Morphological and molecular characterization of Contracaecum australe (Nematoda: Anisakidae) parasitizing Phalacrocorax brasilianus (Aves: Phalacrocoracidae) on the north coast of Brazil / Caracterização morfológica e molecular de Contracaecum australe (Nematoda: Anisakidae) parasitando Phalacrocorax brasilianus (Aves: Phalacrocoracidae) no litoral norte do Brasil

For the first time in Brazil, Contracaecum australe is recorded parasitizing Phalacrocorax brasilianus (Aves, Suliformes, Phalacrocoracidae) from the Marine Extractive Reserve of Soure on Marajó Island, Brazilian Amazon. Its morphology revealed a body with a transversally striated cuticle, smooth or slightly cleft interlabia, lips with auricles, labial papillae, and conspicuous amphids. In males, the presence of the median papilla on the upper lip of the cloaca and spicules that reach almost half of the body of the parasite. These morphological characters, added to the number and distribution of the pre- and postcloacal papillae of the male specimens, and supported by the molecular phylogeny from the analysis of the ITS-1, 5.8S and ITS-2 genes, allowed the identification of these parasites.(AU)

Pela primeira vez no Brasil, Contracaecum australe é registrado parasitando Phalacrocorax brasilianus (Aves, Suliformes, Phalacrocoracidae) da Reserva Extrativista Marinha de Soure na Ilha de Marajó, Amazônia brasileira. Sua morfologia revelou corpo com cutícula estriada transversalmente, interlábios lisos ou levemente fendidos, lábios com aurículas, papilas labiais e anfídeos conspícuos. Nos machos, observa-se a presença da papila mediana no lábio superior da cloaca e espículos que atingem quase a metade do corpo do parasito. Esses caracteres morfológicos, somados ao número e distribuição das papilas pré e pós-cloacais dos espécimes machos, e apoiados pela filogenia molecular a partir da análise dos genes ITS-1, 5.8S e ITS-2, permitiram a identificação desses parasitos.(AU)

Commercial valved spacers versus home-made spacers for delivering bronchodilator therapy in pediatric acute asthma: a cost-effectiveness analysis.

OBJECTIVE: Although valved spacers are the preferred method for administering metered-dose inhaler bronchodilators such as albuterol in pediatric acute asthma, their high cost and their lack of availability have limited their use, especially in low- and middle-income countries (LMICs). Because of this, it is a common practice to use home-made spacers, although a formal analysis evaluating their cost-effectiveness is lacking. Therefore, the objective of this study was to analyze the cost-effectiveness of home-made spacers compared to commercial valved spacers for delivering bronchodilator therapy in pediatric acute asthma. METHODS: A decision-analysis model was used to estimate health outcomes and costs of a simulated cohort of pediatric patients treated for acute asthma. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national healthcare system in Colombia, a middle-income country (MIC). The main outcome of the model was avoidance of hospital admission. RESULTS: Base-case analysis showed that compared to commercial valved spacers, administering bronchodilators with home-made spacers results in lower overall treatment costs (US$126.75 vs. US$128.59 average cost per patient) without a significant difference in the probability of hospitalization avoided (0.8500 vs. 0.8500). CONCLUSIONS: The present study shows that in Colombia, an MIC, compared with commercial valved spacers, the use of home-made spacers for administering bronchodilator therapy is more cost-effective because it yields a similar probability of hospital admission at lower overall treatment costs.

Terapia inalatória em ventilação não-invasiva em pacientes com doença pulmonar obstrutiva crônica / Inhalation therapy during noninvasive ventilation in patients with chronic obstructive pulmonary disease

O objetivo deste estudo é descrever os aspectos técnicos e cuidados a serem observados durante a administração de medicamentos inalatórios contidos em inalador pressurizado (pMDI) em pacientes com doença pulmonar obstrutiva crônica em ventilação não-invasiva (VNI). Trata-se de uma revisão integrativa elaborada em quatro fases: (1) busca na literatura; (2) consulta às sociedades médicas; (3) pesquisaem bulas e monografias dos fármacos inalatórios; e (4) contato com empresas de ventiladores, medicamentos e espaçadores. A busca aos estudos foi conduzida a partir de palavras-chaves e restringida a publicações até 31 de dezembro de 2019, nos idiomas português e inglês. Foram selecionados 9 artigos, sendo 1 estudo primário, 6 estudos de revisão e 2 estudos em modelos experimentais de ventilação. Foram incluídas 2 diretrizes a partir da consulta às sociedades médicas e das 8 empresas contatas, quatro fizeram recomendações quanto à técnica inalatória. Não foram encontradas informações sobre a administração dos fármacos em VNI nas bulas e monografias. Recomenda-se atentar para as medidas que podem aumentar a deposição pulmonar dos fármacos inalatórios, como uso de aerocâmara com pMDI, minimização de escape indesejável de ar, sincronia entre paciente-ventilador, disparo do jato na fase inspiratória e inserção de porta de vazamento na máscara ou circuito. (AU)

The aim of this study is to describe the technical aspects and cautions to be observed during the administration of inhaled medications contained in a pressurized inhaler (pMDI) in patients with chronic obstructive pulmonary disease on noninvasive ventilation. This integrative review consisted of 4 phases: (1) search in the literature; (2) consultation with medical societies; (3) research on package inserts and monographs of inhaled drugs; and (4) contact with ventilator, medication and spacer companies. The search for studies was based on keywords and restricted to articles published until December 31, 2019, written in Portuguese and English. Nine articles were selected, including 1 primary study, 6 review studies and 2 studies on experimental ventilation models. Two guidelines were included from the consultation with medical societies, and of the 8 companies contacted, 4 made recommendations regarding the inhalation technique. No information was found on the administration of noninvasive ventilation drugs in package inserts and monographs. Attention should be given to measures that increase the pulmonary deposition of inhaled drugs, such as the use of an air chamber with pMDI, minimization of undesirable air leakage, patient-ventilator synchronization, jet firing in the inspiratory phase and insertion of a leak port in the mask or circuit. (AU)

