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1.
Pediatr Pulmonol ; 55(2): 484-489, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31738021

RESUMO

OBJECTIVE: To evaluate culture-independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture-negative pleural fluid (PF) in children. METHOD: Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture-independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real-time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of ß-lactam agents, in PF samples. RESULTS: We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty-four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving ß-lactam antibiotics administered empirically. Of the 24 lytA real-time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of ß-lactam susceptibility. CONCLUSION: The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of ß-lactam susceptibility should be explored further.

2.
J. pediatr. (Rio J.) ; 95(5): 614-618, Sept.-Oct. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1040364

RESUMO

Abstract Objective: To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). Methods: Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. Results: The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. Conclusion: Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.


Resumo: Objetivo: Avaliar o nível de concordância a respeito da qualidade de vida relacionada à saúde entre crianças com bronquiolite obliterante pós-infecciosa e seus pais (responsáveis). Métodos: Os participantes entre 8-17 anos, anteriormente diagnosticados com bronquiolite obliterante pós-infecciosa, foram acompanhados regularmente no ambulatório de pneumologia pediátrica. Os pais ou responsáveis legais (cuidadores) desses pacientes também foram convidados a participar do estudo. Uma versão validada e adequada para a idade do Inventário Pediátrico de Qualidade de Vida, versão 4.0, foi utilizada para a avaliação da qualidade de vida relacionada à saúde. Os cuidadores concluíram as versões do questionário correspondentes aos responsáveis. A correlação entre os autorrelatos e os relatos dos responsáveis da qualidade de vida relacionada à saúde foi determinada pelo coeficiente de correlação intraclasse e pelos testes t dependentes. Resultados: A maior parte dos participantes era do sexo masculino (79,4%) e a idade média foi 11,8 anos. As correlações intraclasse entre cada um dos domínios do Inventário Pediátrico de Qualidade de Vida e o escore total foram todas inferiores a 0,6, com intervalo entre 0,267 (baixo) e 0,530 (justo). Quando as médias de cada domínio e o escore total dos questionários foram comparados, observamos que os cuidadores apresentaram qualidade de vida relacionada à saúde significativamente menor em comparação com as crianças, com exceção do domínio social, no qual a diferença não foi significativa. Contudo, as diferenças no escore ultrapassaram o limite de diferença essencial de 4 pontos em todos os outros domínios. Conclusão: Os responsáveis pelas crianças e adolescentes com bronquiolite obliterante pós-infecciosa parecem perceber de forma consistente que suas crianças possuem qualidade de vida relacionada à saúde menor que os próprios pacientes.

3.
J Pediatr (Rio J) ; 95(5): 614-618, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327498

RESUMO

OBJECTIVE: To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). METHODS: Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. RESULTS: The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. CONCLUSION: Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.

5.
J. pediatr. (Rio J.) ; 94(4): 374-379, July-Aug. 2018. tab
Artigo em Inglês | LILACS-Express | ID: biblio-954626

RESUMO

Abstract Objective: To evaluate the overall health-related quality of life in patients with bronchiolitis obliterans. Methods: Participants with a diagnosis of post-infectious bronchiolitis obliterans, who were being followed-up at two specialized outpatient clinics of Pediatric Pulmonology in Porto Alegre, Brazil, and controls aged between 8 and 17 years, of both genders, were included in the study. Controls were paired by gender, age, and socioeconomic level in relation to the group of participants with post-infectious bronchiolitis obliterans. The version of the Pediatric Quality of Life Inventory (PedsQ) tool validated for Brazil was applied for the assessment of Health-related Quality of Life, through an interview. The comparison of the Health-related Quality of Life means between the groups was performed using Student's t-test for independent samples and the chi-squared test, for categorical variables. Results: 34 patients diagnosed with post-infectious bronchiolitis obliterans and 34 controls participated in the study. The mean age of the children included in the study was 11.2 ± 2.5 years, and 49 (72%) of them were males. The groups showed no significant differences in relation to these variables. The quality of life score was significantly and clinically lower in the post-infectious bronchiolitis obliterans group when compared with controls in the health (72.36 ± 15.6, 81.06 ± 16.4, p = 0.031) and school domains (62.34 ± 20.7, 72.94 ± 21.3, p = 0.043), as well as in the total score (69.53 ± 14.9, 78.02 ± 14.8, p = 0.024), respectively. Conclusion: Patients with post-infectious bronchiolitis obliterans presented lower health-related quality of life scores when compared with healthy individuals in the total score and in the health and school domains.


