Clinical aspects of exhaled nitric oxide in adults : Associations with atopy, bronchial hyperresponsiveness, smoking and chronic obstruction

Measurement of fractional exhaled nitric oxide (FENO) has proven useful in assessment of patients with respiratory symptoms, especially in predicting steroid response. The objective of these studies was to clarify issues relevant for the clinical use of FENO. The influence of allergic sensitization per se on FENO in healthy asymptomatic subjects was studied, the association between airway inflammation and bronchial hyperresponsiveness (BHR) in steroid-naive subjects with symptoms suggesting asthma was examined, as well as the possible difference in this association between atopic and nonatopic subjects. Influence of smoking on FENO was compared between atopic and nonatopic steroid-naive asthmatics and healthy subjects. The short-term repeatability of FENO in COPD patients was examined in order to assess whether the degree of chronic obstruction influences the repeatability. For these purposes, we studied a random sample of 248 citizens of Helsinki, 227 army conscripts with current symptoms suggesting asthma, 19 COPD patients, and 39 healthy subjects. FENO measurement, spirometry and bronchodilatation test, structured interview. skin prick tests, and histamine and exercise challenges were performed. Among healthy subjects with no signs of airway diseases, median FENO was similar in skin prick test-positive and –negative subjects, and the upper normal limit of FENO was 30 ppb. In atopic and nonatopic subjects with symptoms suggesting asthma, FENO associated with severity of exercise- or histamine-induced BHR only in atopic patients. FENO in smokers with steroid-naive asthma was significantly higher than in healthy smokers and nonsmokers. Among atopic asthmatics, FENO was significantly lower in smokers than in nonsmokers, whereas no difference appeared among nonatopic asthmatics. The 24-h repeatability of FENO was equally good in COPD patients as in healthy subjects. These findings indicate that allergic sensitization per se does not influence FENO, supporting the view that elevated FENO indicates NO-producing airway inflammation, and that same reference range can be applied to both skin prick test-positive and -negative subjects. The significant correlation between FENO and degree of BHR only in atopic steroid-naive subjects with current asthmatic symptoms supports the view that pathogenesis of BHR in atopic asthma is strongly involved in NO-producing airway inflammation, whereas in development of BHR in nonatopic asthma other mechanisms may dominate. Attenuation of FENO only in atopic but not in nonatopic smokers with steroid-naive asthma may result from differences in mechanisms of FENO formation as well as in sensitivity of these mechanisms to smoking in atopic and nonatopic asthma. The results suggest, however, that in young adult smokers, FENO measurement may prove useful in assessment of airway inflammation. The short-term repeatability of FENO in COPD patients with moderate to very severe disease and in healthy subjects was equally good.

Associations of serum perfluoroalkyl acid levels with T-helper cell-specific cytokines in children: By gender and asthma status

Perfluoroalkyl acids (PFAAs) are a group of common chemicals that ubiquitously exist in wildlife and humans. Experimental data suggest that they may alter T-lymphocyte functioning in situ by preferentially enhancing the development of T-helper 2 (TH2)- and inhibiting TH1-lymphocyte development and might increase allergic inflammation, but few human studies have been conducted. To evaluate the association between serum PFAAs concentrations and T-lymphocyte-related immunological markers of asthma in children, and further to assess whether gender modified this association, 231 asthmatic children and 225 non-asthmatic control children from Northern Taiwan were recruited into the Genetic and Biomarker study for Childhood Asthma. Serum concentrations of ten PFAAs and levels of TH1 [interferon (IFN)-γ, interleukin (IL)-2] and TH2 (IL-4 and IL-5) cytokines were measured. The results showed that asthmatics had significantly higher serum PFAAs concentrations compared with the healthy controls. When stratified by gender, a greater number of significant associations between PFAAs and asthma outcomeswere found in males than in females. Among males, adjusted odds ratios for asthma among those with the highest versus lowest quartile of PFAAs exposure ranged from 2.59 (95% CI: 1.14, 5.87) for the perfluorobutanesulfonate (PFBS) to 4.38 (95% CI: 2.02, 9.50) for perfluorooctanesulfonate (PFOS); and serum PFAAs were associated positively with TH2 cytokines and inversely with TH1 cytokines among male asthmatics. Among females, no significant associations between PFAAs and TH2 cytokines could be detected. In conclusion, increased serum PFAAs levels may promote TH cell dysregulation and alter the availability of key TH1 and TH2 cytokines, ultimately contributing to the development of asthma that may differentially impact males to a greater degree than females. These results have potential relevance in asthma prevention.

