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1.
J Clin Apher ; 2020 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-33382142

RESUMO

Hematopoietic progenitor cells-apheresis (HPC-A) collection is now a routine procedure for autologous hematopoietic stem cell transplantation. Here we present our 25 years' experience of HPC-A collection in children weighing 8 kg or less, with a focus on the evolution of our standard operating procedures, and the safety limits for these young patients, in the Pediatric Apheresis Unit of Clermont-Ferrand University Hospital (France). Fifteen children weighing 8 kg or less underwent 26 HPC-A collections over 25 years. Median CD34+ cell yield by leukapheresis was 4.4 106 /kg. No procedure-related complications were encountered during or after the collection. No patient had profound thrombocytopenia or anemia that needed post-collection transfusions. Our experience in pediatric oncology patients who underwent HPC-A collections shows that this procedure can be performed even in the smallest of children with no increase in toxicity provided all precautions are taken to ensure that the procedure is carried out under the ideal conditions.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32940701

RESUMO

OBJECTIVE: This review examines time to access appropriate care for JIA patients and analyses the referral pathway before the first paediatric rheumatology (PR) visit. We also describe factors associated with a longer referral. METHODS: We performed a systematic literature review, screening electronic databases (PubMed, Web of Science, EMBASE, Cochrane library and Open Grey database) up to February 2020. Articles written before 1994 (i.e. before the introduction of the unifying term JIA) were excluded. RESULTS: From 595 nonduplicate citations found, 15 articles were finally included in the review. Most of the studies took place in Europe. The median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, and elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and healthcare practitioner availabilities, times to access PR were not wide-ranging. CONCLUSION: This is the first systematic review to summarize research on access to PR for JIA patients. The pathway of care for JIA patients remains complex, and reasons for delayed referral depend on several factors. Standardized clinical guidelines and fast-track pathways to facilitate prompt referral to specialized teams have to allow for worldwide disparities in healthcare provision.

3.
Nutrients ; 12(6)2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32599773

RESUMO

Disturbed sleep is common in adolescents. Ingested nutrients help regulate the internal clock and influence sleep quality. The purpose of this clinical trial is to assess the effect of protein tryptophan (Trp)/large neutral amino acids (LNAAs) ratio on sleep and circadian rhythm. Ingested Trp is involved in the regulation of the sleep/wake cycle and improvement of sleep quality. Since Trp transport through the blood-brain barrier is competing with LNAAs, protein with higher Trp/LNAAs were expected to increase sleep efficiency. This randomized double-blind controlled trial will enroll two samples of male adolescents predisposed to sleep disturbances: elite rugby players (n = 24) and youths with obesity (n = 24). They will take part randomly in three sessions each held over a week. They will undergo a washout period, when dietary intake will be calibrated (three days), followed by an intervention period (three days), when their diet will be supplemented with three proteins with different Trp/LNAAs ratios. Physical, cognitive, dietary intake, appetite, and sleepiness evaluations will be made on the last day of each session. The primary outcome is sleep efficiency measured through in-home electroencephalogram recordings. Secondary outcomes include sleep staging, circadian phase, and sleep-, food intake-, metabolism-, and inflammation-related biochemical markers. A fuller understanding of the effect of protein Trp/LNAAs ratio on sleep could help in developing nutritional strategies addressing sleep disturbances.

5.
Acta Paediatr ; 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32420673

RESUMO

AIM: To assess muscle function and functional abilities in children with juvenile idiopathic arthritis (JIA). METHODS: Fourteen children with JIA and 14 healthy controls matched for age and sex were included. Muscle characteristics, both structural (thickness, cross-sectional area (CSA) and fascicle angle) and qualitative (intermuscular adipose tissue; IMAT), were assessed in thigh muscles using ultrasound and peripheral quantitative computed tomography (pQCT). Muscle function and functional abilities were determined from the assessment of maximal voluntary isometric contraction (MVIC) knee extensors force and vertical jump performance. RESULTS: No significant difference in MVIC force was observed between the two groups. However, squat jump height was significantly reduced in children with JIA (18.3 ± 5.4 vs 24.3 ± 7.9 cm, P < .05). No differences in structural parameters were observed, but IMAT/CSA (0.22 ± 0.02 vs 0.25 ± 0.03; P = .01) was significantly lower in children with JIA than in healthy children. CONCLUSION: Knee extensor muscle architecture and force were comparable between children with and without JIA, but functional abilities (vertical jump performance) were poorer in JIA. The lower IMAT area in JIA could result from a lower physical activity level compared with healthy children.