Resumo Objetivo: Avaliar a qualidade de vida relacionada à saúde geral em participantes com bronquiolite obliterante. Métodos: Foram incluídos no estudo participantes com diagnóstico de bronquiolite obliterante pós-infecciosa que estavam em acompanhamento em dois ambulatórios especializados de pneumologia pediátrica em Porto Alegre, Brasil e controles, entre 8 e 17 anos, de ambos os sexos. Os controles foram pareados por sexo, idade e nível socioeconômico em relação ao grupo de participantes com bronquiolite obliterante pós-infecciosa. Para avaliação da Qualidade de Vida Relacionada à Saúde geral foi aplicado a versão validada para o Brasil do instrumento PedsQL (Pediatric Quality of Life Inventory), por meio de entrevista. A comparação entre as médias da Qualidade de Vida Relacionada à Saúde entre os grupos foi realizada mediante o teste t para amostras independentes e para as variáveis categóricas por teste qui-quadrado. Resultados: Participaram do estudo 34 pacientes com diagnóstico de bronquiolite obliterante pós-infecciosa e 34 controles. A média da idade das crianças incluídas foi de 11,2 ± 2,5 anos e 49 (72%) deles eram do sexo masculino. Os grupos não apresentaram diferenças significativas em relação a essas variáveis. O escore de qualidade de vida foi significativamente e clinicamente menor no grupo bronquiolite obliterante pós-infecciosa em comparação com o controle nos domínios saúde: (72,36 ± 15,6; 81,06 ± 16,4; p = 0,031); escolar: (62,34 ± 20,7; 72,94 ± 21,3; p = 0,043) e no escore total (69,53 ± 14,9; 78,02 ± 14,8, p = 0,024), respectivamente. Conclusão: Os pacientes com bronquiolite obliterante pós-infecciosa apresentam escores de qualidade de vida relacionados à saúde menor do que indivíduos saudáveis no escore total e nos domínios saúde e escolares.

6.
J Pediatr (Rio J) ; 94(4): 374-379, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29172039

RESUMO

OBJECTIVE: To evaluate the overall health-related quality of life in patients with bronchiolitis obliterans. METHODS: Participants with a diagnosis of post-infectious bronchiolitis obliterans, who were being followed-up at two specialized outpatient clinics of Pediatric Pulmonology in Porto Alegre, Brazil, and controls aged between 8 and 17 years, of both genders, were included in the study. Controls were paired by gender, age, and socioeconomic level in relation to the group of participants with post-infectious bronchiolitis obliterans. The version of the Pediatric Quality of Life Inventory (PedsQ) tool validated for Brazil was applied for the assessment of Health-related Quality of Life, through an interview. The comparison of the Health-related Quality of Life means between the groups was performed using Student's t-test for independent samples and the chi-squared test, for categorical variables. RESULTS: 34 patients diagnosed with post-infectious bronchiolitis obliterans and 34 controls participated in the study. The mean age of the children included in the study was 11.2±2.5 years, and 49 (72%) of them were males. The groups showed no significant differences in relation to these variables. The quality of life score was significantly and clinically lower in the post-infectious bronchiolitis obliterans group when compared with controls in the health (72.36±15.6, 81.06±16.4, p=0.031) and school domains (62.34±20.7, 72.94±21.3, p=0.043), as well as in the total score (69.53±14.9, 78.02±14.8, p=0.024), respectively. CONCLUSION: Patients with post-infectious bronchiolitis obliterans presented lower health-related quality of life scores when compared with healthy individuals in the total score and in the health and school domains.


