Asthma management and asthma control level in children / 中国当代儿科杂志

OBJECTIVES@#To investigate the influencing factors for asthma management and asthma control level in children.@*METHODS@#A total of 202 children with a confirmed diagnosis of asthma were enrolled. The questionnaire of asthma control level and family management was used to investigate the influencing factors for asthma control level and the indicators of family management. The awareness of childhood asthma and its management was analyzed among the parents, as well as the influence on asthma control level in children, and the association between them was analyzed.@*RESULTS@#Compared with the non-complete control group, the complete control group had significantly longer course of asthma and treatment time (P<0.05). The proportions of asthma attacks ≥3 times and aerosol treatment for asthma attacks >3 times in one year in the complete control group were significantly lower than those in the non-complete control group (P<0.05). The complete control group had a significantly lower proportion of children with frequent respiratory infection, wheezing during respiratory infection, or a family history of allergic diseases (P<0.05). The parents in the complete control group had significantly stronger awareness of short-term escalation to asthma medication after respiratory infection and significantly enhanced management of maintenance medication (P<0.05). Compared with the complete control group, the non-complete control group had a significantly higher proportion of children with abnormal pulmonary function at the initial stage (P<0.05). The level of asthma control in children was associated with short-term escalation to asthma medication during respiratory infection and initial lung function (P<0.05).@*CONCLUSIONS@#The level of asthma control in children is closely associated with the severity of asthma and the comprehensive management of childhood asthma. Early treatment and family management, especially escalation to asthma medication during the early stage of respiratory infection, are of great importance in asthma control. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(1): 73-79.

Algunos desafíos en mucopolisacaridosis tipo I / A few challenges in mucopolysaccharidosis type I

Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto

Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care

Alergia a los metales / Metal allergy

La presencia de metales en contacto con piel o mucosas puede ocasionar en personas sensibles, reacciones de distintos tipo que, muchas veces, no es posible determinar su origen. Ante la sospecha se puede recurrir a un estudio hematológico de laboratorio (Test Melisa) (AU)

The metal exposure in sensitive people could produce, local or general, different reactions of hypersensitive. The Melisa Test is a blood work that could make a diagnosis of those types of allergies (AU)

Hipersensibilidad a corticoides y manejo en asma severa. A propósito de un caso / Hipersensitivity to corticosteroids and management of severe bronchial asthma. Case study

Resumen Las reacciones de hipersensibilidad a corticoides son raras en la población general, se dividen en dos categorías: Inmediatas, típicamente mediadas por Inmunoglobulina E (IgE), donde se incluye la anafilaxia luego de la administración de un fármaco en un corto período. Su prevalencia descrita es de 0,3-0,5%. Otra reacción es la 'no inmediata', que se manifiesta en un tiempo mayor de una hora después de la administración del fármaco. Se revisó la literatura con el objetivo de mejorar y aclarar el tratamiento en pacientes asmáticos que poseen esta condición. Se encontró que las vías posibles para generar estas reacciones son intranasal, aerosol por inhalador, oral y parenteral. Frente a esta condición se requiere una evaluación estrecha y detallada de la historia clínica, síntomas y reacciones secundarias al fármaco sospechoso. Finalmente, al momento de elegir tipo de corticoide a usar es primordial la seguridad del paciente logrando, además, el control de la enfermedad.

Hypersensitivity reactions to corticosteroids are rare in the general population, they fall into two categories: 'immediate', typically mediated by immunoglobulin E (IgE), which includes anaphylaxis after administration of a drug in a short period of time. Its reported prevalence is 0.3-0.5%. Another reaction is 'not immediate', which manifests itself in a time longer than one hour after the administration of the drug. We reviewed the literature with the aim of improving and clarifying the treatment in asthmatic patients with this condition. It was found that the possible routes to generate these reactions are intranasal, aerosol by inhaler, oral and parenteral. Facing this condition requires a close and detailed evaluation of the clinical history, symptoms and side reactions to the suspected drug. Finally, when choosing which corticosteroid to use, the patient's safety is paramount, and control of the disease is also essential.

