Prevalence of Toxocara infection in schoolchildren from the Butantã region, São Paulo, Brazil

Visceral larva migrans syndrome by Toxocara affects mainly children between 2 and 5 years of age, it is generally asymptomatic, and the seroprevalence varies from 3 to 86% in different countries. A total of 399 schoolchildren from 14 public schools of the Butantã region, São Paulo city, Brazil, were evaluated by Toxocara serology (enzyme-linked immunosorbent assay). Epidemiological data to the Toxocara infection obtained from a protocol were submitted to multiple logistic regression analysis for a risk profile definition. Blood was collected on filter paper by finger puncture, with all samples tested in duplicate. Considering titers > 1/160 as positive, the seroprevalence obtained was 38.8%. Among infected children, the mean age was 9.4 years, with a similar distribution between genders. A significant association was observed with the presence of onychophagia, residence with a dirty backyard, living in a slum, previous wheezing episodes, school attended, and family income (p < 0.05). All data, except "living in a slum", were considered to be determinant of a risk profile for the acquisition of Toxocara infection. A monthly income > 5 minimum salaries represented a protective factor, although of low relevance. Toxocara eggs were found in at least one of the soil samples obtained from five schools, with high prevalence of Toxocara infections, indicating the frequent soil contamination by this agent.

The PHA message is clear for World COPD Day - smoking is bad for your lungs

In 2011, 31,574 people were registered as having Chronic Obstructive Pulmonary Disease (COPD) in Northern Ireland. The most common cause of COPD is smoking and to mark this year's World COPD day, which takes place on Wednesday 16 November, the Public Health Agency is encouraging all smokers to make a decision to stop smoking today and reduce their risk of developing the disease.COPD refers to a group of diseases which includes emphysema, chronic bronchitis, and in some cases asthma. With COPD, the airways in the lungs become damaged, causing them to become narrower, therefore restricting airflow and thus making it harder to breathe. The most common symptoms of COPD are breathlessness, wheezing, abnormal sputum (a mix of saliva and mucus in the airway), and a chronic cough often mistaken for a 'smokers' cough'. Symptoms can range from mild to severe, depending upon how advanced the disease is. In advanced cases, daily activities, such as walking up a short flight of stairs, can become very difficult.There is no cure for COPD. Stopping smoking is the single most effective wayto reduce your risk of developing COPD and avoid any further damage to the lungs. Gerry Bleakney, Head of Health and Social Wellbeing Improvement, PHA, said: "Smoking causes the lining of the airways to become inflamed and damaged and is the biggest cause of COPD. The risk of developing COPD increases the more an individual smokes and the longer they smoke. "The good news is that making changes to your lifestyle can reduce your risk of developing COPD. Stopping smoking reduces the risk of developing COPD and also slows down its progression. There is support available to help you quit and I would encourage everyone thinking about stopping smoking to log on to our Want 2 Stop website www.want2stop.info and order a 'Quit Kit' free of charge. Alternatively contact the Smokers' Helpline on 0808 812 8008 for help on planning to stop smoking or to find out where your nearest Stop Smoking Service is. "The Health Minister Edwin Poots said: "The impact of living with COPD can place a considerable strain on the lives of those suffering from the condition and their families. I understand that most smokers want to quit but it is not always easy to succeed and that several attempts are frequently necessary. I would therefore urge all smokers on world COPD day, to make that commitment to stop smoking. Professional help and support are readily available. There are almost 650 smoking cessation services provided all over Northern Ireland, mostly in community pharmacies, but also in GP surgeries, hospitals, community halls and schools."

L'hyperréactivité bronchique et son importance pour le clinician [Bronchial hyperresponsiveness and its importance for the clinician].

Asthma is a chronic inflammatory airway disease, characterised by bronchial hyperresponsiveness causing bronchoconstriction, and thereby provoking typical symptoms (dyspnoea, cough, wheezing). Bronchial hyperres- ponsiveness indicates a temporary airflow limitation when exposed to a bronchoconstricting stimulus. Its measurement by challenge tests can be a valuable tool for confirming or excluding asthma, as well as for evaluating the efficacy of treatment. However, the origin of bronchial hyperresponsiveness is multifactorial and the different challenge tests are not equivalent. Direct challenge tests, like methacholine, mainly reflect chronic airway remo- delling, whereas indirect tests, like mannitol, better reflect bronchial inflammation.

