Doctors' awareness concerning primary immunodeficiencies in Brazil.

BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

Prevalence of symptoms of asthma, rhinitis, and atopic eczema in Brazilian adolescents related to exposure to gaseous air pollutants and socioeconomic status.

OBJECTIVES: To evaluate the relationship between exposure to gaseous air pollutants (ozone [O3], carbon monoxide [CO], nitrogen dioxide [NO2], and sulfur dioxide [SO2]) socioeconomic status and the prevalence of symptoms of asthma, rhinitis and atopic eczema in adolescents. SUBJECTS AND METHODS: A sample of 16 209 adolescents from São Paulo West (SPW), São Paulo South (SPS), Santo André (SA), Curitiba (CR), and Porto Alegre (PoA) were enrolled. Data on air pollutants and socioeconomic status were compared to prevalence of symptoms with the Spearman correlation coefficient. RESULTS: Socioeconomic status was quite similar in all cities. The levels of O3 in SPW, SPS, and SA, and of CO in SA were higher than the acceptable ones. In relation to O3 and CO exposures, adolescents from SPW and SA had a significant risk of current wheezing, whereas living in SPW was associated with a high risk of rhinoconjunctivitis, eczema, and flexural eczema and living in CR to rhinitis. Exposure to NO2 was associated with a high risk of current wheezing in SPW and SA, and of severe asthma in SPW and PoA. Exposure to SO2 was associated with a high risk of current wheezing in SPW and SA, severe asthma in SPW and PoA, and nighttime cough, eczema, flexural eczema and severe eczema in SPW. Living in SPW, CR, or PoA was associated with a high risk of rhinitis, rhinoconjunctivitis, and severe rhinitis. CONCLUSIONS: Although we did not detect a characteristic pattern for all symptoms evaluated or a specific air pollutant, our data suggest a relationship between higher exposure to photochemical pollutants and high prevalence or risk of symptoms of asthma, rhinitis, and atopic eczema.

[Effect of inhaled terbutaline sulphate (dry powder, Turbuhaler and nebulizer solution) in children with acute asthma]. / Estudo dos efeitos do sulfato de terbutalino inalado, sob a forma de pó seco (TurbuhalerR) e solução para nebulização em crianças com asma aguda.

Forty seven children (6-14 years), with an acute mild or moderate attack of asthma (clinical score 3 or FEV1 > 50% of the predicted), were treated with terbutaline sulphate, by inhalation route with a dry powder inhaler (Turbuhaler - 0,5 mg - group T; N=27, or by a nebulizer 1% solution-in saline-compressed air (6 l/min.) group S; N=20. The children were evaluated at 5, 15, 25 and 30 minutes after the initial treatment. In both groups a significant fall of the clinical score (starting at 15 minutes) (p < 0.05) and a significant improvement of the FEV(1), VC and FEF25-75% (starting at 5 minutes), were observed (p < 0.05). There were no significant changes in heart rates, respiratory rates and blood pressure (p > 0.05). At the end of the first treatment, the number of patients with a FEV(1) < 80% was similar in both groups (T = 13/27 and S = 10/20). The same treatment was repeated, and all the children showed a marked improvement, except for one boy of the group T was hospitalized. In conclusion, children with mild or moderate acute attacks of asthma can be treated up to a week with an inhalation of dry powder, resulting in adequate bronchodilatation without important side effects.

[Atopic diseases in Brazilian children--etiologic multicentric study]. / Etiologia da doença atópica em crianças brasileiras--Estudo multicêntrico.

In order to determine the etiologic agents involved in atopic diseases in Brazilian children, we have performed this multicentric study in 8 areas in Brazil. We have done prick tests with inhalants and food antigens and analyzed skin tests results, considering positive the wheal mean diameter 3 mm. 22,2% of skin tests were negative and the majority were positive to inhalants: D.pteronyssinus(Dpt) (66.6%) and D. farinae(Df) (66.0%), house dust extract (29.0%), dogs epithelium (19.2%), cat's epithelium (8.8%), feather (5.5%), molds (4.2%), Penicillium sp (2.2%) and Lollium perene (0.6%). We have had 9,1% of food positive tests: cow milk (5.2%), peanut (3.5%), corn (3.2%), cocoa and soya (2.2%), eggs and wheat (1.9%). We have concluded that the domestic mites are the most important agents involved in the etiology of atopic diseases in Brazilian children, and the extracts involved, in line with the sensitization of each geographical area.

Seguimento de criancas asmaticas apos a alta do Servico de Alergia Respiratoria da Fundacao de Assistencia a Infancia de Santo Andre (F.A.I.S.A.). / Follow-up of asthmatic children after discharge of the Respiratory Allergy Service of the Fundacao de Assistencia a Infancia de Santo Andre

Cento e cinquenta criancas asmaticas foram acompanhadas por um periodo de seis meses a mais de quatro anos apos a alta do programa de reabilitacao do Servico de Alergia Respiratoria da F.A.I.S.A. Cento e vinte e oito criancas (85,3%) nao apresentaram crises asmaticas apos a alta e 104 (69,3%) permaneceram completamente assintomaticas. Foi relacionada a ocorrencia de sintomas com diversos fatores como gravidade da doenca, reatividade cutanea tipo e duracao do tratamento

Avaliacao do cetotifemo no tratamento profilatico da asma bronquica na crianca. / Evaluation of ketotifen in the prophylactic treatment of asthma in children

Durante tres meses 55 criancas, portadoras de asma extrinseca, recebem como tratamento profilatico 1 mg de cetotifeno, por via oral, duas vezes ao dia, num estudo multicentrico aberto. Diversos parametros foram avaliados atraves do preenchimento de uma ficha diaria, sendo que ao final do periodo de observacao 33 criancas (60%) apresentaram bons resultados (ausencia ou diminuicao importante dos sintomas, diminuicao do uso de medicacao sintomatica). Tal estudo sera ampliado com a realizacao de um ensaio duplo-cego, comparativo entre cetotifeno e placebo, em 100 outras criancas asmaticas