Crossense em paciente portador de marcapasso por hipersensibilidade do seio carotídeo / Far-field in patient with pacemaker due to carotid sinus hypersensitivity

Relata-se o caso de um paciente portador de marcapasso dupla-câ- mara, implantado por hipersensibilidade do seio carotídeo, que, em consulta ambulatorial, manifestou reaparecimento tardio dos sintomas que apresentava antes do implante do dispositivo. Após descartar alterações de limiares, sensibilidade ou impedância do sistema de estimulação cardíaca, foi realizada massagem do seio carotídeo e evidenciada inibição inadequada da estimulação ventricular. A radiografia de tórax revelou tratar-se de cabo-eletrodo ventricular posicionado em região látero-basal do ventrículo esquerdo via seio coronário. O problema foi corrigido com ajustes dos parâmetros, devidamente comprovado com a não reprodutibilidade do evento

We report the case of a patient with a dual-chamber pacemaker for carotid sinus hypersensitivity who, at an outpatient visit, presented a late resumption of the symptoms observed before the implantation of the device. After discarding threshold, sensitivity or impedance changes of the cardiac stimulation system, carotid sinus massage was performed and inadequate ventricular pacing inhibition was evidenced. A chest X-ray showed the ventricular lead had been placed at the laterobasal region of left ventricle through the coronary sinus. The problem was corrected by adjusting the parameters, and this was confirmed by a discontinuation of the event

Cross-Reactivity between Oak and Birch Pollens in Korean Tree Pollinosis

Oak and birch trees belong to Fagales order. Specific IgE to pollen allergens of both trees are frequently found in Korea pollinosis patients. Oak trees which comprise 40% of forest area are common in Korea. However, birch trees are sparse. We compared the allergenicity of pollen extracts of white oak, sawtooth and Mongolian oaks which are prevalent species in Korea, with the pollen extract of birch. The cross-reactivity of four pollen extracts was examined with pooled sera of 12 patients by ELISA, immunoblotting and CAP inhibitions. A protein of 17 kDa, putatively homologous to a major birch allergen Bet v 1, displayed strong IgE reactivity from white oak and sawtooth oak pollen extract but not from Mongolian oak pollen. Notably, a 23-kDa protein from sawtooth and white oaks showed strong IgE reactivity and inhibited by Bet v 1. IgE binding to white oak was inhibited a maximum of 94.6% by white oak, 93.4% by sawtooth oak, 83.2% by Mongolian oak, and 68.8% by birch. Furthermore, sawtooth oak, white oak, and Mongolian oak extracts were able to inhibit up to 78.5%, 76.6% and 67.3% of IgE binding to birch extract, while birch extract itself inhibited up to 94.3%. Specific IgE to Bet v 1 was inhibited a maximum of 79.1% by sawtooth oak, 77.4% by white oak, and 72.7% by Mongolian oak, while 81.5% inhibition was shown by birch. Bet v 1 was able to partially inhibit its homologous molecules from sawtooth oak and white oak in immunoblotting. Birch pollen extract was found to be cross-reactive primarily with Bet v 1-homologous allergen from oak pollens in Korea pollinosis patients. Considering the sparseness of birch tree in Korea, oak, especially sawtooth oak may be the main cause of tree pollinosis in Korea, rather than birch.

Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil / Características clínicas de crianças e adolescentes brasileiros com asma grave resistente a terapia

AbstractObjective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA) treated at a referral center in southern Brazil.Methods: We retrospectively analyzed children and adolescents (3-18 years of age) with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting β2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results.Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years). Of those, 18 (86%) were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody), 7 (87.5%) showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations.Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

