Conditions of vulnerability to the inadequate treatment of bronchiolitis

SUMMARY OBJECTIVE To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. METHODS A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. RESULTS Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. CONCLUSIONS Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.

RESUMO OBJETIVOS Analisar variáveis clínicas e demográficas possivelmente associadas às prescrições de terapêuticas não recomendadas, porém rotineiramente utilizadas, para lactentes com bronquiolite viral aguda. MÉTODOS Estudo transversal incluiu lactentes hospitalizados com bronquiolite por vírus sincicial respiratório. Excluídos aqueles com outras infecções e/ou morbidades. Dados coletados de prontuários. RESULTADOS Analisados 120 casos, para os quais foram prescritos: beta-agonistas inalatórios a 90%; corticosteroides a 72,5%, antibióticos a 40% e solução salina hipertônica inalatória a 66,7%. O uso de broncodilatadores não apresentou associação independente com outra variável. Maior uso de corticosteroide associou-se à baixa oximetria, maior tempo de internação e idade >3 meses. Antibioticoterapia associou-se à presença de febre, maior tempo de internação e idade >3 meses. Solução salina hipertônica inalatória associou-se a maior tempo de internação. CONCLUSÕES A frequência das prescrições não recomendadas foi elevada. Corticosteroide e antibioticoterapia foram associados a sinais de gravidade, como esperado, porém, interessantemente, foram mais utilizados nos lactentes com idade acima de 3 meses, o que sugeriu menor segurança no diagnóstico de bronquiolite viral nesses pacientes. O uso de broncodilatadores foi ainda mais preocupante, uma vez que foram indiscriminadamente utilizados, sem associação com outra variável, seja relacionada à gravidade, seja a características do hospedeiro. O uso de solução hipertônica inalatória, apesar de não associado à gravidade, parece ter implicado maior tempo de internação. A identificação dessas condições de maior vulnerabilidade à prescrição de terapêuticas inadequadas contribui para a implantação de protocolos para o tratamento da BVA, para educação continuada e para posteriores comparações e análises de eficácia das estratégias empregadas.

Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program

OBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in São Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (>40 hours/week) occurred in 59%, and 45% earned ≥15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged ≤48 years (group 1) and participants aged >48 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload >40 hours/week (53% vs. 68%, p=0.034); and ≥15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload >40 hours/week (53% vs. 83%, p=0.0002), and ≥15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working >40 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.

Feeding and nutritional profiles of children at 12 months of age living in the western region of the city of São Paulo: The Procriar Project / Perfil alimentar e nutricional de crianças no final do primeiro ano de vida residentes na região Oeste do município de São Paulo: Projeto ProcriAr

ABSTRACT Objective To analyze the feeding profiles, nutritional statuses and influences of maternal characteristics on food consumption of infants at the end of the first year of life. Methods This is a cross-sectional study nested within a cohort of pregnant women that evaluated children with a mean age of 12.1 months. The weights and lengths were measured, and the body mass index was calculated. Food consumption was obtained through 24-hour recall and was assessed qualitatively. The outcomes studied dichotomously (yes/no) were overweight (body mass index ≥+2 Z-scores), consumption of foods considered unhealthy (i.e., sugar, petit suisse cheese, sandwich crackers, and soft drinks), consumption of fruits, legumes and vegetables and a minimum acceptable diet composed of minimum dietary diversity and minimum meal frequency. Logistic regression models were constructed to evaluate the association between maternal variables and the outcomes studied. Results A total of 254 infants were evaluated, of whom 10.7% were overweight. The majority of the infants did not receive a minimum acceptable diet (58.7%), 28.0% consumed petit suisse cheese and 42.0% received added sugar in their preparations. Mothers less than 20 years old or with more schooling were more likely to offer unhealthy foods to their children (.=0.03). Fruits, legumes and vegetables (consumption was higher among children of mothers over 20 years old (.=0.04). Conclusion The study revealed a high prevalence of overweight and an inadequacy of food consumption among children. The finding that adolescent mothers and/or mothers with more schooling tend to offer inadequate food to children may favor the definition of specific educational strategies.