Assuntos
Bronquiolite Obliterante/psicologia , Qualidade de Vida/psicologia , Adolescente , Bronquiolite Obliterante/etiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Testes de Função Respiratória , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
7.
Acta Paediatr ; 103(9): 913-21, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24832610

RESUMO

UNLABELLED: Postinfectious bronchiolitis obliterans (PIBO) is an infrequent chronic lung that causes irreversible obstruction and, or, obliteration of the smaller airways. This review particularly focuses on more than 30 studies from South America. CONCLUSION: The initial PIBO event occurs in the early years of life and is strongly associated with adenovirus infection and the need for mechanical ventilator support. Treatment requires a multidisciplinary strategy. Multicentre studies are needed to determine progression, optimal management and long-term follow-up.


Assuntos
Bronquiolite Obliterante/microbiologia , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/epidemiologia , Bronquiolite Obliterante/terapia , Humanos , Testes de Função Respiratória , Fatores de Risco , América do Sul
8.
J. pediatr. (Rio J.) ; 89(5): 444-449, set.-out. 2013. tab
Artigo em Português | LILACS | ID: lil-690067

RESUMO

OBJETIVO: A pandemia causada pelo vírus Influenza A(H1N1)pdm09 teve seu pico nos meses de julho e agosto de 2009, no Sul do Brasil, sendo a incidência mais alta em crianças e adultos jovens. No período pós-pandêmico, no Brasil, houve aumento de casos nos meses de inverno dos anos de 2011 e 2012, de forma semelhante ao vírus influenza sazonal. Como ainda estão ocorrendo infecções devido ao influenza pandêmico, nosso objetivo foi investigar fatores de risco para pior desfecho em crianças. MÉTODOS: Foi realizado um estudo de coorte retrospectivo analisando as fichas de pacientes menores de 14 anos hospitalizados e com RT-PCR positiva para Influenza A(H1N1)pdm09 durante a primeira onda , em seis centros terciários brasileiros. Definimos a necessidade de ventilação mecânica como desfecho com gravidade e, como possíveis preditores, os fatores idade, doenças crônicas, codetecção bacteriana e viral, achados da radiografia do tórax e uso de oseltamivir. RESULTADOS: No presente estudo, foram incluídos120 pacientes. Em uma análise multivariada, doenças crônicas (razão de prevalência: 2,613; intervalo de confiança de 95%: 1,267 a 5,386) e codetecção viral (razão de prevalência: 2,43; intervalo de confiança de 95%: 1,203 a 4,905) se associaram estatisticamente a um pior desfecho (p < 0,05). CONCLUSÕES: A presença de doenças crônicas como preditores reforça evidências prévias. Além disso, verificamos que a codetecção viral é fator de risco. São necessários outros estudos para confirmar essa associação.


OBJECTIVE: The pandemic caused by influenza A(H1N1)pdm09 virus peaked between July and August of 2009 in southern Brazil, with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases during the winter months of 2011 and 2012 in Brazil, similar to seasonal influenza virus. Since infections due to pandemic influenza are still occurring, the present study aimed to investigate the risk factors for worse outcome in children. METHODS: A retrospective cohort study was performed by reviewing the charts of hospitalized patients younger than 14 years with reverse transcription-polymerase chain reaction (RT-PCR) positive for influenza A(H1N1)pdm09 during the first pandemic wave in six Brazilian tertiary centers. Need for mechanical ventilation was defined as the severity of outcome; age, chronic diseases, bacterial and viral co-detection, chest radiograph findings, and use of oseltamivir were possible predictors. RESULTS: In the present study, 120 patients were included. In a multivariate analysis, chronic diseases (prevalence ratio: 2.613, 95% CI: 1.267-5.386) and viral co-detection (prevalence ratio: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p < 0.05). CONCLUSIONS: The presence of chronic diseases as predictors reinforces previous finding. Furthermore, viral co-detection was found to be a risk factor. Further studies are necessary to confirm this association.