ResumoObjetivo: Descrever as principais características clínicas, a função pulmonar, as características radiológicas e o perfil inflamatório do escarro induzido de crianças e adolescentes com asma grave resistente a terapia (AGRT) tratados em um centro de referência do sul do Brasil.Métodos: Foram analisadas retrospectivamente crianças e adolescentes de 3-18 anos com diagnóstico de AGRT não controlada acompanhados durante pelo menos 6 meses e tratados com doses elevadas de corticoide inalatório associado a um β2-agonista de longa duração. Foram coletados prospectivamente dados relativos ao controle da doença, função pulmonar, teste cutâneo para alérgenos, perfil inflamatório do escarro induzido, TC de tórax e pHmetria esofágica.Resultados: Foram analisados 21 pacientes (média de idade: 9,2 ± 2,98 anos). Dos 21, 18 (86%) eram atópicos. A maioria apresentava asma não controlada e função pulmonar basal próxima do normal. Em 4 e 7 pacientes, o escarro induzido revelou-se eosinofílico e neutrofílico, respectivamente, e 67% dos pacientes que repetiram o exame apresentaram mudança no perfil inflamatório. Dos 8 pacientes que receberam omalizumabe (um anticorpo anti-IgE), 7 (87,5%) apresentaram melhora importante da qualidade de vida, com redução importante das exacerbações e hospitalizações.Conclusões: Crianças com AGRT apresentam função pulmonar próxima do normal e padrão inflamatório das vias aéreas variável durante o seguimento clínico, com importante resposta clínica ao omalizumabe. A AGRT em crianças difere da AGRT em adultos, e são necessários mais estudos para esclarecer os mecanismos da doença.

Guidelines proposal for clinical recognition of mouth breathing children

INTRODUCTION: Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes.OBJECTIVE: The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children.METHODS: Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools.RESULTS: There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction.CONCLUSIONS: The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

INTRODUÇÃO: a respiração bucal (RB) é um fator etiológico para os distúrbios respiratórios do sono (DRS) na infância. O hábito de respirar pela boca pode ser perpetuado mesmo depois da desobstrução das vias aéreas. Tanto o hábito quanto a obstrução podem causar desequilíbrios da musculatura facial e alterações craniofaciais. O objetivo deste trabalho é propor e testar uma diretriz para o reconhecimento clínico da RB e de alguns fatores predisponentes aos DRS em crianças.MÉTODOS: entrevistas semiestruturadas foram realizadas com 110 ortodontistas, com relação aos seus procedimentos para avaliação clínica da RB e aos seus conhecimentos sobre DRS na infância. A partir daí, com base nas respostas obtidas, uma diretriz foi desenvolvida e testada em 687 crianças, com 6 a 12 anos, oriundas de escolas de ensino fundamental.RESULTADOS: não existe padronização para o reconhecimento clínico da RB pelos ortodontistas. Os procedimentos mais comumente realizados foram ineficientes para reconhecer a diferença entre a RB por hábito e a por obstrução.CONCLUSÕES: a diretriz proposta facilita o reconhecimento clínico da RB, diferencia entre RB por hábito e por obstrução, sugere o tratamento mais adequado para cada caso, e evita a manutenção do padrão de respiração bucal na idade adulta.

Contaminantes biológicos del aire interior de la vivienda: factores contribuyentes, afecciones relacionadas y medidas correctivas / Biological indoor air pollutants at home: contributing factors, related diseases and corrective actions

La contaminación biológica del aire interior de las viviendas y locales de uso público constituye una importante causa de morbilidad y malestar frecuente, la que puede interactuar con los efectos de los contaminantes químicos y con los cuales a menudo comparten causas comunes. Los principales contaminantes biológicos incluyen los mohos, el exoesqueleto y heces de ácaros del polvo, cucarachas y otros insectos, la caspa de la piel y el pelo de animales como las mascotas, todos los cuales pueden actuar como alergenos, bacterias como las Legionellas, virus y otros agentes capaces de producir enfermedades infecciosas. Las fuentes y factores contribuyentes incluyen la humedad generada por filtraciones en instalaciones hidráulicas, elevada humedad relativa, ventilación natural e insolación deficientes, inadecuado control técnico de los componentes de sistemas de climatización mecánica, la limpieza deficiente y el hacinamiento. Las medidas de prevención y corrección incluyen la eliminación de las fuentes de humedad y la reducción de la misma, optimización de la ventilación natural y la insolación, correcto mantenimiento de los sistemas de ventilación mecánica, garantizando una adecuada tasa de recambio de aire, limpieza de alfombras con dispositivos de alta eficiencia de remoción de partículas y lavado frecuente del mobiliario y las cortinas (o remoción de éstas si dificultan la ventilación natural)(AU)

