Avaliação do desenvolvimento neuropsicomotor em crianças com hepatopatias crônicas / Neuropsychomotor development evaluation in children with chronic liver diseases

Objetivos: avaliar o desenvolvimento neuropsicomotor (DNPM) de crianças de 3 a 6 anos com hepatopatias crônicas, utilizando teste de triagem de Denver II e verificar a associação entre DNPM e estado nutricional, renda familiar e intervenções cirúrgicas. Métodos: estudo seccional com grupo de comparação, descritivo e exploratório. Foram avaliadas 27 crianças, 16 do GP (grupo de pacientes) e 11 sem hepatopatias do GC (grupo comparação) pelo teste de desenvolvimento de acordo com a idade. Resultados: foi encontrado que 68,8% do GP apresentaram suspeita ou risco para o DNPM. A odds (chance) de ter o Denver positivo para suspeita ou risco no GP foi de 2,2, enquanto, entre as crianças do GC, foi de 0,375, ou seja, uma odds ratio de 5,87. Do GP, 45% com suspeita ou risco para o DNPM apresentaram-se acima do peso no IMC X Idade, 72% do GP com o Denver positivo pertenciam à classe econômica C1 e C2. No GP, 94,1% realizou algum procedimento cirúrgico; destes, mais da metade apresentou suspeita ou risco para DNPM. Conclusão: crianças com hepatopatias crônicas, acima do peso, com renda familiar baixa e as que sofreram algum procedimento cirúrgico apresentam maiores chances de suspeita ou risco para alterações no seu DNPM.

Objectives: to assess the neuropsychomotor development (DNPM) of children aged 3 to 6 years with chronic liver diseases, using Denver II screening test and check out the association between DNPM and nutritional status, family income and surgical interventions. Methods: sectional study with comparison group, descriptive and exploratory. 27 children were evaluated, 16 of the GP (Group of patients) and 11 without liver diseases (comparison group GC) for development testing according to age. Results: it was found that 68.8% of GP presented suspicion or risk for the DNPM. The odds of having the Denver positive for suspicion or risk in GP was 2.2, while among children of the GC was 0.375, i.e. an odds ratio of 5.87. The GP, 45% with suspicion or risk for the DNPM were overweight on BMI X age, 72% of GP with the positive Denver belonged to economy class C1 and C2. In GP, 94.1% conducted some surgical procedure, these more than half were suspected or risk for DNPM. Conclusion: children with chronic liver diseases, overweight, with low family income and those that suffered some surgical procedure have higher chances of suspicion or risk for changes in your DNPM.

Revisiting the Heterogeneous IFN-γ Response of Bacille of Calmette-Guérin (BCG)-Revaccinated Healthy Volunteers in a Randomized Controlled Trial: Effect of the Body Mass Index and of the IFNG+874 A/T Polymorphism.

In trials evaluating the immune responses to Bacille of Calmette-Guérin (BCG), the genetic background and the nutritional status are host-related factors that could affect the heterogeneity in these parameters. The IFNG+874 A/T (rs 62559044) polymorphism has been reported to influence the IFN-γ production by BCG-vaccinated individuals challenged in vitro with mycobacterial antigens. The body mass index (BMI) is a proxy for the nutritional status and has been associated both with the susceptibility to tuberculosis and with the IFN-γ response. We show that although the IFNG+874 A/T polymorphism was not associated with the heterogeneity of IFN-γ production in a randomized controlled trial that evaluated long-term immune responses to BCG revaccination previously conducted in Salvador, Bahia, Brazil, the effect of this polymorphism on the observed increase in IFN-γ production among revaccinated subjects was adjusted in individuals with a low BMI.

