Immediate effect of inhalation therapy combined with oscillatory positive expiratory pressure on the respiratory system of children with cystic fibrosis.

INTRODUCTION: It is recommended the association of inhalation therapies and physiotherapy on the management of cystic fibrosis (CF); however, it is still necessary to understand the effect on respiratory mechanics of these therapies combined. This study aimed to evaluate the immediate effect of inhalation with Dornase-Alfa (DNase) and hypertonic saline solution (HSS), as well as the impact of these inhalation therapies associated with an oral high-frequency oscillation (OHFO) physiotherapy device, on the respiratory mechanics of children and adolescents with CF. METHOD: Children/adolescents with CF were allocated into two groups (DNaseG and HSSG), where they performed inhalation therapy before using the OHFO device for physiotherapy. In each group, the Impulse Oscillometry System was conducted before and after inhalation therapy, and after OHFO. ANOVA was carried out to analyse the respiratory mechanics at different moments of DNaseG and HSSG. The Mann-Whitney test compared the immediate effect of each inhalation therapy and after OHFO. RESULTS: 30 children (6-14 years old) were studied. In DNaseG, the mean value of most oscillometric parameters decreased in the evaluated moments; in HSSG, only reactance showed an immediate increase. CONCLUSION: Children/adolescents with CF showed an immediate decrease in airway resistance and reactance after the use of DNase and associated with OHFO, indicating improvement. The inhalation with HSS has an immediate effect on peripheral airways.

Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review.

BACKGROUND: Rapid maxillary expansion (RME) is an orthodontic procedure used to correct transverse maxillary deficiency. Due to the anatomical relationship between the palate and the nasal cavity, RME promotes an increase in nasal dimensions, which should hypothetically improve nasal respiratory function. Objective: This review aimed to systematically verify studies that assessed the effects of RME on nasal patency in mouth-breathing children and adolescents. MATERIAL AND METHODS: An electronic search was performed in the MEDLINE databases via OVID, Scopus and EMBASE. The terms were: "children and adolescents", "rapid maxillary expansion" and "mouth breathing". The search was conducted in October 2019, according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The assessment of the quality of the studies was conducted by two evaluators, using the Fowkes & Fulton´s guidelines for critical appraisal of medical research. RESULTS: 475 titles were identified and 18 articles were selected. All of them showed high methodological quality, but without randomized clinical trials. The instruments evaluated were: teleradiography, frontal postero-anterior radiography, computed tomography, acoustic rhinometry and computed rhinomanometry. CONCLUSIONS: This review shows that RME promotes the enlargement of dental arches and of the nasal and maxillary structures, with improved mouth breathing in the short term. However, its long-term benefits could not be proved so far. More robust results of the effectiveness of RME in mouth breathing can be achieved with meta-analysis studies, with a consensual definition of the long-term follow-up period after RME. Key words:Child, adolescent, maxillary expansion, palatal expansion, mouth breathing.

Systematic review of quality of life in Turner syndrome.

PURPOSE: This study aimed to systematically review the available literature on "quality of life" (QoL) or "health-related quality of life" (HRQoL) in Turner syndrome (TS) patients and to analyze the relations among height, puberty, and the use of growth hormone (GH) and the QoL of TS patients. METHODS: An electronic bibliographic search was conducted through the PubMed, Embase, Bireme, Scopus, and Web of Science databases. The main terms were "Quality of Life" and "Turner syndrome." RESULTS: Among the databases, 559 articles were found; after the selection process, 13 studies were selected. A quality assessment was conducted, and all the studies were of high quality. Eight well-known QoL questionnaires were used, and the selected studies presented factors that may be related to the QoL of TS patients, such as height, puberty, and GH use. However, a more detailed understanding of which factors are associated with the QoL of TS patients is still needed, which may be due to the lack of specific QoL instruments involving important aspects related to TS. CONCLUSION: The QoL of TS patients appears to be compromised, but existing data regarding the relations among height, puberty, and GH and QoL are still controversial. Although these factors should be carefully considered in TS patients, it was not possible to determine whether they have a significant relation with the QoL of TS patients.