Physician's experience on managing asthma in adolescents: results of the International AMADO (Asthma Management in ADOlescents) survey.

BACKGROUND: Worldwide prevalence of asthma seems to be increasing in adolescents, but limited data is available regarding the management of asthma in this age group. OBJECTIVE: Therefore, we conducted an international survey focused on physicians who manage asthma in order to understand how Asthma Management in ADOlescents (AMADO) is currently performed. METHODS: The AMADO survey is a web-based global survey of physician's attitudes towards the management of asthma in adolescents, circulated for 17 weeks. The survey had an anonymous and voluntary standard. The questionnaire consisted in 27 questions covering the training background of respondents, difficulties in diagnosis, and in management of asthma in adolescents. RESULTS: Two hundred forty-four responses were received from 46 countries, from all continents. Most (65%) of participants indicated allergy as being their main specialty. The majority of participants (62%) had more than 5 years of clinical practice, but 62% have no formal training in management of adolescents with asthma. Most of participants (96%) indicated having at least one case of asthma in adolescents per month. 60% of respondents mentioned that the asthmatic adolescents only had the consultation due to the family imposition. All respondents mentioned having difficulties in the management of asthma in adolescents due to patient poor adherence. Overall, 44% of participants have no specific health care resources for adolescents in their departments. Main suggestions from the participants were: optimization of time and personalized communication to these cohort, and standardization of multidisciplinary actions to improve adherence to asthma control treatment. CONCLUSION: Management of asthma in adolescents is still a challenge in clinical practice. The results from this survey helped us to identify the key issues to improve clinical outcomes in the future. This survey is the first step of the international AMADO initiative, which intends to optimize diagnosis and control of asthma and prevent avoidable deaths.

Epidemiological profile of dengue in Brazil between the years 2014 and 2019.

OBJECTIVE: The aim was to determine the epidemiological profile of dengue fever in Brazil between the years 2014 and 2019. METHODS: This is an observational, descriptive, cross-sectional, and retrospective study, which was carried out through the analysis of secondary data collected from the National System of Notification Appeals (SINAN) and from SUS Computer Department (DATASUS). RESULTS: The total number of reported cases was 5,867,255, and 2015 was the year with the highest cases (1,696,340). The cases were predominant in the Southeast and Midwest macro-regions, the female sex (55.6%), brown people (48%), and clinical and epidemiological criteria of confirmation (63.8%). Regarding the age group, it was observed that during the study period, the highest prevalence occurred in individuals between 20 and 39 years (38.3%). There was a change of serotype from DENV-1 to DENV-2, and dengue was the most prevalent classification (95.2%). Concerning hospitalization rates, there was a limited necessity of admissions (5.7%), as well as few deaths due to the notified disease (3,444). CONCLUSIONS: There was a significant growth in the number of dengue fever cases in Brazil in 2019, which represents a public health problem.

Measles epidemiological profile in Brasil from 2013 to 2018.

BACKGROUND To determine the epidemiological profile of measles in Brasil from 2013 to 2018, and to evaluate the possible association between increased number of cases and vaccination coverage. METHODS This is an observational, descriptive, cross-sectional, retrospective study with quantitative approach, carried out through analysis of secondary data collected through the Notifiable Diseases Information System (SINAN), in the National Immunization Program (PNI). RESULTS The total number of reported cases was 10,886, with the year 2018 having the highest number (10,185). In the North macro-region (93.4%), male (55.53%), autochthonous cases from the city of residence (94.42%) and laboratory confirmation (99.09%) predominated. Regarding the age group, it was observed that in the period from 2013 to 2015 the highest prevalence occurred in <1 year, with 44.5%, 40.6% and 29.0%, respectively, while in 2018, the highest rate was in the 20-29 age group with 24.2%. Vaccination coverage was below 95%, except for SCR - D1 (first dose of triple viral) in the years 2013 to 2016. Regarding the outcome, there was a limited number of deaths secondary to measles (0.12%). CONCLUSIONS There was an exponential growth in the number of measles cases in Brasil in 2018, which represents a public health problem. In view of this, it is necessary to implement measures such as broad vaccination coverage and sanitary control at the borders, in order to reduce the incidence of this disease and, consequently, the number of deaths.