Avaliação do desenvolvimento neuropsicomotor em crianças com hepatopatias crônicas / Neuropsychomotor development evaluation in children with chronic liver diseases

Objetivos: avaliar o desenvolvimento neuropsicomotor (DNPM) de crianças de 3 a 6 anos com hepatopatias crônicas, utilizando teste de triagem Denver II e verificar a associação entre DNPM e estado nutricional, renda familiar e intervenções cirúrgicas. Métodos: estudo seccional com grupo de comparação, descritivo e exploratório. Foram avaliadas 27 crianças, 16 do GP (grupo de pacientes) e 11 sem hepatopatias (grupo comparação - GC) pelo teste de desenvolvimento de acordo com a idade. Resultados: foi encontrado que 68,8% do GP apresentaram suspeita ou risco para o DNPM. A odds de ter o Denver positivo para suspeita ou risco no GP foi de 2,2, enquanto entre as crianças do GC foi de 0,375, ou seja, uma odds ratio de 5,87. Do GP, 45% com suspeita ou risco para o DNPM apresentaram-se acima do peso no IMC X idade, 72% do GP com o Denver positivo pertenciam à classe econômica C1 e C2. No GP, 94,1% realizaram algum procedimento cirúrgico; destes mais da metade apresentou suspeita ou risco para DNPM. Conclusão: crianças com hepatopatias crônicas, acima do peso, com renda familiar baixa e as que sofreram algum procedimento cirúrgico apresentam maiores chances de suspeita ou risco para alterações no seu DNPM.

Objectives: to assess the neuropsychomotor development (DNPM) of children aged 3 to 6 years with chronic liver diseases, using Denver II screening test and check out the association between DNPM and nutritional status, family income and surgical interventions. Methods: sectional Study with comparison group, descriptive and exploratory. 27 children were evaluated, 16 of the GP (Group of patients) and 11 without liver diseases (comparison group GC) for development testing according to age. Results: it was found that 68.8% of GP presented suspicion or risk for the DNPM. The odds of having the Denver positive for suspicion or risk in GP was 2.2, while among children of the GC was 0.375, i.e. an odds ratio of 5.87. The GP, 45% with suspicion or risk for the DNPM were overweight on BMI X age, 72% of GP with the positive Denver belonged to economy class C1 and C2. In GP, 94.1% conducted some surgical procedure, these more than half were suspected or risk for DNPM. Conclusion: children with chronic liver diseases, overweight, with low family income and those that suffered some surgical procedure have higher chances of suspicion or risk for changes in your DNPM.

Duration of exclusive breastfeeding in a Brazilian population: new determinants in a cohort study.

BACKGROUND: Determinants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature. METHODS: This cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox's four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier's survival curve. RESULTS: Median duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner's appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71). CONCLUSIONS: The study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.

Avaliação do consumo alimentar de pacientes com mucopolissacaridose / Assessment of dietary intake of patients with mucopolysaccharidosis

Objetivos: Avaliar o consumo alimentar de crianças e adolescentes com mucopolissacaridose.Métodos: Série de casos de mucopolissacaridose acompanhados regularmente em um serviço de referência da cidade de Salvador, Bahia, no período de janeiro a abril de 2012. Foram considerados para inclusão pacientes de ambos os sexos, entre dois e 18 anos de idade, com ingestão alimentar por via oral, sem complicações clínicas. Foi aplicada anamnese estruturada contemplando informações socioeconômicas, clínicas e avaliação da ingestão alimentar. Dados de consumo alimentar foram obtidos através do recordatório alimentar de 24 horas e registro alimentar de três dias. Foram avaliadas as possíveis inadequações alimentares através das recomendações da Dietary Reference Intakes, 2005. Os dados foram tabulados no Epidata 3.1 e analisados no pacote estatístico R.Resultados: Foram estudados oito meninos e duas meninas, com idade mediana de 10 anos (intervalo interquartil 6,4 anos, mínima 3, máxima 16 anos). O tipo mais frequente da doença foi a mucopolissacaridose VI (60%). Seis pacientes necessitavam de auxílio para se alimentar, nove apresentaram baixa ingestão de calorias e seis apresentaram baixa ingestão de lipídios. Todos os pacientes apresentavam insuficiente ingestão de fibras e consumo adequado de carboidratos e proteínas. O consumo de todos os micronutrientes apresentou inadequação.Conclusões: Detectou-se alta frequência de inadequação no consumo alimentar de crianças e adolescentes com mucopolissacaridose. Algumas limitações osteoarticulares causadas pela doença acarretam problemas na ingestão de alimentos, tendo muitos pacientes necessidade de auxílio no ato de se alimentar. A conduta nutricional especializada poderá auxiliar na qualidade de vida e no prognóstico desses indivíduos...