Caracterización de Fusarium spp. asociado con la pudrición basal de la cebolla de rama / Characterization of Fusarium spp. associated with the basal rot of the green onion

RESUMEN El departamento de Nariño ocupa el cuarto lugar como productor de cebolla de rama, a nivel nacional. En los últimos años, su producción y área de cultivo se han reducido por múltiples limitantes, destacándose, como la más importante, la susceptibilidad al ataque de hongos causantes de pudriciones radicales, los cuales, perjudican el sistema productivo y la rentabilidad. El objetivo del estudio fue caracterizar morfológica y molecularmente las poblaciones de Fusarium, asociados a la enfermedad de pudrición basal de cebolla de rama. Para ello, en los municipios de Pasto, Potosi y Buesaco, se colectaron plantas con síntomas de pudrición basal, acompañada de necrosis de raíces y ablandamiento de tejido. En el laboratorio de Sanidad Vegetal de la Universidad de Nariño, se sembraron tejidos en medio PDA y, a continuación, se purificaron los aislamientos para su posterior caracterización morfológica y molecular. El estudio morfológico, se realizó usando claves taxonómicas para el género Fusarium y la caracterización molecular con cebadores específicos para el género Fusarium y mediante secuenciación. Finalmente, se realizó un análisis filogenético de la variabilidad intraespecífica. Los resultados de la caracterización morfológica y molecular corroboran la presencia de dos especies dentro del género asociadas a esta patología, F. oxysporum f sp. cepae y F. solani. Los análisis filogenéticos muestran alta variabilidad intraespecífica entre los aislamientos de F. oxysporum y F. solani, formando dos complejos Fusarium oxysporum (FOSC) y Fusarium solani (FSSC), manifestando que estas especies no parten de un ancestro común.

ABSTRACT The department of Nariño occupies the fourth place as producer of green onion nationwide. In recent years, its production and cultivation area has been reduced by multiple limitations, highlighting as the most important, the susceptibility to the attack of fungi causing radical problems, which harm the productive system and profitability. This study was carried out in order to morphologically and molecularly characterizes Fusarium populations associated with green onion basal rot disease. For this, in Pasto, Potosi and Buesaco municipalities, plants were collected with basal rot symptoms, tissue deterioration and root necrosis. In the Plant Health laboratory of the University of Nariño, tissues were planted in PDA medium and subsequently the isolates were purified for further morphological and molecular characterization. The morphological study was carried out using taxonomic keys for the genus Fusarium and molecular characterization with specific primers for the genus Fusarium, and by sequencing. Finally, a phylogenetic analysis of the intraspecific variability was carried out. Morphological and molecular characterization results corroborate the presence of two species within the genus associated with this pathology, F. oxusporum f sp. cepae and F. solani. Phylogenetic analyzes show high intraspecific variability between the isolates of F. oxysporum and F. solani, forming two Fusarium oxysporum (FOSC) complexes and Fusarium solani (FSSC), evidencing that these species do not start from a common ancestor.

Primary Total Knee Arthroplasty Implants as Functional Prosthetic Spacers for Definitive Management of Periprosthetic Joint Infection: A Multicenter Study.

BACKGROUND: There are limited data on the utility of a standard primary total knee arthroplasty (TKA) femoral component with an all polyethylene tibia as a functional prosthetic spacer in place of a conventional all cement spacer for the management of periprosthetic joint infection (PJI). The aim of this multicenter study was to retrospectively review (1) ultimate treatment success; (2) reimplantation rates; (3) reoperation rates; and (4) change in knee range of motion in patients managed with functional prosthetic spacers following TKA PJI. METHODS: A retrospective review was performed for patients at 2 tertiary care centers who underwent a functional prosthetic spacer implantation as part of a functional single-stage (n = 57) or all cement spacer conventional two-stage (n = 137) revision arthroplasty protocol over a 5-year period. Outcomes including reinfection, reimplantation, and reoperation rates, success rate as defined by the Delphi criteria, and final range of motion were compared between the 2 cohorts at a minimum of 2-year follow-up. RESULTS: There was no significant difference in reinfection (14.0 vs 24.1%), reoperation (19.3 vs 27.7%), or success rates (78.9 vs 70.8%; P > .05 for all) between the one-stage and two-stage revision TKA cohorts. Mean final total arc of motion was also similar between the 2 groups (105.8 vs 101.8 degrees, respectively). CONCLUSION: Functional prosthetic spacers offer the advantage of a single procedure with decreased overall hospitalization and improved cost-effectiveness with analogous success rates (78.9%) compared with two-stage exchange (70.8%) at mid-term follow-up. Although long-term data are required to determine its longevity and efficacy, the outcomes in this study are encouraging. LEVEL OF EVIDENCE: 3.

Preliminary outcomes of proximal femur megaspacers.

