Alterações orofaciais em doenças alérgicas de vias aéreas

OBJETIVO: Apontar as possíveis alterações orofaciais decorrentes do sintoma obstrução nasal em pacientes portadores de doenças alérgicas de vias aéreas superiores, por meio de revisão de literatura. FONTES DE DADOS: Levantamento bibliográfico utilizando bancos de dados eletrônicos, como Medline, Ovid, SciELO e Lilacs, com as palavras-chave asthma, rhinitis e mouth breathing, abrangendo os 30 últimos anos. Foram incluídos artigos de revisão, estudos observacionais e ensaios clínicos. SÍNTESE DOS DADOS: A obstrução nasal é encontrada freqüentemente em doenças alérgicas de vias aéreas, como rinite e asma. A respiração bucal decorrente da obstrução nasal pode interferir de maneira direta no desenvolvimento infantil, com alterações no crescimento do crânio e orofacial, na fala, na alimentação, na postura corporal, na qualidade do sono e no desempenho escolar. CONCLUSÕES: Devido à variedade de alterações orofaciais encontradas na criança respiradora bucal decorrente de obstrução nasal por doenças alérgicas de vias aéreas, é necessário realizar diagnóstico e tratamento precoces por uma equipe multidisciplinar, composta por médico, ortodontista e fonoaudiólogo, contemplando a visão de uma via respiratória única, que traz conseqüências ao crescimento e desenvolvimento do sistema motor oral.

Salivary cortisol to assess the hypothalamic-pituItary-adrenal axis in healthy children under 3 years old

Objective: To establish reference concentration intervals for salivary cortisol in healthy children, in the morning and in the afternoon, investigating factors that interfere with the concentration measured and the possibility that circadian rhythms are present.Methods: A controlled observational study was carried out with 91 children aged 45 days to 36 months, selected at random and living in Santo Andre, state of São Paulo, Brazil. Inclusion criteria were: healthy, well-nourished, free from fever and corticoid use, subdivided by age group (five subsets) at 6-month intervals. Saliva was collected during home visits in the morning and afternoon. Cortisol was radioimmunoassayed with cortisol 3-oxime-bovine albumin antiserum.Results: the five subsets exhibited higher cortisol concentration during the morning than in the afternoon (p < 0.001), and this difference passed 30% from 1 year of age onwards. Mean concentrations, in nmol/L, were 557.86 (morning) and 346.36 (afternoon). A negative linear correlation was observed between morning concentrations and hours' sleep and frequency of meals (p < 0,05), and in the afternoon with anthropometric measurements (p < 0.05).Conclusions: Reference values for normal salivary cortisol in healthy children were established. At:45 days it was possible to observe circadian rhythms, which reached maturity at 12 months of life. Sleep and food deprivation increased morning cortisol levels.

Antibiotic treatment schemes for very severe community-acquired pneumonia in children: a randomized clinical study

Objective. To compare clinical response to initial empiric treatment with oxacillin plus ceftriaxone and amoxicillin plus clavulanic acid in hospitalized children diagnosed with very severe community-acquired pneumonia (CAP).Methods. A prospective randomized clinical study was conducted among children 2 months to 5 years old with a diagnosis of very severe CAP in the pediatric ward of São Paulo State University Hospital in Botucatu, São Paulo, Brazil, from April 2007 to May 2008. Patients were randomly divided into two groups by type of treatment: an oxacillin/ceftriaxone group (OCG, n = 48) and an amoxicillin/clavulanic acid group (ACG, n = 56). Analyzed outcomes were: time to clinical improvement (fever and tachypnea), time on oxygen therapy, length of stay in hospital, need to widen antimicrobial spectrum, and complications (including pleural effusion).Results. The two groups did not differ statistically for age, sex, symptom duration before admission, or previous antibiotic treatment. Time to improve tachypnea was less among ACG patients than OCG patients (4.8 +/- 2.2 versus 5.8 +/- 2.4 days respectively; P = 0.028), as was length of hospital stay (11.0 +/- 6.2 versus 14.4 +/- 4.5 days respectively; P = 0.002). There were no statistically significant differences between the two groups for fever improvement time, time on oxygen therapy, need to widen antimicrobial spectrum, or frequency of pleural effusion.Conclusions. Both treatment plans are effective in treating very severe CAP in 2-monthto 5-year-old hospitalized children. The only analyzed outcome that favored amoxicillin/clavulanic acid treatment was time required to improve tachypnea.