AIMS: To assess the dietary intake of children and adolescents with mucopolysaccharidosis.METHODS: Series of cases of mucopolysaccharidosis regularly followed in a referral center in Salvador, Bahia state, Brazil, in January-April 2012. Patients of both sexes aged between 2 and 18 years with food intake by mouth and without clinical complications were considered to inclusion. Structured anamnesis was applied contemplating socioeconomic, clinical, and dietary intake information. The food consumption data were obtained from 24-hour dietary recall and food record of three days. Possible dietary inadequacies were evaluated facing the recommendations of the Dietary Reference Intakes, 2005. Data were tabulated in 3.1 Epidata and analyzed by the statistical package R.RESULTS: Eight boys and two girls, with a median age of 10 years (interquartile range 6.4 years, minimum 3, maximum 16 years) were studied. The most common type of the disease was Mucopolysaccharidosis VI (60 %) and less frequent mucopolysaccharidosis I (10%). Six patients needed assistance to feed, nine had low calorie intake, and six had low intake of lipids. All patients had insufficient intake of fiber and adequate intake of carbohydrates and proteins. The intake of all micronutrients had impairments.CONCLUSIONS: There was a high frequency of inadequate dietary intake in children and adolescents with mucopolysaccharidosis. Some osteoarticular limitations caused by the disease lead to problems in food intake, and many patients need assistance in the act of eating. A specialized nutritional intervention may assist in quality of life and prognosis of these individuals...

Risk factors for the incidence of dengue virus infection in preschool children.

OBJECTIVE: To estimate the seroincidence of dengue in children living in Salvador, Bahia, Brazil and to evaluate the factors associated. METHODS: A prospective serological survey was carried out in a sample of children 0-3 years of age. A multilevel logistic model was used to identify the determinants of seroincidence. RESULTS: The seroprevalence of dengue was 26.6% in the 625 children evaluated. A second survey detected an incidence of 33.2%. Multilevel logistic regression showed a statistically significant association between the seroincidence of dengue and age and the premises index. CONCLUSION: In Salvador, the dengue virus is in active circulation during early childhood; consequently, children have heterotypic antibodies and run a high risk of developing dengue haemorrhagic fever, because the sequence and intensity of the three dengue virus serotypes currently circulating in this city are very similar to those that were circulating in Rio de Janeiro, Brazil, in 2008. Therefore, the authors strongly recommend that the health authorities in cities with a similar epidemiological scenario be aware of this risk and implement improvements in health care, particularly targeting the paediatric age groups. In addition, information should be provided to the population and actions should be implemented to combat this vector.

IL28B polymorphisms are markers of therapy response and are influenced by genetic ancestry in chronic hepatitis C patients from an admixed population.