There are very few therapeutic alternatives for patients with proximal femoral epiphyseal bone deficit combined with a fracture at another level and signs of infection. This combination can be successfully managed with a proximal femur megaspacer. This article is intended to review our variation of this technique and to show the initial results obtained from 11 cases. Of these 11 cases, there were 6 women and 5 men. The mean age was 66 years. The average number of previous surgeries was 3. Definitive prosthetic reconstructive treatment was achieved in 7 of these 11 subjects. The average time to reimplantation was 11.7 months. Fractures or nonunion healed uneventfully. Bone union and infection control were achieved in 10 of the 11 patients.

Metered-dose inhaler therapy with spacers: Are newborns capable of using this system correctly?

INTRODUCTION: Aerosol therapy using a metered-dose inhaler (MDI) coupled to a spacer chamber is the most widely used long-term treatment modality for chronic lung disease of prematurity. However, its use in neonates is based on data obtained from other age groups. Proper use of maintenance treatment is essential for the long-term stability of these patients. OBJECTIVE: To ascertain whether newborns are capable of generating negative pressure during the use of a spacer with face mask for aerosol therapy. PATIENTS AND METHODS: Total of 117 low-risk newborns (age 12-48 hours), with no congenital malformations or any detectable clinical symptoms, were included. Inspiratory pressure was measured with a respiratory pressure meter, at each respiratory cycle, during a 10-second period, for three sequential measurements. The meter was connected to the inner chamber of the spacer through a noncollapsible silicone tube. Suitably sized masks were used. RESULTS: Only 43 participants (36.8%) generated a negative pressure capable of opening the spacer valve, as verified by the respiratory pressure meter. In 25 patients, all three measurements were within the expected range. Weight, gestational age, and mode of delivery were in no way associated with the ability to generate a detectable negative pressure. CONCLUSION: In neonates, the MDI therapy with a spacer chamber and face mask is susceptible to failure due to the inability of most patients in this age range to generate a negative inspiratory pressure sufficient to open the spacer valve.

Autologous fat as a rectal-prostate spacer for prostate brachytherapy: Results at 6 months.

PURPOSE: Implanted rectal spacers (IRS) have been developed to increase the distance between the prostate and the rectum, thus optimizing dose escalation. Cost is a disadvantage and there are still uncertainties as to their durability. We have developed an autologous fat transfer (AFT) technique to use as an IRS. We aim to present the feasibility and durability at 6 months of AFT placed immediately after the implant of the seeds in low-dose-rate brachytherapy (BT). METHODS AND MATERIALS: Thirty-five patients underwent AFT (12 were treated with primary BT, 7 with a combined primary treatment of external beam radiotherapy + BT, 16 with salvage BT). The isodose used for primary BT was 14400 cGy, 11,000 cGy after 4600 cGy of external beam radiotherapy in the combined group, and 14400 cGy for the salvage group. Patients underwent a CT scan at 1, 3, and 6 months to measure the distance between the rectum and the prostate. RESULTS: An average of 32.7 cc (20-40) of fat was transferred successfully in 100% of cases. The mean distance to the rectum at the level of the base, middle, and apex at 1 and 6 months were 11.2, 9.7, and 7.6 mm; 8.3, 8.1, and 5.9 mm, respectively. No rectal toxicity or major complications were reported. CONCLUSIONS: The use of fat as an IRS seems to be a valid alternative to reduce rectal toxicity after BT, achieving equivalent distances to synthetic IRS. It is feasible, safe, and the loss of distance at 6 months is small. Cost is lower than other alternatives.

Natural diversity of CRISPR spacers of Thermus: evidence of local spacer acquisition and global spacer exchange.

We investigated the diversity of CRISPR spacers of Thermus communities from two locations in Italy, two in Chile and one location in Russia. Among the five sampling sites, a total of more than 7200 unique spacers belonging to different CRISPR-Cas systems types and subtypes were identified. Most of these spacers are not found in CRISPR arrays of sequenced Thermus strains. Comparison of spacer sets revealed that samples within the same area (separated by few to hundreds of metres) have similar spacer sets, which appear to be largely stable at least over the course of several years. While at further distances (hundreds of kilometres and more) the similarity of spacer sets is decreased, there are still multiple common spacers in Thermus communities from different continents. The common spacers can be reconstructed in identical or similar CRISPR arrays, excluding their independent appearance and suggesting an extensive migration of thermophilic bacteria over long distances. Several new Thermus phages were isolated in the sampling sites. Mapping of spacers to bacteriophage sequences revealed examples of local acquisition of spacers from some phages and distinct patterns of targeting of phage genomes by different CRISPR-Cas systems. This article is part of a discussion meeting issue 'The ecology and evolution of prokaryotic CRISPR-Cas adaptive immune systems'.

Morphological and molecular characterisation of a new species of Gyrodactylus von Nordmann, 1832 (Monogenoidea: Gyrodactylidae) of cichlid fishes (Perciformes) from Mexico.

Gyrodactylus mojarrae n. sp. is described from the gills of the Neotropical cichlids Thorichthys maculipinnis, Rocio octofasciata, Vieja zonata and V. fenestrata from several localities across southern Mexico. The new species is erected on the basis of the morphology of the haptoral elements (anchors, bars and hooks), and its phylogenetic position within the Gyrodactylidae is evaluated based on the analysis of partial sequences of the ITS1, 5.8 rRNA gene and ITS2. Gyrodactylus mojarrae n. sp. differs from other congeneric species by having hooks with a straight shaft and recurved point, pointed toe and convex heel, presence of reduced superficial anchor roots, by the number and disposition of spinelets of the male copulatory organ, and the absence of shield and lateral processes of the superficial bar. Molecular circumscription of isolates of G. mojarrae n. sp. from different host and hydrological basins showed that these isolates are conspecific and represent a distinct lineage from other congeners, including newly sequenced isolates of Gyodactylus sp. A and Gyrodactylus sp. B from Astyanax mexicanus (Characidae) and Gobiomorus dormitor (Eleotridae), respectively. Genetic affinities of Gyodactylus sp. A and B indicate that they might represent undescribed species infecting freshwater fish from the Americas.

