C Reactive protein and disease severity in bronchiolitis.

A diagnosis of bronchiolitis is made clinically and the use of supportive laboratory examinations, including the quantification of C reactive protein (CRP), is not well established. The aim of this study was to evaluate the correlation between CRP value and indirect markers of disease severity in patients with bronchiolitis. This study included the patients diagnosed with bronchiolitis admitted to the Pediatrics Department of S. João Hospital in 2006. A retrospective review was made through analysing clinical files. 176 patients aged 0 to 36 months (median of 4 months) were included. 63.1% were males. CRP level was measured in 94.3% of the patients, with va- lues ranging from zero to 256 mg/L and a median of 11 mg/L. CRP value in this population had a statistically significant relation with admission to Intensive Care Unit (ICU) (p=0.008), length of hospital stay (p=0.025) and need for supplementary oxygen during hospital stay (p=0.022). This work raises the hypothesis that the CRP value on admission might be a marker of disease severity and have prognostic significance in patients with bronchiolitis. Further investigation is necessary to validate these results and exclude the potential confounding effect of associated infections.

Role of viruses and atypical bacteria in asthma exacerbations among children in Oporto (Portugal).

BACKGROUND: Upper respiratory tract infections are known to be a significant precipitant of acute asthma exacerbations. The aim of this study was to evaluate seasonal trends and the role of these pathogens in asthma exacerbations in school-aged children from Oporto (Portugal). METHODS: Nasal aspirates were collected from children aged 6 to 12 years old with asthma exacerbations attended in the Pediatric Emergency Department one day per week from January 1 to December 31, 2003. Demographic data, severity of asthma and asthma exacerbations, and current treatment were recorded. Samples were obtained through nasal wash with 1 ml saline and were processed by immunofluorescence assays (respiratory syncytial virus, adenovirus, parainfluenza and influenza virus), retrotranscription polymerase chain reaction (rhinovirus) and polymerase chain reaction (enterovirus, Chlamydia pneumoniae and Mycoplasma pneumoniae). RESULTS: In 54 eligible children, 37 nasal samples were obtained. Infectious agents were detected in 78 % of the patients. Rhinovirus was detected in 70.3 %, Mycoplasma pneumoniae in 16.2 %, enterovirus in 10.8 %, and Chlamydia pneumoniae in 2.7 %. Coinfection was identified in 21.6 % of the samples. There was no significant correlation between current treatment status, severity of asthma or exacerbations and the isolated agents. Two distinct peaks of asthma exacerbation were found, 40.5 % in spring and 32.4 % in autumn [corrected] The highest number of cases was recorded in March and the lowest in August and January. Rhinoviruses was detected in 27 % of the cases in autumn and in 24.3 % in spring [corrected] CONCLUSIONS: These results confirm the previously reported high frequency of rhinovirus detection in asthma exacerbations in children and provide evidence that asthma exacerbations and rhinovirus infections follow a seasonal pattern, occurring mostly in spring and autumn. The findings also underscore the frequency of Mycoplasma pneumoniae detection, and emphasize the importance of this agent as a possible trigger of asthma exacerbations.

Role of viruses and atypical bacteria in asthma exacerbations among children in Oporto (Portugal)