BACKGROUND: IL28B polymorphisms are predictors of therapy response in hepatitis C virus (HCV) patients. We do not know whether they are markers of treatment response in admixed populations or not. AIMS: To determine whether IL28B polymorphisms are predictors of therapy response in patients with HCV from an admixed population and are influenced by genetic ancestry. METHODS: rs12979860 and rs8099917 were genotyped in 222 HCV patients treated with pegylated interferon and ribavirin. Ancestry was determined using genetic markers. RESULTS: IL28B rs12979860 C/C was associated with sustained virological response (SVR), whereas C/T and T/T were associated with failure to therapy (P = 1.12 × 10(-5) ). IL28B rs8099917 T/T was associated with SVR, and G/G and G/T were associated with nonresponse/relapse (NR/R) (P = 8.00 × 10(-3) ). Among HCV genotype 1 patients with C/C genotype, genomic ancestry did not interfere with therapy response. Among patients with rs12979860 T/T genotype, African genetic contribution was greater in the NR/R group (P = 1.51 × 10(-3) ), whereas Amerindian and European genetic ancestry contribution were higher in the SVR group (P = 3.77 × 10(-3) and P = 2.16 × 10(-2) respectively). Among HCV type 1 patients with rs8099917 T/T, African genetic contribution was significantly greater in the NR/R group (P = 5.0 × 10(-3) ); Amerindian and European ancestry genetic contribution were greater in the SVR group. CONCLUSION: IL28B rs12979860 and rs8099917 polymorphisms were predictors of therapy response in HCV genotypes 1, 2 and 3 subjects from an admixed population. Genomic ancestry did not interfere with response to therapy in patients with rs12979860 C/C, whereas it interfered in patients with C/T and T/T genotypes. Among HCV genotype 1 rs8099917 T/T patients, genomic ancestry interfered with response to therapy.

Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study.

BACKGROUND: Breastfeeding within the first hour of life is a potential mechanism for health promotion. The purpose of this study was to evaluate the prevalence of breastfeeding initiation within the first hour of life in Feira de Santana, Bahia, Brazil, between 2004 and 2005, and investigate the influence of maternal, child and prenatal factors on this practice. METHODS: This is a cross-sectional study extracted from the results of a contemporary cohort conducted in 10 maternity hospitals in the city of Feira de Santana, Bahia, Brazil. A group of 1,309 mother-child pairs was included in the study. Information about mother's and baby's characteristics, pregnancy, birth, and time of breastfeeding initiation was collected in the first 72 hours after delivery, through interview with mothers and hospital records. The data gathered were stored and analyzed using the SPSS 16.0 and R 8.0. The chi-square test and binary logistic regression analysis were used to examine the relationship between breastfeeding within the first hour and different variables. RESULTS: 47.1% of the mothers initiated breastfeeding within the first hour after birth. Early initiation of breastfeeding was associated with birth at full term pregnancy (adjusted Prevalence Ratio 1.43; 95% confidence interval 1.10 to 2.00), mothers who received prenatal guidance regarding the advantages of breastfeeding (aPR1.23; 95% CI 1.11 to 1.41) and vaginal delivery (aPR 2.78; 95% CI 2.38 to 3.23). CONCLUSIONS: In order to improve the rates of breastfeeding within the first hour of life, health care professionals must promote the factors favoring this practice such as prenatal guidance regarding the advantages of breastfeeding, vaginal delivery and full term birth, and stimulate this practice in vulnerable situations such as mothers with cesarean section and preterm birth.

Comparison of yogurt, soybean, casein, and amino acid-based diets in children with persistent diarrhea.

Although previous studies have shown successful treatment of persistent diarrhea (PD) with the use of yogurt-based diets, some recent ones speculate the need of special formulas for the nutritional management of PD complicated cases. In the present study, we tested the hypothesis that the consumption of 3 lactose-free diets, with different degrees of complexity, is associated with lower stool output and shorter duration of diarrhea when compared with the use of a yogurt-based one on the nutritional management of PD. A total of 154 male infants, aged between 1 and 30 months, with PD and with or without dehydration, were randomly assigned to 1 of 4 treatment groups. Throughout the study, the patients were placed in a metabolic unit; their body weights and intakes of oral rehydration solution, water, and formula diets, in addition to outputs of stool, urine, and vomit, were measured and recorded at 24-hour intervals. Four different diets were used in this study: diet 1, yogurt-based formula; diet 2, soy-based formula; diet 3, hydrolyzed protein-based formula; and diet 4, amino acid-based formula. Throughout the study, only these formula diets were fed to the children. The data showed that children fed the yogurt-based diet (diet 1) or the amino acid-based diet (diet 4) had a significant reduction in stool output and in the duration of diarrhea. The use of an inexpensive and worldwide-available yogurt-based diet is recommended as the first choice for the nutritional management of mild to moderate PD. For the few complicated PD cases, when available, a more complex amino acid-based diet should be reserved for the nutritional management of these unresponsive and severe presentations. Soy-based or casein-based diets do not offer any specific advantage or benefits and do not seem to have a place in the management of PD.