Efecte de la nutrició precoç en el desenvolupament de sibilàncies

Objectiu: provar que, enfront de l’aparició de sibilàncies, l’alletament matern es comporta com a un factor protector i l’alletament artificial com a un factor inductor. Material i mètodes: assaig clínic controlat, randomitzat, a doble cec amb grup control i seguiment de 8 anys, de la submostra espanyola, en el seu 5è any de seguiment, del treball multicèntric europeu EU CHILDHOOD OBESITY PROGRAMME (QLK1-2001-00389). La població es va dividir en 3 grups: nadons alimentats amb lactància artificial amb baix contingut proteic, nadons alimentats amb lactància artificial amb alt contingut proteic i un grup control de nadons alimentats amb llet materna. Per avaluar l’aparició de sibilàncies i la seva evolució en el temps es van realitzar entrevistes als pares a mesura que la població assolia els 6 anys de vida sobre qüestions referides als 3 i als 6 anys i s’havien de realitzar entrevistes als 8 anys de vida sobre qüestions referdies a aquesta mateixa edat. Per comprovar la repercussió en la funció pulmonar i valorar la base atòpica, es tenia previst realitzar, als 8 anys, espirometria, prik test amb aeroalergens, determinació de IgE sèrica total i quantificació dels eosinòfils en sang perifèrica. S’han valorat possibles factors de confusió com antecedents familiars de malalties de base al•lèrgica, nivell socioeconòmic familiar, factors, ambient epidemiològic i s’ha estudiat altra morbiditat associada com episodis de febre, vòmits, diarrea, dermatitis atòpica, refredat de vies respiratòries altes i prescripció mèdica d’antibiòtics. Resultats: només un 20’8% van rebre alletament matern. No s’han trobat diferències estadísticament significatives entre la història d’episodis de sibilàncies i el tipus d’alletament rebut. Tampoc s’han trobat diferències estadísticament significatives entre l’alimentació rebuda i la història de dermatitis atòpica. La llet artificial es va associar, amb significació estadística, a una major prescripció d’antibiòtics i una major incidència de patir diarrees i, sense significació estadística, es va associar a un augment del risc de patir RVA. La lactància materna es va associar amb significació estadística a una menor prescripció d’antibiòtics. La presència de germans grans i un baix nivell d’educació de la mare van contribuir a augmentar la morbiditat durant el primer any de vida. El consum d’alcohol durant l’embaràs es va associar a més episodis de vòmits i el consum de tabac a més episodis de diarrea. Conclusions: l’alletament artificial no predisposa a patir més episodis de sibilàncies ni de dermatitis atòpica. La lactància materna exclusiva durant almenys 3 mesos disminueix el risc de diarrees en els primers 6 mesos de vida i retarda l’aparició d’infeccions aparentment bacterianes que requereixen tractament antibiòtic. L’alletament matern exclusiu durant un mínim de tres mesos no comporta una substancial disminució de la morbiditat durant els primers 12 mesos de vida.

Pandemic 2009 A(H1N1) infection requiring hospitalization of elderly Spanish adults.