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Respiração Artificial , Fatores Etários , Brasil/epidemiologia , Doença Crônica , Comorbidade , Coinfecção/virologia , Hospitalização/estatística & dados numéricos , Influenza Humana/terapia , Tempo de Internação , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
9.
J Pediatr (Rio J) ; 89(5): 444-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23845706

RESUMO

OBJECTIVE: The pandemic caused by influenza A(H1N1)pdm09 virus peaked between July and August of 2009 in southern Brazil, with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases during the winter months of 2011 and 2012 in Brazil, similar to seasonal influenza virus. Since infections due to pandemic influenza are still occurring, the present study aimed to investigate the risk factors for worse outcome in children. METHODS: A retrospective cohort study was performed by reviewing the charts of hospitalized patients younger than 14 years with reverse transcription-polymerase chain reaction (RT-PCR) positive for influenza A(H1N1)pdm09 during the first pandemic wave in six Brazilian tertiary centers. Need for mechanical ventilation was defined as the severity of outcome; age, chronic diseases, bacterial and viral co-detection, chest radiograph findings, and use of oseltamivir were possible predictors. RESULTS: In the present study, 120 patients were included. In a multivariate analysis, chronic diseases (prevalence ratio: 2.613, 95% CI: 1.267-5.386) and viral co-detection (prevalence ratio: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p<0.05). CONCLUSIONS: The presence of chronic diseases as predictors reinforces previous finding. Furthermore, viral co-detection was found to be a risk factor. Further studies are necessary to confirm this association.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Respiração Artificial , Adolescente , Fatores Etários , Brasil/epidemiologia , Criança , Pré-Escolar , Doença Crônica , Coinfecção/virologia , Comorbidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Influenza Humana/terapia , Tempo de Internação , Masculino , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
J Pediatr (Rio J) ; 88(2): 155-60, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22544046

RESUMO

OBJECTIVE: To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS: We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS: Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m(2); in the placebo group and increased 0.46 kg/m(2); in the intervention group (p = 0.027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION: Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.


Assuntos
Estimulantes do Apetite/uso terapêutico , Índice de Massa Corporal , Ciproeptadina/uso terapêutico , Fibrose Cística/complicações , Ganho de Peso/efeitos dos fármacos , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Masculino , Espirometria
11.
J. pediatr. (Rio J.) ; 88(2): 155-160, mar.-abr. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-623462

RESUMO

OBJETIVO: O objetivo deste estudo foi determinar se a administração de ciproheptadina é capaz de induzir ganho de peso em pacientes com fibrose cística. MÉTODOS: Foi realizado um estudo duplo-cego, controlado com placebo em dois centros no Brasil. Vinte e cinco pacientes com fibrose cística entre 5 e 18 anos completaram o estudo. Os pacientes foram randomizados em dois grupos, para receber ciproheptadina 4 mg três vezes por dia durante 12 semanas ou placebo. Todos os dados foram coletados no início e no final do período de estudo e incluíram peso, altura e espirometria. RESULTADOS: O ganho de peso médio foi de 0,67 kg e 1,61 kg nos grupos placebo e ciproheptadina, respectivamente (p = 0,036). O índice de massa corporal (IMC) diminuiu 0,07 kg/m² no grupo placebo e aumentou 0,46 kg/m² no grupo intervenção (p = 0,027). A mudança no IMC para a idade (escore z) foi de -0,19 no grupo placebo e 0,20 no grupo ciproheptadina (p = 0,003). O IMC escore z diminuiu 0,19 no grupo placebo e aumentou 0,2 no grupo ciproheptadina (p = 0,003). Alterações na função pulmonar não foram estatisticamente diferentes. CONCLUSÃO: O uso de ciproheptadina em pacientes com fibrose cística foi bem tolerado, apresentando um ganho de peso significativo e um aumento no IMC após 12 semanas. Foi encontrado um tamanho de efeito clinicamente relevante para o peso/idade (escore z) e IMC para idade (escore z). Tais achados sugerem que a prescrição de ciproheptadina pode ser uma abordagem alternativa para pacientes que precisam de suporte nutricional por um curto período de tempo.


