins in public databases, including those from other AMDs, thus indicating the potential novelty of proteins associated with a specialized acidophilic community. Ten of the 16 hydrolases were successfully expressed in Escherichia coli. The pH for optimal activity ranged from 7.0 to 9.0, with the enzymes retaining 33-68% of their activities at pH 5.5, which was consistent with the relative frequencies of acid residues (from 54 to 67%). The enzymes were the most active at 30-65°C, retaining 20-61% of their activity under the thermal conditions characterizing Los Rueldos (13.8 ± 0.6°C). The analysis of the substrate specificity revealed the capacity of six hydrolases to efficiently degrade (up to 1,652 ± 75 U/g at pH 8.0 and 30°C) acrylic- and terephthalic-like [including bis(2-hydroxyethyl)-terephthalate, BHET] esters, and these enzymes could potentially be of use for developing plastic degradation strategies yet to be explored. Our assessment uncovers the novelty and potential biotechnological interest of enzymes present in the microbial populations that inhibit the Los Rueldos AMD system.

Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.

We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR: 1.007; 95% CI 1.004 to 1.01), MIS-C (OR: 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR: 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR: 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR: 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.Conclusion: Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known: • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New: • We have gathered the primary diagnoses into five major syndromes of decreasing severity: MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.

Dynamics of Reverse Transcription-Polymerase Chain Reaction and Serologic Test Results in Children with SARS-CoV-2 Infection.

OBJECTIVES: To determine the time to reverse transcription-polymerase chain reaction (RT-PCR) negativity after the first positive RT-PCR test, factors associated with longer time to RT-PCR negativity, proportion of children seroconverting after proven severe acute respiratory syndrome coronavirus 2 infection, and factors associated with the lack of seroconversion. STUDY DESIGN: The Epidemiological Study of Coronavirus in Children of the Spanish Society of Pediatrics is a multicenter study conducted in Spanish children to assess the characteristics of coronavirus disease 2019. In a subset of patients, 3 serial RT-PCR tests on nasopharyngeal swab specimens were performed after the first RT-PCR test, and immunoglobulin G serology for severe acute respiratory syndrome coronavirus 2 antibodies was performed in the acute and follow-up (<14 and ≥14 days after diagnosis) phase. RESULTS: In total, 324 patients were included in the study. The median time to RT-PCR negativity was 17 days (IQR, 8-29 days), and 35% of patients remained positive more than 4 weeks after the first RT-PCR test. The probability of RT-PCR negativity did not differ across groups defined by sex, disease severity, immunosuppressive drugs, or clinical phenotype. Globally, 24% of children failed to seroconvert after infection. Seroconversion was associated with hospitalization, persistence of RT-PCR positivity, and days of fever. CONCLUSIONS: Time to RT-PCR negativity was long, regardless of the severity of symptoms or other patient features. This finding should be considered when interpreting RT-PCR results in a child with symptoms, especially those with mild symptoms. Seroprevalence and postimmunization studies should consider that 11 in 4 infected children fail to seroconvert.

A política de emprego no Brasil e no Chile: a permanência da pobreza e do desemprego / An employment policy in Brazil and Chile: an end to poverty and unemployment

Este artigo é resultado de uma pesquisa documental sobre as políticas de emprego no Brasil e no Chile no período de 2013-2018. Trata-se de uma análise comparativa sobre as políticas supramencionadas e, embora algumas particularidades do desenvolvimento do capitalismo em ambos os países, os resultados nos permitem considerar que a política de emprego está submetida a uma lógica comum, pois seguem parâmetros propostos pelas agências multilaterais e estão subordinadas à dinâmica de crescimento econômico fundomonetarista. Portanto, configuram-se como medidas paliativas, mantendo a pobreza e a desigualdade social como traço marcante na formação social dos países em tela

This article is the result of a documentary survey conducted about on employment policies in Brazil and Chile in the period 2005-2017. The result of this research is that the employment and income policy is subject to a common logic, since they follow parameters proposed by the multilateral agencies and are subordinated to the dynamics of economic growth. Therefore, they are seen as palliative measures, maintaining poverty and social inequality as a striking feature of our social formation

Biogeography of Argylia D. Don (Bignoniaceae): Diversification, Andean Uplift and Niche Conservatism.