Damp building moulds: Assessment of sensitization in patients and studies into mechanisms of airway inflammation using experimental models

Exposure to water-damaged buildings and the associated health problems have evoked concern and created confusion during the past 20 years. Individuals exposed to moisture problem buildings report adverse health effects such as non-specific respiratory symptoms. Microbes, especially fungi, growing on the damp material have been considered as potential sources of the health problems encountered in these buildings. Fungi and their airborne fungal spores contain allergens and secondary metabolites which may trigger allergic as well as inflammatory types of responses in the eyes and airways. Although epidemiological studies have revealed an association between damp buildings and health problems, no direct cause-and-effect relationship has been established. Further knowledge is needed about the epidemiology and the mechanisms leading to the symptoms associated with exposure to fungi. Two different approaches have been used in this thesis in order to investigate the diverse health effects associated with exposure to moulds. In the first part, sensitization to moulds was evaluated and potential cross-reactivity studied in patients attending a hospital for suspected allergy. In the second part, one typical mould known to be found in water-damaged buildings and to produce toxic secondary metabolites was used to study the airway responses in an experimental model. Exposure studies were performed on both naive and allergen sensitized mice. The first part of the study showed that mould allergy is rare and highly dependent on the atopic status of the examined individual. The prevalence of sensitization was 2.7% to Cladosporium herbarum and 2.8% to Alternaria alternata in patients, the majority of whom were atopic subjects. Some of the patients sensitized to mould suffered from atopic eczema. Frequently the patients were observed to possess specific serum IgE antibodies to a yeast present in the normal skin flora, Pityrosporum ovale. In some of these patients, the IgE binding was partly found to be due to binding to shared glycoproteins in the mould and yeast allergen extracts. The second part of the study revealed that exposure to Stachybotrys chartarum spores induced an airway inflammation in the lungs of mice. The inflammation was characterized by an influx of inflammatory cells, mainly neutrophils and lymphocytes, into the lungs but with almost no differences in airway responses seen between the satratoxin producing and non-satratoxin producing strain. On the other hand, when mice were exposed to S. chartarum and sensitized/challenged with ovalbumin the extent of the inflammation was markedly enhanced. A synergistic increase in the numbers of inflammatory cells was seen in BAL and severe inflammation was observed in the histological lung sections. In conclusion, the results in this thesis imply that exposure to moulds in water damaged buildings may trigger health effects in susceptible individuals. The symptoms can rarely be explained by IgE mediated allergy to moulds. Other non-allergic mechanisms seem to be involved. Stachybotrys chartarum is one of the moulds potentially responsible for health problems. In this thesis, new reaction models for the airway inflammation induced by S. chartarum have been found using experimental approaches. The immunological status played an important role in the airway inflammation, enhancing the effects of mould exposure. The results imply that sensitized individuals may be more susceptible to exposure to moulds than non-sensitized individuals.

Early life determinants of atopy : A 20-year prospective follow-up study on unselected, healthy newborns

Atopy-related allergic diseases, i.e. allergic rhinoconjunctivitis, atopic dermatitis and asthma, have increased in frequency in the industrialized countries. In order to reverse this trend, effective preventive strategies need to be developed. This requires a better understanding of the early-life events leading to the expression of the atopic phenotype. The present study has aimed at defining early-life factors and markers associated with the subsequent development of allergic diseases in a cohort of 200 healthy, unselected Finnish newborns prospectively followed up from birth to age 20 years. Their mothers were encouraged to start and maintain exclusive breastfeeding as long as it was nutritionally sufficient for the infant. Consequently, all the infants received some duration of exclusive breastfeeding, 58% of the infants were on exclusive breastfeeding for the first 6 months of life, and 18% received this feeding at least for the first 9 months. Of the infants, 42% had a family history of allergy. After the first year of follow-up, the children were re-assessed at ages 5, 11 and 20 years with clinical examination, skin prick testing, and parental and personal interviews. Exclusive breastfeeding for over 9 months was associated with atopic dermatitis and symptoms of food hypersensitivity at age 5 years, and with symptoms of food hypersensitivity at age 11 years in the children with a familial allergy. Subjects with allergic symptoms or a positive skin prick test in childhood or adolescence had lower retinol concentrations during their infancy and childhood than others. An elevated cord serum immunoglobulin E concentration predicted subsequent atopic manifestations though with modest sensitivity. Children and adolescents with allergic symptoms, skin prick test positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the nonatopic subjects. In conclusion, prolonging strictly exclusive breastfeeding for over 9 months of age was not of help in prevention of allergic symptoms; instead, it was associated with increased atopic dermatitis and food hypersensitivity symptoms in childhood. Due to the modest sensitivity, cord serum IgE is not an effective screening method for atopic predisposition in the general population. Retinol and cholesterol concentrations in infancy were inversely associated with the subsequent development of allergic symptoms. Based on these findings, it is proposed that there may be differences in the inborn regulation of retinol and cholesterol levels in children with and without a genetic susceptibility to atopy, and these may play a role in the development of atopic sensitization and allergic diseases.