OBJECTIVE: To determine whether the administration of cyproheptadine was able to induce weight gain in patients with cystic fibrosis. METHODS: We performed a double-blind, placebo-controlled trial in two centers in Brazil. Twenty-five patients with cystic fibrosis between 5 and 18 years completed the study. Patients were randomized into two groups, to receive either cyproheptadine 4 mg three times per day for 12 weeks or placebo. All data were collected at the beginning and at the end of the study period and included weight, height and spirometry. RESULTS: Average weight gain was 0.67 kg in the placebo group and 1.61 kg in the cyproheptadine group (p = 0.036). Body mass index (BMI) decreased 0.07 kg/m² in the placebo group and increased 0.46 kg/m² in the intervention group (p = 0,027). The change in BMI for age (z score) was -0.19 in the placebo group and +0.20 in the cyproheptadine group (p = 0.003). BMI z score decreased 0.19 in the placebo group and increased 0.2 in the cyproheptadine group (p = 0.003). Changes in pulmonary function were not statistically different. CONCLUSION: Use of cyproheptadine in cystic fibrosis patients was well tolerated, showing a significant weight gain and a significant increase in BMI after 12 weeks. A clinically relevant effect size for weight/age (z score) and body mass index for age (z score) was found. Such findings suggest that the prescription of cyproheptadine can be an alternative approach for patients who need nutritional support for a short period of time.


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estimulantes do Apetite/uso terapêutico , Índice de Massa Corporal , Ciproeptadina/uso terapêutico , Fibrose Cística/complicações , Ganho de Peso/efeitos dos fármacos , Método Duplo-Cego , Espirometria
12.
Paediatr Respir Rev ; 12(1): 27-30, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21172672

RESUMO

Pleural tuberculosis effusion (PTE) in children is a diagnosis which must be considered in isolated pleural effusions in non-toxemic children. It is more common in children over 5 years of age. A history of close contact with an adult with pulmonary tuberculosis reinforces the suspicion for its diagnosis. Pleural effusion without any parenchymal lesion is the characteristic finding on the chest x-ray. However, in 20% to 40% of patients, intrathoracic disease may also occur. Adenosine deaminase, interferon-gamma, analysis of pleural fluid and pleural biopsy are the main tools for diagnostic confirmation. Tuberculin skin test may provide supporting evidence of tuberculous infection. PTE has a good prognosis in children and no long term sequelae are expected.


Assuntos
Tuberculose Pleural/diagnóstico , Tuberculose Pleural/terapia , Adulto , Criança , Pré-Escolar , Humanos
13.
Paediatr Respir Rev ; 11(4): 233-9, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21109182

RESUMO

Bronchiolitis Obliterans (BO) is an infrequent chronic and obstructive lung disease secondary to an insult to the terminal airway and its surroundings. In children, the most common presentation is the post-infectious variant, closely related to a severe viral infection in the first three years of life. However, the increase in the number of lung and bone-marrow transplants has also been followed by an increase in post-transplant BO. Post-transplant BO is progressive while post-infectious BO does not seem to be, but both forms share some common pathways that result in a characteristic histopathology of bronchiolar obliteration. This review covers up-to-date evidence on epidemiology, diagnosis, treatment and prognosis of post-infectious bronchiolitis obliterans, including areas of controversy that need to be addressed in future studies.


Assuntos
Bronquiolite Obliterante , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/epidemiologia , Bronquiolite Obliterante/terapia , Criança , Humanos
14.
Pediatr Pulmonol ; 45(4): 315-9, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20205267

RESUMO

BACKGROUND: The image findings of post-infectious bronchiolitis obliterans (PIBO) have been described, however, we do not know if such findings can predict lung function (LF) deterioration with increasing patient age. AIM: To assess whether computed tomography (CT) abnormalities detected at an early stage of the disease can anticipate abnormal LF a decade later in children with PIBO. METHODS: We compared CT scans of 21 children with PIBO, done within their first 3 years of life, and their actual LF. To evaluate CT scans we used a modified Bhalla score and, for LF, FEV1 as percentage of predicted values. We calculated prevalence ratios (PRs) by comparing the proportion of patients with worst CT score and worst LF, with the proportion of those with best CT score and worst LF. RESULTS: PR was 1.17 (CI 1.02; 1.34, P = 0.02). CONCLUSIONS: The CT finding early in the life of children with PIBO, when assessed by the Bhalla, score seem to anticipate future LF status.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/fisiopatologia , Adolescente , Bronquiolite Obliterante/etiologia , Criança , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Testes de Função Respiratória , Infecções Respiratórias/complicações , Tomografia Computadorizada por Raios X
15.
J Asthma ; 47(2): 166-9, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20170324