To describe the clinical presentation and prognosis of elderly adults hospitalized with pandemic 2009 A(H1N1) influenza infection and to compare these data with those of younger patients. DESIGN: Prospective, observational, multicenter study. SETTING: Thirteen hospitals in Spain. PARTICIPANTS: Adults admitted to the hospital with confirmed pandemic 2009 A(H1N1) influenza infection. MEASUREMENTS: Demographic, clinical, laboratory, radiological, and outcome variables. RESULTS: Between June 12 and November 10, 2009, 585 adults with confirmed 2009 A(H1N1) influenza were hospitalized, of whom 50 (8.5%) were aged 65 and older (median age 72, range 65-87). Older adults (≥ 65) were more likely to have associated comorbidities (88.0% vs 51.2%; P < .001), primarily chronic pulmonary diseases (46.0% vs 27.3%; P < .001). Lower respiratory tract symptoms and signs such as dyspnea (60.0% vs 45.6%) and wheezing (46.0% vs 27.8%; P = .007) were also more common in these elderly adults, although pulmonary infiltrates were present in just 14 (28.0%) of the older adults, compared with 221 (41.3%) of the younger adults (P = .06). Multilobar involvement was less frequent in elderly adults with pulmonary infiltrates than younger adults with pulmonary infiltrates (21.4% vs 60.0%; P = .05). Rhinorrhea (4.0% vs 21.9%; P = .003), myalgias (42.0% vs 59.1%; P = .01), and sore throat (14.0% vs 29.2%; P = .02) were more frequent in younger adults. Early antiviral therapy (<48 hours) was similar in the two groups (34.0% vs 37.9%; P = .58). Two older adults (4.0%) died during hospitalization, compared with 11 (2.1%) younger adults (P = .30). CONCLUSION: Elderly adults with 2009 A(H1N1) influenza had fewer viral-like upper respiratory symptoms than did younger adults. Pneumonia was more frequent in younger adults. No significant differences were observed in hospital mortality.

Occupational asthma in workers exposed to Mesalazine powder inhalation

Background: Due to complains of respiratory symptoms of some employees a pharmaceutical company asked in 2008 the occupational medical department of the Institute for Work and Health in Lausanne to evaluate the health status of their workers exposed to Mesalazine powder, which is the active agent of a drug used for the treatment of bowels inflammation. Therefore we examined the 21 workers exposed to Mesalazine powder. Method: After a visit of the pharmaceutical company in order to investigate the Mesalazine powder production, we performed an individual medical evaluation of the 21 workers. Our medical protocol was based on the safety data sheet of Mesalazine, the data found in the scientific literature and the «Compendium Suisse des Médicaments» and covered upper and lower respiratory tract as well as skin and eyes. Results: Sixty two percent (62%) of the exposed employees had symptoms of skin, eyes and throat irritation. Three employees reported respiratory symptoms such as dyspnoea, cough and expiratory wheezing, which appeared during the working hours. The Peak Flow series performed at the workplace was lowered in the three employees with lower respiratory tract symptoms. None of the three had consulted a physician, even though the symptoms had been present since some months. The pneumological evaluation confirmed for all three cases the asthma diagnoses. Conclusion: It is known that patients who are treated with drugs including Mesalazine can develop adverse health effect such as asthma. However occupational asthma in workers exposed to Mesalazine powder inhalation is until now not described in the literature. Immunologic investigations in order to know if the occupational asthma caused by Mesalazine is of allergic or mechanical irritation nature are still ongoing. Concerning the three workers with asthma, inability to work with Mesalazine was pronounced. Furthermore, the SUVA recognized the three patients with asthma as occupational respiratory diseases. Following our results and recommendations, the company undertook some measures to reduce the exposure to Mesalazine. A new health evaluation of the employees in the Mesalazine production is hence planned in 2009. As each year new causes of occupational asthma are described, the possible work relation of new asthma onset has to be carefully investigated as the consequences for the patient e.g. removal from exposure and for the exposed co-workers are of substantial importance.

Does this child have a foreign body aspiration?