Andean uplift and the concomitant formation of the Diagonal Arid of South America is expected to have promoted species diversification through range expansions into this novel environment. We evaluate the evolution of Argylia, a genus belonging to the Bignoniaceae family whose oldest fossil record dates back to 49.4 Ma. Today, Argylia is distributed along the Andean Cordillera, from 15°S to 38.5°S and from sea level up to 4,000 m.a.s.l. We ask whether Argylia's current distribution is a result of a range expansion along the Andes Cordillera (biological corridor) modulated by climatic niche conservatism, considering the timing of Andean uplift (30 Ma - 5 Ma). To answer this question, we reconstructed the phylogenetic relationships of Argylia species, estimated divergence times, estimated the realized climatic niche of the genus, reconstructed the ancestral climatic niche, evaluated its evolution, and finally, performed an ancestral range reconstruction. We found strong evidence for climatic niche conservatism for moisture variables, and an absence of niche conservatism for most of the temperature variables considered. Exceptions were temperature seasonality and winter temperature. Results imply that Argylia had the capacity to adapt to extreme temperature conditions associated with the Andean uplift and the new climatic corridor produced by uplift. Ancestral range reconstruction for the genus showed that Argylia first diversified in a region where subtropical conditions were already established, and that later episodes of diversification were coeval with the of Andean uplift. We detected a second climatic corridor along the coastal range of Chile-Peru, the coastal lomas, which allowed a northward range expansion of Argylia into the hyperarid Atacama Desert. Dating suggests the current distribution and diversity of Argylia would have been reached during the Late Neogene and Pleistocene.

Reference values for spirometry in Brazilian children.

OBJECTIVE: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. METHODS: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. RESULTS: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. CONCLUSIONS: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.

Reference values for spirometry in Brazilian children / Valores de referência de espirometria para crianças brasileiras

ABSTRACT Objective: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. Methods: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. Results: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. Conclusions: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.

RESUMO Objetivo: Gerar valores de referência para espirometria em crianças brasileiras de 3-12 anos de idade e comparar os resultados obtidos com as equações em uso no Brasil. Métodos: Foram incluídas crianças sadias de 3-12 anos recrutadas em 14 centros (dados primários) e resultados de espirometria de crianças com as mesmas características de seis bancos de dados (dados secundários). As equações quantílicas foram geradas após transformações logarítmicas dos dados espirométricos e antropométricos. A classificação por cor da pele foi autodeclarada. Os resultados obtidos foram comparados com os previstos nas equações em uso no Brasil para testar sua adequação. Resultados: Foram incluídos 1.990 indivíduos de 21 fontes de dados primários e secundários, sendo 1.059 (53%) do sexo feminino. Equações para VEF1, CVF, VEF1/CVF, FEF25-75% e FEF25-75%/CVF foram geradas para crianças brancas e para crianças negras e pardas. Os logaritmos da estatura e da idade e a cor da pele foram os melhores preditores para VEF1 e CVF. Os resultados obtidos foram significativamente maiores do que as estimativas geradas pelas equações em uso no Brasil, tanto para valores previstos quanto para o limite inferior da normalidade, particularmente em crianças negras e pardas. Conclusões: Novas equações espirométricas foram geradas para crianças brasileiras de 3-12 anos de cor branca, negra e parda. As equações atualmente em uso no Brasil parecem subestimar a função pulmonar de crianças brasileiras menores de 12 anos de idade e deveriam ser substituídas pelas equações propostas neste estudo.

