Ferramentas para avaliação e acompanhamento da urticária crônica / Patient-reported outcomes for the evaluation and follow-up of chronic urticaria

Urticária é uma doença pruriginosa da pele na qual ocorrem urticas e/ou angioedema. A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica tem um grande impacto na vida diária do paciente. Atualmente, não há biomarcadores confiáveis para identificar e medir a atividade da doença na urticária crônica espontânea. Consequentemente, o uso de ferramentas conhecidas por patient-reported outcomes (PROs) é crucial ao avaliar e monitorar diferentes aspectos da urticária crônica, como atividade/gravidade da doença, controle da doença e qualidade de vida. Apresentamos uma visão geral de cinco PROs usados na avaliação da urticária crônica, e destacamos suas vantagens, limitações e uso na prática clínica e pesquisa.

Urticaria is an itching skin disease characterized by the presence of wheals and/or angioedema. Urticaria is defined as chronic when it persists for 6 weeks or more. Chronic urticaria has great impact on the daily lives of patients. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, the use of tools known as patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of the five PROs used in the evaluation of chronic urticaria, highlighting their advantages, limitations, and use in clinical practice and research.

Conhecimento sobre asma de pediatras de hospitais públicos do Rio de Janeiro / Asthma knowledge among pediatricians at public hospitals in Rio de Janeiro, Brazil

Objetivo: Avaliar o conhecimento, atitudes e práticas sobre asma de pediatras que atuavam em serviços públicos hospitalares. Métodos: Estudo descritivo transversal envolvendo 76 pediatras de quatro hospitais públicos de emergência do município do Rio de Janeiro (RJ). Foram avaliados o conhecimento global (CGA) e específico sobre asma, além de atitudes e práticas, como frequência de prescrição de ß2-agonistas através de aerossol dosimetrado (AD), encaminhamento ao especialista, uso de espaçadores e do medidor do pico de fluxo expiratório (PFE). Resultados: Em relação ao CGA, 73,7% (55/76) da amostra total obteve conceito final insuficiente. Classificação e tratamento da asma alcançaram os percentuais mais baixos de acertos, 23,7% e 14,5% respectivamente. Somente 13,2% dos participantes utilizaram o PFE frequentemente, e a prescrição de ß2-agonistas através de AD foi indicada por apenas 21,9% da amostra, porém esta prática associou-se de modo significativo com o uso frequente de espaçadores (RP = 8,75; IC 95%: 1,07-71,06; p = 0,028) e do PFE (RP = 10,80; IC 95%: 2,31-50,45; p = 0,003). Houve forte associação entre ser alergista/pneumologista pediátrico e CGA suficiente (RP = 8,28; IC 95%: 1,46-46,8; p = 0,015) e uso frequente do PFE (RP = 6,64; IC 95%: 1,22-35,95; p = 0,044). Conclusões: O nível de conhecimento sobre asma dos pediatras que atuavam nos hospitais de emergência avaliados foi insatisfatório. Houve baixa utilização do PFE e subutilização de ß2-agonistas através de AD. A especialização melhorou a compreensão global da doença. Estes resultados reforçam a necessidade de estratégias na educação médica continuada, voltada para asma infantil, nos hospitais públicos do Município do RJ.