Context: Foreign body aspiration (FbA) is a serious problem in children. Accurate clinical and radiographic diagnosis is important because missed or delayed diagnosis can result in respiratory difficulties ranging from life-treatening airway obstruction to chronic wheezing or recurrent pneumonia. Bronchoscopy also has risks and accurate clinical and radiographc diagnosis can support the decision of bronchoscopy. Objective: To rewiev the diagnostic accuracy of clinical presentation (CP) and pulmonary radiograph (PR) for the diagnosis of FbA. There is no previous rewievMethods: A search of Medline is conducted for articles containing data regarding CP and PR signes of FbA. Calculation of likelihood ratios (LR) and pre and post test probability using Bayes theorem were performed for all signs of CP and PR. Inclusion criteria: Articles containing prospective data regarding CP and PR of FbA. Exclusion criteria: Retrospectives studies. Articles containing incomplete data for calculation of LR. Results: Five prospectives studies are included with a total of 585 patients. Prevalence of FbA is 63% in children suspected of FbA. If CP is normal, probability of FbA is 25% and if PR is normal, probability is 14%. If CP is pathologic, probability of FbA is 69-76% with presence of cough (LR = 1.32) or dyspnea (LR = 1.84) or localized crackles (LR = 1.5). Probability is 81-88% if cyanosis (LR = 4.8) or decreased breaths sounds (LR = 4.3) or asymetric auscultation (LR = 2.9) or localized wheezing (LR = 2.5) are present. When CP is anormal and PR show mediatinal shift (LR = 100), pneumomediatin (LR = 100), radio opaque foreign body (LR = 100), lobar distention (LR = 4), atelectasis (LR = 2.5), inspiratory/expiratory abnormal (LR = 7), the probability of FbA is 96-100%. If CP is normal and PR is abnormal the probability is 40-100%. If CP is abnormal and PR is normal the probability is 55-75%. Conclusions: This rewiev of prospective studies demonstrates the importance of CP and PR and an algorithm can be proposed. When CP is abnormal with or without PR pathologic, the probability of FbA is high and bronchoscopy is indicated. When CP and PR are normal the probability of FbA is low and bronchoscopy is not necessary immediatly, observation should be proposed. This approach should be validated with prospective study.

Asma y actividad física. Revisión

El asma es una enfermedad inflamatoria crónica de elevada prevalencia a nivel mundial, siendo el colectivo más afectado el formado por niños y adolescentes. Su sintomatología se caracteriza por la aparición de tos, disnea, sibilancias, sensación de opresión en el pecho y broncoconstricción. Tradicionalmente se había pensado que el deporte y el ejercicio físico estaban contraindicados en pacientes asmáticos. Por otro lado, el paciente asmático suele presentar niveles de condición física y práctica deportiva menores que los sujetos sanos. Actualmente se ha propuesto la actividad física regular como un camino válido para mejorar la percepción y el autoconocimiento personal sobre esta enfermedad. Se aconseja la prescripción de actividad física como forma de mejorar su sintomatología y evolución. La práctica de una actividad física regular en pacientes asmáticos debería ser considerada dentro de los actuales y futuros programas de salud como un objetivo fundamental.

Tratamento cirúrgico do schwannoma traqueal

Schwannoma is a rare benign tumor of the proximal tracheobronchial tree. The aim of the present study is to report a case of tracheal schwannoma causing airway obstruction. A 16-year-old woman complained of cough, wheezing and dyspneia. Bronchoscopy and computerized tomography showed a polypoide intratracheal mass obstructing approximately 80% of the lumen. The treatment consisted of tracheal resection and primary anastomosis. Histological analysis revealed a tracheal schwannoma. The postoperative course was uneventful and the patient remains well twelve months after surgery.

Patient and physician evaluation of the severity of acute asthma exacerbations

We studied the ability of patients not experienced in the use of peak expiratory flow meters to assess the severity of their asthma exacerbations and compared it to the assessment of experienced clinicians. We also evaluated which data of physical examination and medical history are used by physicians to subjectively evaluate the severity of asthma attacks. Fifty-seven adult patients (15 men and 42 women, with a mean (± SD) age of 37.3 ± 14.5 years and 24.0 ± 17.9 years of asthma symptoms) with asthma exacerbations were evaluated in a University Hospital Emergency Department. Patients and physicians independently evaluated the severity of the asthma attack using a linear scale. Patient score, physician score and forced expiratory volume at the first second (FEV1) were correlated with history and physical examination variables, and were also considered as dependent variables in multiple linear regression models. FEV1 correlated significantly with the physician score (rho = 0.42, P = 0.001), but not with patient score (rho = 0.03; P = 0.77). Use of neck accessory muscles, expiratory time and wheezing intensity were the explanatory variables in the FEV1 regression model and were also present in the physician score model. We conclude that physicians evaluate asthma exacerbation severity better than patients and that physician's scoring of asthma severity correlated significantly with objective measures of airway obstruction (FEV1). Some variables (the use of neck accessory muscles, expiratory time and wheezing intensity) persisted as explanatory variables in physician score and FEV1 regression models, and should be emphasized in medical schools and emergency settings.