Telemedicina: acercando la reumatología a la población de la zona sur / Telemedicine: bringing rheumatology to the population of the chilean south zone

La Telemedicina constituye una herramienta que permite proporcionar atención médica especializada usando la tecnología de las telecomunicaciones.Entre mayo del 2015 y julio del 2017 se realizaron 1020 atenciones a través de esta modalidad, entre el Hospital Puerto Montt (HPM) y distintos centros de Atención primaria del SS Reloncaví.Se utilizaron dos modalidades de atención: asincrónica y sincrónica con presencia virtual del paciente.Se realizaron 1020 atenciones con una resolución inmediata en el 61,7% de los casos. Esta modalidad de atención implicó un ahorro de 139.412 Km, y por concepto de pasajes de $ 10.675.200 requeridos para el desplazamiento de los pacientes desde su lugar de origen al HPM.En lugares geográficamente distantes, la Telereumatología se convierte en una herramienta fundamental que permite expandir la cobertura de atenciones de salud por especialista, reducir las listas de espera, disminuir los tiempos de traslado y el costo que estos implican.

Telemedicine constitutes a tool that allows to provide specialized medical attention using telecommunications technology.Between May 2015 and July 2017, 1,020 care were carried out through this modality, between the Puerto Montt Hospital (HPM) and different primary care centers of the SS Reloncavi.Two care modalities were used: asynchronous and synchronous with the virtual presence of the patient.1020 visits were performed with immediate resolution in 61.7% of the cases.This care modality implied a saving of 139,412 km, and for the concept of passages of $ 10,675,200 required for the movement of patients from their place of origin to the HPM.In geographically remote places, Telerheumatology becomes a fundamental tool that allows expanding the coverage of health care by specialist, reducing waiting lists, reducing travel times and the cost that these imply.

Benefits of Maxillary Expansion for a Patient With Spinal Muscular Atrophy Type 2.

This case report involves a 10-yr-old boy diagnosed with spinal muscular atrophy type 2 who underwent nighttime mechanical ventilation with bilevel positive airway pressure. The oral examination revealed restricted mouth opening, lip interposition, dental crowding, and maxillary compression. After maxillary expansion, the upper airway volume increased 18.6%; 13 episodes of airway infections (20 days of hospitalization) were recorded in the 2 yrs before the maxillary expansion and only 4 episodes (no hospital admissions) in the 2 subsequent years. In conclusion, maxillary expansion in children with systemic disease that involves respiratory impairment may, in some cases, provide functional and clinical improvements, increase upper airway airflows, and possibly decrease the number of respiratory infections.

Chemical characterization, texture and consumer acceptability of yogurts supplemented with quinoa flour

Abstract Quinoa can be used as a functional ingredient in food formulations. The aim of this study was to evaluate the effects on proximate composition, stability during storage, texture and consumer acceptability of yogurts supplemented with quinoa flour at 1, 3 and 5 g 100 mL-1. A product without supplementation was used as control. Products were assessed for moisture, carbohydrates, proteins, fats, total dietary fibre (TDF), ashes and minerals. The pH, acidity and syneresis of yogurts were measured after 1, 7, 14 and 21 days of storage and a Texture Profile Analysis (TPA) was carried out. Applying hedonic scale, 102 consumers analyzed the overall acceptability, color, texture, flavor and aroma of yogurts. Supplemented products showed significant higher protein, carbohydrate and fat contents. Hardness and adhesiveness showed a negative association whereas a positive one was found between springiness and cohesiveness. Yogurt is not necessarily the adequate matrix for hauling quinoa compounds since the addition of greater amounts of 1 g 100 mL-1 quinoa flour had undesirable effects on gel stability (syneresis and increases in total acidity) and consumer acceptability.