6.
J Clin Med ; 9(3)2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32245056

RESUMO

BACKGROUND: Calprotectin (CP) is a protein complex involved in many inflammatory diseases. Obesity is characterized by low-grade inflammation and elevated circulating levels of calprotectin. However, associations between body mass index (BMI) and calprotectin levels have not been explored in otherwise healthy children. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed and Cochrane Library database up to July 2019. Healthy children's blood calprotectin values were extracted, and potential correlations were explored. RESULTS: A total of six studies that included data on 593 healthy children were identified. Median calprotectin value was 900.0 (482.0; 1700) ng·mL-1. Multivariable analysis showed no significant associations with age, sample type (serum vs. plasma), or sex. In contrast, a significant effect of BMI z-score (p < 0.001) emerged. Indeed, a positive correlation between BMI z-score and CP, was detected in girls (R: 0.48; p < 0.001) and boys (R: 0.39; p < 0.001). CONCLUSION: Calprotectin blood levels correlate with the degree of adiposity in healthy children, but are not affected by age, sex, or sample type (serum or plasma).

7.
Rheumatology (Oxford) ; 59(10): 2947-2952, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32125423

RESUMO

OBJECTIVE: The new classification criteria for the hereditary recurrent fever (HRF) syndrome [cryopyrin-associated periodic syndrome (CAPS), TNF-α receptor-associated periodic syndrome (TRAPS), FMF and mevalonate kinase deficiency] have been published recently. These criteria define two core sets of criteria for each HRF: mixed criteria, including genetic and clinical variables, and clinical criteria, relying on clinical variables only. Our aim was to validate the criteria for HRF in an independent cohort, the JIR Cohort database, an international repository of systemic inflammatory diseases. METHODS: We enrolled patients with HRF, periodic fever, adenitis, pharyngitis and aphthous stomatitis syndrome (PFAPA) and syndrome of undefined recurrent fever (SURF). A score ranging from zero to two was attributed to their respective genotypes: zero (no mutation), one (non-confirmatory genotype) or two (confirmatory genotype). The criteria were applied to all patients based on genotype scoring. The treating physician's diagnosis served as the gold standard for the determination of specificity. RESULTS: We included 455 patients. The classification criteria showed excellent specificity for CAPS and TRAPS (98% specificity each), fair specificity for FMF (88%), but poor specificity for mevalonate kinase deficiency (58%). Sub-analysis showed excellent accuracy of the mixed criteria for all four HRFs. Misclassification was mainly attributable to clinical criteria sets, with false-positive patients in all four HRF clinical criteria sets. CONCLUSION: This study represents the final validation step of the HRF classification criteria as recommended by the ACR. Genetic data appear to be necessary to classify patients with HRF correctly.

8.
J Clin Med ; 9(2)2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32092881

RESUMO

BACKGROUND: Leukemia is the most common cancer in pediatrics, with many late effects such as higher risk of dyslipidemia, insulin resistance, obesity, and metabolic syndrome. The objective of this work was to investigate substrate oxidation during submaximal exercise in survivors of childhood acute leukemia. METHODS: A total of 20 leukemia survivors and 20 healthy children were matched by sex, age, and Tanner stage. They all took a submaximal incremental exercise test to determine fat and carbohydrate oxidation rates. RESULTS: Cardiorespiratory fitness was significantly lower in leukemia survivors, with lower relative VO2 peaks (p < 0.001), lower heart rate values (p = 0.02), and lower exercise power (p = 0.012), whereas rest metabolism and body mass index did not differ between the two groups. During exercise, upward of heart rate relative to VO2 peak was significantly higher (p < 0.001) in childhood leukemia survivors. We found lower carbohydrate and fat oxidation rates (p = 0.07) in leukemia survivors compared with healthy children, and also a significantly lower relative maximal fat oxidation rate (p = 0.014). CONCLUSION: Despite impaired physical fitness and metabolic response to exercise, childhood leukemia survivors remained sensitive to physical activity interventions, and could readily adapt to submaximal exercise intensity.