RESUMO Objetivo Analisar o perfil alimentar, o estado nutricional e a influência das características maternas sobre o consumo alimentar de lactentes ao final do primeiro ano de vida. Métodos Trata-se de um estudo transversal aninhado a uma coorte de gestantes que avaliou crianças com idade média de 12,1 meses. Foram aferidos o peso e comprimento e calculado o índice de massa corporal. O consumo alimentar foi obtido através de recordatório de 24 horas, avaliado de forma qualitativa. Os desfechos estudados dicotomicamente (sim/não) foram: sobrepeso (índice de massa corporal ≥+2 score-Z), consumo de alimentos considerados não saudáveis (açúcar, queijo petit suisse, bolacha recheada, refrigerantes entre outros), consumo de frutas, legumes e verduras e dieta mínima aceitável composta pela diversidade mínima da dieta e frequência mínima de refeições. Foram construídos modelos de regressão logística para avaliar a associação entre variáveis maternas e os desfechos estudados. Resultados Foram avaliados 254 lactentes sendo 10,7% classificados com excesso de peso. A maioria não recebeu dieta mínima aceitável (58,7%), 28,0% consumiram queijo petit suisse e 42,0% receberam açúcar adicionado às preparações. Mães com menos de 20 anos ou com maior escolaridade tiveram maior chance de oferecer ali-mentos não saudáveis aos filhos (p=0,03). O consumo de frutas, legumes e verduras foi maior entre os filhos de mães acima de 20 anos (p=0,04). Conclusão O estudo revelou alta prevalência de sobrepeso e inadequação do consumo alimentar entre as crianças. A identificação de que mães adolescentes e/ou com maior escolaridade tendem a oferecer alimentação inadequada às crianças pode favorecer a definição de estratégias educativas específicas.

Longitudinal study of lung function in pregnant women: Influence of parity and smoking

OBJECTIVES: To evaluate pulmonary function in the first and third trimesters of pregnancy and analyze the influence of parity and smoking on spirometry parameters. METHODS: This longitudinal prospective study included a cohort of 120 pregnant women. The inclusion criteria were as follows: singleton pregnancy, gestational age less than 13.86 weeks, and no preexisting maternal diseases. The exclusion criteria were as follows: change of address, abortion, and inadequate spirometry testing. ClinicalTrials.gov: NCT02807038. RESULTS: A decrease in values of forced vital capacity and forced expiratory volume were noted in the first second from the first to third trimester. In the first and third trimesters, multiparous women demonstrated lower absolute forced vital capacity and forced expiratory volume values in the first second compared with nulliparous women (p<0.0001 and p=0.001, respectively). Multiparous women demonstrated reduced forced expiratory flow in 25% to 75% of the maneuver compared with nulliparous women in the first (p=0.005) and third (p=0.031) trimesters. The absolute values of forced expiratory flow in 25% to 75%, forced expiratory volume in the first second and predicted peak expiratory flow values in the third trimester were higher in smokers compared with nonsmokers (p=0.042, p=0.039, p=0.024, and p=0.021, respectively). CONCLUSION: There was a significant reduction in forced vital capacity and forced expiratory volume values in the first second during pregnancy. Parity and smoking significantly influence spirometric variables.

Genetic variability in G2 and F2 region between biological clones of human respiratory syncytial virus with or without host immune selection pressure

Human respiratory syncytial virus (HRSV) is an important respiratory pathogens among children between zero-five years old. Host immunity and viral genetic variability are important factors that can make vaccine production difficult. In this work, differences between biological clones of HRSV were detected in clinical samples in the absence and presence of serum collected from children in the convalescent phase of the illness and from their biological mothers. Viral clones were selected by plaque assay in the absence and presence of serum and nucleotide sequences of the G2 and F2 genes of HRSV biological clones were compared. One non-synonymous mutation was found in the F gene (Ile5Asn) in one clone of an HRSV-B sample and one non-synonymous mutation was found in the G gene (Ser291Pro) in four clones of the same HRSV-B sample. Only one of these clones was obtained after treatment with the child's serum. In addition, some synonymous mutations were determined in two clones of the HRSV-A samples. In conclusion, it is possible that minor sequences could be selected by host antibodies contributing to the HRSV evolutionary process, hampering the development of an effective vaccine, since we verify the same codon alteration in absence and presence of human sera in individual clones of BR-85 sample.