Eficácia clínica da imunoterapia nasal comparada com imunoterapia sublingual em pacientes com rinite alérgica / Clinical efficacy of nasal immunotherapy compared to sublingual immunotherapy in patients with allergic rhinitis

A eficácia da imunoterapia (IT) com extratos alergênicos em pacientes com rinite alérgica (RA) tem sido demonstrada por via subcutânea ou sublingual, não existindo comprovação da eficácia terapêutica da IT tópica nasal. Objetivo: Comparar a eficácia da IT sublingual com a IT tó¬pica nasal em pacientes com RA. Pacientes e Método: Quarenta indivíduos com RA persistente, leve ou moderada, foram divididos em dois grupos em estudo prospectivo, duplo-cego, randomizado, com duração de doze meses. O grupo I utilizou IT tópica nasal com extratos alergênicos de ácaros da poeira domiciliar + placebo sublingual e o grupo II foi submetido a IT sublingual com extratos alergênicos + placebo tópico nasal. Foram realizadas oito avaliações durante o estudo, determinando-se a gravidade da RA e o consumo de medicamentos, além das alterações das mucosas nasais ao exame físico. Níveis de IgE e IgG4 anti-Oermatophagoides pteronyssinus foram determinados em amostras de soro de 22 pacientes, antes e após tratamento. Resultados: Vinte e cinco pacientes concluíram o estudo (grupo I, n=l1 e grupo lI, n=14). Redução significante na gravidade da RA e no consumo de medicamentos foi observada após tratamento nos dois grupos, enquanto que a redução nas alterações da mucosa nasal só foi observada no grupo Il. Não se observaram alterações significantes nos níveis de IgE e IgG4 anti-D. pteronyssinus nos dois grupos. Conclusão: Ambos os procedimentos de IT (sublingual e nasal) são eficazes na redução dos sintomas e do consumo de medicamentos de pacientes com RA por alérgenos de ácaros da poeira domiciliar. No grupo de pacientes que receberam IT sublingual, houve redução nas alterações da mucosa nasal.

Several studies have demonstrated the efficacy of subcutaneous or sublingual immunotherapy (IT) with allergen extracts for the treatment of perennial allergic rhinitis (AR), but there are no actual data on nasal IT efficacy. Aim: Evaluate the efficacy of topical nasal IT compared to sublingual IT in AR patients. Patients and Methods: Forty patients with mild or mederate perennial AR were selected to participate on this prospective, one-year follow-up, doubleblind randomized study. They were divided in 2 groups: group I (n=20) was treated with sublingual IT containing mite allergen extracts plus placebo on nasal mucosa and group II (n=20) was treated with topical nasal IT containing mite allergen extracts plus placebo via sublingual. A total of eight evaluations were performed during the follow-up to determine rhinitis severity and medicine consumption, as well as abnormalities of nasal mucosa. IgE and IgG4 antibodies anti-Oermatophagoides pteronyssinus were determined in serum samples of 22 subjects before and after IT. Results: Twenty-five subjects concluded the study (group I, n=l1 and group lI, n=14). There was a significant reduction on rhinitis severity and medicine consumption before and after the treatment in both groups. In addition there was a significant reduction on nasal mucosa abnormalities before and after treatment in group II patients. There were no changes on leveis of IgE or IgG4 antibodies anti-D. pteronyssinus before and after IT in both groups. Conclusion: The efficacy of sublingual and nasal IT was demonstrated in patients with AR, by reducing symptoms and medicine consumption. In addition, sublingual IT also reduced nasal mucosa abnormalities.