RESUMO

BACKGROUND: The epidemiology of asthma has been investigated with questionnaires, such as the International Study of Asthma and Allergies in Childhood protocol. AIM: To investigate the performance of the questions of the International Study of Asthma and Allergies in Childhood questionnaire to diagnose asthma in adolescents. METHODS: This is a population-based cross-sectional study of adolescents in the Syndrome of Obesity and Risk Factors for Cardiovascular Disease study. The validity of the asthma symptoms of the International Study of Asthma and Allergies in Childhood protocol was assessed by calculating sensitivity, specificity, positive and negative posttest probabilities, and Youden's Index, taking as a gold standard the history of a medical diagnosis of asthma. Risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for sex and age, were calculated using Cox regression model. RESULTS: In total, 575 adolescents were investigated. Overall, 28.7% reported a lifetime medical diagnosis of asthma, and 40.0% reported at least one episode of wheezing. Ever wheezing had the highest sensitivity (80.6%) for the diagnosis of asthma, compared with the other ISAAC questions. Adolescents who reported ever wheezing were about 8 times more likely (adjusted RR: 8.3; 95% CI: 4.9-14.2) to have ever had asthma, independent of age and sex. Symptoms within the last 12 months (wheezing, cough without cold or respiratory infection, sleep disturbed due to wheezing, wheezing due to exercise, speech limited due to wheezing) had specificity of 92.0% or higher. Dry cough at night without cold or respiratory infection was the strongest independent predictor of asthma (adjusted RR: 8.8; 95% CI: 6.1-12.7). CONCLUSIONS: Ever wheezing is the most sensitive indicator of the diagnosis of asthma but falsely identifies a portion of adolescents as asthmatic. Symptoms of asthma in the last 12 months, such as cough without cold or respiratory infection, are rarely positive in the absence of a lifetime asthma diagnosis. The combination of ever wheezing for screening and the presence of other symptoms within the past 12 months to confirm the diagnosis could be an effective strategy to identify the prevalence of asthma in communities.


Assuntos
Asma/diagnóstico , Asma/epidemiologia , Inquéritos e Questionários , Adolescente , Asma/complicações , Asma/tratamento farmacológico , Brasil/epidemiologia , Tosse/epidemiologia , Estudos Transversais , Serviços Médicos de Emergência/estatística & dados numéricos , Exercício , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Sensibilidade e Especificidade , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Distúrbios da Fala/epidemiologia , Distúrbios da Fala/etiologia
16.
Pulmäo RJ ; 18(2): 64-69, 2009. ilus, tab
Artigo em Português | LILACS | ID: lil-607386

RESUMO

Introdução: A bronquiolite viral aguda é uma doença freqüente na infância. Tem sido estudado o papel de marcadores imunológicos e inflamatórios como determinantes da sua gravidade. O objetivo deste estudo foi determinar a contagem de eosinófilos no sangue periférico e a concentração sérica de proteína catiônica eosinofílica em pacientes internados com bronquiolite viral aguda e comparar com diferentes graus de gravidade. Metodologia: A contagem de eosinófilos e a concentração da proteína catiônica eosinofílica foram determinadas em lactentes menores de 1 ano, hospitalizados com quadro clínico de bronquiolite. Foram realizadas comparações do número de eosinófilos e da concentração de proteína catiônica,de acordo com gravidade, sexo e faixa etária. Foram utilizados como critérios de gravidade a saturação em ar ambiente e a prevalência de ventilação mecânica. Resultados: Foram estudados 58 pacientes, com idade média de 2 meses. Dezenove pacientes foram classificados como graves, de acordo com a saturação da hemoglobina, inferior a 90%. Sete pacientes necessitaram ventilação mecânica (12%). A contagem de eosinófilos variou de 0 a 1104, com mediana de 100. O número de eosinófilos foi significativamente menor nos pacientes com saturação mais baixa (p<0.05). A concentração da proteína catiônica eosinofílica variou de 2 a 114 mg/litro, com mediana em 6 mg/l. Não houve correlação com a saturação. Conclusão: Houve associação entre baixo número de eosinófilos e gravidade da bronquiolite medida pela satHb. Estudos adicionais são necessários para elucidar melhor o papel de eosinófilos e seus derivados na determinação da gravidade da bronquiolite.