Probiotics in the prevention of clinical manifestations of common infectious diseases in children and in the elderly

Infectious diseases put an enormous burden on both children and the elderly in the forms of respiratory, gastrointestinal and oral infections. There is evidence suggesting that specific probiotics may be antagonistic to pathogens and may enhance the immune system, but the clinical evidence is still too sparce to make general conclusions on the disease-preventive effects of probiotics. This thesis, consisting of four independent, double-blind, placebo-controlled clinical trials, investigated whether Lactobacillus GG (LGG) or a specific probiotic combination containing LGG would reduce the risk of common infections or the prevalence of pathogens in healthy and infection-prone children and in independent and institutionalised elderly people. In healthy day-care children, the 7-month consumption of probiotic milk containing Lactobacillus GG appeared to postpone the first acute respiratory infection (ARI) by one week (p=0.03, adjusted p=0.16), and to reduce complicated infections (39% vs. 47%, p<0.05, adjusted p=0.13), as well as the need for antibiotic treatment (44% vs. 54%, p=0.03, adjusted p=0.08) and day-care absences (4.9 vs. 5.8 days, p=0.03, adjusted p=0.09) compared to the placebo milk. In infection-prone children, the 6-month consumption of a combination of four probiotic bacteria (LGG, L. rhamnosus LC705, Propionibacterium freudenreichii JS, Bifidobacterium breve 99) taken in capsules appeared to reduce recurrent ARIs (72% vs. 82%, p<0.05; adjusted p=0.06), and the effect was particularly noticeable in a subgroup of children with allergic diseases (12% vs. 33%, p=0.03), although no effect on the presence of nasopharyngeal rhinovirus or enterovirus was seen. The 5-month consumption of the same probiotic combination did not show any beneficial effects on the respiratory infections in frail, institutionalised elderly subjects. In healthy children receiving Lactobacillus GG, the reduction in complications resulted in a marginal reduction in the occurrence of acute otitis media (AOM) (31% vs. 39%, p=0.08; adjusted p=0.19), and the postponement of the first AOM episode by 12 days (p=0.04; adjusted p=0.09). However, in otitis-prone children, a probiotic combination did not reduce the occurrence of AOM or the total prevalence of common AOM pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis), except in the case of children with allergic diseases, in whom probiotics reduced recurrent AOM episodes (0% vs. 14%, p=0.03). In addition, interaction between probiotics and bacterial carriage was seen: probiot-ics reduced AOM in children who did not carry any bacterial pathogens (63% vs. 83%), but the effect was the reverse in children carrying bacteria in the nasopharynx (74% vs 62%) (p<0.05). Long-term probiotic treatment, either LGG given in milk to healthy children for 7 months or a combination of probiotics given in capsules to institutionalised elderly subjects for 5 months, did not reduce the occurrence of acute diarrhoea. However, when the probiotic combination (LGG, L. rhamnosus LC705, Propionibacterium JS) was given in cheese to independent elderly subjects for 4 months, the oral carriage of high Candida counts was reduced in the probiotic group vs. the placebo group (21% vs. 34%, p=0.01, adjusted p=0.004). The risk of hyposalivation was also reduced in the probiotic group (p=0.05). In conclusion, probiotics appear to slightly alleviate the severity of infections by postponing their appearance, by reducing complications and the need for antimicrobial treatments. In addition, they appear to prevent recurrent infections in certain subgroups of children, such as in infection-prone children with allergic diseases. Alleviating ARI by probiotics may lead to a marginal reduction in the occurrence of AOM in healthy children but not in infection-prone children with disturbed nasopharyngeal microbiota. On the basis of these results it could be supposed that Lactobacillus GG or a specific combination containing LGG are effective against viral but not against bacterial otitis, and the mechanism is probably mediated through the stimulation of the immune system. A specific probiotic combination does not reduce respiratory infections in frail elderly subjects. Acute diarrhoea, either in children or in the elderly, is not prevented by the continuous, long-term consumption of probiotics, but the consumption of a specific probiotic combination in a food matrix is beneficial to the oral health of the elderly, through the reduction of the carriage of Candida.