Gravidade das coinfecções virais em lactentes hospitalizados com infecção por vírus sincicial respiratório / Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection

OBJETIVO: Comparar a gravidade de infecções causadas por um único vírus (VSR) com a gravidade de coinfecções. MÉTODOS: Este estudo avaliou uma coorte histórica de lactentes com infecção aguda por VSR. Secreção de nasofaringe foi coletada de todos os pacientes rotineiramente para pesquisa viral usando técnicas de biologia molecular. Os seguintes desfechos foram analisados: tempo total de internação, duração da oxigenioterapia, admissão em unidade de terapia intensiva e uso de ventilação mecânica. Os resultados foram ajustados para os fatores confundidores (prematuridade, idade e aleitamento materno). RESULTADOS: Foram incluídos no estudo 176 lactentes com idade média de 4,5 meses e diagnósticos de bronquiolite e/ou pneumonia. Cento e vinte e um tinham infecção única por VSR, e 55 tinham coinfecções (24 VSR + adenovírus, 16 VSR + metapneumovírus humano e 15 outras associações menos frequentes). Os quatro desfechos de gravidade avaliados foram semelhantes entre o grupo com infecção única por VSR e os grupos com coinfecções, independente do tipo de vírus associado com o VSR. CONCLUSÃO: As coinfecções virais não parecem alterar o prognóstico de lactentes hospitalizados com infecção aguda por VSR.

OBJECTIVE: To compare the severity of single respiratory syncytial virus (RSV) infections with that of coinfections. METHODS: A historical cohort was studied, including hospitalized infants with acute RSV infection. Nasopharyngeal aspirate samples were collected from all patients to detect eight respiratory viruses using molecular biology techniques. The following outcomes were analyzed: duration of hospitalization and of oxygen therapy, intensive care unit admission and need of mechanical ventilation. Results were adjusted for confounding factors (prematurity, age and breastfeeding). RESULTS: A hundred and seventy six infants with bronchiolitis and/or pneumonia were included in the study. Their median age was 4.5 months. A hundred and twenty one had single RSV infection and 55 had coinfections (24 RSV + adenovirus, 16 RSV + human metapneumovirus and 15 other less frequent viral associations). The four severity outcomes under study were similar in the group with single RSV infection and in the coinfection groups, independently of what virus was associated with RSV. CONCLUSION: Virus coinfections do not seem to affect the prognosis of hospitalized infants with acute RSV infection.

Comparison between ectodomain and G2 region of G glycoprotein for genotyping of HRSV

The Human Respiratory Syncytial Virus (HRSV), isolated in 1955, is the main cause of hospitalization of babies and infants with respiratory illness. Several studies have been conducted worldwide aiming the development of a safe and effective vaccine against HRSV. The G2 region of glycoprotein G is used as genotyping default. In the present study, we performed a phylogenetic analysis of G protein and a comparative study between G2 region and ectodomain of attachment glycoprotein. Fifty-three nasal swab samples from children less than 5 years old and presenting symptoms of acute respiratory illness, assisted at the University Hospital (UH) of University of Sao Paulo (USP) in 2004, were submitted to sequencing by PCR and compared with GenBank sequences. We concluded that the G2 region is adequate for HRSV genotyping.

O vírus respiratório sincicial humano (HRSV), isolado em 1955, é a principal causa da hospitalização de bebês e crianças pequenas com sintomas de doença respiratória. No mundo inteiro, vários estudos para o desenvolvimento de uma vacina segura e eficiente contra o HRSV têm tido alta prioridade. A região G2 da glicoproteína G é usada como padrão para genotipagem do HRSV. Neste estudo, foi realizada a análise filogenética da glicoproteína G e o estudo comparativo entre a região G2 e o ectodomínio dessa glicoproteína. Cinquenta e três amostras de swab nasal de crianças com menos de cinco anos de idade, apresentando doença respiratória aguda, atendidas no Hospital Universitário (HU) da Universidade de São Paulo durante o ano de 2004, foram submetidas a sequenciamento por PCR e comparadas com seqüências do GenBank. A região G2 mostrou ser adequada para a genotipagem do HRSV.

Etiologia das bronquiolites. (Carta ao Editor) / The etiology of bronchiolitis. (Letter to the Editor)

A bronquiolite é responsável por elevados índices de hospitlização de crianças, em todo o mundo. Nos Estados Unidos, a bronquiolite é a primeira causa de internação de lactentes; no Hospital Universitário da USP é secundada pelas pneumonias. O principal agente etiológico da bronquiolite...

Características do lactente hospitalizado com infecção do aparelho respiratório inferior por vírus sincicial respiratório: tipos e genótipos do vírus e anticorpos séricos específicos / Characteristics of infants hospitalized with lower respiratory tract infection due to respiratory syncytial virus: types and genotypes of the virus and specific serum antibodies

As doenças do aparelho respiratório inferior (DARI) são responsáveis por altos índices de morbi-mortalidade em crianças em todo o mundo. O principal agente causador de DARI em lactentes é o vírus sincicial respiratório (VSR), que acomete, principalmente os lactentes no primeiro ano de vida. O perfil dos tipos e genotipos de VSR causadores de DARI e o papel dos anticorpos séricos do lactente ainda estão indefinidos. Este conhecimento é importante para o desenvolvimento de medidas terapêuticas e profiláticas eficazes.Throughout the world, lower respiratory tract infection (LRTI) is responsible for high mortality rates among children. The main etiological agent of LRTI in infants is respiratory syncytial virus (RSV) that mainly involves infants in the first year of life. The profile of the types and genotypes of RSV that cause LRTI and the role of the infant's serum antibodies have yet to be fully clarified. This knowledge is important for the development of effective therapeutic and prophylactic measures...

