Atopic dermatitis pediatric patients show high rates of nasal and intestinal colonization by methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci.

BACKGROUND: Atopic dermatitis (AD) patients have high rates of colonization by Staphylococcus aureus, which has been associated with worsening of the disease. This study characterized Staphylococcus spp isolates recovered from nares and feces of pediatric patients with AD in relation to antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, presence of pvl genes and clonality. Besides, gut bacterial community profiles were compared with those of children without AD. RESULTS: All 55 AD patients evaluated had colonization by Staphylococcus spp. Fifty-three (96.4%) patients had colonization in both clinical sites, whereas one patient each was not colonize in the nares or gut. Staphylococcus aureus was identified in the nostrils and feces of 45 (81.8%) and 39 (70.9%) patients, respectively. Methicillin-resistant Staphylococcus spp. isolates were found in 70.9% of the patients, and 24 (43.6%) had methicillin-resistant S. aureus (MRSA). S. aureus (55.6%) and S. epidermidis (26.5%) were the major species found. The prevalent lineages of S. aureus were USA800/SCCmecIV (47.6%) and USA1100/SCCmecIV (21.4%), and 61.9% of the evaluated patients had the same genotype in both sites. Additionally, gut bacterial profile of AD patients exhibits greater dissimilarity from the control group than it does among varying severities of AD. CONCLUSIONS: High rates of nasal and intestinal colonization by S. aureus and methicillin-resistant staphylococci isolates were found in AD patients. Besides, gut bacterial profiles of AD patients were distinctly different from those of the control group, emphasizing the importance of monitoring S. aureus colonization and gut microbiome composition in AD patients.

Dermatite atópica grave: guia prático de tratamento da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Severe atopic dermatitis: a practical treatment guide from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença cutânea inflamatória, crônica, comum, complexa e de etiologia multifatorial, que se manifesta clinicamente com prurido muitas vezes incapacitante, lesões recorrentes do tipo eczema, xerose e que pode evoluir para liquenificação. Embora o conhecimento sobre a sua fisiopatologia venham crescendo nos últimos anos, ainda as formas graves são frequentes e representam um desafio para o clínico. Para o presente guia realizou-se revisão não sistemática da literatura relacionada à DA grave refratária aos tratamentos habituais com o objetivo de elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados à sua apresentação. A integridade da barreira cutânea é um dos pontos fundamentais para a manutenção da homeostase da pele. Além dos cuidados gerais: evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes, suporte emocional, entre outros, o uso de agentes anti-inflamatórios/imunossupressores de uso tópico e/ou sistêmico também foi revisado. A aquisição de novos agentes, os imunobiológicos e as pequenas moléculas, melhorou a terapêutica para os pacientes com formas graves de DA, sobretudo as refratárias aos tratamentos convencionais.

Atopic dermatitis is a chronic, common, and complex inflammatory skin disease with a multifactorial etiology. It manifests clinically with often disabling pruritus, recurrent eczema-like lesions, and xerosis, and can progress to lichenification. Although understanding of the disease's pathophysiology has been growing in recent years, severe forms are still frequent and represent a challenge for clinicians. A non-systematic review of the literature on severe atopic dermatitis refractory to conventional treatment was conducted to develop the present guide, whose purpose is to help clarify the mechanisms involved in the disease and possible risk factors. The integrity of the skin barrier is fundamental for maintaining skin homeostasis. In addition to general care, patients should avoid triggering and/or irritating agents and moisturizers and seek emotional support, etc.; the use of topical and/or systemic anti-inflammatory/immunosuppressive agents was also reviewed. New agents, immunobiologicals, and small molecules have led to a broader range of therapies for patients with severe forms of the disease, especially cases refractory to conventional treatment.

Methicillin-resistant and methicillin-sensitive Staphylococcus aureus isolates from skin and nares of Brazilian children with atopic dermatitis demonstrate high level of clonal diversity.