Asma e a técnica inalatória do inalador pressurizado dosimetrado acoplado ao espaçador: revisão integrativa / Asma y la técnica de inhalación con inhalador presurizado con dosificador acoplado a la cámara espaciadora: revisión integral / Asthma and the inhalation technique for the pressurized metered-dose inhaler with spacer: an integrative review

RESUMO Objetivo: identificar quais técnicas inalatórias do Inalador Pressurizado Dosimetrado, acoplado ao espaçador, têm sido utilizadas em pacientes com asma. Método: trata-se de revisão integrativa, realizada em janeiro de 2018, nas bases de dados US National Library of Medicine e na Literatura Latino-Americana e do Caribe em Ciências de Saúde. Foram selecionados 14 artigos, publicados entre janeiro de 2011 e dezembro de 2017, que continham a descrição da sequência de passos da técnica inalatória. Resultados: os artigos, predominantemente, estudaram indivíduos com idade igual ou superior a 14 anos e justificaram a adoção dos passos da técnica inalatória em referências da literatura. Os passos indicados por cada artigo foram revisados por pares e realizou-se uma quantificação daqueles mais citados, em que 15 passos foram definidos. Conclusão: a síntese do conhecimento gerado pode auxiliar profissionais de saúde no manejo adequado da asma, uma vez que traz evidências relacionadas à eficácia de cada passo.

RESUMEN Objetivo: identificar las técnicas de inhalación del inhalador presurizado con dosificador acoplado al espaciador que se utilizan en pacientes con asma. Método: revisión integral, que se realizó en enero de 2018, en las bases de datos US National Library of Medicine y en Literatura Latinoamericana y del Caribe en Ciencias de Salud. Se eligieron 14 artículos, publicados entre enero de 2011 y diciembre de 2017, con la descripción de la secuencia de procedimientos de la técnica de inhalación. Resultados: los artículos, de modo predominante, abordaron individuos con edad igual o superior a 14 años y justificaron la adopción de los procedimientos de la técnica de inhalación en referencias de la literatura. Se revisaron los procedimientos apuntados por cada artículo por pares y se realizó una cuantificación de aquellos más mencionados, en la cual se definieron 15 procedimientos. Conclusión: la síntesis del conocimiento que se generó puede ayudar a los profesionales de salud en el manejo adecuado del asma, pues trae evidencias asociadas con la eficacia de cada procedimiento.

ABSTRACT Objective: to identify which Pressurized Metered-Dose Inhaler with spacer inhalation techniques have been used in patients with asthma. Method: this was an integrative review, conducted in January 2018, in the US National Library of Medicine and Latin American and Caribbean Health Sciences Literature databases. 14 articles, published between January 2011 and December 2017, which contained the description of the sequence of inhalation technique steps, were selected. Results: the articles predominantly studied individuals aged 14 years or over and justified the adoption of the steps of the inhalation technique from literature references. The steps indicated by each article were reviewed by experts and a quantification of those most cited was performed, with 15 steps being defined. Conclusion: the synthesis of the knowledge generated can help healthcare providers in the proper management of asthma, since it provides evidence related to the efficacy of each step.

Padronização de multiplex PCR para detecção de dermatófitos em pelos e crostas de cães e gatos / Standardization of a PCR multiplex for the detection of dermatophytes in dogs and cats fur and crusts

Objetivou-se padronizar uma reação do tipo multiplex PCR (mPCR) para detectar Microsporum canis, Microsporum gypseum e o complexo Trichophyton mentagrophytes em amostras de pelos e/ou crostas de cães e gatos. 250 amostras de pelos e/ou crostas de cães e gatos foram analisadas por meio de exame direto e cultura, o DNA das mesmas foi extraído para mPCR. Primers foram desenhados e como controle positivo da reação utilizou-se o DNA extraído de colônias de M. canis (URM 6273), M. gypseum (URM 6921) e T. mentagrophytes (URM 6211), provenientes da Coleção de Culturas (Micoteca URM), Departamento de Micologia, Centro de Ciências Biológicas da Universidade Federal de Pernambuco (CCB/UFPE). Como controles negativos de reação, utilizou-se água destilada esterilizada e DNA extraído de Alternaria sp. para verificar a especificidade dos primers. Do total de amostras analisadas, 15 (6%) foram identificadas, em cultura, como dermatófitos, e destas, 10 foram M. canis, três M. gypseum e dois T. mentagrophytes (complexo). Destas 15 amostras positivas, 11 (73,3%) foram detectadas por meio da mPCR. Além destas, seis outras, negativas em cultura, foram identificadas como M. gypseum. Verificou-se uma boa concordância entre os resultados da cultura e mPCR (Kappa: 0,66). O protocolo padronizado neste estudo pode ser utilizado como um método de triagem, por apresentar uma sensibilidade maior que a da cultura, usado paralelamente aos exames de rotina, permitindo um diagnóstico em menor tempo.(AU)