9.
Pediatr Obes ; 15(6): e12613, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32020733

RESUMO

BACKGROUND: Although adolescence and obesity are related to impaired sleep duration and quality, exercise was admitted as a nonpharmacological treatment for sleep and better control of energy balance. OBJECTIVES: To investigate the acute effects of intense exercise on sleep and subsequent dietary intake. METHODS: Sixteen adolescent girls with obesity (age 13.7 ± 1.1 years, weight 82.7 ± 10.2 kg, body mass index (BMI) 30.5 ± 3.4 kg/m2 , fat mass (FM) 39.2 ± 3.1%, Pittsburgh Sleep Quality Index (PSQI) 8.6 ± 2.8, paediatric daytime sleepiness scale (PDSS) 19.6 ± 5.9) took part in two experimental sessions in a random order: Control (CTL) and Exercise (EX). The two sessions were identical except for a continuous ergocycle exercise bout lasting 40 minutes and performed at 70% VO2max at the end of the morning of EX. Energy expenditure and sleep were measured by accelerometry and next-morning dietary intake in an ad libitum meal. RESULTS: Higher sleep duration (P < 0.03) and quality (decreased WASO: P < 0.02; increased SE%: P < 0.02) were observed in EX compared with CTL. This was associated with a nonsignificant decrease in caloric intake (-78 kcal) and a significant decrease in food energy density (P < 0.04), fat, and sugar consumption (respectively, P < 0.02 and P < 0.05) the following morning. CONCLUSIONS: Acute exercise efficaciously increased sleep duration and quality, resulting in a decrease in subsequent energy-dense food consumption in adolescent girls with obesity.


Assuntos
Ingestão de Energia , Exercício Físico , Obesidade/fisiopatologia , Sono , Adolescente , Índice de Massa Corporal , Criança , Metabolismo Energético , Feminino , Humanos , Obesidade/psicologia
10.
Pediatr Blood Cancer ; 67(2): e28053, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31625676

RESUMO

BACKGROUND/OBJECTIVES: Survival rates in children diagnosed with malignant brain tumors exceed 70%. A higher risk of dyslipidemia, central obesity, and insulin resistance has been reported among these children. We investigated substrate utilization during submaximal exercise. DESIGN/METHODS: Ten brain tumor survivors and 10 healthy children were matched by sex, age, and Tanner stage. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates. RESULTS: The relative oxygen volume (VO2 ) peak was significantly higher in the control group than in the survivors of childhood brain tumors (43.3 ± 11.9 and 32.4 ± 10.2 mL/kg /min, P = .04). At the same relative exercise intensity, there was no difference in the carbohydrate or lipid oxidation rate between the two groups, or in the maximal fat oxidation (MFO) rate, or in the heart rate or percentage of VO2 peak to reach MFO. Healthy children achieved MFO at significantly higher muscular power than did brain tumor survivors (47.9 ± 20.8 and 21.8 ± 9.6 W, P = .003). CONCLUSION: Because child brain tumor survivors are less physically fit than healthy children, and substrate utilization during submaximal exercise is not different, physical activity should be promoted for child brain tumor survivors.