Chemical approaches of penicillin allergy—III Isolation of the penicillin-free carrier receptor protein (CRP) on a polymeric 7-deoxy penicillin analogue template and its role in penicillin immunogeneses in rabbit and man

Specific penicillin-carrier receptor proteins (CRP) have been isolated from the sera of penicillin allergic rabbits and human subjects in the unconjugated native state in electrophoretically homogeneous form by employing a synthetic polymeric affinity template containing the 7-deoxy analogue of penicillin G. The synthesis of the 7-deoxy analogue has been described. In this affinity system the antipenicillin-antibody is desorbed by 0·9M thiourea and the CRP in 8M urea. The CRP after incubation with penicillin is converted into the full-fledged antigen. Studies on the origin of CRP and the nature of antibody as well as comparative studies on the properties of the rabbit antibody and those of antibodies elicited by a BSA-BPO conjugate are reported.

The role of inflammation and matrix proteins in airway remodelling

Asthma is a chronic inflammatory disorder of the airways. Remodelling in asthma is defined as the structural changes seen in the airways of asthmatics in comparison to healthy controls. Progressive loss of lung function also seen in asthma might be caused by remodelling. The research aims of this thesis were to investigate inflammation and remodelling in the airways of different types of asthmatics and smokers. The association between inflammation and remodelling was also examined in a mouse model of allergic airway inflammation. Healthy smokers showed increased numbers of macrophages in the BAL with no changes in the inflammatory cells in biopsies. Macrophages seemed to be quite quiescent, since mRNA expression for a wide variety of inflammatory mediators, especially chemokines CCL3, CCL4, CCL5 and CCL20, secreted by macrophages was significantly lower than in healthy non-smokers. Attenuated macrophage activity in the airway lumen may render smokers more susceptible to airway infections and have an impact on the development of other airway pathology. Patients with diisocyanate-induced asthma (DIA) on inhaled corticosteroids (ICS) who still had non-specific bronchial hyperreactivity (NSBHR) at the end of the follow-up showed increased expression of TNF-α, IL-6 and IL-15 mRNA in BAL cells compared to those without NSBHR. In addition to being markers for poor prognosis and possible slight glucocorticoid resistance, these cytokines might aid in guiding the treatment of DIA. The increase in the thickness of tenascin-C layer in the bronchial basement membrane (BM) was much less than usually seen in other types of asthma, which might not make tenascin-C a good marker for DIA. OVA-induced tenascin-C expression in the lung was attenuated in STAT4-/- mice with impaired Th1-type immunity compared to WT mice. Interestingly, STAT6-/- mice with impaired Th2-type immunity showed tenascin-C expression levels similar to those of WT mice. The clearest difference between these two knockout strains in response to OVA was that STAT4-/- mice exhibited no upregulation of IFN-γ and TNF-α mRNA expression. Thus, tenascin-C expression was unexpectedly more related to Th1 type reactions. In vitro studies confirmed the results. Human fibroblasts stimulated by TNF-α and IFN-γ showed increased expression of tenascin-C. Patients with newly diagnosed asthma showed increased expression of laminin α2 in the bronchial BM in comparison to patients with asthma symptoms only and healthy controls. Both patients with asthma and those with only asthma symptoms showed increased expression of the laminin β2 chain in comparison to controls. Thus, laminin α2 expression differentiated patients with clinical asthma from patients with symptoms only. Furthermore, the expression of laminin α2 and β2 was associated with NSBHR, linking very specific remodelling events to clinical findings.

A Genetic Study of Immunoglobulin E and Atopic Disease Based on Families Ascertained through Asthmatic Children

In order to investigate the modes of inheritance of serum immunoglobulin E (IgE) levels and atopic disease, serum IgE levels and data on allergic disease were obtained from 42 families ascertained through asthmatic children visiting an allergy clinic. Although the mean IgE levels were elevated (mean 637 U/ml), the prevalence of atopic disease in this population was surprisingly low. When the data were analyzed using complex segregation analysis, no major locus could be detected. Moreover, the polygenic heritability was unexpectedly small even though the correlation between serum IgE levels and the liability to atopic disease was around 0.4. Given this unusual set of findings, it is postulated that parasitic infections in this population have (in accordance with well-established results of parasitic disease) caused both elevated levels of serum IgE and a decreased prevalence of allergic disease with the possible masking of the various genetic components of serum IgE levels and atopic disease.