Background: Upper respiratory tract infections are known to be a significant precipitant of acute asthma exacerbations. The aim of this study was to evaluate seasonal trends and the role of these pathogens in asthma exacerbations in school-aged children from Oporto (Portugal). Methods: Nasal aspirates were collected from children aged 6 to 12 years old with asthma exacerbations attended in the Pediatric Emergency Department one day per week from January 1 to December 31, 2003. Demographic data, severity of asthma and asthma exacerbations, and current treatment were recorded. Samples were obtained through nasal wash with 1 ml saline and were processed by immunofluorescence assays (respiratory syncytial virus, adenovirus, parainfluenza and influenza virus), retrotranscription polymerase chain reaction (rhinovirus) and polymerase chain reaction (enterovirus, Chlamydia pneumoniae and Mycoplasma pneumoniae). Results: In 54 eligible children, 37 nasal samples were obtained. Infectious agents were detected in 78 % of the patients. Rhinovirus was detected in 70.3 %, Mycoplasma pneumoniae in 16.2 %, enterovirus in 10.8 %, and Chlamydia pneumoniae in 2.7 %. Coinfection was identified in 21.6 % of the samples. There was no significant correlation between current treatment status, severity of asthma or exacerbations and the isolated agents. Two distinct peaks of asthma exacerbation were found: 27 % in autumn and 24.3 % in spring. The highest number of cases was recorded in March and the lowest in August. Rhinoviruses were detected between March and May in 46 % of the patients, and between September and November in 30.8 %. Conclusions: These results confirm the previously reported high frequency of rhinovirus detection in asthma exacerbations in children and provide evidence that asthma exacerbations and rhinovirus infections follow a seasonal pattern, occurring mostly in spring and autumn. The findings also underscore the frequency of Mycoplasma pneumoniae detection, and emphasize the importance of this agent as a possible trigger of asthma exacerbations

Antecedentes: Se sabe que las infecciones del tracto respiratorio superior son desencadenantes significativos de las exacerbaciones de asma. Los autores se proponen evaluar la tendencia estacional y el papel de estos patógenos en las exacerbaciones de asma en niños en edad escolar, en Oporto. Métodos: se obtuvieron muestras de moco nasal en niños de 6 a 12 años con una crisis aguda de asma, atendidos en el Departamento de Urgencia Pediátricas, un día por semana, desde el 1 de enero al 31 de diciembre de 2003. Se anotaron los datos demográficos, gravedad de la crisis y el tratamiento empleado en cada caso. Las muestras se tomaron mediante lavado nasal con 1 ml de solución salina y se procesaron mediante inmunofluorescencia (virus respiratorio syncytial, adenovirus y virus parainfluenza e influenza), reacción de retrotranscripción de la cadena de polimerasa (rinovirus) y reacción en cadena de la polimerasa (enterovirus, Chlamydia pneumoniae y Mycoplasma pneumoniae). Resultados: Se obtuvieron 37 muestras del lavado nasal en 54 de los niños incluidos. Se detectaron agentes infecciosos en el 78% de ellos: Rinovirus en el 70.3%, Mycoplasma pneumoniae en el 16.2%, enterovirus en el 10.8% y Chlamydia pneumoniae en el 2.7%. En el 21.6% de las muestras se encontró más de un agente infeccioso. No hubo correlación significativa entre el tratamiento, gravedad del asma o de la exacerbación y los agentes infecciosos aislados. Se constataron dos picos en la estacionalidad de las crisis, 27% en otoño y 24,3% en primavera. Marzo fue el mes con más crisis y agosto con menos. Rinovirus se detectaron en el 46% de los casos entre marzo y mayo y en el 38,8% entre septiembre y noviembre. Conclusiones: estos resultados confirman la ya conocida alta frecuencia con que se encuentran rinovirus en las exacerbaciones del asma en los niños, con un predominio estacional predominante en primavera y otoño. Los hallazgos también subrayan la frecuencia del Mycoplasma pneumoniae enfatizando la importancia de éste agente como posible desencadenante de exacerbaciones de asma

[Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis]. / Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis.