Correlations between pulse oximetry and peak expiratory flow in acute asthma

Few studies are available concerning correlations between pulse oximetry and peak expiratory flow in children and adolescents with acute asthma. Although the Global Initiative for Asthma states that measurements of lung function and oximetry are critical for the assessment of patients, it is not clear if both methods should necessarily be included in their evaluation. Since there is a significant difference in cost between pulse oximetry equipment and peak expiratory flow devices, we determined whether clinical findings and peak expiratory flow measurements are sufficient to determine the severity of acute asthma. The present prospective observational study was carried out to determine if there is correlation between pulse oximetry and peak expiratory flow determination in 196 patients with acute asthma aged 4 to 15 years diagnosed according to the Global Initiative for Asthma criteria. Patients experiencing their first or second wheezing episode, with fever, related acute or chronic diseases, and unable to perform the peak expiratory flow maneuver were excluded. Measurements of peak expiratory flow and pulse oximetry were performed at admission and after 15 min of each inhaled salbutamol cycle. Correlations obtained by linear regression using the Pearson correlation coefficients (r) were 0.41 (P < 0.0001), 0.53 (P < 0.0001), 0.51 (P < 0.0001), and 0.61 (P < 0.0001) at admission and after the first, second and third cycles of salbutamol, respectively. These correlations showed that one measure cannot substitute the other (Pearson's coefficient <0.7), probably because they evaluate different aspects in the airways, suggesting that peak expiratory flow should not be used alone in the assessment of acute asthma in children and adolescents.

Remodelage du muscle lisse péribronchique dans l’inflammation respiratoire chronique

Le souffle chez les chevaux et l’asthme chez l’humain sont des maladies respiratoires qui partagent plusieurs caractéristiques, notamment des épisodes de bronchospasme et de détresse respiratoire dus à une inflammation pulmonaire inappropriée en réponse à une inhalation de substances antigéniques. Les manifestations cliniques incluent des efforts respiratoires augmentés, des sifflements et de la toux. Au niveau des voies respiratoires, on observe une augmentation du muscle lisse péribronchique, une fibrose sous épithéliale, une métaplasie/hyperplasie épithéliale et du mucus en quantité augmentée. L’augmentation du muscle lisse est particulièrement importante car elle n’affecte pas seulement le calibre basal des voies respiratoires, mais elle accentue l’obstruction respiratoire lors de bronchoconstriction. Ces changements sont regroupés sous le terme de « remodelage » et sont associés à un déclin accéléré de la fonction respiratoire chez les patients asthmatiques. Alors que les traitements actuels contrôlent efficacement le bronchospasme et relativement bien l’inflammation, leurs effets sur le remodelage sont mal connus. Dans le cadre de thèse, la réversibilité du remodelage musculaire péribronchique a été investiguée chez des chevaux atteints du souffle dans deux études longitudinales. Ces études, faites principalement sur du tissu pulmonaire prélevé par thoracoscopie, sont difficilement réalisables chez l’humain pour des raisons éthiques, ou chez d’autres animaux, car ceux-ci présentent rarement une inflammation de type asthmatique de façon spontanée. Les résultats démontrent que les chevaux atteints du souffle ont approximativement deux fois plus de muscle péribronchique que les chevaux sains d’âge similaire gardés dans les mêmes conditions, et que la prolifération des myocytes contribue à cette augmentation. Ils démontrent aussi qu’une stimulation antigénique relativement brève chez des chevaux atteints du souffle depuis plusieurs années n’accentue pas le remodelage, ce qui suggère que l’augmentation du muscle lisse atteint un plateau. Nous avons également montré que le remodelage du muscle lisse chez des chevaux adultes est partiellement réversible et que cette réversibilité peut être accélérée par l’administration de corticostéroïdes par inhalation. Il semble toutefois qu’une portion du remodelage chronique est irréversible puisque les corticostéroïdes ont accéléré la diminution du muscle mais sans toutefois mener à une amélioration plus marquée au terme de l’étude qu’avec une modification environnementale stricte. La diminution de trente pourcent observée sur un an paraît modeste mais elle démontre clairement, et pour une première fois, que le remodelage du muscle lisse présent chez des chevaux adultes malades depuis plusieurs années est au moins partiellement réversible.