Molecular profiling of indoor microbial communities in moisture damaged and non-damaged buildings

Epidemiological studies have shown an elevation in the incidence of asthma, allergic symptoms and respiratory infections among people living or working in buildings with moisture and mould problems. Microbial growth is suspected to have a key role, since the severity of microbial contamination and symptoms show a positive correlation, while the removal of contaminated materials relieves the symptoms. However, the cause-and-effect relationship has not been well established and knowledge of the causative agents is incomplete. The present consensus of indoor microbes relies on culture-based methods. Microbial cultivation and identification is known to provide qualitatively and quantitatively biased results, which is suspected to be one of the reasons behind the often inconsistent findings between objectively measured microbiological attributes and health. In the present study the indoor microbial communities were assessed using culture-independent, DNA based methods. Fungal and bacterial diversity was determined by amplifying and sequencing the nucITS- and16S-gene regions, correspondingly. In addition, the cell equivalent numbers of 69 mould species or groups were determined by quantitative PCR (qPCR). The results from molecular analyses were compared with results obtained using traditional plate cultivation for fungi. Using DNA-based tools, the indoor microbial diversity was found to be consistently higher and taxonomically wider than viable diversity. The dominant sequence types of fungi, and also of bacteria were mainly affiliated with well-known microbial species. However, in each building they were accompanied by various rare, uncultivable and unknown species. In both moisture-damaged and undamaged buildings the dominant fungal sequence phylotypes were affiliated with the classes Dothideomycetes (mould-like filamentous ascomycetes); Agaricomycetes (mushroom- and polypore-like filamentous basidiomycetes); Urediniomycetes (rust-like basidiomycetes); Tremellomycetes and the family Malasseziales (both yeast-like basidiomycetes). The most probable source for the majority of fungal types was the outdoor environment. In contrast, the dominant bacterial phylotypes in both damaged and undamaged buildings were affiliated with human-associated members within the phyla Actinobacteria and Firmicutes. Indications of elevated fungal diversity within potentially moisture-damage-associated fungal groups were recorded in two of the damaged buildings, while one of the buildings was characterized by an abundance of members of the Penicillium chrysogenum and P. commune species complexes. However, due to the small sample number and strong normal variation firm conclusions concerning the effect of moisture damage on the species diversity could not be made. The fungal communities in dust samples showed seasonal variation, which reflected the seasonal fluctuation of outdoor fungi. Seasonal variation of bacterial communities was less clear but to some extent attributable to the outdoor sources as well. The comparison of methods showed that clone library sequencing was a feasible method for describing the total microbial diversity, indicated a moderate quantitative correlation between sequencing and qPCR results and confirmed that culture based methods give both a qualitative and quantitative underestimate of microbial diversity in the indoor environment. However, certain important indoor fungi such as Penicillium spp. were clearly underrepresented in the sequence material, probably due to their physiological and genetic properties. Species specific qPCR was a more efficient and sensitive method for detecting and quantitating individual species than sequencing, but in order to exploit the full advantage of the method in building investigations more information is needed about the microbial species growing on damaged materials. In the present study, a new method was also developed for enhanced screening of the marker gene clone libraries. The suitability of the screening method to different kinds of microbial environments including biowaste compost material and indoor settled dusts was evaluated. The usability was found to be restricted to environments that support the growth and subsequent dominance of a small number microbial species, such as compost material.

