Potenciais impactos da variabilidade climática sobre a morbidade respiratória em crianças, lactentes e adultos / Potential impacts of climate variability on respiratory morbidity in children, infants, and adults

OBJETIVO: Estudar a relação existente entre a o número de internações por doenças do aparelho respiratório em lactentes, crianças e adultos e as variações meteorológicas na cidade de Campo Grande (MS). MÉTODOS Foram utilizados dados diários de internações por doenças respiratórias, precipitação, temperatura do ar, umidade e velocidade dos ventos entre 2004 e 2008. Foram calculados os índices de conforto térmico humano, temperatura efetiva e temperatura efetiva com velocidade do vento com base nas variáveis meteorológicas. Foram realizados modelos lineares generalizados utilizando o modelo múltiplo de regressão de Poisson para predizer as internações por doenças respiratórias. RESULTADOS: Foram observados valores relativamente elevados dos coeficientes de correlação entre as variáveis estudadas e internações por pneumonia em crianças (R² = 68,4%), lactentes (R² = 71,8%) e adultos (R² = 81,8%). CONCLUSÕES: Os resultados aqui apresentados indicam em termos quantitativos o risco para um aumento no número de hospitalizações de crianças, lactentes e adultos de acordo com o aumento ou a diminuição das temperaturas, umidade, precipitação, velocidade dos ventos e índice de conforto térmico na cidade de Campo Grande.

OBJECTIVE: To determine whether climate variability influences the number of hospitalizations for respiratory diseases in infants, children, and adults in the city of Campo Grande, Brazil. METHODS: We used daily data on admissions for respiratory diseases, precipitation, air temperature, humidity, and wind speed for the 2004-2008 period. We calculated the thermal comfort index, effective temperature, and effective temperature with wind speed (wind-chill or heat index) using the meteorological data obtained. Generalized linear models, with Poisson multiple regression, were used in order to predict hospitalizations for respiratory disease. RESULTS: The variables studied were (collectively) found to show relatively high correlation coefficients in relation to hospital admission for pneumonia in children (R² = 68.4%), infants (R² = 71.8%), and adults (R² = 81.8%). CONCLUSIONS: Our results indicate a quantitative risk for an increase in the number of hospitalizations of children, infants, and adults, according to the increase or decrease in temperature, humidity, precipitation, wind speed, and thermal comfort index in the city under study.

Actividad espontánea de nociceptores cutáneos en pacientes con neuropatía de fibras delgadas / Spontaneous activity of cutaneous nociceptors in patients with painful polyneuropathy. Report of three patients

Background: Painful polyneuropathy may result from selective impairment of small diameter nerve fibers, while tactile and motor functions are preserved. In these patients clinical and electrophysiological assessment is usually unrevealing. We report three patients with a pure painful polyneuropathy. One of them had neurogenic pruritus additionally. Quantitative sensory analysis disclosed a slight warm hypoesthesia (3/3) and paradoxical hot sensation (2/3) in the feet. Intraneural recordings from the peroneal nerve demonstrated abnormal spontaneous activity in 8 of 17 nociceptive afferents. One of them displayed double firing reflecting impulse multiplication. These results support the notion that patients with pain or pruritus with a distal distribution similar to a polyneuropathy, could have small diameter afferent fiber damage, despite normal function of large diameter fibers.

Thermal record of the test tubes method used for small fibers assessment / Registro térmico do método dos tubos de ensaio aplicado na avaliação de fibras finas

In Brazil, the test that uses test tubes filled with cold water (25ºC) and tubes filled with water heated to a temperature of 45ºC is recommended by the Ministry of Health as a way of evaluate thermal sensitivity on the injured skin of leprosy patients. The purpose of this work was to quantify the thermal stimulation applied to the skin, as well as the temperature variation of the heated water and of the tube's outer surface during stimulation sessions. The experiment had the participation of 14 healthy volunteers (31.2±11.4 years-old), ten of which were male (33.1±13.5 years-old) and four were female (26.5±4.7 years-old). Three consecutive stimulation sessions were carried out, each of them with four stimuli. The maximum skin temperature at the end of the stimuli was measured at 35.8±0.6ºC. Such temperature values may be useful in the assessment of the loss of small fibers, which are responsible for the sensation of warmth.