Introduction: The aim of the present study is to determine peripheral blood eosinophil counts and eosinophil cationic protein (ECP) serum concentration in hospitalized patients with acute viral bronchiolitis and to compare with different degrees of severity. Methodology: Peripheral blood eosinophil counts and eosinophil cationic protein serum concentration was performed on infants under 12 months of age who were hospitalized presenting acute viral bronchiolitis. Associations of eosinophil counts and ECP concentration among groups of patients were performed according to severity, gender and age.Severity was defined by haemoglobin saturation in room air and prevalence of mechanical ventilation. Results: Fifty-eight patients were studied. The mean age was 2 months. Nineteen patients were classified as severe according to haemoglobin saturation, lower than 90%. Seven patients needed mechanical ventilation (12%). Eosinophil counts ranged from 0 to 1104 and the median value was 100. Eosinophil counts were lower in patients with lower saturation (p<0.05). Patients who needed mechanical ventilation also showed lower eosinophil counts. ECP serum concentration ranged from 2 to 114 mg/land the median value was 6 mg/l. ECP was not associated with neither saturation nor mechanical ventilation. Conclusion: A correlation was found between eosinophil counts and severity measured by haemoglobin saturation. There was no correlation between ECP and severity. Additional studies are necessary to better explain the role of eosinophils and its proteins to determine the severity of bronchiolitis.


Assuntos
Humanos , Masculino , Feminino , Lactente , Bronquiolite Viral , Proteína Catiônica de Eosinófilo , Eosinófilos , Biomarcadores , Obstrução das Vias Respiratórias , Estudos Transversais , Fatores de Risco
17.
Cad Saude Publica ; 24(6): 1429-38, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18545768

RESUMO

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.


Assuntos
Bem-Estar da Criança , Inquéritos Epidemiológicos , Infecções Respiratórias/epidemiologia , Brasil/epidemiologia , Pré-Escolar , Métodos Epidemiológicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Idade Materna , Mães , Cuidado Pré-Natal , Classe Social , Fatores Socioeconômicos
18.
Pediatr Exerc Sci ; 20(2): 121-8, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18579894

RESUMO

This study assessed sweat electrolyte concentration and losses in asthmatic children during exercise in the heat. Eleven asthmatics (AG; 11 +/- 2 years old) and 11 nonasthmatics (CG; 10 +/- 1 year old) underwent a maximal progressive cycleergometer test. During a second session, participants cycled in the heat (35 degrees C, 60% RH) of a climatic chamber for 30 min at 50-60% of maximal workload. Sweat was collected using sweat patches attached to the dorsal region. No differences were observed in sweat [Na+] (AG = 35 +/- 12.9 and CG = 43.4 +/- 18 mmol/L) and [Cl-] (AG = 27.3 +/- 10.4 and CG = 38.5 +/- 19.1 mmol/L). There was no difference in sweat Na+ losses (AG = 0.47 +/- 0.36 and CG = 0.66 +/- 0.68 mmol/kg/h) and Cl- losses (AG = 0.37 +/- 0.29 and CG = 0.59 +/- 0.62 mmol/kg/h) between groups. Asthmatic children did not differ from nonasthmatics in their sweat electrolyte concentrations and electrolyte losses.


