Low-dose chlorine exposure impairs lung function, inflammation and oxidative stress in mice.

AIM: To explore the different consequences of acute and chronic exposure to chlorine gas (Cl2) on the functional and histological parameters of health mice. MAIN METHODS: Firstly, male BALB/c mice were acute exposed to 3.3 or 33.3 or 70.5 mg/m3 Cl2. We analyzed the lung function, the inflammatory cells in the bronchoalveolar lavage, cell influx in the peribrochoalveolar space and mucus production. In a second phase, mice were chronic exposed to 70.5 mg/m3 Cl2. Besides the first phase analyses, we also evaluated the epithelial cells thickness, collagen deposition in the airways, immunohistochemistry stain for IL-1ß, iNOS, IL-17 and ROCK-2 and the levels of IL-5, IL-13, IL-17, IL-1ß and TNF-α in lung homogenate. KEY FINDINGS: Acute exposure to chlorine impaired the lung function, increased the number of inflammatory cells in the BALF and in the airways, also increased the mucus production. Furthermore, when chlorine was exposed chronically, increased the airway remodeling with collagen deposition and epithelial cells thickness, positive cells for IL-1ß, iNOS, IL-17 in the airways and in the alveolar walls and ROCK-2 in the alveolar walls, lung inflammation with increased levels of IL-5, IL-13, IL-1ß and TNF-α in the lung homogenate, and also, induced the acid mucus production by the nasal epithelium. SIGNIFICANCE: Acute and chronic exposure to low dose of chlorine gas worsens lung function, induces oxidative stress activation and mucus production and contributes to augmenting inflammation in health mice.

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents.

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Ocorrência e registro de infecções do trato geniturinário na gestação / Occurrence and recording of genitourinary tract infections during pregnancy

A quantitative descriptive research, whose objective was to verify the occurrence and recording of genitourinary tract infections in pregnant women. According to the data collected through interviews with 100 puerperae of a philanthropic maternity hospital and analyses of their prenatal care cards, 51% of the women reported having had urinary tract infection during pregnancy. Of these, only 70% reported having been treated with antibiotics and 47% having repeated urine tests after the treatment. Of the total cases of reported urinary tract infections, only 41% had been entered on the prenatal care cards, which in only 25% of the cases indicated uroculture as being the test of cure. Of the 8% of women who reported genital infections, 50% had been treated with vaginal cream. Concerning data entries, 11% of the prenatal care cards indicated genital infection and 64% of those did not report any treatment. All the data demonstrated high percentages of both failure to record data and inadequate knowledge of the women as to the actual presence of such infections, the need for treatment and the proper follow-up. It was concluded that health care professionals need to reevaluate the way they assist patients during the prenatal care period, especially regarding the women?s information and the complete recording of data on the prenatal care card.

Pesquisa descritiva e quantitativa que objetivou verificar a ocorrência e o registro das infecções geniturinárias em gestantes. Os dados, coletados por meio de entrevista com 100 puérperas de uma maternidade filantrópica e análise do cartão de pré-natal, mostraram que 51% das mulheres referiram infecção urinária na gestação. Destas, apenas 70% informaram ter realizado tratamento com antibióticos e 47% a repetição do exame de urina após o tratamento. Do total de casos de infecções urinárias relatadas, apenas 41% foram registrados no cartão do pré-natal que, em somente 25% dos casos, mostrava a urocultura como exame de controle de cura. Das 8% de mulheres que referiram infecções genitais, 50% informaram tratamento com creme vaginal. Quanto ao registro, 11% dos cartões continham dados relativos à presença de infecção genital, sendo que 64% deles não indicavam qualquer tratamento. Todos os dados mostraram altos percentuais tanto de falta de registro quanto de conhecimento inadequado das mulheres quanto a real presença dessas infecções, a necessidade do tratamento e do seguimento adequado. Conclui-se que os profissionais de saúde precisam rever o modo como assistem o pré-natal, especialmente no que se refere à informação da mulher e o completo registro de dados no cartão da gestante.