BACKGROUND: Atopic dermatitis (AD) primarily affects the pediatric population, which is highly colonized by S. aureus. However, little is known about the genetic features of this microorganism and other staphylococcal species that colonize AD patients. OBJECTIVE: This study aimed to characterize Staphylococcus spp. isolated from the nares and skin (with and without lesion) of 30 AD and 12 non-AD Brazilian children. METHODS: Skin and nasal swabs were cultured onto mannitol salt agar, and bacterial colonies were counted and identified by matrix assisted laser desorption ionization time of flight mass spectrometry and polymerase chain reaction (PCR). Antimicrobial susceptibility was evaluated by phenotypic and genotypic tests. In S. aureus isolates, Panton-Valentine leukocidin genes were detected by PCR, and their clonality was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS: S. aureus was more prevalent in the nares (P = 0.005) and lesional skin (P = 0.0002) of children with AD, while S. hominis was more frequent in the skin of non-AD children (P < 0.0001). All children in the study, except one from each group, were colonized by methicillin-resistant coagulase-negative Staphylococcus and 24% by methicillin-resistant S. aureus. Despite the great clonal diversity of S. aureus (18 sequence types identified), most AD children (74.1%) were colonized by the same genotype in both niches. CONCLUSION: High colonization by polyclonal S. aureus isolates was found among children with AD, while S. hominis was more frequent among non-AD children. The high prevalence of methicillin-resistant staphylococcal isolates highlights the importance of continued surveillance, especially when considering empiric antibiotic therapy for the treatment of skin infections in these patients.

Can 2,4-D promote the hormesis effect in upland rice?

This study aimed to evaluate the influence of low doses of 2,4-D on the agronomic traits of upland rice applied at different stages of crop growth. The work was carried out in a randomized completly blocks, and consisted of the application of 5 low doses of the 2,4-D herbicide (0, 0.68, 1.36, 2.04, 3.40 and 5.44 g acid equivalent (e.a.) ha-1) in two stages of rice development (tillering and floral differentiation). Nitrogen contentes in leaves, SPAD index and yield are higher when low doses of 2,4-D is applied in the tillering stage. Application of 2,4-D at a dose of 2.04 g a.e ha-1 results in a 19% increase in the number of spikelet per panicle. On the other hand, there is no effect of the application of low doses of 2,4-D on height, number of stems, active tillering and weight of 100 seeds. Our results contribute to increase knowledge of the hormesis effect in plants in order to increase crop yield.

Detection and estimation of Mastigimas anjosi (Hemiptera: Calophyidae) populations on Cedrela fissilis trees.

Mastigimas anjosi is an important pest of Cedrela fissilis in the southeastern and southern regions of Brazil. The objective of the present study was to investigate the effect of the temperature, relative humidity, rainfall and natural enemies on the flight activity of adults and the movement of M. anjosi nymphs, with two sampling methods, yellow sticky traps and direct collections on the leaves of C. fissilis trees. The sex ratio of this pest was also assessed. The number of M. anjosi individuals was negatively correlated with the minimum and maximum temperatures, with a population peak in late May and early June 2017. The numbers of individuals of this psyllid was positively correlated with the relative humidity and rainfall. Larvae and adults of Cycloneda sanguinea, Hippodamia convergens adults and Atopozelus opsimus nymphs and adults preyed upon M. anjosi adults and nymphs on C. fissilis leaves in the field. Mastigimas anjosi sex ratio was 0.46. Information about sampling methods of M. anjosi and its natural enemies is presented and can contribute to the integrated management of this pest in the field.

Can the application of low doses of paraquat induce the hormesis effect in upland rice?

This study aimed to verify the effects of the application of paraquat low doses on the agronomic traits of upland rice in two different application modes. The treatments consisted of a combination of 6 low doses of the paraquat (0; 20; 40; 60; 80 and 120 g a.i. ha-1) and 2 application modes of low doses a) single application performed between active tillering and floral differentiation b) application split into four applications, the first being carried out at the beginning of active tillering, the second being carried out between active tillering and floral differentiation, the third application carried out after floral differentiation and the fourth application carried out after flowering with 25% of the dose in each application. The application of low doses of paraquat does not promote the hormesis effect of upland rice. The increase in the frequency of the plant to the herbicide caused by the splitting of applications negatively affected the plant height, number of spikelets per panicle, yield, leaf nitrogen and sulfur as the low doses levels were increased. On the other hand, there is no influence of paraquat low doses levels when single applied to the agronomic traits of upland rice.

Influence of the production environment on the cultivation of lettuce and arugula with spent mushroom substrate.

After mushroom production, the substrate plus the cultivated mycelium represents a byproduct, the so-called "spent mushroom substrate" (SMS). We evaluated different SMS types in fresh form, recently taken from the cultivation rooms, for the production of lettuce and arugula in the open field, greenhouse and greenhouse in pot. Three kinds of SMS were used (i - SMS of ABL (Agaricus subrufescens), ii - SMS of POS (Pleurotus ostreatus) and iii - 50% SMS of ABL + 50% SMS of POS) at three doses (1, 2 and 4 kg m-2). For comparison purposes, two commercial soil conditioners, Forth Condicionador® and Visa Fértil Orgânico®, were used. Finally, chicken manure with reference as international organic material was used. A control treatment consisted of a soil plot without any organic material. The application of fresh SMS in the production of LE (lettuce) and AR (arugula) is feasible considering several agronomic parameters evaluated, therefore that in F (field) the superior results were obtained by the ABL dose of 4 kg m-2, in the GR (green house) at a lower dose ABL with 1 kg m-2, POS with 2 kg m-2 and mix with ABL + POS at doses of 2-4 kg m-2, and finally in GR/P (greenhouse pot) it was proved that in a protected environment by rain the combination ABL + POS at dose of 4 kg m-2 is recommended.