Assuntos
Neoplasias Encefálicas/fisiopatologia , Sobreviventes de Câncer/estatística & dados numéricos , Exercício Físico/fisiologia , Metabolismo dos Lipídeos , Consumo de Oxigênio , Neoplasias Encefálicas/metabolismo , Criança , Feminino , Seguimentos , Humanos , Masculino , Projetos Piloto , Prognóstico , Taxa de Sobrevida
11.
Transfus Apher Sci ; 58(4): 515-524, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383541

RESUMO

Background - Extracorporeal photopheresis (ECP) has shown encouraging results in the prevention of allograft rejection in heart transplantation. However, the role of ECP in kidney transplant (KT) rejection needs to be determined. Methods - This multicentre retrospective study included 33 KT recipients who were treated with ECP for allograft rejection (23 acute antibody-mediated rejections (AMRs), 2 chronic AMRs and 8 acute cellular rejections (ACRs)). The ECP indications were KT rejection in patients who were resistant to standard therapies (n = 18) or in patients for whom standard therapies were contraindicated because of concomitant infections or cancers (n = 15). Results - At 12 months (M12) post-ECP, 11 patients (33%) had a stabilization of kidney function with a graft survival rate of 61%. The Banff AMR score (g + ptc + v) was a risk factor for graft loss at M12 (HR 1.44 [1.01-2.05], p < 0.05). The factorial mixed data analysis identified 2 clusters. Patients with a functional graft at M12 tended to have cellular and/or chronic rejections. Patients with graft loss at M12 tended to have acute rejections and/or AMR; higher serum creatinine levels; DSA levels and histologic scores of AMR; and a longer delay between the rejection and ECP start than those of patients with functional grafts. Conclusions - ECP may be helpful to control ACR or moderate AMR in KT recipients presenting concomitant opportunistic infections or malignancies when it is initiated early.


Assuntos
Rejeição de Enxerto/tratamento farmacológico , Transplante de Rim , Fotoferese , Adolescente , Adulto , Idoso , Feminino , Rejeição de Enxerto/fisiopatologia , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Pediatr Rheumatol Online J ; 17(1): 47, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331342

RESUMO

BACKGROUND: Children with juvenile idiopathic arthritis (JIA) have impaired physical abilities. TNF-α plays a crucial role in this pathogenesis, but it is also involved in the use of lipids and muscle health. Objective of this study was to explore substrate oxidation and impact of TNF blockade on energy metabolism in children with JIA as compared to healthy children. METHODS: Fifteen non-TNF-blockaded and 15 TNF-blockaded children with JIA and 15 healthy controls were matched by sex, age, and Tanner stage. Participants completed a submaximal incremental exercise test on ergocycle to determine fat and carbohydrate oxidation rates by indirect calorimetry. RESULTS: The maximal fat oxidation rate during exercise was lower in JIA children untreated by TNF blockade (134.3 ± 45.2 mg.min- 1) when compared to the controls (225.3 ± 92.9 mg.min- 1, p = 0.007); but was higher in JIA children under TNF blockade (163.2 ± 59.0 mg.min- 1, p = 0.31) when compared to JIA children untreated by TNF blockade. At the same relative exercise intensities, there was no difference in carbohydrate oxidation rate between three groups. CONCLUSIONS: Lipid metabolism during exercise was found to be impaired in children with JIA. However, TNF treatment seems to improve the fat oxidation rate in this population. TRIAL REGISTRATION: In ClinicalTrials.gov, reference number NCT02977416 , registered on 30 November 2016.


Assuntos
Artrite Juvenil/metabolismo , Metabolismo dos Carboidratos , Metabolismo Energético , Exercício Físico , Metabolismo dos Lipídeos , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Fator de Necrose Tumoral alfa/metabolismo , Adolescente , Artrite Juvenil/tratamento farmacológico , Calorimetria Indireta , Estudos de Casos e Controles , Criança , Teste de Esforço , Feminino , Humanos , Masculino , Oxirredução , Consumo de Oxigênio
14.
Pediatr Emerg Care ; 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31181022

RESUMO

INTRODUCTION: The purpose of this study was to assess differences in observed pain-related behaviors during cannulation between a device combining cold and vibration (Buzzy) and the standard care (EMLA patch). METHODS: Patients 18 months to 6 years old, requiring venous access in a pediatric emergency department, received either the Buzzy device or the EMLA patch. Predefined week randomization ensured equal allocation to the 2 intervention groups. Pain during cannulation was measured using the Children's Hospital of Eastern Ontario Pain Scale. Parent and nurse reports, cannulation success, and venous access times were also assessed. RESULTS: In total, 607 included patients were randomized into the Buzzy group (n = 302) or the EMLA group (n = 305). Observed pain-related behaviors scores, parent-assessed pain scores, and nurse-reported pain ratings were higher with Buzzy. CONCLUSIONS: Pain relief by a combination of cold and vibration during cannulation is not as effective as the standard-care method in children 18 months to 6 years old.