Biological indoor air pollution in households and public places is an important cause of morbidity and discomfort. It may interact with chemical pollution, with which it often shares common sources. The main biological pollutants are moulds, exoskeletons and feces of dust acari, cockroaches and other insects, skin flakes, and hair from pets, all of which may act as allergens, bacteria such as Legionella, viruses and other infection disease agents. Contributing sources and factors include the dampness created by leaks in the plumbing, high relative humidity, poor natural ventilation or insolation, inadequate technical control of components of air conditioning equipment, deficient cleaning, and crowding. Prevention and correction measures include the reduction of humidity and elimination of its sources, optimization of natural ventilation and insolation, appropriate maintenance of mechanical ventilation systems ensuring an adequate rate of air renewal, cleaning of carpets with highly efficient particle removal devices, and frequent washing of the furniture and curtains (or removal of the latter if they obstruct natural ventilation)(AU)

Use of digital media for the education of health professionals in the treatment of childhood asthma / Uso de mídia digital na educação de profissionais de saúde para tratamento da asma infantil

OBJECTIVES: Inhalation therapy is the main treatment for asthma and its adequate use has been a factor responsible for disease control; therefore, the aim of the study was to determine whether a digital media tool, which features portability on mobile phones, modifies the assimilation of the inhalation technique. METHODS: A total of 66 professionals working in the health care area with the pediatric population were selected. They were submitted to a pre-test on their knowledge of inhalation therapy. The professionals were randomized into two groups (A and B). Group A received a media application on their mobile phones showing the steps of inhalation therapy, while group B received the same information in written form only. A post-test was applied after 15 days. The results (pre- and post-) were analyzed by two pediatric pulmonologists. RESULTS: Of the 66 professionals, 87.9% were females. Of a total possible score of ten, the mean score obtained in the pre-test was 5.3 ± 3, and in the second test, 7.5 ± 2 (p < 0.000). There were no significant differences when comparing the two groups (p = 0.726). The nurses had the lowest mean scores in the initial test (2.3 ± 2); however, they were the group that learned the most with the intervention, showing similar means to those of other groups in the second test (6.1 ± 3). CONCLUSION: There was significant improvement in knowledge about inhalation therapy in all professional categories using both methods, demonstrating that education, when available to professionals, positively modifies medical practice. .

OBJETIVOS: A inaloterapia representa a principal forma de tratamento da asma e seu uso adequado tem sido fator responsável pelo controle da doença. Desse modo, o objetivo do estudo foi determinar se uma ferramenta de mídia digital, dotada de portabilidade na forma de telefonia móvel, modifica a assimilação da técnica inalatória. MÉTODOS: Foram selecionados 66 profissionais que atuam na área da saúde com população pediátrica e submetidos a um pré-teste sobre seus conhecimentos de inaloterapia. Os profissionais foram randomizados em dois grupos (A e B). O grupo A recebeu em seu telefone móvel um aplicativo de mídia com os passos da inaloterapia, enquanto o grupo B recebeu as mesmas informações apenas de forma escrita. Após 15 dias, fez-se um pós-teste. Os resultados (pré e pós) foram analisados por dois pneumologistas pediátricos. RESULTADOS: Dos 66 profissionais, 87,9% eram do sexo feminino. Num escore total possível de 10, a média das notas obtidas no pré-teste foi de 5,3 ± 3 e as do segundo teste 7,5 ± 2 (p < 0,000). Não houve diferenças significativas na comparação os dois grupos (p = 0,726). Os profissionais de enfermagem apresentaram a menor média nas provas iniciais (2,3 ± 2), porém foi o grupo que aprendeu mais com a intervenção e apresentou média similar aos outros grupos na segunda prova (6,1 ± 3). CONCLUSÃO: Houve melhoria significativa no conhecimento sobre inaloterapia em todas as categorias profissionais com o uso de ambos os métodos. Isso comprovou que a educação, quando oferecida aos profissionais, modifica positivamente a prática médica. .