The aim of this study was to standardize a multiplex PCR (mPCR) reaction to detect Microsporum canis, Microsporum gypseum and the Trichophyton mentagrophytes complex in dog and cat fur and/or crusts. 250 fur and/or crusts samples from dogs and cats were analyzed by direct examination and culture, DNA from them was extracted for mPCR. Primers were designed and the DNA extracted from colonies of M. canis (URM 6273), M. gypseum (URM 6921) and T. mentagrophytes (URM 6211) from the Collection of Cultures - URM Micoteca - Department of Mycology, Biological Sciences Center of the Federal University of Pernambuco (CCB / UFPE). As negative controls, sterile distilled water and DNA extracted from Alternaria sp., were used to verify the specificity of the primers. Of the total samples analyzed, 15 (6%) were identified in culture as dermatophytes, and of these, 10 were M. canis, three M. gypseum and two T. mentagrophytes (complex). Of these 15 positive samples, 11 (73.3%) were detected by mPCR. Besides these, six others, negative in culture, were identified as M. gypseum. There was good agreement between culture results and mPCR (Kappa: 0.66). The protocol standardized in this study can be used as a screening method, because it has a sensitivity greater than that of the culture, used in parallel to the routine exams, allowing a diagnosis in a shorter time.(AU)

Padronização de multiplex PCR para detecção de dermatófitos em pelos e crostas de cães e gatos / Standardization of a PCR multiplex for the detection of dermatophytes in dogs and cats fur and crusts

Objetivou-se padronizar uma reação do tipo multiplex PCR (mPCR) para detectar Microsporum canis, Microsporum gypseum e o complexo Trichophyton mentagrophytes em amostras de pelos e/ou crostas de cães e gatos. 250 amostras de pelos e/ou crostas de cães e gatos foram analisadas por meio de exame direto e cultura, o DNA das mesmas foi extraído para mPCR. Primers foram desenhados e como controle positivo da reação utilizou-se o DNA extraído de colônias de M. canis (URM 6273), M. gypseum (URM 6921) e T. mentagrophytes (URM 6211), provenientes da Coleção de Culturas (Micoteca URM), Departamento de Micologia, Centro de Ciências Biológicas da Universidade Federal de Pernambuco (CCB/UFPE). Como controles negativos de reação, utilizou-se água destilada esterilizada e DNA extraído de Alternaria sp. para verificar a especificidade dos primers. Do total de amostras analisadas, 15 (6%) foram identificadas, em cultura, como dermatófitos, e destas, 10 foram M. canis, três M. gypseum e dois T. mentagrophytes (complexo). Destas 15 amostras positivas, 11 (73,3%) foram detectadas por meio da mPCR. Além destas, seis outras, negativas em cultura, foram identificadas como M. gypseum. Verificou-se uma boa concordância entre os resultados da cultura e mPCR (Kappa: 0,66). O protocolo padronizado neste estudo pode ser utilizado como um método de triagem, por apresentar uma sensibilidade maior que a da cultura, usado paralelamente aos exames de rotina, permitindo um diagnóstico em menor tempo.(AU)

The aim of this study was to standardize a multiplex PCR (mPCR) reaction to detect Microsporum canis, Microsporum gypseum and the Trichophyton mentagrophytes complex in dog and cat fur and/or crusts. 250 fur and/or crusts samples from dogs and cats were analyzed by direct examination and culture, DNA from them was extracted for mPCR. Primers were designed and the DNA extracted from colonies of M. canis (URM 6273), M. gypseum (URM 6921) and T. mentagrophytes (URM 6211) from the Collection of Cultures - URM Micoteca - Department of Mycology, Biological Sciences Center of the Federal University of Pernambuco (CCB / UFPE). As negative controls, sterile distilled water and DNA extracted from Alternaria sp., were used to verify the specificity of the primers. Of the total samples analyzed, 15 (6%) were identified in culture as dermatophytes, and of these, 10 were M. canis, three M. gypseum and two T. mentagrophytes (complex). Of these 15 positive samples, 11 (73.3%) were detected by mPCR. Besides these, six others, negative in culture, were identified as M. gypseum. There was good agreement between culture results and mPCR (Kappa: 0.66). The protocol standardized in this study can be used as a screening method, because it has a sensitivity greater than that of the culture, used in parallel to the routine exams, allowing a diagnosis in a shorter time.(AU)

Home-made spacer as an auxiliary device in administration of beclomethasone via pressurized metered dose inhaler for asthma control. A randomized controlled pragmatic trial.

BACKGROUND: Holding chambers or spacers can enhance the efficacy of pressurized metered dose inhalers (pMDI) in delivering inhaled medications, as they reduce the need for hand-breath coordination and improve lower airways deposition. Nevertheless, their cost can be high for patients in low-income countries. OBJECTIVE: To compare asthma control achieved with beclomethasone-dipropionate administered through a hydrofluoroalkane-driven pMDI (BDp-pMDI) coupled to a home-made spacer (HmS) or to a valved commercial spacer (VCS) as auxiliary devices. METHODS: Sixty-three patients with poorly controlled asthma that had a BDp-pMDI prescription were randomized to use the inhaler coupled to a HmS made of 500 ml plastic bottles (Group HmS, n = 32) or to a VCS (Group VCS, n = 31) for 60 days. All were given training sessions. Asthma control was assessed through the Asthma Control Test (ACT) and forced expiratory volume in the first second (FEV1), both measured before, and 30 and 60 days after treatment began. RESULTS: Both groups showed significant improvement in ACT scores after 30 and 60 days compared to baseline values (an increase of 7 and 7.8 points for the HmS group and 5.9 and 7.0 points for the VCS group, respectively, p < 0.001). There was no statistically significant difference in ACT scores between groups at any observation time (P = 0.261). FEV1 showed the same behavior. CONCLUSIONS: A similar level of asthma control was achieved with beclomethasone-dipropionate administered through a pMDI whether the inhaler was coupled to the HmS or VCS. These results are significant for asthma control planning strategies in low-income communities. (Trial Register Number: RBR-5x4dc9).