Allergenic Cross-Reactivity between Parthenium and Ragweed Pollen Allergens

Cross-reactivity of allergens from the pollen of the Compositae weeds, Parthenium hysterophorus (American feverfew) and Ambrosia (ragweed), in 2 groups of patients with different geographic distributions was studied. Parthenium-sensitive Indian patients, who were never exposed to ragweed, elicited positive skin reactions with ragweed pollen extracts. A significant correlation in the RAST scores of Parthenium and ragweed-specific IgE was observed with the sera of Parthenium and ragweed-sensitive Indian and US patients, respectively. RAST inhibition experiments demonstrated that the binding of IgE antibodies in the sera of ragweed-sensitive patients to short (Wl) and giant (W3) ragweed allergen discs could be inhibited by up to 94% by Parthenium pollen extracts. Similar inhibition (up to 82%) was obtained when the sera of Parthenium rhinitis patients were incubated with ragweed allergen extracts. A dose-dependent proliferation of lymphocytes from a Parthenium-sensitive rhinitis patient with elevated levels of both Parthenium and ragweed-specific IgE was observed when incubated with Parthenium and ragweed pollen extracts. A 1.6-fold higher proliferation, however, was observed with Parthenium pollen extract at a concentration of 100 µg/ml. These results suggest that shared epitopes present on Parthenium and ragweed pollen allergens are recognized by both Indian and US patients sensitized by exposure to Parthenium and ragweed pollen, respectively. The high degree of cross-reactivity between Parthenium and ragweed pollen allergens suggests that individuals sensitized to Parthenium may develop type-I hypersensitivity reactions to ragweed and vice versa when they travel to regions infested with the weed to which they had not been previously exposed.

Avaliação de propriedades de artefatos à base de borracha natural

A combinação de excelentes propriedades mecânicas aliadas à biocompatibilidade torna a borracha natural um material amplamente empregado na fabricação de artefatos voltados à saúde, tais como bicos de chupetas e de mamadeiras, e luvas cirúrgicas e de procedimentos não-cirúrgicos. Esses artefatos são processados a partir de látices de poli(cis-isopreno) extraído de seringueiras. Entretanto, o grande número de insaturações presentes na cadeia polimérica, mesmo após a vulcanização, resulta em uma baixa resistência desse material ao envelhecimento, causado principalmente pela associação de fatores como temperatura, oxigênio, ozônio e radiação. Outro inconveniente associado à aplicação da borracha natural é a presença de proteínas no látex, com potencial alergênico, podendo promover reações fisiológicas em alguns usuários. Por esse motivo artefatos comerciais à base de material sintético também são encontrados no mercado. Esses artefatos também não são isentos dos processos naturais de desgaste e decomposição. Esta Dissertação teve como objetivo realizar um estudo comparativo de propriedades dos produtos comerciais à base de borracha natural e à base de material sintético (bicos de chupeta e de mamadeiras e luvas) de diferentes fabricantes, como adquiridos e após sofrerem envelhecimento acelerado. O estudo foi feito empregando-se as técnicas de espectroscopia na região do infravermelho com transformada de Fourier (FTIR) e termogravimetria (TG). Uma avaliação mecânica com métodos padronizados foi também realizada

A relação entre indústria farmacêutica e a assistência farmacêutica no âmbito do Sistema Único de Saúde (SUS): a compra estadual e municipal de medicamentos no Rio de Janeiro

Esta dissertação tem como objeto o estudo da relação estabelecida entre a indústria farmacêutica e a assistência farmacêutica no âmbito do SUS. O objetivo é avaliar como estão sendo feitas as compras de medicamentos para os programas de assistência farmacêutica básica para hipertensão, diabetes e asma e rinite. A captura de dados foi realizada nas Secretarias de Saúde do estado e do município do Rio de Janeiro. Realizou-se comparação dos preços unitários dos medicamentos adquiridos no estado, no município do Rio de Janeiro e no Banco de Preços em Saúde (BPS), no período de janeiro de 2000 a dezembro de 2006. Em alguns momentos foram utilizados dados da Revista ABCFARMA, sobre preços unitários do mercado varejista. A pesquisa tornou possível registrar que o Estado do Rio de Janeiro compra medicamentos a um preço unitário mais alto do que aqueles praticados pela prefeitura e pelo Banco de Preços em Saúde. A hipótese apresentada é que o preço unitário mais alto se deve às inúmeras compras emergenciais realizadas, que estimulam os fornecedores a compensar o risco com preços maiores. Como a maioria dos fornecedores é distribuidora de medicamentos, elas estariam onerando os preços unitários, pois tiveram problemas no passado com o cumprimento da dívida pelo estado. Segundo autoridades estaduais da Secretaria de Estado de Saúde, esta situação indesejável está sendo superada através de uma nova forma de aquisição de medicamentos. A prefeitura do Rio de Janeiro, por outro lado, tem realizado as compras de medicamentos por licitações na modalidade concorrência. Esta forma possibilitou a aquisição de medicamentos a preços inferiores aos outros entes pesquisados. A maioria dos fornecedores da prefeitura é a própria indústria de medicamentos, o que, em princípio, torna o preço mais baixo. Conclui-se, então: que o Estado do Rio de Janeiro passou por crises de desabastecimento ou abastecimento irregular dos programa de assistência farmacêutica básica, o que contribuiu para a elevação dos preços praticados; e que a prefeitura do Rio de Janeiro tem conseguido comprar medicamentos em condições mais favoráveis que o governo de estado.