Oxigenoterapia inalatória em pacientes pediátricos internados em hospital universitário

OBJETIVO: Avaliar o uso da oxigenoterapia inalatória em crianças internadas em hospital universitário. MÉTODOS: Estudo prospectivo de crianças atendidas no Pronto-Socorro Pediátrico do Hospital das Clínicas da Faculdade de Medicina de Botucatu e que receberam oxigenoterapia durante a internação, de maio a setembro de 2005. Indicou-se oxigenoterapia se saturação de oxigênio inferior a 90% e frequência respiratória elevada para idade. Crianças em uso crônico de oxigênio ou com necessidade de ventilação mecânica foram excluídas. Foram avaliados: sintomas respiratórios, diagnósticos clínicos, saturação de oxigênio, método e tempo de oxigenoterapia e responsável pela prescrição. RESULTADOS: Foram atendidas 8.709 crianças no pronto-socorro, sendo que 2.769 (32%) apresentaram doenças respiratórias e 97 necessitaram de internação na enfermaria. Destas, 62 (64%) receberam oxigenoterapia. Das 62 crianças, 37 eram do sexo masculino e a idade variou de 2 meses a 14 anos (mediana: 8 meses). A causa de hipóxia foi pneumonia em 52 crianças (84%), asma em cinco, bronquiolite em quatro e traqueomalácia em uma. As prescrições de oxigenoterapia foram feitas por médicos, com monitoração de saturação de oxigênio por oxímetro de pulso. O tempo mediano de administração de O2 foi 6 dias e o cateter nasal foi usado em 94% dos casos, sendo raro o uso de máscaras ou capuz de oxigênio. CONCLUSÕES: A oxigenoterapia inalatória foi mais frequente em crianças com menor idade e em pacientes com pneumonia, sendo sua indicação compatível com critérios internacionais. O uso do cateter nasal mostrou-se seguro, simples, efetivo e de baixo custo.

Foreign body in the tracheobronchial tree

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.

Incidência e evolução da polipose nasal em crianças e adolescentes com fibrose cística

Nasal polyps are a clinical sign of alert for investigating Cystic Fibrosis (CF). Aims: To study the incidence of nasal polyps in children and adolescents with cystic fibrosis, its possible association with age, gender, clinical manifestations, genotype and sweat chlorine level, and its evolution with topical steroid therapy. Methods: Clinical symptoms, sweat chlorine level and genotype were studied in 23 cystic fibrosis patients. Nasal polyps were diagnosed by nasal endoscopy and treated with topical steroids during 6 months, followed by a second nasal endoscopy. Fisher test was used for statistical analysis. Results: Nasal polyps were found in 39.1% of the patients (five bilateral, four unilateral), all older than six years, recurrent pneumonia in 82.6%, pancreatic insufficiency in 87% and malnutrition in 74%. No association was seen between nasal polyps and sweat chlorine level, genotype, clinical sings of severity and nasal symptoms. Seven patients improved in their nasal polyps with topical steroids, six showed complete resolution. Conclusion: The study showed a high incidence of nasal polyps in older children, who span the entire range of clinical severity, even in the absence of clinical nasal symptoms. Topical steroid therapy showed good results. An interaction among pediatricians and otolaryngologists is necessary for diagnosis and follow-up. 2008 © Revista Brasileira de Otorrinolaringologia. All Rights reserved.

Dornase alfa improves the health-related quality of life among Brazilian patients with cystic fibrosis - A one-year prospective study