Objective: To evaluate asthma knowledge, attitudes and practices among pediatricians working at public hospital services in Rio de Janeiro, Brazil. Methods: This cross-sectional study involved 76 pediatricians working at four publicly funded municipal emergency hospitals in Rio de Janeiro. Global knowledge on asthma (GKA) as well as specific knowledge, attitudes and practices such as frequency of prescription of inhaled ß2-agonists (in aerosol formulation), when to refer patients to specialists, use of spacers and peak expiratory flow (PEF) meters, were evaluated. Results: Regarding GKA, 73.7% of the sample (55/76) showed an insufficient final score. Asthma classification and treatment reached the lowest percentages of correct answers, with 23.7% and 14.5%, respectively. Only 13.2% of the participants used PEF meters regularly, and only 21.9% prescribed inhaled ß2-agonists; however, the latter practice was significantly associated with the use of spacers (PR = 8.75, 95%CI 1.07-71.06; p = 0.028) and PEF meters (RP = 10.80, 95%CI 2.31-50.45; p = 0.003). There was a strong association between being a pediatric allergist/ pulmonologist and having sufficient GKA knowledge (PR = 8.28, 95%CI 1.46-46.8; p = 0.015) and using a PEF meter frequently (PR = 6.64, 95%CI 1.22-35.95; p = 0.044). Conclusions: The level of asthma knowledge among pediatricians working at the emergency hospitals evaluated was unsatisfactory. There was a low frequency of use of PEF meters and also underuse of inhaled ß2-agonists. Being a specialist improved the global understanding of the illness. These results reinforce the need for continued medical education strategies focused on childhood asthma at public emergency hospitals in the city of Rio de Janeiro.

Histophatology and ultrastructure of Henneguya caudalongula sp. n. infecting Prochilodus lineatus (Pisces: Prochilodontidae) cultivated in the state of São Paulo, Brazil

The histological and ultrastructural characteristics of a new species of Henneguya and the host reactions to infection by this species are reported. Henneguya caudalongula sp. n. was found in the inter and intralamellar regions of the gills of Prochilodus lineatus (Valenciennes, 1836) cultivated at Center for the Research and Management of Continental Fishing Resources located in the municipality of Pirassununga, state of São Paulo, Brazil. The plasmodia were white and round or ellipsoidal and measured 0.2 to 1 mm in length. The development of the parasite was asynchronous and the mature spores were fusiform, with a total length 71 ± 1.4 æm, body length of 16.6 ± 0.54 æm and width 4.6 ± 0.2 æm. The caudal process was 52.6 ± 1.5 æm long. The polar capsules were elongate (length 6.1 ± 0.19 æm, width 1.6 ± 0.15 æm) and of equal size. The polar filament was coiled in 10-11 turns. The prevalence of the parasite was 48.3 percent and did not vary significantly with the season or host size.

A new species of Henneguya, a gill parasite of Astyanax altiparanae (Pisces: Characidae) from Brazil, with comments on histopathology and seasonality

A new species of Myxosporea, Henneguya chydadea, is described parasitizing the gills of Astyanax altiparanae collected from a lake on Rio das Pedras farm near Campinas, state of Säo Paulo, Brazil. Of the fish examined, 88.3 percent had gills parasitized by myxosporeans. The prevalence of the parasite ranged from 80 percent in the spring and fall, 93 percent in the summer and 100 percent in the winter. The parasite induced the formation of white, oval-shaped cysts measuring 40-64 æm x 64-80 æm which deformed the gill lamellae, compressed the capillaries, and caused retraction of the neighboring lamellae. The mature spores were elongated and had two identical, parallel elongate polar capsules. Each capsule contained a polar filament with 9-10 turns. There was no mucous envelope or iodinophilous vacuole. Morphometric differences between this parasite and other species of the genus Henneguya indicated, that he parasite observed in A. altiparanae is a new species. This is the first report of a myxosporeanparasitizing A. altiparanae

Myxobolus absonus sp. n. (Myxozoa: Myxosporea) parasitizing Pimelodus maculatus (Siluriformes: Pimelodidae), a South American freshwater fish

A new myxoporean species is described from a freshwater fish in Brazil. Myxobolus absonus sp. n. was found infecting Pimelodus maculatus captured in the river Piracicaba, State of Säo Paulo, Brazil. Cysts were found free in the opercular cavity. The spores are large (length-15.7 ± 1.5 µm, width-10.2 ± 0.7 µm; mean ± S.D.) and oval in shape, with the anterior end slightly pointed. The spore valves are relatively thin, smooth, and asymmetrical in a frontal view. The polar capsules are pyriform in shape, and unequal in size; the largest are 6.4 ± 0.7 µm long and 3.6 ± 0.5 µm wide, while the smallest are 4.2 ± 0.6 µm long and 2.5 ± 0.5 µm wide