Tomografia computadorizada no planejamento cirúrgico em Periodontia: revisão de literatura / Computed tomography in Periodontal surgery planning: a literature review

Objetivo: o objetivo deste trabalho foi realizar uma revisão da literatura sobre a utilização das imagens de tomografia computadorizada na Periodontia, para determinar a extensão e gravidade das lesões periodontais, motivando o desenvolvimento de um novo conceito para diagnóstico e planejamento cirúrgico periodontal. Material e Métodos: foi realizada uma busca na literatura na base de dados PubMed, usando as palavras chave tomografia computadorizada, diagnóstico, periodontia, defeitos ósseos, lesões de furca, biótipo periodontal. Trinta e três artigos foram incluídos. Resultados: os artigos revisados sugerem benefícios no uso dessa tecnologia para o planejamento cirúrgico periodontal, no tratamento de lesões de furca, defeitos ósseos, determinação do biótipo periodontal. Conclusão: as imagens tridimensionais da tomografia computadorizada são superiores às radiografias convencionais e também minimizam a exposição do paciente à radiação ionizante, otimizam o planejamento cirúrgico e reduzem o tempo operatório, o que pode proporcionar uma melhor resposta ao tratamento. A utilização desta tecnologia é muito útil na prática clínica, mas ainda pouco difundida em Periodontia, devendo ser amplamente divulgada entre os profissionais.

Objective: The aim of this study was to conduct a literature review on the use of cone-beam computed tomography in periodontics and determine the extent and severity of periodontal lesions so as to encourage the development of a new concept for diagnosis and surgical planning in periodontics. Material and methods: A literature search was conducted in PubMed database using the following keywords: computed tomography, diagnosis periodontics, bone defects, furcation lesions, and periodontal biotype. A total of 33 articles were found. Results: A review of the articles suggested benefits in using this technology in periodontal surgical planning, for treatment of furcation lesions, bone defects, and determination of periodontal biotype. Conclusion: Cone-beam computed tomography three-dimensional images is superior to conventional radiography. It also minimizes patient exposure to ionizing radiation, optimizes surgical planning, and decreases operative time, leading to a better response to treatment. This technology is very useful in clinical practice, but is not used widely in periodontics. We believe that the use of this technology should be promoted among professionals.

Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility.

OBJECTIVE: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. METHODS: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. RESULTS: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25-75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. CONCLUSIONS: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications. OBJETIVO: A bronquiolite obliterante pós-infecciosa (BOPI) é uma entidade clínica que tem sido classificada como obstrução fixa e constritiva do lúmen por tecido fibrótico. Entretanto, estudos recentes utilizando oscilometria de impulso relataram resposta ao broncodilatador em pacientes com BOPI. O objetivo deste estudo foi avaliar a resposta broncodilatadora em pacientes pediátricos com BOPI, comparando critérios diferentes para a definição da resposta. MÉTODOS: Foram avaliados pacientes pediátricos com diagnóstico de BOPI tratados em um de dois ambulatórios de pneumologia pediátrica na cidade de Porto Alegre (RS). Parâmetros espirométricos foram medidos de acordo com recomendações internacionais. RESULTADOS: Foram incluídos 72 pacientes pediátricos com BOPI no estudo. As médias dos valores pré- e pós-broncodilatador foram claramente inferiores aos valores de referência para todos os parâmetros, especialmente FEF25-75%. Houve uma melhora pós-broncodilatador. Quando medidos como aumentos percentuais médios, VEF1 e FEF25-75% melhoraram em 11% e 20%, respectivamente. Entretanto, quando os valores absolutos foram calculados, as médias de VEF1 e FEF25-75% aumentaram somente em 0,1 l. Verificamos que a idade da agressão viral, história familiar de asma e alergia não tiveram efeitos significativos na resposta ao broncodilatador. CONCLUSÕES: Pacientes pediátricos com BOPI têm uma obstrução das vias aéreas periféricas que responde ao tratamento, mas não uma reversão completa com o broncodilatador. O conceito de BOPI como obstrução fixa e irreversível parece não se aplicar a essa população. Nossos dados sugerem que a obstrução de vias aéreas em pacientes com BOPI é variável, e esse achado pode ter importantes implicações clínicas.

Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility / Avaliação da resposta ao broncodilatador em pacientes pediátricos com bronquiolite obliterante pós-infecciosa: uso de diferentes critérios de identificação de reversibilidade das vias aéreas

ABSTRACT Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25-75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications.

RESUMO Objetivo: A bronquiolite obliterante pós-infecciosa (BOPI) é uma entidade clínica que tem sido classificada como obstrução fixa e constritiva do lúmen por tecido fibrótico. Entretanto, estudos recentes utilizando oscilometria de impulso relataram resposta ao broncodilatador em pacientes com BOPI. O objetivo deste estudo foi avaliar a resposta broncodilatadora em pacientes pediátricos com BOPI, comparando critérios diferentes para a definição da resposta. Métodos: Foram avaliados pacientes pediátricos com diagnóstico de BOPI tratados em um de dois ambulatórios de pneumologia pediátrica na cidade de Porto Alegre (RS). Parâmetros espirométricos foram medidos de acordo com recomendações internacionais. Resultados: Foram incluídos 72 pacientes pediátricos com BOPI no estudo. As médias dos valores pré- e pós-broncodilatador foram claramente inferiores aos valores de referência para todos os parâmetros, especialmente FEF25-75%. Houve uma melhora pós-broncodilatador. Quando medidos como aumentos percentuais médios, VEF1 e FEF25-75% melhoraram em 11% e 20%, respectivamente. Entretanto, quando os valores absolutos foram calculados, as médias de VEF1 e FEF25-75% aumentaram somente em 0,1 l. Verificamos que a idade da agressão viral, história familiar de asma e alergia não tiveram efeitos significativos na resposta ao broncodilatador. Conclusões: Pacientes pediátricos com BOPI têm uma obstrução das vias aéreas periféricas que responde ao tratamento, mas não uma reversão completa com o broncodilatador. O conceito de BOPI como obstrução fixa e irreversível parece não se aplicar a essa população. Nossos dados sugerem que a obstrução de vias aéreas em pacientes com BOPI é variável, e esse achado pode ter importantes implicações clínicas.

Frequência de sucesso de pré-escolares e escolares com e sem sintomas respiratórios nos testes de função pulmonar / Frecuencia de éxito de los preescolares y escolares con y sin síntomas respiratorios en pruebas de función pulmonar / Success rate of preschool and school children with/without respiratory symptoms in pulmonary function tests

RESUMO O objetivo deste estudo foi avaliar a frequência de sucesso de pré-escolares e escolares com e sem sintomas respiratórios nos testes de função pulmonar. Foram incluídas crianças e adolescentes com idade entre quatro e 12 anos com e sem sintomas respiratórios, baseados no questionário de doenças respiratórias. Os participantes foram recrutados em duas escolas e classificados, de acordo com sua faixa etária, em pré-escolares (4-6 anos) e escolares (7-12 anos). Foram coletados dados demográficos e antropométricos, além das variáveis dos testes de manovacuometria (PIMAX e PEMAX) e de espirometria (VEF1, CVF, VEF1/CVF e FEF25-75%). Os testes de função pulmonar foram considerados bem-sucedidos quando os participantes preenchiam os critérios de aceitabilidade e reprodutibilidade das diretrizes nacionais e internacionais. Para fins estatísticos, utilizou-se o teste de qui-quadrado e correlação de Pearson. Foram incluídos 148 participantes, com média de idade de 8,1±1,7 anos, sendo 51,4% do sexo feminino e 85,1% saudáveis. A taxa de sucesso no teste de manovacuometria e de espirometria foi de 91,9% e 91,2%, respectivamente. Houve uma taxa de sucesso significativamente menor no grupo de pré-escolares em comparação aos escolares, tanto para o teste de manovacuometria (p=0,044) como para o exame espirométrico (p=0,015). As correlações entre as variáveis do teste de manovacuometria e do exame espirométrico mostraram-se positivas e moderadas entre a PIMAX e a CVF, e a PEMAX e o VEF1 e FEF25-75%. Os achados demonstram uma frequência de sucesso significativamente menor no grupo etário pré-escolar em comparação com os sujeitos escolares em ambos os testes de função pulmonar avaliados.