Background: Health-related quality of life (HRQOL) measurements provide valuable information about the psychological and social impact of treatment on patients with cystic fibrosis (CF). This study evaluated the HRQOL of Brazilian patients with CF and assessed the changes in HRQOL domains over 1 year after dornase alfa (Pulmozyme) introduction. Patients and Methods: One hundred fifty-six stable patients with CF and 89 caregivers answered the Portuguese-validated version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (T 0), and at 3 (T 1), 6 (T 2), 9 (T 3), and 12 (T 4) months of follow-up. Eighteen patientswere excluded because they did not fulfill the inclusion criteria. The patients were analyzed in two groups: those aged 6-11 years and those aged 14 years and older. ANOVA for observed repeated results and the last observation carried forward (LOCF) method for missing data were used for the statistical analysis. Results: After 1 year of follow-up, there was significant improvement in respiratory symptoms (T 4-T 0=8.1; 95% confidence interval (95% CI)=[2.1;14.0]; effect size (ES)=0.35; P<0.001), Emotional Functioning (T 4-T 0=5.6; 95% CI=[1.1;10.1]; ES=0.31; P<0.05), Social Functioning (T 4-T 0=6.0; 95% CI=[1.3;11.7]; ES=0.31; P<0.05), Body Image (T 4-T 0=11.9; 95% CI=[4.1;19.7]; ES=0.42; P<0.05), and Treatment Burden (T 4-T 0=5.3; 95% CI=[0.3;10.3]; ES=0.24; P<0.05) domains in the younger group. A significant improvement in Role Functioning (T 4-T 0=6.1; 95% CI=[1.1;11.1]; ES=0.40; P<0.05), Body Image (T 4-T 0=12.6; 95% CI=[3.5;21.7]; ES=0.46; P<0.05), and Weight (T 4-T 0=11.7; 95% CI=[1.8;21.6]; ES=0.40; P<0.05) was obtained in the older group. The caregivers' CFQ-R showed improvements in the Digestive Symptoms (T 4-T 0=5.5; 95% CI=[1.5;9.4]; ES=0.30; P<0.05), Respiratory Symptoms (T 4-T 0=7.6; 95% CI=[3.9;11.4]; ES=0.48; P<0.05), and Weight (T 4-T 0=10.1; 95% CI=[1.6;18.6]; ES=0.26; P<0.05) domains. Conclusion: The introduction of dornase alfa improved the HRQL of the patients with CF during the first year of treatment. © 2010 Wiley-Liss, Inc.

Qualidade de vida de crianças e adolescentes asmáticos: Sua relação com estratégias de enfrentamento materno

Objective: To evaluate the quality of life of asthmatic children and adolescents, its relation with sociodemographic and clinical variables, and maternal coping strategies. Methods: Cross-sectional study in which children and adolescents with asthma answered a quality of life questionnaire, and their mothers did the same with a coping scale. Results: Out of the 42 children and adolescents investigated, 74% were classified as having mild/severe persistent asthma; 19%, mild persistent asthma; and 7%, intermittent asthma. A total of 69% of the participants showed impaired quality of life with mean scores ranging between 4.7 and 3.5, with greater harm in the domain of symptoms (score=3.6). There was a significant association between maternal schooling and the general index of quality of life, whereas maternal coping strategies were not associated with the severity of asthma. A large number of strategies used by mothers to cope with their children's crises were related to the management of stressors or to religious practices, and the latter presented negative correlation with the children's quality of life general index, showing that mothers whose children had worse quality of life used more religious coping. Conclusions: Asthmatic children, particularly those with moderate/severe persistent asthma, showed significant alterations as to quality of life. The high percentage of mothers using religious strategies, particularly in face of more severe clinical conditions, seem to indicate that they feel powerless to act, thus requiring concrete and useful orientation to low income families.

Interpretação de perfis dos carbonatos fraturados da Bacia do Pará-Maranhão

A finalidade deste trabalho é apresentar um estudo de caso dos carbonatos terciários da bacia do Pará-Maranhão, do ponto de vista da interpretação dos perfis registrados nessa área. Dois poços-chave, X e Y, foram escolhidos para o estudo. O tratamento dos dados foi realizado utilizando os recursos do programa LOGCALC, instalado no computador IBM-3090, da Petrobrás, e, também, o sistema DLPS, instalado no VAX-8600, da Universidade Federal de Pará. A avaliação da porosidade e, principalmente, das saturações, é dificultada pelas características não-convencionais dos carbonatos. A litologia é complexa, a salinidade da água de formação é relativamente baixa, em torno de 10.000 ppm de NaCl, a densidade das rochas é elevada e os carbonatos estão fraturados. Para diminuir o efeito da composição mineralógica, foi necessário discriminar os diferentes tipos litológicos. Três tipos de carbonatos foram identificados: calcário, calcário arenoso e calcário dolomitizado. A identificação litológica permite maior controle dos parâmetros da matriz e dos expoentes de porosidade das rochas, conduzindo a estimativas de porosidade e de saturações mais confiáveis. A presença de fraturas influencia, marcadamente, a resposta dos perfis, conforme pode ser notado no perfil de identificação de fraturas, nos perfis de resistividade, de densidade e na curva de raios-gama espectral do poço X. O expoente de porosidade, m, tomado do gráfico de Pickett, é frequentemente inferior a 1,5, valor considerado inerente a rochas fraturadas. Os modelos de Rasmus (1983) e de Porter et al.(1969), foram testados para calcular as saturações de água e óleo. A equação tradicional de Archie (1942), com a e m apropriados, também foi aplicada neste trabalho. O esquema para estimativa de saturações que conduz a resultados mais coerentes com os dados dos testes de formação, nos intervalos fraturados, é a saturação de Rasmus, calculada com a relação de Archie aplicada com o expoente de porosidade variável, tomado do modelo de Rasmus.