Brachylaima mazzantti trematoda first record in zenaida auriculata aves columbidae

Veintitres ejemplares de zenaida auriculata Des Murs, 1847 fueron capturados en el municipio de Junqueirópolis en la región oeste del estado de Sao Paulo, Brasil. Brachylaima mazzantii (Travassos, 1927) Dollfus, 1935 fue encontrado parasitando a uno de los ejemplares examinados. Este es el primer registro de este tremátodo en palomas del género zenaida

Prevalence and intensity of Haemoproteus columbae in three species of wild doves from Brazil

The prevalence and intensity of blood parasites in three species of wild doves were studied in the municipality of Junqueirópolis, in the western region of the State of São Paulo, Brazil. Three species of doves were surveyed: 331 specimens of Zenaida auriculata Des Murs, 1847, 62 specimens of Columbina talpacoti Temminck, 1811 and 57 specimens of Scardafella squammata Lesson, 1831. Haemoproteus columbae Kruse, 1890 was found in blood from all the doves species. The prevalence of this parasite was 100 percent in Z. auriculata, 51.6 percent in C. talpacoti and 19.3 percent in S. squammata. Specimens of Z. auriculata had a higher intensity of infection than the other doves species

Eimeria curvata n. sp.(Apicomplexa: Eimeriidae) in Columbina talpacoti and Scardafella squammata (Aves: Columbidae) from Brazil

Eimeria curvata is a new coccidian described in the doves Columbina talpacoti and Scardafella squammata from western of the State of São Paulo, Brazil. The oocysts are ovoid to ellipsoid, 18.3 (17-19) µm x 15.5 (15-17) µm, with a shape index of 1.2 (1.1-1.3). The wall is colorless, smooth and double-layered. A polar granule is present, but there is no micropyle or oocyst residuum. The sporocysts are elongate, 12.3 (11.5-13) µm x 5.8 (5.5-6) µm with a curved anterior portion and a smooth, thin, single-layered wall. The Stieda body is protuberant and nipple-like; there is no substieda body. The sporozoites lie head-to-tail in the sporocyst and contain a large refractile body at the extremities. The sporocyst residuum contains small granules uniformly distributed in the middle of the sporocyst. The prevalence of E. curvata n. sp. was 17.4 per cent and 12.8 per cent in C. talpacoti and S. squammata, respectively.

Giardiose e criptosporidiose em creches no município de Campinas, SP / Giardiases and cryptosporidiasis in child care settings in the municipality of Campinas, Säo Paulo State

The prevalence of the Giardia duodenalis and Cryptosporidium parvum infections were studied in children 2-60 months old (n = 310) grouped to sex and age, enrolled in 8 day-care centers. Giardiasis was found in 42 (13.5 per cent) of the children and, was most frequent in the age group corresponding to 19-24 months old although children at the first six months of life also presented positive faecal samples. Statistical analysis indicated no association between sex (p > 0.05) and prevalence for Giardia infection. C. parvum was detected in 20 (6.4 per cent) of the children. Children seven to twelve months old showed the greatest prevalence of this parasite. There were not oocysts in the stools from the children 25-30 months and from those older than 36 months. Oocytes were detected in 4 children from the 0-6 months old group. There was no significative difference on sex (p = 0.09) and day-care-facility (p = 0.068) for C. parvum infection while age was associated with infection (p = 0.004). Epidemiological aspects were studied by familiar inquiry, by parasitological examinations of stools from the contact-members of each case and from animals present at the residence. Prevalence for C. parvum was higher when at least one of the parents was a professional in the Human Health Centers (73.6 per cent positives), when there was report of concomitant disease (52.6 per cent positives) and when diarrhoea was the main symptom at the collection of the faecal specimens (78.9 per cent positives). Faecal examinations of the domestic animals were negatives for these two parasites.