Avaliação da qualidade de vida entre adolescentes asmáticos

Nesta tese vamos investigar as associações entre: Artigo 1 - Avaliar a qualidade de vida (QV) e sua associação com a gravidade da asma, presença de outras doenças crônicas e estilo de vida; Artigo 2 - O objetivo dessa pesquisa foi avaliar a associação entre TMC e qualidade de vida em adolescentes asmáticos. Artigo 1 - Trata-se de um estudo seccional de base ambulatorial em 210 adolescentes asmáticos entre 12 e 21 anos, de ambos os sexos atendidos em um serviço especializado em atenção ao adolescente em uma universidade pública no estado do Rio de Janeiro. Para avaliação da QV utilizou-se um questionário autopreenchível, o Paediatric Asthma Quality of Life Questionnaire PAQLQ. As variáveis explicativas foram: as outras doenças alérgicas, uso de medicamentos, fumo passivo, trabalho, gravidade da asma e o estilo de vida. As análises foram conduzidas considerando o desfecho em estudo (QV) dicotômico (boa-ruim) a partir da média dos escores. Modelos lineares generalizados (log-binomial) foram utilizados para o cálculo de razões de prevalência brutas e ajustadas; Artigo 2 - Estudo seccional de base ambulatorial, entre 210 adolescentes asmáticos de 12 a 21 anos atendidos em um ambulatório especializado de um serviço universitário voltado à atenção ao adolescente, no Rio de Janeiro, Brasil. A qualidade de vida (QV) foi avaliada através do Paediatric Asthma Quality of Life Questionnaire PAQLQ e os TMC, pelo General Health Questionnaire (GHQ-12). A qualidade de vida total e suas diferentes dimensões foram tratadas como variável dicotômica e utilizou-se o modelo log-binomial para o cálculo das razões de prevalência brutas e ajustadas. Artigo 1 - Quarenta e seis por cento das adolescentes apresentavam uma qualidade de vida ruim, assim como 57% dos meninos. Não houve correlação entre outras doenças crônicas e QV ruim. Escolaridade baixa, uso de medicamentos, fumo passivo e trabalho tiveram relação estatisticamente significativa (p<0,05) com QV ruim. A análise ajustada mostrou que asma grave (RP=1,53; IC 95% 1,12-2,11), uso de medicação (RP=1,58; IC 95% 1,09-2,28), ter menos de 5 anos de diagnóstico de asma (RP= 1,30.; IC 95% 0,97-1,86), fumo passivo (RP= 1,38; IC 95%; 1,35-2,00) e estar trabalhando (RP=1,30 IC 95% 0,96 1,74) associavam-se à qualidade de vida ruim; Artigo 2 - A prevalência total de asmáticos com TMC foi de 32,4%. A prevalência de QV ruim entre adolescentes com TMC foi de 36,6%. O modelo final ajustado mostrou uma associação entre TMC e QV total ruim (RP= 1,84 IC 95% 1,19-2,86), assim como para os domínios referentes à emoção (RP=1,77 IC 95% 1,16-2,62) e sintomas (RP=1,75 IC 95% 1,14-2,70). Para o domínio atividade física, a associação com TMC foi de apenas borderline (RP=1,43 IC 95% 0,97-2,72). Artigo 1 - O impacto negativo na qualidade de vida está diretamente relacionado a ter asma grave, ser fumante passivo e um diagnóstico mais recente de asma. A equipe multidisciplinar necessita enfrentar esse desafio que é a busca e manutenção de uma boa qualidade de vida, visando uma melhor adequação desse paciente com a sociedade e com ele próprio; Artigo 2 - Os resultados desse estudo tornam visíveis as necessidades de atenção aos aspectos emocionais dos adolescentes portadores de doenças crônicas, de forma a subsidiar ações mais efetivas na área de saúde mental, visando à melhor qualidade de vida e ao tratamento global do paciente asmático.