Assessing the influence of mechanical ventilation on blood gases and blood pressure in rattlesnakes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Literacy Research: Issues of Authority, Ownership, and Representation

With the “social turn” of language in the past decade within English studies, ethnographic and teacher research methods increasingly have acquired legitimacy as a means of studying student literacy. And with this legitimacy, graduate students specializing in literacy and composition studies increasingly are being encouraged to use ethnographic and teacher research methods to study student literacy within classrooms. Yet few of the narratives produced from these studies discuss the problems that frequently arise when participant observers enter the classroom. Recently, some researchers have begun to interrogate the extent to which ethnographic and teacher research methods are able to construct and disseminate knowledge in empowering ways (Anderson & Irvine, 1993; Bishop, 1993; Fine, 1994; Fleischer. 1994; McLaren, 1992). While ethnographic and teacher research methods have oftentimes been touted as being more democratic and nonhierarchical than quantitative methods—-which oftentimes erase individuals lived experiences with numbers and statistical formulas—-researchers are just beginning to probe the ways that ethnographic and teacher research models can also be silencing, unreflective, and oppressive. Those who have begun to question the ethics of conducting, writing about, and disseminating knowledge in education have coined the term “critical” research, a rather vague and loose term that proposes a position of reflexivity and self-critique for all research methods, not just ethnography or teacher research. Drawing upon theories of feminist consciousness-raising, liberatory praxis, and community-action research, theories of critical research aim to involve researchers and participants in a highly participatory framework for constructing knowledge, an inquiry that seeks to question, disrupt, or intervene in the conditions under study for some socially transformative end. While critical research methods are always contingent upon the context being studied, in general they are undergirded by principles of non-hierarchical relations, participatory collaboration, problem-posing, dialogic inquiry, and multiple and multi-voiced interpretations. In distinguishing between critical and traditional ethnographic processes, for instance, Peter McLaren says that critical ethnography asks questions such as “[u]nder what conditions and to what ends do we. as educational researchers, enter into relations of cooperation. mutuality, and reciprocity with those who we research?” (p. 78) and “what social effects do you want your evaluations and understandings to have?” (p. 83). In»the same vein, Michelle Fine suggests that critical researchers must move beyond notions of the etic/emic dichotomy of researcher positionality in order to “probe how we are in relation with the contexts we study and with our informants, understanding that we are all multiple in those relations” (p. 72). Researchers in composition and literacy stud¬ies who endorse critical research methods, then, aim to enact some sort of positive transformative change in keeping with the needs and interests of the participants with whom they work.

Wilson's disease: an analysis of 28 Brazilian children

OBJECTIVES: Clinical-laboratory and evolutionary analysis of twenty-eight patients with Wilson's disease. METHODS: Twenty-eight children (twelve females and sixteen males) with Wilson's disease were evaluated retrospectively between 1987 and 2009, with a follow-up of 72 months (1 -240 months). The clinical, laboratory, and histologic features at diagnosis were recorded at the end of the study. RESULTS: The median age at diagnosis was 11 years (2 -18 years). Twelve patients were asymptomatic, seven had hepatitis symptoms, five had raised aminotransferase levels, three had hepatomegaly associated with neurological disorders, one had fulminant hepatitis with hemolytic anemia, and six patients presented with a Kayser-Fleischer ring. A histological analysis revealed that six children had chronic hepatitis, seven had cirrhosis, two had steatosis, one had portal fibrosis, and one had massive necrosis. The treatment consisted of D-penicillamine associated with pyridoxine for 26 patients. Adverse effects were observed in the other two patients: one presented with uncontrollable vomiting and the other demonstrated elastosis perforans serpiginosa. At the end of the study, all 26 treated patients were asymptomatic. Twenty-four of the patients were treated with D-penicillamine and pyridoxine, and two were treated with trientine and zinc sulfate. A liver transplant was performed in one patient with fulminant hepatitis, but the final patient died 48 hours after admission to the intensive care unit. CONCLUSIONS: Family screenings associated with early treatment are important in preventing Wilson's disease symptoms and potentially fatal disease progression. The study suggests that Wilson's disease must be ruled out in children older than two years presenting with abnormal levels of hepatic enzymes because of the heterogeneity of symptoms and the encouraging treatment results obtained so far.