Assuntos
Asma/fisiopatologia , Ciclismo , Eletrólitos , Exercício , Temperatura Alta/efeitos adversos , Suor/química , Desequilíbrio Hidroeletrolítico/diagnóstico , Fatores Etários , Estudos de Casos e Controles , Criança , Bem-Estar da Criança , Ergometria , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Inquéritos e Questionários , Equilíbrio Hidroeletrolítico , Desequilíbrio Hidroeletrolítico/etiologia
19.
Cad. saúde pública ; 24(6): 1429-1438, jun. 2008. ilus, tab
Artigo em Inglês | LILACS | ID: lil-484199

RESUMO

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9 percent presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US$ 200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.


Este estudo teve por objetivo determinar a prevalência de doenças respiratórias agudas baixas e identificar fatores associados à sua ocorrência entre crianças menores de cinco anos de idade em Rio Grande, Rio Grande do Sul, Brasil. Realizou-se estudo transversal de base populacional com aplicação de questionário em nível domiciliar às mães ou responsáveis pelas crianças. Foram coletadas informações sobre características sócio-econômicas, condições de habitação da família e tabagismo dos pais; sobre as crianças, investigou-se padrão de amamentação e dieta, estado nutricional, assistência à gestação e ao parto e utilização de serviços de saúde. A análise incluiu cálculo das razões de prevalência e regressão logística conforme modelo hierárquico previamente estabelecido. Dentre as 771 crianças estudadas, 23,9 por cento apresentavam doenças respiratórias agudas baixas. Os principais fatores de risco identificados foram antecedente de infecção respiratória, sibilância anterior, aglomeração, escolaridade materna menor que cinco anos, renda familiar menor que dois salários mínimos mensais, quatro ou mais pessoas no quarto da criança, história de asma na família e tabagismo materno. Idade materna igual ou superior a trinta anos mostrou-se protetor. Esses resultados podem contribuir para estabelecer medidas específicas visando a reduzir a morbimortalidade por doenças respiratórias agudas baixas nessa população.


Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Bem-Estar da Criança , Inquéritos Epidemiológicos , Infecções Respiratórias/epidemiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Idade Materna , Mães , Cuidado Pré-Natal , Classe Social , Fatores Socioeconômicos
20.
Int J Pediatr Otorhinolaryngol ; 71(6): 973-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17459490

RESUMO

OBJECTIVE: To evaluate the effect of adenotonsillectomy on the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders (SBD). METHODS: A non-controlled clinical trial was performed. Thirty-one children with suspected SBD and a clinical indication for adenotonsillectomy were recruited. All of them underwent overnight oxygen saturation monitoring before and after surgery. RESULTS: Twenty-seven patients completed the study. The mean age was 5.2+/-1.8 years. Eighteen (66.7%) were male. The most prevalent symptoms were: snoring (100%), respiratory pauses (96.8%), nocturnal mouth breathing (96.8%), restless sleep (80%) and drooling (74.1%). Twenty-three children (85.2%) presented grade 3 or 4 tonsillar hyperplasia. There was a significant improvement in the postoperative oxygen desaturation index (ODI) (0.65; 0.5-1.3) compared with the preoperative index (1.63; 1.1-2.4) (p<0.001). CONCLUSION: Adenotonsillectomy improved the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders.


Assuntos
Adenoidectomia , Oxigênio/sangue , Síndromes da Apneia do Sono/cirurgia , Tonsilectomia , Tonsila Faríngea/patologia , Obstrução das Vias Respiratórias/sangue , Obstrução das Vias Respiratórias/cirurgia , Pré-Escolar , Feminino , Seguimentos , Humanos , Hiperplasia , Masculino , Respiração Bucal/sangue , Respiração Bucal/fisiopatologia , Oximetria , Tonsila Palatina/patologia , Sialorreia/sangue , Sialorreia/fisiopatologia , Síndromes da Apneia do Sono/sangue , Transtornos do Sono-Vigília/sangue , Transtornos do Sono-Vigília/fisiopatologia , Ronco/sangue , Ronco/fisiopatologia , Tonsilite/sangue , Tonsilite/cirurgia
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