Análisis de polimorfismos genéticos del receptor beta-2 adrenérgico en pacientes pediátricos asmáticos y controles sanos en una muestra de la ciudad de Bogotá

El asma bronquial es una enfermedad inflamatoria crónica, se asocia a hiperrespuesta de la vía aérea, la cual lleva a episodios recurrentes de sibilancias, tos y disnea. La entidad se ha correlacionado con una gran variedad de genes involucrados en su fisiopatología, dentro de los cuales se encuentran genes localizados en el cromosoma 5 (5q23-31), como el del Receptor ß2 Adrenérgico (RB2A). En el presente trabajo se realizó una estimación de las frecuencias de los polimorfismos Arg16Gly, Gln27Glu y Thr164Ile de este receptor, y se estudió la relación existente entre los diferentes polimorfismos y asma, así como su relación con respecto a la severidad de la enfermedad, finalmente se estimó la relación de los haplotipos conformados por estos tres polimorfismos y su asociación con la enfermedad y severidad del fenotipo asmático.

Asma ocupacional y su relación con los isocianatos

El asma ocupacional es una enfermedad cuya prevalencia esta en aumento, tanto en países desarrollados como tercermundistas. La Organización Panamericana de la Salud (OPS) atribuye del 5% al 10% de la mortalidad por causas respiratorias al asma1. En el Reino Unido se calcula que uno de cada cinco trabajadores desarrolló esta enfermedad a causa de su trabajo2. Esta patología respiratoria es ocasionada por un ambiente ocupacional específico, los síntomas que comprenden disnea, sibilancias y tos entre otros, suelen presentarse veinticuatro horas después de la exposición y característicamente mejoran en los periodos de vacaciones y los fines de semana. Se debe diferenciar entre el asma agravada por el trabajo cuando el trabajador esta previamente diagnosticado y presenta síntomas de empeoramiento de su patología al entrar en contacto con la sustancia desencadenante; y el asma ocupacional clásica donde el trabajador desarrolla la enfermedad al exponerse a la sustancia irritante. Este es un problema creciente toda vez que no se accede con facilidad a los mecanismos necesarios para un diagnóstico y manejo oportuno de estos trabajadores, debido a que no se cuenta con la infraestructura necesaria para una reubicación oportuna y tampoco se instruye al personal médico de primer nivel en el diagnostico de esta patología. En esta revisión, se analizarán algunos estudios en los que se demuestra la relación entre la exposición a los Isocianatos y el desarrollo de asma ocupacional; se concluye pues, que si bien es importante realizar un diagnóstico correcto y oportuno, iniciar el manejo médico adecuado tambien es de vital importancia, resultando fundamental también capacitar al trabajador y empleador para proteger la salud y prevenir el desarrollo de esta patología tan dramática. PALABRAS

Guía para el diagnóstico, atención integral y seguimiento de asma en niños y niñas

El Ministerio de la Protección Social encargó a la Asociación Colombiana de Neumología Pediátrica el desarrollo de una Guía Clínica sobre asma en pediatría. La Guía establece recomendaciones basadas en la mejor evidencia clínica disponible y en la racionalización del gasto. El grupo desarrollador de la guía (GDG) fue conformado por un grupo multidisciplinario que asegura que todas las áreas del conocimiento pertinentes de la enfermedad estén representadas y que toda la evidencia científica sea evaluada de forma crítica. Se aplicó la matriz de decisión: adaptación o desarrollo de novo de GPC, se eligió adaptar una o más GPC. Con base en lo anterior y con la aplicación de la matriz de decisión – adaptación o desarrollo de novo de guías de práctica clínica se decidió adaptar para Colombia las guías de atención integral de la BTS y el NAEPP, tomando como prioritaria para la adaptación la guía de atención integral de la BTS; en el área de terapia respiratoria e inhaloterapia, las preguntas se respondieron de novo por no encontrar la mejor información y aplicabilidad para nuestro medio. El GDG realizó una alianza estratégica con el Instituto de Efectividad Clínica Sanitaria (IECS) de la ciudad de Buenos Aires, este es un grupo de expertos en evaluaciones económicas de medicamentos y tecnologías sanitarias quien participó en el proceso de la elaboración de las evaluaciones económicas contenidas en la Guía y en la definición del alcance de dichas evaluaciones.