RESUMEN Este estudio tiene por objeto evaluar la frecuencia de éxito en los preescolares y escolares con y sin síntomas respiratorios en pruebas de función pulmonar. Del estudio, participaron niños y adolescentes de 4 a 12 años de edad con y sin síntomas respiratorios, con base en el cuestionario de enfermedades respiratorias. Se les invitaron a los participantes de dos escuelas, y se los clasificaron según el rango etario en preescolares (4-6 años) y escolares (7-12 años). Se recolectaron datos demográficos y antropométricos, además de las variables de la prueba de presión inspiratoria y presión espiratoria máximas (PImáx y PEmáx) y espirometría (VEF1, CVF, VEF1/CVF y FEF25-75%). Se consideraron las pruebas de función pulmonar exitosas cuando los participantes rellenaban los criterios de aceptación y reproducción de las directrices nacional e internacional. Para análisis estadístico, se empleó la prueba Chi-cuadrado y la correlación de Pearson. Se incluyeron 148 participantes, con promedio de edad de 8,1±1,7 años, siendo el 51,4% del género femenino y el 85,1% saludables. Las tasas de éxito en la prueba de presión inspiratoria y presión espiratoria máximas y de espirometría fueron de 91,9% y 91,2%, respectivamente. Hubo una tasa de éxito significativamente menor en el grupo preescolar en comparación con el escolar, tanto en la prueba de presión inspiratoria y presión espiratoria máximas (p=0,044) como para la de espirometría (p=0,015). Las correlaciones entre las variables de la prueba de presión inspiratoria y presión espiratoria máximas y la de la espirometría presentaron valores positivos y moderados entre la PImáx y la CVF, y la PEmáx y VEF1 y FEF25-75%. Los resultados mostraron una frecuencia de éxito significativamente menor para el grupo preescolar en comparación con el escolar en ambas pruebas de función pulmonar evaluadas.

ABSTRACT The aim of this study was to evaluate the success rate of preschool and school children with/without respiratory symptoms in pulmonary function tests. Children and adolescents, aged 4 to 12 years, with/without respiratory symptoms based on the questionnaire of respiratory diseases were included. Participants were recruited from two schools and classified according to their age group in preschool children (4-6 years) and school children (7-12 years). We collected demographic and anthropometric data, and the variables of the manovacuometry test (MIP and MEP) and spirometry test (FEV1, FVC, FEV1/FVC, and FEF25-75%). Pulmonary function tests were considered successful when the participants reached acceptability and reproducibility criteria established by national and international guidelines. In the statistical analysis, we used the chi-square test and Pearson correlation test. We included 148 participants, mean age of 8.1±1.7 years, being 51.4% female and 85.1% healthy. The success rate for the manovacuometry test and spirometry was 91.9% and 91.2%, respectively. There was a significantly lower success rate in the preschool group, compared to school children for both manovacuometry (p=0.044) and spirometry (p=0.015) tests. We found positive correlations between the MIP and FEV1 and MEP and FEF25-75%. The findings demonstrated a significantly lower success rate in preschool age group, compared to pre-school subjects in both pulmonary function tests evaluated.

[Nutritional status in university students: its relation to the number of daily intakes and macronutrients consumption]. / Estado nutricional en estudiantes universitarios: su relación con el número de ingestas alimentarias diarias y el consumo de macronutrientes.