Clinical oral profile of pediatric patients with atopic dermatitis: A cross-sectional study.

OBJECTIVES: This work aims to describe oral health conditions, eating habits, and oral hygiene in pediatric and adolescent patients with atopic dermatitis and correlate them with the severity of the Scoring Atopic Dermatitis (SCORAD). Also, we aim to estimate the effect of several variables on the diagnosis of dental caries in these patients. MATERIAL AND METHODS: A total of 92 children and adolescents with atopic dermatitis had their oral cavities examined. The effect of independent variables on the diagnosis of dental caries (outcome) was assessed using multiple binary logistic regression model. RESULTS: Mild patients presented higher score of decayed, missing, and filled teeth in permanent dentition than moderate patients (p = 0.040). In the multivariable regression final model, the covariates using inhaled corticoid (OR = 6.4; p = 0.003), type of teething [deciduous dentition (OR = 7.9; p = 0.027) and mixed dentition (OR = 10.5; p = 0.007)], and brushing quality [poor mechanical control (OR = 10.6; p < 0.0001)] demonstrated significant direct effect on the diagnosis of dental caries. CONCLUSIONS: Our findings suggest that the presence of dental biofilm, use of inhaled corticoid, and type of teething are related to the presence of caries in atopic dermatitis patients.

Green Manure Species for Phytoremediation of Soil With Tebuthiuron and Vinasse.

Tebuthiuron is often used to control weed growth in sugarcane cultures. This herbicide is highly toxic and can persist in soil for up to 2 years according to its degradation half-life. Hence, its residual effect is highly hazardous for the environment and local habitants via leaching, surface runoff. Screening out of species of green manure as potential phytoremediators for tebuthiuron in soil, with and with no vinasse, accordingly is the scientific point of this study. Green manure species selected for the trial in greenhouse were jack bean [Canavalia ensiformis (L.) DC.], pigeon pea [Cajanus cajan (L. Millsp.)], velvet bean [Mucuna pruriens (L.) DC.)], and millet [Pennisetum glaucum (L.) R.Br.], and Crotalaria juncea L. as bioindicator of this herbicide. The determination/quantification of height, stem diameter, and number of leaves in all plants were monitored, as well as other morphological traits for drafting any inference on biomass production. Moreover, ecotoxicity bioassays were performed from soil samples at the beginning and at the end of the experiment. Results showed preliminary evidence of effective phytoremediation capacity by M. pruriens and P. glaucum in soils with tebuthiuron, as the growth of C. juncea was sustained. Both Gompertz approach and principal component analysis predicted that these green manure species could grow healthier and for longer periods in soils containing tebuthiuron and vinasse and, thus, reduce physiological anomalies due to ecotoxicity. The implications of this study may aid in the implementation of cost-effective strategies targeting decontamination of tebuthiuron in sugarcane crops with vinasse application in fertigation.

High incidence of acquiring methicillin-resistant Staphylococcus aureus in Brazilian children with Atopic Dermatitis and associated risk factors.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in Atopic Dermatitis (AD) patients can contribute to worsening their clinical condition. OBJECTIVE: A cohort study was carried out to determine the incidence of MRSA acquisition and its risk factors in AD children. METHODS: Patients with AD (2 months-14 years old) were followed up for about 1 year at a reference center for AD treatment in Rio de Janeiro, Brazil, from September 2011 to February 2014. Nasal swabs from patients and contacts were collected every 2 months. The SCORAD system assessed the severity of the AD. S. aureus isolates were evaluated to determine the methicillin resistance and the clonal lineages. RESULTS: Among 117 AD patients, 97 (82.9%) were already colonized with S. aureus and 26 (22.2%) had MRSA at the first evaluation. The incidence of MRSA acquisition in the cohort study was 27.47% (n = 25). The SCORAD assessments were: mild (46.15%), moderate (37.36%) or severe (16.48%). Risk factors were: colonized MRSA contacts (HR = 2.27; 95% CI: 1.16-7.54), use of cyclosporine (HR = 5.84; 95% CI: 1.70-19.98), moderate or severe AD (HR = 3.26; 95% CI: 1.13-9.37). Protective factors were: availability of running water (HR = 0.21; 95% CI: 0.049-0.96) and use of antihistamines (HR = 0.21; 95% IC: 0.64-0.75). MRSA isolates carried the SCCmec type IV and most of them were typed as USA800/ST5. CONCLUSIONS: The high incidence of MRSA acquisition found among AD patients and the risk factors associated show that an effective surveillance of MRSA colonization in these patients is needed.