Measles epidemiological profile in Brasil from 2013 to 2018

SUMMARY BACKGROUND To determine the epidemiological profile of measles in Brasil from 2013 to 2018, and to evaluate the possible association between increased number of cases and vaccination coverage. METHODS This is an observational, descriptive, cross-sectional, retrospective study with quantitative approach, carried out through analysis of secondary data collected through the Notifiable Diseases Information System (SINAN), in the National Immunization Program (PNI). RESULTS The total number of reported cases was 10,886, with the year 2018 having the highest number (10,185). In the North macro-region (93.4%), male (55.53%), autochthonous cases from the city of residence (94.42%) and laboratory confirmation (99.09%) predominated. Regarding the age group, it was observed that in the period from 2013 to 2015 the highest prevalence occurred in <1 year, with 44.5%, 40.6% and 29.0%, respectively, while in 2018, the highest rate was in the 20-29 age group with 24.2%. Vaccination coverage was below 95%, except for SCR - D1 (first dose of triple viral) in the years 2013 to 2016. Regarding the outcome, there was a limited number of deaths secondary to measles (0.12%). CONCLUSIONS There was an exponential growth in the number of measles cases in Brasil in 2018, which represents a public health problem. In view of this, it is necessary to implement measures such as broad vaccination coverage and sanitary control at the borders, in order to reduce the incidence of this disease and, consequently, the number of deaths.

RESUMO OBJETIVO Determinar o perfil epidemiológico do sarampo no Brasil no período de 2013 a 2018, além da possível correlação entre incidência de casos e cobertura vacinal. MÉTODO Trata-se uma pesquisa observacional, com delineamento descritivo, transversal, retrospectivo e com abordagem quantitativa, feita por meio de análises de dados secundários coletados no Sistema Nacional de Agravos de Notificação (Sinan), no Programa Nacional de Imunizações (PNI). RESULTADOS O total de casos confirmados foi 10.886, sendo o ano de 2018 com o maior número (10.185). Predominou a macrorregião Norte (93,4%), sexo masculino (55,53%), casos autóctones do município de residência (94,42%) e confirmação laboratorial (99,09%). Com relação à faixa etária, observou-se que, no período de 2013 a 2015, a maior prevalência ocorreu em <1 ano, com 44,5%, 40,6% e 29,0%, respectivamente, enquanto que, em 2018, o maior índice foi na faixa de 20-29 anos, com 24,2%. A cobertura vacinal ficou abaixo de 95%, exceto a SCR - D1 (primeira dose da tríplice viral) nos anos de 2013 a 2016. Quanto ao desfecho, houve limitado número de óbitos secundários ao sarampo (0,12%). CONCLUSÃO Verifica-se um crescimento exponencial no número de casos de sarampo no Brasil em 2018, o que representa um problema de saúde pública. Diante disso, carece que medidas como ampla cobertura vacinal e controle sanitário, nas fronteiras, sejam implementadas, a fim de reduzir a incidência dessa enfermidade e, consequentemente, o número de óbitos.

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review.

OBJECTIVE: The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab. METHODS: A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: "Dupilumab", "asthma", "Bronchial Asthma" AND "Asthma, Bronchial" AND their correspondent in Portuguese "asma", "Asma brônquica" and "Asma brônquica". The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded. RESULTS: The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients. CONCLUSIONS: Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

SUMMARY OBJECTIVE The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab. METHODS A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: "Dupilumab", "asthma", "Bronchial Asthma" AND "Asthma, Bronchial" AND their correspondent in Portuguese "asma", "Asma brônquica" and "Asma brônquica". The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded. RESULTS The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients. CONCLUSIONS Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

RESUMO OBJETIVO Este artigo teve como objetivo fazer uma revisão sistemática sobre o tratamento da asma moderada a grave, administrando Dupilumabe. MÉTODOS Foi realizada uma busca nas plataformas on-line Ebsco, SciELO, PubMed, Medline Bireme, Lilacs e New England Journal of Medicine. Foram selecionadas publicações de 2010 a 2018 referentes a artigos que continham grupos controle, que testaram a validade de Dupilumabe e verificaram a resposta dos pacientes por meio de testes controlados. Para a busca desses artigos, foram utilizadas as seguintes palavras-chave: "Dupilumab", "asthma", "Bronchial Asthma" and "Asthma, Bronchial". E o correspondente em português: "asma", "Asma brônquica" and "Asma brônquica". Os critérios de exclusão, revisões de literatura, notícias, artigos sem grupos de controle, artigos sobre diferentes assuntos, estudos de Dupilumabe sobre outras doenças, artigos sobre asma sem uso de Dupilumabe e artigos repetidos em plataformas de busca foram descartados. RESULTADOS A literatura aponta que a medicação apresenta boa resposta no tratamento da asma moderada a grave e auxilia na melhora da função pulmonar, além de resultar em poucos efeitos colaterais. Apresenta boa eficácia, segurança e tolerância pelos pacientes. CONCLUSÕES Dupilumabe é promissor para o tratamento da asma em que a terapia convencional se revela insuficiente. Maiores estudos adicionais são necessários para confirmar a segurança e a eficácia em longo prazo.