Evaluación del conocimiento de los padres de la técnica de aerosolterapia con aerocámara / Evaluation of parental knowledge of the aerosol technique with holding chamber

Introducción. Los episodios de tos, disnea y sibilancias son causa frecuente de consulta pediátrica. Su tratamiento de elección es la administración de fármacos a través de la aerosolterapia. El éxito de esta estrategia depende de la correcta aplicación de la técnica inhalatoria. Objetivo. Evaluar el conocimiento de padres de niños con patología obstructiva recurrente de la vía aérea en el uso de la aerosolterapia con aerocámara. Población y métodos. Estudio transversal, observacional, descriptivo. Se incluyeron aleatoriamente padres de niños menores de 6 años con tos, disnea y/o sibilancias con antecedentes de uso de aerocámara en la consulta al Servicio de Pediatría y/o de Alergia e Inmunología. Se evaluó el conocimiento en el empleo del inhalador mediante observación de la técnica. Resultados. Se incluyeron 114 niños, 51% masculino, con una edad promedio de 29,23 meses (DE=18,30). La persona a cargo de realizar la aerosolterapia tenía una media de edad de 32,28 años (DE=5,29); la mayoría de los responsables evaluados fueron madres (92,98%), con nivel de educación superior (71,05%). La forma de aprendizaje de la técnica fue demostrativa visual en 62 casos (54,4%), y el principal instructor de la misma fue el pediatra. Se demostró que 68 (72%) padres no realizaban en forma correcta la técnica y se encontró asociación entre edad del paciente y la correcta realización de la aerosolterapia (r=0,21; p=0,03). Conclusión. La mayoría de los padres realizan la aerosolterapia de forma incorrecta y la edad del niño influye en la técnica de la terapia inhalatoria.(AU)

Introduction. Symptoms of cough, dyspnea and wheezing are common cause for medical consultation. Their treatment is the administration of drugs through the aerosol. The success of this strategy depends on the correct application of inhalation technique. Objective. To evaluate the knowledge of parents of children with recurrent obstructive airway disease in the use of aerosol therapy with valved holding chamber. Population and Methods. Cross-sectional, observational, descriptive study. Randomly included parents of children under six years with cough, dyspnea and / or wheezing with a background of use in the office holding chamber of Pediatric and / or of Allergy and Immunology section of an Hospital. We evaluated the knowledge about the inhaler technique by medical observation. Results. We included 114 children, 51% male, with an average age of 29.23 months (SD=18.30). The median age o the caregiver responsible for conducting the aerosol therapy was 32.28 years (SD=5.29); the majority of evaluated makers were mothers (92.98%) with higher education level (71.05%). The most frequent way for learning was the visual demonstration technique in 62 cases (54.4%), and the main instructor was the pediatrician. Sixty-eight (72%) of parents did not perform properly the inhalation technique and a positive association was found between patient age and the proper realization of the aerosol (r=0.21; P=0.03). Conclusion. Most parents perform incorrectly aerosol therapy with valved holding chamber and the child's age influences the inhalation technique.(AU)

Utilização e eficácia de espaçadores no tratamento farmacológico de pacientes asmáticos: uma revisão integrativa / Use and effectiveness of spacers in the pharmacological treatment of patients with asthma: an integrative review / Uso y eficacia de espaciadores en el tratamiento farmacológico de pacientescon asma: una revisión integradora

Trata-se de uma revisão integrativa que objetivou analisar a produção científica, publicada entre 1999 e 2010, referente ao uso e eficácia de dispositivos inalatórios acoplados a espaçadores no tratamento da asma. A seleção dos estudos foi realizada nas bases de dados: Medical Literature Analysis and Retrieval System Online/Biblioteca Virtual em Saúde (MEDLINE/BVS) e Scientific Electronic Library Online (SciELO) e resultou em 20 artigos científicos. Foram evidenciadas diversas vantagens na utilização dos espaçadores, entre elas destaca-se a reversão mais rápida do broncoespasmo durante as crises agudas, a redução no tempo de preparo e administração das medicações, a menor evidência de efeitos colaterais e a redução de custos, especialmente quando se opta pelo uso de espaçadores artesanais. Desse modo, profissionais atuantes em programas de controle da asma, especialmente os enfermeiros envolvidos nesses serviços, precisam estar aptos a orientar os pacientes e relatar os benefícios da utilização dos espaçadores no tratamento farmacológico da asma.

This integrative review aimed to analyze the scientific production published between 1999 and 2010 on the useand effectiveness of inhaler devices connected to spacers in the treatment of asthma. Selection of studies in the Medical Literature Analysis and Retrieval System Online/Biblioteca Virtual em Saúde (MEDLINE/BVS) and Scientific Electronic Library Online (SciELO) databases yielded 20 scientific articles. Use of spacers was shown to offer a number of advantages, particularly more rapid relief of bronchospasm in acute attacks, reduced drug preparation and administration times, fewer side-effects and lower costs, especially with homemade spacers. Accordingly, personnel – especially nurses – involved in asthma control programs must be capacitated to advise patients and to report the benefits of using spacers in pharmacological treatment of asthma.