16.
Joint Bone Spine ; 86(6): 739-745, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31121314

RESUMO

OBJECTIVE: A better understanding about the referral pathway of patients suffering from juvenile idiopathic arthritis (JIA) is required The aim of this study was to describe and analyze time from onset of symptoms to first pediatric rheumatology (PR) visit and the referral pathway of children with incident JIA in two French competence centers. METHODS: From October 2009 to October 2017, new JIA patients were registered in the "Auvergne-Loire cohort on JIA". We collected referral pathway, symptom onset, biological and clinical data at first assessment in PR department. RESULTS: In all, 111 children were included. Median time to first PR visit was 3.3 months [interquartile range (IQR) 1.3, 10.7] with a significant difference between JIA subtypes. After exclusion of systemic JIA, older age at onset of symptoms, and presence of enthesitis or joint pain were significantly associated with a longer time to first PR visit, while joint swelling or limping, abnormal ESR or CRP were associated with a shorter time. The median number of health care practitioners met was 3 [IQR 3, 4]. Orthopedists referred children to a PR center in 64% of cases, pediatricians in 50%, emergency care practitioners in 27% and general practitioners in 25%. Although non-systemic JIAs are not an emergency, 45% were referred to the emergency room. CONCLUSION: Time to first PR visit is rather short compared to other countries but remains too long. Pediatric rheumatologists should offer primary care providers basic training on JIA and fast direct access to PR departments if JIA is suspected.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/epidemiologia , Procedimentos Clínicos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Reumatologistas/estatística & dados numéricos , Adolescente , Fatores Etários , Artrite Juvenil/diagnóstico , Criança , Bases de Dados Factuais , Feminino , França , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Pediatria , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
17.
Front Physiol ; 10: 528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118902

RESUMO

Objectives: The objective of this study was to evaluate muscular metabolic function in children with inactive juvenile idiopathic arthritis (JIA). Methods: Fifteen children with inactive JIA and fifteen healthy controls were matched by sex, biological age, and Tanner stage. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates. Results: Between the two groups, heart rate values and carbohydrate oxidation rates were the same, regardless of the relative intensity of exercise. Lipid oxidation rates were lower in JIA patients, regardless of the percentage of VO2 peak (p < 0.05). Respiratory exchange ratios beyond 50% of VO2 peak were higher in patients with JIA (p < 0.05). Respective maximal fat oxidation rates (MFO) for controls and children with JIA were 218.7 ± 92.2 vs. 157.5 ± 65.9 mg ⋅ min-1 (p = 0.03) and 4.9 ± 1.9 vs. 3.4 ± 1.2 mg ⋅ min-1 ⋅ kg-1 (p = 0.04). There was no difference between the two groups in heart rate, percentage of VO2 peak, or power of exercise to achieve MFO. Controls reached their MFO at an exercise power significantly higher than did JIA subjects (42.8 ± 16.8 and 31.9 ± 9.8 W, p = 0.004). Conclusion: Children with JIA show metabolic disturbance during exercise, even when the disease is considered inactive. This disturbance is seen in a lower lipid oxidation rate during submaximal exercise.

18.
Pediatr Res ; 86(2): 149-156, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31029060

RESUMO

BACKGROUND: Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS: A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS: The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION: Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.