Casos de leishmaniose tegumentar americana por Leishmania (Viannia) braziliensis nos Municípios de Cosmópolis e Indaiatuba-regiäo de Campinas, Estado de Säo Paulo, Brasil / Cases of mucocutaneous leishmaniasis due to Leishmania (Viannia) braziliensis from Cosmópolis and Indaituba municipalities - Campinas region, State of Säo Paulo, Brazil

A study was carried out to identify Leishmania species involved in skin lesions of patients from Cosmópolis and Indaiatuba, State of Säo Paulo, Brazil. The epidemiological data of cutaneous leishmaniasis in two cities suggested a epidemic situation in 1994. The lesions were clinically characteristic of cutaneous leishmaniasis and five out six patients responded positively to Montenegro's intradermal test. The histopathology of skin lesions were characterized by two patterns: exudative-cellular reaction and exudative granulomatous reaction. The clinical and histopathological parameters suggested Leishmania (Viannia) braziliensis as the possible etiologic agent. In agreement, it was difficult to isolate and maintain the parasite in the laboratory. Characterization by in situ hybridization with kDNA amastigotes from lesions fragments confirmed that Leishmania (Viannia) braziliensis was the parasite responsible for the studied cutaneous lesions.

Verificaçäo de antagonismo entre larvas de Schistosoma mansoni e larvas de outros Digenea em Biomphalaria tenagophila, molusco planorbídeo de criadouro natural situado na regiäo de Campinas, SP, Brasil / Verification of the antagonism between larvae of Schistosoma mansoni and those of other Digenea in Biomphalaria tenagophila, a planorbid molusc from a natural breeding ground in the region of Campinas, SP, Brazil

Foi observado o comportamento de larvas de S. mansoni em moluscos prévia e naturalmente infectados por larvas de outros Digenea. Foi verificado que as larvas de S. mansoni näo se desenvolveram nos moluscos previamente infectados com purcocercárias longifurcadas com ocelos ou com furcocercárias longifurcadas sem ocelos. Observou-se resistência parcial ao desenvolvimento de S. mansoni nos moluscos previamente infectados por equinostomocercárias ou por distomocercárias com acúleo. A ausência de reaçäo amebocitária em torno dos esporocistos de S. mansoni nos moluscos infectados por outros digenéticos parece indicar a näo participaçäo dos amebócitos na resistência oferecida ao desenvolvimento das larvas de S. mansoni

Urocleidoides astyanacis n. sp. Mongenva ancyrocephalinae from frescwater characidians on the genus Astyanax

Uma nova espécie de Urocleidoides, U. astyanacis (Monogenea, Ancyrocephalinae) é descrita dos lambaris Astyanax scabripinnis (Jenyns, 1842) e de A. fasciatus (Cuvier, 1819). Os hospedeiros foram coletados nos rios Atibaia e Jaguari, próximo a Campinas, Estado de Säo Paulo, Brasil

Algumas consideraçöes sobre cercárias naturalmente encontradas em Biomphalaria Tenagophila (Orbigny, 1835), capturados em Louveira, SP / Some considerations about cercarias naturally joined in Biomphalaria Tenagophila (Orbigny, 1835), captured in Louveira, SP

O exame parasitológico efetuado em numerosos exemplares de Biomphalaria tenagophila (Orbigny,1835), capturados em Louveira, SP, revelou o parasitismo por cinco diferentes espécies de digenéticos, näo sendo infrequente o parasitismo contemporâneo por mais de uma espécie. Foi feito um estudo comparativo entre as cercárias ora encontradas e as descritas por Ruiz em B. tenagophila e B.glabrata (Say, 1818). Opinam os A. A. que as cercárias por eles encontradas näo se ajustam às descritas por Ruiz