Vascular and metabolic response to statin in the mildly hypertensive hypercholesterolemic elderly.

INTRODUCTION: Much evidence indicates the importance of the endothelium and hypercholesterolemia in atherosclerosis, as well as the decline in endothelial function with aging. However, it is unclear if treating dyslipidemia in elderly patients improves endothelial function and reduces C-reactive protein levels. OBJECTIVES: To evaluate vasomotor function, lipids and C-reactive protein in mildly hypertensive and hypercholesterolemic elderly patients treated with atorvastatin. METHODS: Forty-seven elderly Brazilian subjects (> or = 65 years old) with LDL cholesterol (LDL-c) > or = 130 mg/dL were randomly assigned, in a double-blinded manner, to receive either placebo (n = 23) or 20 mg/day of atorvastatin (n = 24) for 4 weeks. Exclusion criteria included diabetes, serious hypertension, obesity, steroid use, hormone replacement, and statin use within the previous six months. All patients underwent clinical examinations, laboratory tests (glucose, lipids, liver enzymes, creatine phosphokinase and high sensitivity C-reactive protein) and assessment of vasomotor function by high-resolution ultrasound examination of the brachial artery (flow-mediated dilation and sublingual nitrate), both before and after treatment. RESULTS: The patients were 65 to 91 years old; there was no significant difference between basal flow-mediated dilation of placebo (7.3 +/- 6.1%) and atorvastatin (4.5 +/- 5.1%; p = 0.20). The same was observed after treatment (6.6 +/- 6.2 vs. 5.0 +/- 5.6; p = 0.55). The initial nitrate dilatation (8.1 +/- 5.4% vs. 10.8 +/- 7.5%; p = 0.24) and that after 4 week treatment (7.1 +/- 4.7% vs. 8.6 +/- 5.0%; p = 0.37) were similar. Atorvastatin produced a reduction of 20% of the C-reactive protein and 42% in the LDL-c; however, there were no changes in the flow-mediated dilation. CONCLUSIONS: Atorvastatin produced a significant change of lipids and C-reactive protein; however, there were no changes in vasomotor function, suggesting the existence of intrinsic age-related vessel alterations.

Vascular and metabolic response to statin in the mildly hypertensive hypercholesterolemic elderly

INTRODUCTION: Much evidence indicates the importance of the endothelium and hypercholesterolemia in atherosclerosis, as well as the decline in endothelial function with aging. However, it is unclear if treating dyslipidemia in elderly patients improves endothelial function and reduces C-reactive protein levels. OBJECTIVES: To evaluate vasomotor function, lipids and C-reactive protein in mildly hypertensive and hypercholesterolemic elderly patients treated with atorvastatin. METHODS: Forty-seven elderly Brazilian subjects (> 65 years old) with LDL cholesterol (LDL-c) > 130 mg/dL were randomly assigned, in a double-blinded manner, to receive either placebo (n = 23) or 20 mg/day of atorvastatin (n = 24) for 4 weeks. Exclusion criteria included diabetes, serious hypertension, obesity, steroid use, hormone replacement, and statin use within the previous six months. All patients underwent clinical examinations, laboratory tests (glucose, lipids, liver enzymes, creatine phosphokinase and high sensitivity C-reactive protein) and assessment of vasomotor function by high-resolution ultrasound examination of the brachial artery (flow-mediated dilation and sublingual nitrate), both before and after treatment. RESULTS: The patients were 65 to 91 years old; there was no significant difference between basal flow-mediated dilation of placebo (7.3 ± 6.1 percent) and atorvastatin (4.5 ± 5.1 percent; p = 0.20). The same was observed after treatment (6.6 ± 6.2 vs. 5.0 ± 5.6; p = 0.55). The initial nitrate dilatation (8.1 ± 5.4 percent vs. 10.8 ± 7.5 percent; p = 0.24) and that after 4 week treatment (7.1 ± 4.7 percent vs. 8.6 ± 5.0 percent; p = 0.37) were similar. Atorvastatin produced a reduction of 20 percent of the C-reactive protein and 42 percent in the LDL-c; however, there were no changes in the flow-mediated dilation. CONCLUSIONS: Atorvastatin produced a significant change of lipids and C-reactive protein; however, there were no changes in vasomotor ...