INTRODUCTION: There is increasing scientific evidence that nutrition influence positive and negative on health along life. Many studies have reported that the student population is a particularly vulnerable group from the nutritional point of view, due to it is characterized by meal skipping frequently and nibble between eating occasions. OBJECTIVE: to establish the relationship between the number of daily dietary intakes and nutritional status in male students aged 23 to 33 years of the National Technological University, in the city of Córdoba, in 2013. METHODS: in order to achieve this aim, a prospective, cross-sectional and descriptive correlational design was used. Descriptive and inferential analysis were applied by using multiple logistic regression models. RESULTS: Almost 50% of the sample analyzed presented overweight (OW) and 40% high body fat (BF). In relation to the intakes numbers, the students that take less than 4 and more than 6 had 2 times more chance of presenting overweight and high body fat. It was found that as age increases it also does the Body Fat Storage, whereas diminished physical activity increases the chance of having high Body Mass Index and Body Fat. Moreover, high ingestion of carbohydrates increases the chance of high Body Fat and Overweight, and a high intake of protein and lipids increases the risk of high Body Fat. CONCLUSION: it is recognized that high or low number of daily intakes than recommended, low level of physical activity, high consumption of carbohydrates and having more than 29 years is related to high overweight and body fat.

Introducción: existe una creciente evidencia científica de que la nutrición ejerce una influencia tanto positiva como negativa en la salud a lo largo de la vida. Diversos autores han destacado que la población universitaria es un grupo especialmente vulnerable desde el punto de vista nutricional ya que se caracteriza por omitir comidas con frecuencia y realizar pequeñas ingestas repetidas veces entre las comidas principales. Objetivo General: establecer la relación existente entre el número de ingestas alimentarias diarias (NIAD), el consumo de macronutrientes y el estado nutricional (EN) en estudiantes de 23-33 años de la Universidad Tecnológica Nacional (UTN), de la ciudad de Córdoba, en el año 2013. Métodos: se utilizó un diseño prospectivo de tipo descriptivo simple correlacional de corte transversal. Se realizó análisis descriptivo e inferencial mediante modelos de regresión logística múltiple. Resultados: de la muestra analizada casi un 50% presentó sobrepeso (SP) y un 40% grasa corporal (GC) elevada. En relación al número de ingestas, los estudiantes que realizaron menos de 4 y más de 6 ingestas tuvieron 2 veces más chance de presentar exceso de peso y de GC. A medida que aumenta la edad también lo hacen los depósitos de GC, y cuando disminuyen los niveles de actividad física (AF) aumenta la chance de presentar un índice de masa corporal (IMC) y GC elevada. Por otro lado, el consumo excesivo de glúcidos aumenta la chance de presentar GC elevada y SP, y el de proteínas y lípidos, el riesgo de GC elevada. Conclusión: Se reconoce al NIAD inferior o superior al recomendado, el bajo nivel de AF, el elevado consumo de carbohidratos, y la edad superior a 29 años como variables relacionados con el SP y la GC elevada.

Espirometria em pré-escolares / Spirometry in Preschool Children

A espirometria é ainda pouco utilizada em pré-escolares em função de dificuldades de compreensão, de colaboração e de coordenação motora nessa fase da vida. Nesta revisão, discute-se a metodologia adotada na obtenção de curvas expiratórias máximas em pré-escolares, os estudos recentes que relatam a utilidade clínica e o sucesso na obtenção de espirometrias e, por fim, as publicações relativas a equações de referência disponíveis. Existem padronizações internacionais recentes, mas não há padrão de normalidade de espirometria em pré-escolares brasileiros. Esta revisão poderá incentivar futuros estudos nacionais para gerar valores de referência no país.

Spirometry is still underused in preschool children because of the difficulties in comprehension, collaboration and coordination encountered among such children. In this review, we discuss the recommended methodology to obtain maximal expiratory curves in preschool children, recent reports of success rates and its clinical utility, as well as the available literaturerelated to reference values. International standards of normality have recently been established for spirometry in preschool children. However, there are no such standards for preschool children in Brazil. We hope that this review will prompt researchers to conduct further studies on this topic in Brazil. Such studies could define spirometry reference values for preschool children in Brazil.