Brain creatine kinase activity is inhibited after hepatic failure induced by carbon tetrachloride or acetaminophen.

Encephalopathy is an important cause of morbidity and mortality in patients with severe hepatic failure and the mechanisms underlying hepatic encephalopathy are still not fully known. Considering that creatine kinase (CK) play a crucial role in brain energy homeostasis and is inhibited by free radicals, and that oxidative stress is probably involved in the pathogenesis of hepatic encephalopathy, we evaluated CK activity in hippocampus, striatum, cerebellum, cerebral cortex and prefrontal cortex of rats submitted to acute administration of carbon tetrachloride or acetaminophen. The effects of the administration of antioxidants, N-acetylcysteine (NAC) plus deferoxamine (DFX) in association, and taurine, were also evaluated. Our findings demonstrated that carbon tetrachloride inhibited CK activity in cerebellum; acetaminophen inhibited the enzyme in cerebellum and hippocampus. CK activity was not affected in other brain areas. The administration of NAC plus DFX reversed the inhibition of CK activity caused by carbon tetrachloride in cerebellum and by acetaminophen in cerebellum and hippocampus. On the other hand, taurine was not able to reverse the inhibition in CK activity. Although it is difficult to extrapolate our findings to the human condition, the inhibition of brain CK activity after hepatic failure may be involved in the pathogenesis of hepatic encephalopathy.

Inhibition of mitochondrial respiratory chain in the brain of rats after hepatic failure induced by carbon tetrachloride is reversed by antioxidants.

Hepatic encephalopathy is an important cause of morbidity and mortality in patients with severe hepatic failure. This disease is clinically characterized by a large variety of symptoms including motor symptoms, cognitive deficits, as well as changes in the level of alertness up to hepatic coma. Carbon tetrachloride is frequently used in animals to produce an experimental model to study the mechanisms involved in the progression of hepatic disease and the impact of various drugs on this progression. The brain is highly dependent on ATP and most cell energy is obtained through oxidative phosphorylation, a process requiring the action of various respiratory enzyme complexes located in a special structure of the inner mitochondrial membrane. In this context, we evaluated the activities of mitochondrial respiratory chain complexes in the brain of rats submitted to acute administration of carbon tetrachloride and treated with NAC and DFX alone or in combination. Our results showed that complexes I, II and IV were inhibited after carbon tetrachloride administration and that NAC and DFX alone or in combination were able to prevent the inhibition of these enzymes. On the other hand, complex III was not affected. The participation of oxidative stress has been postulated in the hepatic encephalopathy and it is well known that the electron transport chain itself is vulnerable to damage by this species. Based on our findings, we suggest that oxidative stress may be involved in the inhibition of complexes from mitochondrial respiratory chain.

Effect of electroconvulsive shock on mitochondrial respiratory chain in rat brain.

It is well described that impairment of energy production has been implicated in the pathogenesis of a number of diseases. Although several advances have occurred over the past 20 years concerning the use and administration of electroconvulsive therapy (ECT) to minimize its side effects, little progress has been made in understanding its mechanism of action. In this work, our aim was to measure the activities of mitochondrial respiratory chain complexes II and IV and succinate dehydrogenase from rat brain after acute and chronic electroconvulsive shock (ECS). Our results showed that mitochondrial respiratory chain enzymes activities were increased after acute ECS in hippocampus, striatum and cortex of rats. Besides, we also demonstrated that complex II activity was increased after chronic ECS in cortex, while hippocampus and striatum were not affected. Succinate dehydrogenase, however, was inhibited after chronic ECS in striatum, activated in cortex and not affected in hippocampus. Finally, complex IV was not affected by chronic ECS in hippocampus, striatum and cortex. Our findings demonstrated that brain metabolism is altered by ECS.

Decreased creatine kinase activity caused by electroconvulsive shock.

Although several advances have occurred over the past 20 years concerning the use and administration of electroconvulsive therapy to minimize side effects of this treatment, little progress has been made in understanding its mechanism of action. Creatine kinase is a crucial enzyme for brain energy homeostasis, and a decrease of its activity has been associated with neuronal death. This work was performed in order to evaluate creatine kinase activity from rat brain after acute and chronic electroconvulsive shock. Results showed an inhibition of creatine kinase activity in hippocampus, striatum and cortex, after acute and chronic electroconvulsive shock. Our findings demonstrated that creatine kinase activity is altered by electroconvulsive shock.