Long-Term Burden and Respiratory Effects of Respiratory Syncytial Virus Hospitalization in Preterm Infants — The SPRING Study

The health status of premature infants born 32(1)-35(0) weeks' gestational age (wGA) hospitalized for RSV infection in the first year of life (cases; n = 125) was compared to that of premature infants not hospitalized for RSV (controls; n = 362) through 6 years. The primary endpoints were the percentage of children with wheezing between 2-6 years and lung function at 6 years of age. Secondary endpoints included quality of life, healthcare resource use, and allergic sensitization. A significantly higher proportion of cases than controls experienced recurrent wheezing through 6 years of age (46.7% vs. 27.4%; p = 0.001). The vast majority of lung function tests appeared normal at 6 years of age in both cohorts. In children with pulmonary function in the lower limit of normality (FEV1 Z-score [-2; -1]), wheezing was increased, particularly for cases vs. controls (72.7% vs. 18.9%, p = 0.002). Multivariate analysis revealed the most important factor for wheezing was RSV hospitalization. Quality of life on the respiratory subscale of the TAPQOL was significantly lower (p = 0.001) and healthcare resource utilization was significantly higher (p<0.001) in cases than controls. This study confirms RSV disease is associated with wheezing in 32-35 wGA infants through 6 years of age.

Papel regulatório da proteína anexina-1 e de seu derivado Ac2-26 no modelo experimental de asma alérgica em camundongos

A asma é uma doença inflamatória crônica caracterizada por hiper-reatividade das vias aéreas, acúmulo de eosinófilos, secreção de muco e remodelamento. No decorrer do estabelecimento do processo inflamatório, há liberação de mediadores endógenos que atuam limitando a evolução do quadro patológico e garantindo a manutenção da homeostasia (COHN, ELIAS e CHUPP, 2004). Dentre estes recebem destaque os hormônios glicocorticóides, reconhecidos por sua atividade anti-inflamatória, dependente, em parte, da geração de fatores intermediários como a proteína anexina-1 (AnxA1) (KAMAL, FLOWER e PERRETTI, 2005; PERRETTI, 2003). Neste estudo investigou-se o papel regulatório da AnxA1 e do peptídeo derivado Ac2-26 (50 - 200 g/animal) no modelo experimental de asma alérgica murina. Camundongos BALB/c (AnxA1+/+) e depletados do gene codificante para AnxA1 (AnxA1-/-) foram sensibilizados com ovoalbumina (OVA 50 g) e hidróxido de alumínio (5 mg), por via subcutânea. Após 14 dias, foi feito reforço com OVA (25 g), por via intraperitoneal, e nos dias 19, 20 e 21 foram desafiados com OVA (25 g), por via intranasal. O tratamento consistiu na administração intranasal do peptídeo Ac2-26 (50 - 200 g), 1 h antes de cada desafio. As análises foram feitas 24 h após o último desafio e incluíram: i) função pulmonar (resistência e elastância) e hiper-reatividade das vias aéreas à metacolina (3 27 mg/ml) através de pletismografia invasiva; ii) alterações morfológicas através de histologia clássica; iii) quantificação de colágeno e iv) quantificação de mediadores inflamatórios através de ELISA. Verificou-se que camundongos AnxA1-/-, quando ativamente sensibilizados e desafiados com OVA apresentaram exacerbação do quadro de hiper-reatividade das vias aéreas, assim como do número de eosinófilos no lavado broncoalveolar e no infiltrado peribrônquico, deposição de colágeno e nos níveis de IL-13 em comparação aos controles AnxA1+/+. Em paralelo, observou-se que o peptídeo Ac2-26 levou a uma redução da hiper-reatividade das vias aéreas frente à estimulação com metacolina nos animais AnxA1+/+. O peptídeo Ac2-26 reduziu o infiltrado inflamatório no parênquima pulmonar e o número de eosinófilos peribronquiolares, além da produção de muco no tecido pulmonar e da geração IL-4, IL-13, eotaxina-1 e -2. Em conjunto, nossos achados mostram que os camundongos AnxA1-/- mostraram-se mais responsivos à estimulação antigênica, o que foi indicativo de que a AnxA1 parece exercer um papel regulatório importante sobre a resposta inflamatória alérgica murina. Além disso, o efeito inibitório do peptídeo Ac2-26 sobre a resposta alérgica pulmonar foi indicativo de que este se coloca como um composto anti-inflamatório e anti-alérgico promissor para utilização na terapia da asma.