Fenotipo de la reparación por escisión de nucleótidos en pacientes cubanos con hipersensibilidad al sol / Phenotype of the nucleotide excision repair in Cuban sun-hypersensitive patients

INTRODUCCIÓN: deficiencias en los mecanismos de reparación del ácido desoxirribonucleico constituyen un factor de riesgo para el desarrollo del cáncer, como ocurre en el xeroderma pigmentoso. OBJETIVOS: evaluar el fenotipo de la reparación por escisión de nucleótidos en pacientes cubanos con una elevada hipersensibilidad al sol, y la sospecha clínica de xeroderma pigmentoso en la fase eritematopigmentaria, mediante la variante alcalina del ensayo cometa. MÉTODOS: se estudiaron 28 pacientes, con predominio de las edades pediátricas. Como inductor del daño al ácido desoxirribonucleico se utilizó la radiación ultravioleta C (254 nm) a una dosis de 40 J/m². El daño del ácido desoxirribonucleico se cuantificó inmediatamente, después de irradiar las células (tiempo 0 minutos) y un tiempo después de la irradiación, incubado a 37 ºC en medio de cultivo, enriquecido con suero fetal al 10 % (tiempo 45 min). Con estos datos se determinó el por ciento de la diferencia en las unidades arbitrarias (UA) entre ambos momentos. RESULTADOS: no se obtuvieron diferencias significativas (p= 0,080976) entre el grupo de pacientes (224,23 UA) y el grupo de sujetos controles (195,43 UA). Los pacientes reconocieron y escindieron el daño inducido en el ácido desoxirribonucleico por luz ultravioleta C, con una eficiencia similar a la de los controles. CONCLUSIONES: el ensayo cometa alcalino acoplado a radiación ultravioleta C permitió identificar, claramente y de forma indirecta, el funcionamiento de los mecanismos de reparación por escisión de nucleótidos, donde actúan las proteínas XPA a XPG. Los sujetos en estudio fueron excluidos de presentar la forma clásica de la enfermedad.

INTRODUCTION: deficiencies in the deoxyribonucleic acid repair mechanisms are a risk factor for cancer as is the case of xeroderma pigmentosum. OBJECTIVES: to evaluate the phenotype of nucleotide excision repair in Cuban sun hypersensitive patients with clinical suspicion of xeroderma pigmentosum at erythematopigmentary phase, by using the Comet assay alkaline variant. METHODS: twenty eight patients mainly at pediatric ages were studied. The used DNA damage inducer was ultraviolet radiation C (254 nm) at 40 J/m2 dose. The DNA damage was quantified immediately after cell irradiation (0 minutes) and some time afterwards, then cultured at 37 ºC and enriched with 10 % fetal serum (45 minutes). This data allowed determining the percentage of difference in arbitrary units (AU) between both moments. RESULTS: there was no significant differences (p= 0.080976) between the group of patients (224.23 AU) and the control group (195.43 UA). The UV-C induced DNA damage was recognized and excised in the patients with similar effectiveness to that of the controls. CONCLUSIONS: the UV-C radiation-coupled alkaline comet assay allowed clearly and indirectly identifying the functioning of the nucleotide excision repair mechanisms in which XPA to XPG proteins influence. The studied subjects did not show the classical form of this disease.

Test de Parche como método diagnóstico de las reacciones adversas a medicamentos / Patch test as a diagnostic method for adverse drug reactions

Las reacciones adversas a medicamentos (RAM) son un motivo frecuente de consulta en la práctica dermatológica. La hipersensibilidad a fármacos es una causa común de RAM, y es de gran relevancia confirmar este mecanismo para que el paciente evite futuras exposiciones. El test de parche tiene un rol relevante en el proceso diagnóstico de las reacciones de hipersensibilidad no inmediatas, otros test como la intradermorreacción o el test de provocación son más invasivos o de alto riesgo, y los exámenes in vitro para reacciones tardías no se encuentran fácilmente disponibles. El problema es que existe escasa estandarización del procedimiento y el valor predictivo del examen es incierto. En esta revisión exponemos la mejor evidencia disponible, lo que permitirá al especialista decidir cuándo hacer este examen y cómo interpretar sus resultados.