Normal values for respiratory muscle strength in healthy preschoolers and school children.

AIM: To generate reference values for respiratory muscle strength in healthy children aged three to twelve years. METHODS: Participants were recruited from three schools and selected after a respiratory disease questionnaire analysis and written informed consent by parents or guardians. All participants included in the study had normal spirometry, height and weight were measured on the same day. Respiratory muscle strength was evaluated by a single examiner following the guidelines for pulmonary function tests. The association between MIP and MEP values with the potential predictive variables was analyzed using a multiple linear regression model. RESULTS: A total of 171 participants were selected and distributed evenly by age. The age, height, weight and forced vital capacity showed moderate to strong correlations with both respiratory pressures. However, the regression model showed that height and weight were the best variables to predict MIP in both sexes, and age and weight to predict MEP. The power of prediction (R²) ranged from 46 to 58%. The intraclass correlation coefficient was used in a subgroup and demonstrated excellent reproducibility between tests. CONCLUSION: The results of this study demonstrate that the behavior of respiratory muscle strength in healthy preschool and school children can be explained by age, height and weight.

Differences between "classical" risk factors for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and risk factors for nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec type IV MRSA strain.

OBJECTIVE: To identify risk factors associated with nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec (SCCmec) type IV strain of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: An unmatched case-control study (at a ratio of 1:2) performed during the period from October 2002 through September 2003. SETTING: A 2,000-bed tertiary care teaching hospital affiliated with the University of São Paulo in São Paulo, Brazil. METHODS: Case patients (n=30) were defined either as patients who had a bloodstream infection due to SCCmec type IV MRSA diagnosed at least 48 hours after hospital admission or as neonates with the infection who were born in the hospital. Control patients (n=60) were defined as patients with SCCmec type III MRSA infection diagnosed at least 48 hours after hospital admission. Genes encoding virulence factors were studied in the isolates recovered from case patients, and molecular typing of the SCCmec type IV MRSA isolates was also done by pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS: In multivariate analysis, the following 3 variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: an age of less than 1 year, less frequent use of a central venous catheter (odds ratio [OR], 0.07 [95% confidence interval {CI}, 0.02-0.28]; p= .025), and female sex. A second analysis was performed that excluded the case and control patients from the neonatal unit, and, in multivariate analysis, the following variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: less frequent use of a central venous catheter (OR, 0.12 [95% CI, 0.03-0.55]; p= .007), lower Acute Physiology and Chronic Health Evaluation II score on admission (OR, 0.14 [95% CI, 0.03-0.61]; p= .009), less frequent surgery (OR, 0.21 [95% CI, 0.06-0.83]; p= .025), and female sex (OR, 5.70 [95% CI, 1.32-24.66]; p= .020). Of the 29 SCCmec type IV MRSA isolates recovered from case patients, none contained the Panton-Valentine leukocidin, gamma-hemolysin, enterotoxin B or C, or toxic shock syndrome toxin-1. All of the isolates contained genes for the LukE-LukD leukocidin and alpha-hemolysin. Genes for enterotoxin A were present in 1 isolate, and genes for beta-hemolysin were present in 3 isolates. CONCLUSIONS: "Classical" risk factors do not apply to patients infected with the SCCmec type IV strain of MRSA, which is an important cause of nosocomial bacteremia. This strain infects a patient population that is less ill and has had less frequent invasive procedures than a patient population infected with the multidrug-resistant strain of SCCmec type III MRSA. We found that virulence factors were rare and that Panton-Valentine leukocidin was absent. There were multiple clones of the SCCmec type IV strain in our hospital. Children under 1 year of age were at a higher risk. There was a predominant clone (sequence type 5) in this patient population.