The potential role of peak nasal inspiratory flow to evaluate active sinonasal inflammation and disease severity.

Although the pathophysiology of nasal polyposis is incompletely understood, rhinologists have seldom studied it with rhinomanometry or peak nasal inspiratory flow (PNIF) due to technical limitations and the perception that polyp size might impair reproducibility and the usefulness of recordings. The objective of this study is to assess how measures of rhinomanometry and PNIF relate to disease activity. Nineteen patients with polyps, 15 patients with chronic sinusitis without polyps and 11 negative controls were evaluated with active anterior rhinomanometry and PNIF. Sinusitis and polyp patients were re-evaluated after medical treatment. Polyp patients had the highest median Lund-Mackay score (14) and a median Johansen score of 1. PNIF and its variation after treatment were also lowest in this group (median 90 L/min before and after treatment; median variation of 0 L/min). Nasal resistance was similar between groups, and only correlated with Johansen score (Spearman = 0.517, p = 0.048) after treatment. Our study suggests that evaluating polyp patients using rhinomanometry and PNIF may provide useful and reproducible data. Several findings considered together suggest that polyp size is not the main determinant of nasal functional changes in these patients, warranting further studies to verify whether PNIF changes reflect sinus inflammation or merely airway obstruction.

Recovery of cochlear and vestibular function after labyrinthine haemorrhage.

Inner ear haemorrhage is a rare disorder with disabling symptoms. Prognosis is generally considered to be poor with essentially no chance of functional recovery. The most common aetiologies are related to blood dyscrasias, anticoagulant therapy or local trauma. The association with autoimmune diseases is exceptional. The authors report a case of sudden deafness with vertigo in a patient with rheumatoid arthritis, caused by labyrinthine haemorrhage. Clinical picture and progress of audiovestibular function are described along with imagiological features from magnetic resonance imaging. Inner ear haemorrhage is a rare disorder with disabling symptoms and poor prognosis. To the best of the authors' knowledge, this is the first case described with documented vestibular function recovery following labyrinthine haemorrhage.

A hemorragia do ouvido interno é uma doença rara com sintomas incapacitantes e mau prognóstico funcional. As etiologias mais comuns estão relacionadas com discrasias sanguíneas, terapêutica anticoagulante ou traumatismo local. A associação com doenças autoimunes é excecional. Os autores relatam um caso de surdez súbita e vertigem em doente com artrite reumatóide, causada por hemorragia labiríntica. O quadro clínico e a evolução da função audiovestibular são descritos juntamente com os achados imagiológicos em ressonância magnética. Tanto quanto é do conhecimento dos autores, este é o primeiro caso descrito de recuperação da função vestibular após hemorragia labiríntica.

[Reported drug allergy among children attending day care centers]. / Alergia a medicamentos reportada em crianças que frequentam infantários.

INTRODUCTION: Data about drug allergy prevalence in the general population, particularly in children, are lacking. This study aimed to estimate the prevalence of parent-reported drug allergy, in children attending day care centers in Lisbon and Oporto. MATERIAL AND METHODS: In Phase II of the "ENVIRH study - Environment and Health in Children Day Care Centers", a health questionnaire which included questions about drug allergies was administered to children by stratified, random sampling of day care centers. RESULTS: The final analysis included 1,169 questionnaires, 52.5% from boys. The mean age was 3.5 ± 1.5 years. The prevalence of reported drug allergy was 4.1% (95% CI: 3.0 - 5.2%). The most frequently reported drugs were antibiotics (27 cases) and NSAIDs (in 6 cases). In the multivariate analysis, reported drug allergy was directly associated with age (OR 1.19; 95% CI 1.01 - 1.41) and reported food allergy (OR 3.19; 95% CI 1.41 - 7.19). It was inversely associated with the level of parental education (OR 0.25; 95% CI 0.10 - 0.59). DISCUSSION: Even though the limitations of the study our results are in accordance with those reported by previous authors and suggest that there is a high prevalence of reported drug allergy in the considered age group. CONCLUSION: A correct assessment of these situations is needed in order to avoid unnecessary drug evictions.

Introdução: A prevalência de alergia a fármacos na população geral não se encontra devidamente caraterizada, existindo poucos estudos publicados que tenham abordado esta situação em crianças com idades inferior a seis anos de idade. Este estudo tem como objetivo principal estimar a prevalência de alergia a medicamentos reportada pelos pais de crianças de infantários de Lisboa e do Porto. Material e Métodos: No âmbito da Fase II do projeto "ENVIRH ­ Ambiente e Saúde em Creches e Infantários" foi aplicado um questionário sobre alergia a medicamentos aos pais das crianças, recrutadas por amostragem aleatória estratificada dos infantários. Resultados: Foram analisados 1 169 questionários, 52,5% de rapazes. A idade média foi de 3,5 ± 1,5 anos. A prevalência de alergia a medicamentos reportada foi de 4,1% (IC 95%: 3,0 - 5,2%). Os fármacos mais referidos foram os antibióticos (em 27 reações) e os AINEs (em seis reações). Na análise multivariável, a alergia a medicamentos reportada associou-se diretamente com a idade da criança (OR 1,19; IC 95% 1,01 - 1,41) e com a referência a alergia alimentar (OR 3,19; IC95% 1,41 - 7,19) e inversamente com o nível de escolaridade dos pais (OR 0,25; IC95% 0,10 - 0,59). Discussão: Apesar das limitações do estudo, os resultados encontram-se de acordo com o reportado por outros autores e sugerem que a prevalência reportada de alergia a medicamentos seja elevada no grupo etário estudado. Conclusão: Torna-se necessário que situações de alergia a medicamentos reportadas pelos pais sejam devidamente estudadas, no sentido de evitar evicções desnecessárias que possam condicionar opções terapêuticas em futuras situações de doença.

Food allergy and anaphylaxis in infants and preschool-age children.

Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children's day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC's (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children's median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention.

CO(2) concentration in day care centres is related to wheezing in attending children.

UNLABELLED: Poor ventilation at day care centres (DCCs) was already reported, although its effects on attending children are not clear. This study aimed to evaluate the association between wheezing in children and indoor CO2 (a ventilation surrogate marker) in DCC and to identify behaviours and building characteristics potentially related to CO2. In phase I, 45 DCCs from Lisbon and Oporto (Portugal) were selected through a proportional stratified random sampling. In phase II, 3 months later, 19 DCCs were further reassessed after cluster analysis for the greatest difference comparison. In both phases, children's respiratory health was assessed by ISAAC-derived questionnaires. Indoor CO2 concentrations and building characteristics of the DCC were evaluated in both phases, using complementary methods. Mixed effect models were used to analyze the data. In phase I, which included 3,186 children (mean age 3.1 ± 1.5 years), indoor CO2 concentration in the DCC rooms was associated with reported wheezing in the past 12 months (27.5 %) (adjusted odds ratio (OR) for each increase of 200 ppm 1.04, 95 % CI 1:01 to 1:07). In phase II, the association in the subsample of 1,196 children seen in 19 out of the initial 45 DCCs was not significant (adjusted OR 1.02, 95 % CI 0.96 to 1.08). Indoor CO2 concentration was inversely associated with the practices of opening windows and internal doors and with higher wind velocity. A positive trend was observed between CO2 and prevalence of reported asthma (4.7 %). CONCLUSION: Improved ventilation is needed to achieve a healthier indoor environment in DCC.