Adverse drugs reactions (ADR) are a frequent diagnosis in dermatological practice. Drug hypersensitivity is a common ADR etiology, and it is greatly relevant to confirm this mechanism to avoid future exposures of the patient to the culprit drug. Patch test has an outstanding role in non-immediate hypersensitivity reactions diagnosis process, other tests like intradermal reaction or provocation test are more aggressive or implies more risk, and in-vitro test for non-inmediate reactions are not easily available. One of the main problems of patch test is the lack of standarization of the procedure and the uncertain predictive value. In this review is exposed the best evidence available, so the specialist could decide when to do the test and how interpret its results.

Atopia e hipertrofia adenoamigdaliana em pacientes respiradores bucais em um centro de referencia / Atopy and adenotonsillar hypertrophy in mouth breathers from a reference center

O respirador bucal utiliza a cavidade oral como principal via durante a respiração. Dentre as principais causas, destacam-se: as hipertrofias adenoamigdalianas e as doenças inflamatórias como a rinite alérgica. OBJETIVO: Verificar a presença de atopia, os principais alérgenos envolvidos e verificar a coexistência de atopia com o grau de hipertrofia das tonsilas faríngeas e palatinas, em pacientes respiradores bucais. MÉTODO: Estudo de coorte histórico com corte transversal com revisão de 308 prontuários de pacientes acompanhados em um centro do respirador bucal de um hospital terciário, no período de 2008 a 2010. Foram coletados dados sobre a história clínica de respirador bucal e realizados exames clínico otorrinolaringológico, nasofibroscópico e teste cutâneo de leitura imediata aos aeroalérgenos. RESULTADOS: Dos 308 pacientes, 36% apresentaram positividade no teste alérgico, sendo que dos atópicos 95% foram positivos para ácaros. Do total de pacientes, 46% apresentaram hipertrofia adenoideana. Destes, 37% são atópicos e 47% apresentaram hipertrofia amigdaliana e, destes, 33% são atópicos. CONCLUSÃO: Nenhuma correlação direta entre atopia e o grau de aumento das tonsilas palatinas e faríngeas foi observada nos pacientes respiradores bucais avaliados. .

Mouth breathers use the oral cavity as their principal breathing route. The main causes include: adenotonsillar hypertrophy and inflammatory diseases such as allergic rhinitis. OBJECTIVE: To look for atopy, the main allergens involved and to check for atopy as a comorbidity with the degree of hypertrophy of the tonsils and adenoids in mouth breathers. METHOD: A historical cohort study with cross-sectional review of 308 medical charts of patients treated at a mouth breather care center of a tertiary hospital in the period of 2008-2010. We collected data on the mouth breather's clinical history and we ran otolaryngological exams, flexible nasal endoscopy and skin prick test to aeroallergens. RESULTS: Of 308 patients, 36% were positive on allergy testing, with 95 % of atopic patients being positive for mites. Among all patients, 46% had adenoid hypertrophy; of these, 37% were atopic and 47% had tonsillar hypertrophy, and among these, 33% were atopic. CONCLUSION: We found no direct correlation between atopy and the degree of tonsils and adenoid hypertrophy observed among the mouth-breathing patients assessed. si. .

Insect bite reactions.