Low frequency of positive skin tests in asthmatic patients infected with Schistosoma mansoni exposed to high levels of mite allergens.

Helminthic infections and allergic diseases are highly prevalent in many parts of the world. Although skin reactivity to indoor allergens is decreased in subjects from helminthic endemic areas, the degree of exposure to mite allergens has not yet been investigated in these areas. This study evaluated the association between exposure to dust mites and skin reactivity to mite allergens in subjects with a history of wheezing in the last 12 months selected from a rural endemic area for schistosomiasis (group I, n = 21), and two non-Schistosoma mansoni endemic locale, a rural area (group II, n = 21) and a urban slum area (group III, n = 21). All subjects were evaluated by skin prick tests with mite allergens, and for total and specific immunoglobulin E (IgE) against dust mites, antibodies for S. mansoni, and for intestinal parasites. Dust samples from each subjects' home were quantified for mite allergen and species of the mite identification. Except for S. mansoni infection which was more prevalent in group I than in groups II and III (p < 0.0001), the prevalence of intestinal parasites, and total and specific IgE levels were similar for all groups. Despite the levels of mite allergens and specifically to Der p 1 detected in dust samples of subjects home from all three areas, the frequency of positive skin reactivity to mite antigens was significantly lower (19.0%) in subjects from group I relative to group II (76.2%) and group III (57.1%; p < 0.001). This result suggests that S. mansoni infection could modulate the immediate hypersensitivity skin response to mite allergens in highly exposed subjects.

Urticária e angioedema: avaliaçäo de 793 casos / Urtcaria and angioedema: an evaluation of 793 cases

Introduçäo: Urticária (U) e/ou angioedema (AE) säo freqüentes na prática médica, porém poucos dados estäo disponíveis quanto à freqüência e etiologia destas doenças no Brasil. Objetivo: O presente estudo teve como objetivo avaliar a freqüência de formas de U e/ou AE na cidade de Salvador-BA. Métodos: Tratou-se de um estudo de prevalência, com revisäo de prontuários e obtençäo de dados sobre idade, sexo, estado civil, antecedentes pessoais e familiares, tempo de evoluçäo , características clínicas e hipótese diagnóstica, que foram submetidas à análise estatística. Resultados: U e/ou AE foi observada em 18,6 por cento (793/4273) da amostra, sendo 69,1 por cento do sexo feminino: a idade mediana foi de 29 anos. Formas crônicas foram mais freqüêntes (68,9 por cento) e houve um predomínio de lesöes de U (67,3 por cento). U e/ou AE por estímulos físicos (40,6 por cento), drogas (23 por cento) e formas idiopáticas (20,7 por cento) foram as mais observadas. Adicionalmente, foram observads associaçöes significativas entre U e/ou AE físicos e idiopáticos (p=0,001), entre U e/ou AE físicos e doenças de tireóide (p=0,05), entre U e/ou AE idiopáticos e doenças de tireóide (p=0,001), entre antecedentes pessoais de atopia e urticária (p=0,009) e entre história pregressa de U e/ou AE e história atual de U (p=0,01). Conclusäo: Os dados obtidos säo coerentes com diversos estudos internacionais, no que diz respeito a acometimento do sexo feminino, faixa etária e freqüência de formas crónicas. Deve-se ressaltar neste estudo o baixo percentual de formas idiopáticas e a forte associaçäo de doenças de tireóide com U e/ou AE idiopático ou por estímulos físicos.