Infeccao nosocomial pelo virus respiratorio sincicial em enfermaria de pediatria / Nosocomial respiratory syncytial virus infection at pediatric ward

Objetivo : avaliar a taxa de infeccao nosocomial causada por virus no trato respiratorio inferior de criancas internadas em uma enfermaria geral de pediatria durante a epidemia...

Montelucaste versus beclometasona no tratamento da rinite alergica da crianca e adolescente / Montelukast versus beclometasone in children and adolescent allergic rhinists treatment

Objetivo: comparar o efeito terapeutico do montelucaste versus beclometasona em criancas e adolescentes com rinite alergica. Casuistica e metodos: foi realizado estudo clinico prospectivo aberto, randomizado com pacientes...

Uso profilatico de antagonista de leucotrieno no controle de pacientes com asma grave / Prophylactic use of leukotriene antagonists in control of patients with gravis asthma

A incidencia da asma esta aumentando no mundo, assim como o numero de casos, graves, de dificil controle clinico. As causas estao associadas a urbanizacao das populacoes, que conduziu ao aumento das infeccoes das vias aereas e ao aumento da poluicao ambiental. No sentido de reduzir a morbi-mortalidade desse grupo, sao recomendadas a terapeutica precoce das crises bronco-oclusivas, com beta 2 adrenergicos e corticosteroides, assim como a promocao de...

Ha potencial letal decorrente da inalaçäo de fenoterol pela criança asmatica? / Is there a potential letal effect of inhaled fenoterol at the asmatic child?

Verificar as evidencias laboratoriais, clinicas e epidemiologicas de potencial letalidade associada ao uso do fenoterol inalado por...

Atelectasia cronica infectada do lobo inferior esquerdo tratada cirurgicamente: relato de tres casos / Left lower lobe chronic atlectasis treated surgically: description of three cases

Os autores descrevem três casos de atelectasias cronicas do lobo inferior esquerdo que evoluiram com infecçöes e destruiçäo lobar, necessitando ressecçäo cirurgica. As atelectasias de duas das crianças nao foram reconhecidas e tratadas na fase aguda, o que pode ter influido na evoluçäo desfavorável destes casos. Os autores ressaltam a dificuldade no diagnostico clinico e radiografico da atelectasia cronica do lobo inferior esquerdo e a eventual necessidade de terapeutica cirurgica

Nebulizaçäo continua com Beta-2 adrenergico no atendimento de urgência da criança asmatica / Continuous nebulization with Beta-2 agonist in the asthmatic children in crisis

Os autores realizaram estudo prospectivo com crianças asmaticas, em crise, comparando o efeito terapeutico do sulfato de terbutalino ministrado por via inalatoria em nebulizaçäo continua (sub-grupo A) e através de duas inalaçöes intermitentes (sub-grupo B). Foi empregada dosagem media de 3mg de sulfato de terbutalino por criança em 1 hora. Os pacientes tiveram o perfil clinico pré-definido: idade entre 2 e 5 anos, peso entre 15 e 21 kg, ausência de febre, condensaçäo pulmonar, e patologias crônicas. O escore clínico médio (Wood-Downes) inicial foi 4,74 para o sub-grupo A e 5,07 para o sub-grupo B, e ao final de 1 hora foram, respectivamente, 3,83 e 4,03. A análise estatística näo mostrou diferenças na eficácia das duas formas de inaloterapia

Infecçäo por parvovirus: apresentaçäo atípica em três crianças / Infection due to parvovirus: atypical clinical aspects in three children

Os autores descrevem três casos de infecçäo causada por Parvovirus em escolares com apresentaçäo clínica atípica. Aspectos relativos ao exantema, enfartamento ganglionar, hepatomegalia, e outros comemorativos foram distintos do observado no eritema infeccioso classicamente descrito. Os autores ressaltam a dificuldade no diagnóstico e o significado dos achados frente as recentes descriçöes de quadros graves causados por Parvovirus