Insects are a class of living creatures within the arthropods. Insect bite reactions are commonly seen in clinical practice. The present review touches upon the medically important insects and their places in the classification, the sparse literature on the epidemiology of insect bites in India, and different variables influencing the susceptibility of an individual to insect bites. Clinical features of mosquito bites, hypersensitivity to mosquito bites Epstein-Barr virus NK (HMB-EBV-NK) disease, eruptive pseudoangiomatosis, Skeeter syndrome, papular pruritic eruption of HIV/AIDS, and clinical features produced by bed bugs, Mexican chicken bugs, assassin bugs, kissing bugs, fleas, black flies, Blandford flies, louse flies, tsetse flies, midges, and thrips are discussed. Brief account is presented of the immunogenic components of mosquito and bed bug saliva. Papular urticaria is discussed including its epidemiology, the 5 stages of skin reaction, the SCRATCH principle as an aid in diagnosis, and the recent evidence supporting participation of types I, III, and IV hypersensitivity reactions in its causation is summarized. Recent developments in the treatment of pediculosis capitis including spinosad 0.9% suspension, benzyl alcohol 5% lotion, dimethicone 4% lotion, isopropyl myristate 50% rinse, and other suffocants are discussed within the context of evidence derived from randomized controlled trials and key findings of a recent systematic review. We also touch upon a non-chemical treatment of head lice and the ineffectiveness of egg-loosening products. Knockdown resistance (kdr) as the genetic mechanism making the lice nerves insensitive to permethrin is discussed along with the surprising contrary clinical evidence from Europe about efficacy of permethrin in children with head lice carrying kdr-like gene. The review also presents a brief account of insects as vectors of diseases and ends with discussion of prevention of insect bites and some serious adverse effects of mosquito coil smoke.

A Case of Hypersensitivity to Mosquito Bites without Peripheral Natural Killer Cell Lymphocytosis in a 6-Year-Old Korean Boy

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.

Association between Maternal Characteristics and Neonatal Birth Weight in a Korean Population Living in the Seoul Metropolitan Area, Korea: A Birth Cohort Study (COCOA)

Previous studies suggest that maternal characteristics may be associated with neonatal outcomes. However, the influence of maternal characteristics on birth weight (BW) has not been adequately determined in Korean populations. We investigated associations between maternal characteristics and BW in a sample of 813 Korean women living in the Seoul metropolitan area, Korea recruited using data from the prospective hospital-based COhort for Childhood Origin of Asthma and allergic diseases (COCOA) between 2007 and 2011. The mean maternal age at delivery was 32.3 +/- 3.5 yr and prepregnancy maternal body mass index (BMI) was 20.7 +/- 2.5 kg/m2. The mean BW of infant was 3,196 +/- 406 g. The overall prevalence of a maternal history of allergic disease was 32.9% and the overall prevalence of allergic symptoms was 65.1%. In multivariate regression models, prepregnancy maternal BMI and gestational age at delivery were positively and a maternal history of allergic disease and nulliparity were negatively associated with BW (all P < 0.05). Presence of allergic symptoms in the mother was not associated with BW. In conclusion, prepregnancy maternal BMI, gestational age at delivery, a maternal history of allergic disease, and nulliparity may be associated with BW, respectively.

Custos diretos e indiretos da asma: revisão de literatura / Direct and indirect costs of asthma: a review

Objetivo: Realizar revisão da literatura sobre análises econômicas utilizadas para a asma, os custos diretos e indiretos, tendo em vista a sobrecarga econômica que essa doença acarreta para o sistema de saúde. Fonte de dados: Pesquisa de artigos originais, revisões e consensos, indexados nos bancos de dados Medline, Lilacs, Embase e Pubmed, publicados entre 1996-2012. Síntese dos dados: A asma é uma doença pulmonar inflamatória crônica que acomete pessoas de todas as idades, cujo descontrole leva a hospitalizações frequentes, visitas à emergência e aumento na morbidade, gerando grande impacto na vida social e econômica dos pacientes, com piora da qualidade de vida. A partir dos programas de controle da asma e rinite alérgica e da dispensação de medicamentos de alto custo, houve significativa queda das hospitalizações por asma no período de 2006 a 2010. Em 2012, implementou-se o “Programa Saúde não tem Preço”, ação integrante do “Programa Farmácia Popular” do Ministério da Saúde (MS), com fornecimento gratuito de brometo de ipratrópio, diproprionato de beclometasona e sulfato de salbutamol. Com este programa, houve crescimento significante de 443% no número de asmáticos beneficiados, aumentando de 48.495 para 263.227 pessoas. Os dados do MS apontaram que a asma ainda causa a morte de 2,5 mil pessoas por ano no Brasil. Em 2011 do total de 117,8 mil internações no Sistema Único de Saúde (SUS) em decorrência da asma, 77,1 mil acometeram crianças na faixa etária de 0 a 6 anos. A asma ainda representa um importante problema global de saúde pública com elevados custos diretos e indiretos, que oneram de forma expressiva os pacientes e os sistemas públicos de saúde. Conclusão: Os programas implementados proporcionaram melhora da saúde dos indivíduos, tornando-os mais aptos ao trabalho, aumentando a produtividade e reduzindo significativamente os custos para a sociedade