BACKGROUND: Respiratory syncytial virus (RSV) is the most frequently implicated agent in bronchiolitis. The virus presents two antigenic subtypes (A and B). The results of studies on the relationship between viral subtype and clinical severity are conflicting. PURPOSE: To evaluate whether the subtype of this virus constitutes an independent variable in the severity of clinical expression of RSV infection. PATIENTS AND METHODS: We prospectively studied previously healthy children aged less than 2 years admitted for RSV infection during an epidemic season. Clinical presentation and evolution, laboratory and radiological aspects were compared in subsets of children infected with RSV subtype A or B. Clinical severity parameters included score and duration of respiratory distress, oxygen requirements, admission to the intensive care unit, mechanical ventilation and length of hospital stay. RESULTS: Eighty-five patients were enrolled in the study (50 boys and 35 girls; mean age 4.8,4.3 months). Fifty-nine children were infected with RSV subtype A. No differences were found in age, sex or antecedents but children with subtype B were less likely to have been breast-fed. Clinical presentation and laboratory and radiological findings were similar in both groups. No statistically significant differences in clinical severity parameters were found between subsets A and B. Age less than 3 months was associated with greater duration of respiratory distress and longer hospital stay. CONCLUSION: The results do not support the hypothesis that subtype A infection is associated with more severe respiratory syncytial virus disease.

Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis / Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis

Antecedentes: El virus respiratorio sincitial (VRS) es el principal agente de la bronquiolitis y presenta dos subtipos distintos (A y B). Los trabajos acerca de la relación entre el subtipo de virus y la gravedad de la enfermedad obtienen resultados discordantes. Propósito: Analizar si el subtipo de este virus constituye una variable independiente en la gravedad clínica de la enfermedad. Pacientes y métodos: Estudio prospectivo que incluye niños previamente sanos menores de 2 años de edad, hospitalizados por infección respiratoria por VRS durante un brote epidémico anual. Se comparan la presentación y evolución clínica, las exploraciones complementarias y la radiografía pulmonar en los pacientes infectados por los subtipos A y B de VRS. Los indicadores clínicos de gravedad incluyen el grado y duración del distrés respiratorio, la necesidad de oxígeno suplementario, la admisión en cuidados intensivos, la ventilación mecánica y la duración del ingreso hospitalario. Resultados: De los 85 enfermos incluidos (35 mujeres, 50 varones; edad media, 4,8 ± 4,3 meses), 59 casos pertenecían al subtipo A. Ambos grupos no se diferenciaban en cuanto a sexo, edad y antecedentes, excepto en la lactancia materna que fue menos frecuente en el subtipo B. La presentación clínica, analítica y radiológica fue semejante en los dos grupos. Los indicadores clínicos de gravedad no difirieron de forma significativa en los dos grupos. La edad por debajo de los 3 meses se asoció a mayor duración del distrés respiratorio y de la estancia hospitalaria. Conclusión: Los resultados no apoyan la hipótesis de que la infección por el subtipo A del VRS se asocie a mayor gravedad clínica (AU)

Childhood asthma and outdoor air pollution in Oporto area.

The influence of outdoor air pollution, on childhood asthma, is not yet completely understood, especially a long exposition to low but persistent pollutants levels. This paper presents the relationship between air pollution, as sulphur dioxide (SO2) and black smoke (BS), and asthmatic attacks on children living in the Oporto area, during the period between 1983 and 1987, when its levels ranged below the official "security" ones. There was no correlation between daily levels of SO2 or BS, and the asthmatic attacks rate. However, for longer periods, as months and quarters, an increased positive correlation was found, but only with SO2 (r = 0.334, p = 0.01; r = 0.473, p = 0.07, for month and quarter periods, respectively). These data suggest that, neither SO2 nor BS seem to be direct bronchospasm inductors, at least when its levels stay between the relatively low limits observed. On the other hand, the longer exposition to SO2 appears to lower the threshold of the asthmatic children to other bronchospasm stimulus.

Autoradiographic study of RNA synthesis in adrenal cells of the young rat in primary culture.

Primary cultures of young rat adrenal cells were used in a radioautographic study of the effect of ACTH on RNA synthesis. Control and ACTH-stimulated cultures were incubated with 5.6 [3H]-uridine for 30 min and chased for 15 and 30 min. Labelling over nucleolar and extranucleolar areas was always lower in the ACTH-stimulated animals at all experimental times. At 30 min chase-time a relatively high labelling of nuclei in both experimental conditions suggest the slow metabolism of RNA in adrenal. The results confirm the inhibitor effect of adrenocorticotrophin on [3H]-uridine incorporation.