Se trata de una revisión integradora que objetivó analizar la producción científica, publicada entre 1999 y 2010, respecto al uso y efectividad de los dispositivos inhaladores acoplados a espaciadores en el tratamiento de la asma. La selección de los estudios he sido realizada en las bases de datos: Medical Literature Analysis and Retrieval System Online/ Biblioteca Virtual en Salud (MEDLINE/BVS) y Scientific Electronic Library Online (SciELO) y resultó en 20 artículoscientíficos. Fueron evidenciadas diversas ventajas en la utilización de los espaciadores, entre ellas se destaca la inversión más rápida del broncoespasmo durante los ataques agudos, la reducción del tiempo de preparación y administración de medicamentos, la más mínima evidencia de efectos secundarios y la reducción de costos, especialmente cuando se opta por el uso de espaciadores de fabricación artesanal. Así, los profesionales que participan en programas de control de la asma, sobre todo los enfermeros envueltos en esos servicios, deben ser capaces de enseñar y informar los beneficios del uso de losespaciadores en el tratamiento farmacológico de la asma.

Prova broncodilatadora na espirometria: efeito do uso de espaçador de grande volume com tratamento antiestático na resposta ao broncodilatador / Spirometry with bronchodilator test: effect that the use of large-volume spacers with antistatic treatment has on test response

OBJETIVO: Avaliar se o uso de salbutamol inalatório através de inalador dosimetrado acoplado a espaçadores de grande volume com tratamento antiestático na espirometria com prova broncodilatadora modifica os resultados do teste quando comparado à técnica usual (sem espaçador). MÉTODOS: Estudo prospectivo envolvendo 24 pacientes, com idades entre 18 e 45 anos e suspeita clínica de asma, atendidos no Ambulatório de Pneumologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte (MG). Os pacientes foram submetidos a duas espirometrias com prova broncodilatadora realizadas com e sem o uso de espaçador de grande volume. RESULTADOS: Não houve diferença significativa na variação do VEF1 antes e após o uso de broncodilatador entre as duas técnicas (ΔVEF1 média = 0,01 L; IC95 por cento: -0,05 a 0,06; p = 0,824). Não houve diferença estatisticamente significativa entre as duas técnicas em relação ao resultado qualitativo da prova broncodilatadora (p = 1,00). Houve concordância dos resultados da prova broncodilatadora entre as técnicas (coeficiente kappa = 0,909; p < 0,005). CONCLUSÕES: De acordo com os resultados deste estudo, a utilização de espaçadores de grande volume não modificou de forma significativa os resultados da prova broncodilatadora.

OBJECTIVE: To evaluate whether the use of inhaled albuterol via a metered-dose inhaler with a large-volume spacer with antistatic treatment modifies the bronchodilator test results when compared with the usual technique (no spacer). METHODS: A prospective study involving 24 patients, 18-45 years of age, clinically suspected of having asthma, and under treatment at the Outpatient Pulmonary Clinic of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. All of the patients underwent two bronchodilator tests: one with and one without the use of a large-volume spacer. RESULTS: There was no significant difference in the variation of FEV1 prior to and after bronchodilator use between the two techniques (mean ΔFEV1 = 0.01 L; 95 percent CI: -0.05 to 0.06; p = 0.824). No statistically significant difference was found between the two techniques regarding the qualitative results on the bronchodilator test (p = 1.00). There was concordance between the techniques in terms of the bronchodilator test results (kappa coefficient = 0.909; p < 0.005). CONCLUSIONS: According to the results of this study, the use of large-volume spacers does not significantly modify bronchodilator test results.

Uso de inaladores dosimetrados em pacientes com asma: conhecimentos e efeitos de uma orientação teórico-prática para pediatras / Metered-dose inhaler for asthma patients: knowledge and effects of a theoretical and practical guidance for pediatricians

Objective: To evaluate the effect of a theoretical and practical guidance on knowledge of pediatricians regarding the use of metered dose inhalers with spacers. To identify major deficiencies, correct them and train these physicians on the correct use of the devices. Methods: Pediatricians who participated in a theoreticalpractical program focusing on the use of inhaler devices answered a questionnaire with five questions about the use of these devices before and after the program. A comparison of the scores obtained in the pre- and post-training tests was performed by Wilcoxon test for related samples, and a significance level of 0.05 was adopted. Results: Twenty pediatricians performed pre- and post-training tests. The performance of pediatricians in the post-training test was significantly better than baseline (p<0.001). Conclusion: A brief orientation program for pediatricians significantly improved their knowledge on the use of metered-dose inhalers with spacers, which may translate into an improvement in quality and quantity of prescriptions of these devices in clinical practice. The questions with higher rates of errors in the pre-training test were the questions about the waiting time between two sprays in successive applications and about the correct way to attach the inhaler to the spacer, both with high levels of success in the post-training test.

Objetivo: Avaliar o efeito de uma orientação teórico-prática sobre o conhecimento de pediatras a respeito do uso de inaladores dosimetrados com espaçadores. Detectar as principais deficiências, corrigi-las e capacitar esses médicos para a correta utilizaçãodesses inaladores. Métodos: Pediatras que participaram de um curso teórico-prático a respeito do uso de dispositivos inalatórios responderam a um questionário com cinco perguntas sobre o uso desses dispositivos antes e após o curso. A comparação entre asnotas obtidas no pré e no pós-teste foi feita por meio do teste de Wilcoxon para amostras relacionadas, sendo adotado um nível de significância de 0,05. Resultados: Vinte pediatras realizaram o pré e o pós-teste. O desempenho dos médicos no pós-teste foi significativamente melhor que o inicial (p<0,001). Conclusão: Um breve programa de orientação a pediatras melhorou de forma significativa o conhecimento desses médicos a respeito do uso de inaladores dosimetrados com espaçadores, fato que pode se traduzir em uma melhora na qualidade e na quantidade de prescrições desses dispositivos na prática clínica. As questões com maiores índices de erros no pré-teste foram a relativa ao tempo necessário entre dois jatos em aplicações sucessivas e a que diz respeito à maneira correta de se acoplar o inalador ao espaçador, todas com altos níveis de acertos no pós-teste.