Objective: To review the literature on economic analyzes used for asthma, the direct and indirect costs and the economic burden that this disease poses to the health system.Source of data: Survey of original articles, reviews and consensus, indexed in Medline, Lilacs, Embase and PubMed, published between 1996-2012. Data Synthesis: Asthma is a chronic inflammatory lung disease that affects people of all ages, whose lack leads to frequent hospitalizations, emergency room visits and increased morbidity, generating great impact on social and economic life of patients with worsening quality of life. After the beginning of asthma and allergic rhinitis control programs with free delivery of expensive drugs expensive, there was a significant drop in hospitalizations for asthma in the period from 2006 to 2010. In 2012, 48,495 people had access to drugs for asthma, from the implementation of the “Health Program”, integral action of “Popular Pharmacy Program” of the Ministry of Health (MH), with free supply of ipratropium bromide, beclomethasone dipropionate and salbutamol sulphate, this number increased signifcantly from 48,495 to 263,227 people, representing growth of 443% adherence to the program. The MH data showed that asthma still kills 2500 people a year in Brazil, in 2011 the total of 117,800 hospitalizations in the Unified Health System (UHS) due to asthma were affected 77.1 thousand children aged 0-6 years. In addition, asthma is an important global public health problem with high direct and indirect costs, which affect expressively patients and public health systems. Conclusion: The programs implemented provided improves the health of individuals, making them more apt to work, increasing productivity and significantly reducing costs to society

Glucocorticoid hypersensitivity syndrome: a case report / Síndrome de la hipersensibilidad glucocorticoidea reporte de caso

Glucocorticoid hypersensitivity syndrome has been reported to date only in several patients. This article describes a unique case of this syndrome in a 24-year old female admitted to hospital because of arterial hypertension and obesity. Although her clinical picture suggested Cushing's syndrome, she had low adrenocorticotropic hormone (ACTH) and cortisol levels with a poor response to corticotrophin-releasing hormone and Synacthen. In turn, an overnight dexamethasone suppression test with 0.25 mg of dexamethasone led to a dramatic decrease in morning cortisol. A diagnosis of glucocorticoid hypersensitivity was made and the patient started treatment with ketoconazole and cabergoline, which resulted in some clinical improvement. This case illustrates the need for clinical awareness of glucocorticoid hypersensitivity in patients suspected of Cushing's syndrome.

El síndrome de la hipersensibilidad glucocorticoidea ha sido reportado hasta la fecha en varios pacientes. Este artículo describe un caso único de este síndrome en una mujer de 24 años, ingresada en el hospital debido a hipertensión arterial y obesidad. Aunque su cuadro clínico hizo pensar en el síndrome de Cushing, presentaba un bajo nivel tanto de hormona adrenocorticotropa (ACTH) como de cortisol, acompañado de una respuesta pobre a la hormona liberadora de corticotropina y al synacthen. A su vez, una prueba de supresión de la dexametasona realizada durante la noche con 0.25 mg de dexametasona, condujo a una disminución dramática del cortisol en la mañana. Se hizo un diagnóstico de hipersensibilidad glucocorticoide, y la paciente empezó el tratamiento con ketoconazol y cabergolina, lo cual trajo como consecuencia cierta mejoría clínica. Este caso ilustra la necesidad de una mayor conciencia clínica en torno a la hipersensibilidad glucocorticoidea en pacientes sospechosos de padecer el síndrome de Cushing.