Assuntos
Artrite Juvenil/terapia , Exercício Físico , Doenças Inflamatórias Intestinais/terapia , Comportamento Sedentário , Adolescente , Artrite Juvenil/fisiopatologia , Criança , Pré-Escolar , Feminino , Nível de Saúde , Humanos , Inflamação , Doenças Inflamatórias Intestinais/fisiopatologia , Masculino , Aptidão Física
19.
J Clin Apher ; 34(4): 450-460, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30860623

RESUMO

BACKGROUND: Extracorporeal photopheresis (ECP) is an effective therapy for graft vs host disease (GVHD), based on infusion of UVA-irradiated and 8 methoxy-psoralen (PUVA)-treated leukocytes. Reinfusion of these apoptosing cells affects the functionality of pathogenic T cells through poorly understood immunomodulatory mechanisms. Apoptosis is usually a silent, tolerance-associated process, but can also be immunogenic, depending on death-inducers and environmental context. METHODS: To understand ECP mechanisms of action, human alloreactive T cells generated in an in vitro model mimicking GVHD were used, as well as primary cells from GVHD patients. Cells were submitted to PUVA treatment and their phenotype and immunogenicity were analyzed, using cell culture and flow cytometry. RESULTS: In vitro PUVA treatment induced the expression of several damage-associated molecular patterns (DAMPs) by dying T cells (calreticulin, high-mobility group box-1, and to a lesser extent heat shock proteins 70 and 90), especially upon T cell activation, leading to their phagocytosis by macrophages and dendritic cells (DCs). Allogeneic DCs preincubated with PUVA treated T cells induced comparable naive T cell proliferation and polarization as control allogeneic DC. CONCLUSION: Altogether, in our experimental settings, in vitro PUVA-treatment induces a partially immunogenic phenotype allowing phagocytosis of apoptotic cells by macrophages and DC, however not sufficient to induce dendritic cell maturation and T cell activation. These data refine current models of ECP-mediated immune modulation and emphasize the need to further analyze PUVA-treated cell interactions with immune cells.


Assuntos
Calreticulina/metabolismo , Doença Enxerto-Hospedeiro/terapia , Proteína HMGB1/metabolismo , Fotoferese/métodos , Linfócitos T/metabolismo , Apoptose , Células Cultivadas , Células Dendríticas/imunologia , Humanos , Macrófagos/imunologia , Metoxaleno , Fagocitose , Linfócitos T/patologia , Raios Ultravioleta
20.
Eur J Clin Pharmacol ; 75(3): 303-311, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30465062

RESUMO

PURPOSE: Upper respiratory tract infection (URTI) is a common infection in children, generally caused by viral respiratory infection. Vitamin C is currently proposed as prophylaxis for URTI. The purpose of this study was to assess the effectiveness of vitamin C administration in children for the prevention and reduced duration of URTI through a systematic literature review. METHODS: Review of the literature conducted between October 2017 and January 2018 in the main medical databases (CENTRAL, Medline and Embase) and by a gray literature approach. The selection criteria were: double-blind randomized controlled trials (RCTs) comparing vitamin C use to placebo in children aged 3 months to 18 years without chronic infection. Efficacy was assessed in terms of incidence, duration and severity of symptoms of URTI. A meta-analysis was conducted where possible. RESULTS: Eight RCTs, including 3135 children aged 3 months to 18 years, were selected. Quantitative analysis showed no difference between vitamin C administration and placebo (odds ratio = 0.75, 95% CI [0.54-1.03], p = 0.07, I2 = 74%). Vitamin C administration was found to decrease the duration of URTI by 1.6 days (standardized mean differences = -0.30 [-0.53; -0.08], p = 0.009, I2 = 70%). Children under 6 years of age benefit from more effective vitamin C supplementation associated with echinacea. No serious adverse events were reported. CONCLUSIONS: Although no preventive effects were found, vitamin C intake reduced the duration of URTI. Considering the frequency of URTI, the inappropriate prescription of antibiotics, and the safe nature of vitamin C, its supplementation is justified, especially in children under 6 years of age and those who present a high frequency of URTI. There is a sound rationale for further trials with greater statistical power among children of this age.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/prevenção & controle , Adolescente , Fatores Etários , Antioxidantes/administração & dosagem , Antioxidantes/efeitos adversos , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/efeitos adversos , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções Respiratórias/epidemiologia
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