Avanços na inaloterapia em pediatria / Advances in inhalation therapy in pediatrics

OBJETIVOS: Revisar os artigos mais relevantes a respeito dos aspectos técnicos da terapêutica inalatória, dos inaladores disponíveis e principalmente dos principais avanços obtidos na inaloterapia em pediatria. FONTES DOS DADOS: Foram revisados os artigos contidos na base de dados MEDLINE a partir de 1983, além de capítulos de livros, e selecionados os de maior importância de acordo com os critérios estabelecidos para este artigo. SÍNTESE DOS DADOS: Os nebulizadores convencionais apresentam uma série de inconveniências, sendo que inaladores com desempenho melhorado pela respiração e os ativados pela respiração são opções mais atrativas. Dentre os inaladores de pó seco, destacam-se os que utilizam mecanismos passivos e ativos de dispersão de pó, que propiciam maiores taxas de deposição pulmonar das drogas. Entre os inaladores pressurizados dosimetrados destacam-se os ativados pela respiração, os coordenados pela respiração e os modificadores de velocidade. Devem ser usados preferencialmente em conjunto com espaçadores, pois a utilização deste aumenta em até duas vezes a deposição pulmonar das drogas. CONCLUSÕES: Para menores de 8 anos, os inaladores pressurizados dosimetrados com espaçadores são os mais adequados, dada a sua praticidade associada à elevada deposição pulmonar que proporcionam. Nos maiores de 8 anos capazes de gerar altos fluxos inspiratórios, os dispositivos de pó são os mais indicados.

OBJECTIVES: To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation therapy in pediatrics. SOURCES: Articles of MEDLINE database from 1983 were reviewed, in addition to book chapters, and the most important studies were selected according to the criteria established for this article. SUMMARY OF THE FINDINGS: Conventional nebulizers have a number of inconveniences, and breath-enhanced and breath-actuated inhalers are more attractive options. Among dry powder inhalers, we highlight those using passive and active powder dispersion mechanisms, which provide higher rates of drug deposition in the lung. Among pressurized metered-dose inhalers, we highlight breath-actuated, breath-coordinated, and velocity-modifying inhalers. These inhalers should be used preferably together with spacers, since the use of spacers produces a twofold increase in pulmonary drug deposition. CONCLUSIONS: For children younger than 8 years, pressurized metered-dose inhalers with spacers are the most appropriate devices, since they provide a practical approach associated with greater lung deposition. In children older than 8 years who can generate high inspiratory flow rates, dry powder devices are best suited.

Avaliação do conhecimento sobre o uso de inaladores dosimetrados entre profissionais de saúde de um hospital pediátrico / Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers

OBJETIVO: Avaliar os conhecimentos sobre o uso e manejo de inaladores pressurizados dosimetrados entre profissionais de um hospital pediátrico terciário. MÉTODOS: Foram realizadas avaliações sobre o conhecimento do uso de inaladores pressurizados dosimetrados através de questionários teóricos e práticos, com médicos, fisioterapeutas, enfermeiras e auxiliares de enfermagem, atribuindo-se uma nota de 0 a 10 para cada avaliação. Calcularam-se as medianas das notas obtidas pelos profissionais de cada categoria, as questões com maiores e menores índices de erros, e foi feita a comparação descritiva do desempenho das diversas categorias profissionais. A análise estatística foi feita através do método de Kruskal-Wallis de comparação de medianas. Também foi realizada a análise através de regressão logística múltipla seqüencial. RESULTADOS: Foram avaliados 30 médicos residentes ou estagiários de pediatria, 23 médicos assistentes, 29 fisioterapeutas, 33 enfermeiras e 31 auxiliares de enfermagem. Os médicos residentes, fisioterapeutas e médicos assistentes obtiveram desempenho significativamente superior aos dos enfermeiros e auxiliares de enfermagem. Apenas os médicos residentes obtiveram mediana superior a 6. CONCLUSÕES: O conhecimento a respeito do uso de inaladores dosimetrados entre os profissionais de saúde da instituição é insatisfatório, principalmente entre enfermeiros e auxiliares de enfermagem, diretamente envolvidos na aplicação prática dos inaladores dosimetrados.

OBJECTIVE: To evaluate health professionals working at a tertiary pediatric hospital in terms of their knowledge regarding the practical use of metered-dose inhalers. METHODS: Practical and written tests on the use of metered-dose inhalers were applied to physicians, physical therapists, nurses and nursing assistants. A score from 0 to 10 was assigned to each evaluation, and median scores were calculated for each professional category. Questions with higher and lower correct values were identified, and a descriptive comparison was made regarding the performance of the various professional categories. Statistical analysis was performed using the Kruskal-Wallis method for comparison of medians. A sequential logistic multiple regression analysis was also performed. RESULTS: A total of 30 resident physicians or interns in the pediatrics department, 23 attending physicians, 29 physical therapists, 33 nurses and 31 nursing assistants were evaluated. Resident physicians, physical therapists and attending physicians performed significantly better than did nurses and nursing assistants. Only resident physicians had a median score greater than 6. CONCLUSIONS: The health professionals evaluated, particularly the nurses and nursing assistants, who are directly involved in the practical use of metered-dose inhalers, possess insufficient knowledge regarding the use of such inhalers.