No Brasil, o teste que utiliza tubos de ensaio preenchidos com água aquecida (45ºC) e resfriada (25ºC) é preconizado pelo Ministério da Saúde como forma de avaliar a sensibilidade térmica nas lesões de pele de pacientes com hanseníase. O objetivo deste trabalho foi quantificar o estímulo térmico na pele e a variação das temperaturas da água aquecida e da superfície externa do tubo, durante as sessões de estimulação. O experimento contou com 14 voluntários saudáveis (31,2±11,4 anos), sendo dez do gênero masculino (33,1±13,5 anos) e quatro do gênero feminino (26,5±4,7 anos). Realizaram-se três sessões seguidas de estimulação com quatro estímulos em cada sessão. A temperatura registrada na pele, ao final dos estímulos, apresentou diferenças entre as sessões, atingindo o máximo de 35,8±0,6ºC. Estes valores de temperatura podem ser úteis na avaliação da perda de fibras finas responsáveis pela sensação de aquecimento.

Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies / Validação de um aparelho brasileiro de teste de quantificação sensitiva brasileiro para o diagnóstico de neuropatia de fibras finas

Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

Teste de quantificação sensitiva (TQS) significa determinação de limiares de percepção sensitiva frente a um estímulo de intensidade controlada. Nosso objetivo foi validar um novo equipamento de TQS adaptado à população brasileira. Em 20 adultos saudáveis, limiares termoalgésicos foram avaliados, utilizando um aparelho protótipo do TQS (Heat Pain Stimulator-1.1.10; Brazil). Foi utilizado um termodo de 30 × 30 mm², com estímulo térmico de 1°C/s. A média dos limiares de três estímulos consecutivos foi obtida em duas sessões diferentes, separadas por pelo menos 2 semanas. Adicionalmente, foram aplicados estímulos térmicos dolorosos de longa duração. Para avaliar a consistência do nosso método, foram também analisados 11 pacientes com neuropatia de fibras finas. Os resultados mostraram boa reprodutibilidade dos limiares de percepção nos indivíduos saudáveis, assim como limiares anormais nos pacientes. Em conclusão, nosso aparelho de TQS apresentou boa confiabilidade ao analisar a via nociceptiva de controles e pacientes.

Utilizacao dos monofilamentos de Semmes-Weinstein na avaliacao de sensibilidade dos membros superiores de pacientes hansenianos atendidos no Distrito Federal / ?

Como o comprometimento neural e marcante em todas as formas clinicas da hanseniase, o presente trabalho teve como objetivo identificar a incidencia das alteracoes de sensibilidade nos membros superiores dos pacientes hansenianos inscritos no Programa de Controle da Hanseniase do Distrito Federal. Trata-se de um estudo descritivo de delineamento transversal cuja amostra constou de 80 pacientes e o instrumento utilizado na coleta de dados foram os monofilamentos de Semmes-Weinstein, tambem connhecidos como Estesiometro (modelo de bolso - Senskit). Os resultados foram trabalhados atraves de analise estatistica descritiva, que mostrou um predominio das formas Virchowianas (67,5 por cento)seguidos dos Tuberculoides (16,2) e Dimorfos (13,8). De uma maneira geral os pacientes concentraram-se nas faixas etarias de maior produtividade laborativa e de trabalho.

Neuropatía diabética: sensibilidad térmica y control metabólico en diabéticos no insulinodependientes / Diabetic neuropathy: thermal sensation and metabolic control in non insulin dependent diabetics

Background: The early detection of peripheral neuropathy in diabetics is important since it is the main riskfactor for lower limb trophic lesions in diabetics. Aim: To assess the relationship between feet thermal sensation threshold and metabolic control in ambulatory non-insulin-dependent diabetics. Pattients and methods: A random sample of 34 non-insulin-dependent diabetic followed for more than five years in a special clinic, out of 368 patients, was selected. Warmth sensation thresbolds were measured in the dorsum of booth feet using a MSTP-III thermostimulator The average value of all glycosylated hemoglobins obtained during the 9.7 ñ 5.3 years of follow up for each patient was calculated. A multiple stepwise regression analysis was performed between thermal sensation as the dependent variable and glycosylated hemoglobin, fasting blood glucose, age and diabetes duration. Results: The regression model disclosed glycosylated hemoglobin as the only independent predictor of warmth sensation threshold (partial r= 0.385; p= 0.043). Fifteen diabetic patients with metabolic control, defined as those with a mean glycosylated hemoglobin of less than 9.5 percent, had a warmth sensation threhold of 35.6 ñ 3.7 ºC, whereas 19 diabetics with a bad control (glycosylated hemoglobin 9.5 percent) had a threshold of 39 ñ 3.8 ºC(p= 0.017). Conclusions: In this group of diabetics there is a relationship between the severity of distal polyneuropathy and the metabolic contrl, assessed with glycosylated hemoglobin levels