Multiple independent origins of mitochondrial control region duplications in the order Psittaciformes

mitochondrial genomes are generally thought to be under selection for compactness, due to their small size, consistent gene content, and a lack of introns or intergenic spacers. As more animal mitochondrial genomes are fully sequenced, rearrangements and partial duplications are being identified with increasing frequency, particularly in birds (Class Ayes). In this study, we investigate the evolutionary history of mitochondrial control region states within the avian order Psittaciformes (parrots and cockatoos). To this aim, we reconstructed a comprehensive multi-locus phylogeny of parrots, used PCR of three diagnostic fragments to classify the mitochondrial control region state as single or duplicated, and mapped these states onto the phylogeny. We further sequenced 44 selected species to validate these inferences of control region state. Ancestral state reconstruction using a range of weighting schemes identified six independent origins of mitochondrial control region duplications within Psittaciformes. Analysis of sequence data showed that varying levels of mitochondrial gene and tRNA homology and degradation were present within a given clade exhibiting duplications. Levels of divergence between control regions within an individual varied from 0-10.9% with the differences occurring mainly between 51 and 225 nucleotides 3' of the goose hairpin in domain I. Further investigations into the fates of duplicated mitochondrial genes, the potential costs and benefits of having a second control region, and the complex relationship between evolutionary rates, selection, and time since duplication are needed to fully explain these patterns in the mitochondrial genome. (C) 2012 Elsevier Inc. All rights reserved.

Diversity of lithologic components at Meridiani Planum, Mars: Insights from Mössbauer spectroscopic investigations

The two Mars Exploration Rovers (MER), Spirit and Opportunity, landed on the Martian surface in January 2004 and have since collected a wealth of information about their landing sites. As part of their payload, the miniaturised Mössbauer spectrometer MIMOS II contributes to the success of the mission by identifying Iron-bearing minerals and by determining Iron oxidation states in them. The basis of this work is the data set obtained at Opportunity’s landing site at Meridiani Planum. A portion of this data set is evaluated with different methods, with the aim to thoroughly characterize lithologic components at Meridiani Planum and possible relations between them.rnMIMOS II is able to measure Mössbauer spectra at different energies simultaneously, bearing information from different sampling depths of the investigated target. The ability of depth-selective Mössbauer spectroscopy to characterize weathered surface layers is illustrated through its application to two suitable rock targets that were investigated on Mars. In both cases, an enhanced concentration of Iron oxides at the rock surface was detected, pointing to a low degree of aqueous alteration. rnThe mineral hematite (α-Fe2O3) is present in the matrix of outcrop rocks and in spherules weathering from the outcrop. Simultaneous fitting of Mössbauer spectra was applied to data sets obtained on both target types to characterize the hematite component in detail. This approach reveals that two hematite populations are present, both in the outcrop matrix as well as in spherules. The hematite component with a comparably high degree of crystallinity and/or chemical purity is present in the outcrop matrix. The investigation of hematite at Meridiani Planum has shown that simultaneous fitting is a suitable and useful method to evaluate a large, correlated set of Mössbauer spectra.rnOpportunity encountered loose, cm-sized rocks along its traverse. Based on their composition and texture, these “cobbles” can be divided into three different groups. Outcrop fragments are impact-derived ejecta from local outcrop rocks. Cobbles of meteoritic origin contain the minerals kamacite (Fe,Ni) and troilite (FeS) and exhibit high Ni contents. Melt-bearing impact breccias bear similarities to local outcrop rocks and basaltic soil, with a phase composition and texture consistent with a formation scenario involving partial melting and inclusion of small, bright outcrop clasts. rnIron meteorites on the Martian surface experience weathering through the presence of even trace amounts of water due to their metallic nature. Opportunity encountered and investigated four Iron meteorites, which exhibit evidence for physical and chemical weathering. Discontinuous coatings contain Iron oxides, pointing to the influence of limited amounts of water. rnA terrestrial analogue site for Meridiani Planum is the Rio Tinto basin in south-west Spain. With its deposits of sulfate- and iron-oxide-bearing minerals, the region provides an adequate test bed for instrumentation for future Mars missions. In-situ investigations at Rio Tinto were carried out with a special focus on the combined use of Mössbauer spectroscopy with MIMOS II and Raman spectroscopy with a field-portable instrument. The results demonstrate that the two instruments provide complementary information about investigated samples.