Buscando indicadores de riesgo de pie diabético: parte II: umbrales de sensibilidad al calor medidos con el aparato de sensibilidad térmica / Searching risk indicators of diabetic foot: part II: sensory threshold to heat measured with termical sensibility instrument

La aplicación de nueva tecnología para medir neuropatía diabética es crucial para la detección de grupos de alto riesgo de pie dibético. Objetivos: evaluar la medición de umbrales de sensibilidad al calor, como potencial predictor de pie diabético. Material y método: grupo C, controles no diabéticos (n=16; 47,1 ñ 8,2 años) grupo D controles diabéticos (n=14; 61,3 ñ 10,2 años; HbA1=10,6 ñ 1,6 por ciento; duración= 12,7 ñ 6,0 años), y grupo U, diabéticos con úlcera del pie (n=6; 62,1 ñ 10,3 años, HbA1=9,9 ñ 0,9 por ciento, duración= 21,8 ñ 11,8 años). Medimos umbrales de sensibilidad al calor (USC) en pies, piernas, región radiocarpiana, brazos y cara con nuestro aparato de sensibilidad térmica, sensibilidad a la corriente eléctrica en nervios peroneo y mediano con neurometer (5 Hz, 250 Hz y 2000 Hz), y sensibilidad a la presión con monofilamento. Pletismografía más presiones segmentarias doppler fueron usadas para estudiar enfermedad y vascular periférica. Resultados: 4/14 del grupo D y 0/6 del gupo U tuvieron calcificación arterial (p>0,05). 2/14 del grupo D y 2/6 del grupo U tuvieron estenosis arterial (p>0,05). Los índices de monofilamento en grupos C,D y U fueron: 6,0 ñ 0,0, 5,2 ñ 2,0 y 1,0 ñ 1,0 (p<0,01). Los umbrales de sensibilidad a la corriente (nervio peroneo, 2000 Hz, mA x 10-2) fueron, en grupos C,D y U: 386,6 ñ 117,5, 517,7 ñ 280,4, y 871,3 ñ 244,7 (p<0,005). Los USC en el pie fueron (ºC) en grupos C,D y U: 32,0 ñ 5,21, 35,39 ñ 5,79, y 42,36 ñ 2,69 (p<0,03). Las tasas de verdaderos positivos/falsos positivos [punto de corte] fueron: 1,0/0,21 [38,0 ºC] para los USC en el pie, 0,83/0,14 [5,0 puntos] para el monofilamento, y 0,83/0,42 [400 mA x 10-2] para el neurometer. Conclusiones: los umbrales de sensibilidad al calor en el pie tienen la mejor combinación de verdaderos positivos/falsos positivos como potencial predictor de úlcera de los pies en diabéticos

Assessment of newborn baby's temperature by human touch: a potentially useful primary care strategy.

Fifty healthy term neonates delivered at All India Institute of Medical Sciences Hospital were assessed by three pediatricians for skin temperature to the nearest +/- 0.5 degrees C at the three body sites, i.e., mid-forehead, abdomen and dorsum of right foot by touch. The predicted temperatures at different sites were compared with simultaneously recorded temperatures at the same sites with the help of an electronic thermometer having a sensitivity of +/- 0.1 degree C. Rectal temperature was also recorded in all the babies with a rectal thermister to compare the variations between the core and skin temperatures. There was a good correlation between the skin temperatures of the babies as perceived by touch and values recorded with the help of an electronic thermometer. All the hypothermic babies were correctly picked up by all the observers. There was good correlation between core temperature and skin temperature at different sites except forehead. It is amazing that even during the month of May, when ambient temperature was maintained between 26-28 degrees C, nearly one fifth of the healthy term babies were under cold stress as evidenced by greater than 2 degrees C difference between the core and peripheral skin temperatures. It is recommended that health professionals and mothers should be explained the importance of evaluating the core and peripheral skin temperature by touch for early identification of babies under cold stress in order to prevent occurrence of life threatening hypothermia.