Use of peanut waste for oyster mushroom substrate supplementation-oyster mushroom and peanut waste.

The aim of the research was to verify the influence of macro and micronutrients present in the peanut waste (hulls and nuts) for supplementation of Pleurotus ostreatus substrate. The raw materials for base substrate preparation were Brachiaria dictyoneura, sugarcane bagasse (bulk material), rice and wheat bran, calcitic limestone, and gypsum. The following supplement formulations were used as treatments: (1) 100% peanut hulls, (2) 80% peanut hulls + 20% nuts, (3) 60% peanut hulls + 40% nuts, (4) 40% peanut hulls + 60% nuts, (5) 20% peanut hulls + 80% nuts, and (6) 100% nuts. A commercial supplement was also used as an additional treatment. The supplementation was done at spawning using the rates of 1% and 2% wet weight of the substrate. Positive correlations amongst yield and N content, and weight of mushroom and P and K content were verified with 1% supplement. A positive correlation between yield and Cu content, and a negative correlation between yield and Mn content were observed with 2% supplement. The use of peanut waste can be used as supplement for the production of P. ostreatus increasing biological efficiency up to 61%. A better combination can be reached with 20% peanut hulls + 80% nuts or 100% nuts. The addition of 2% supplement in the substrate provided greater yield than 1%.

Megastigmus seed wasp damage on native Schinus terebinthifolia drupes in ecological restoration area in Brazil.

Megastigmus transvaalensis Hussey (Hymenoptera: Torymidae) parasitizes drupes of Rhus genus plants in Africa and Schinus (Anacardiaceae) in South America. This exotic wasp damages Schinus terebinthifolia Raddi drupes in native forests and ecological restoration areas in Brazil. The objective of the present study was to investigate the precipitation, temperature and relative humidity effects on M. transvaalensis flight activity, and to determine the parasitism rate and sex ratio of this wasp on S. terebinthifolia plants. The study was conducted with yellow sticky traps and S. terebinthifolia drupes collected in an ecological restoration area, from August 2014 to September 2015, in the Sorocaba municipality, São Paulo state, Brazil. Megastigmus transvaalensis populations were negatively correlated with maximum and minimum temperatures and precipitation, with population peaks at the end of May 2015, with 927 insects per evaluation (48.8 adults per trap). The M. transvaalensis sex ratio was higher in the laboratory (0.42) than in the field (0.08). The parasitism rate of S. terebinthifolia drupes by M. transvaalensis ranged from zero to 36.3% under natural environmental conditions. Megastigmus transvaalensis can be monitored with yellow sticky traps. Damage by M. transvaalensis in S. terebinthifolia drupes may decrease the germination of the seeds and the establishment of this plant in native and restoration ecological areas.

Interference of spray volume, fruit growth and rainfall on spray deposits in citrus black spot control periods / Interferência do volume de calda, crescimento dos frutos e precipitação pluviométrica sobre os depósitos da pulverização no período de controle da mancha preta dos citros

ABSTRACT: Citrus black spot (CBS) caused by Guignardia citricarpa is one of the most serious Brazilian citrus diseases. This study aims to assess the interference of three application volumes in spray deposition citrus fruit, as well as fruit growth and rainfall effects on spray deposit reduction during the CBS control period. The experiment was carried out in a commercial citrus orchard, with sixteen-year-old trees of the Valencia variety, in Mogi Guaçu, São Paulo State, Brazil. The spray volumes were: 3.5 (1333L ha-1), 4.5 (1714L ha-1) and 8.5 (3238L ha-1) litres per tree, sprayed by an airblast sprayer using fungicides at recommended periods for disease control. The spray deposition quantification and residue was done by spectrophotometry using a copper oxychloride tracer. Samples were collected in three height zones of the tree (top, middle and bottom) and placed between trees on line plantation. Spray depositions were significantly smaller in the first application as a consequence of reduced fruit size. The spray losses on average for each day of rainfall ranged from 4.0 to 5.7%. There was no significant difference between application volumes regarding spray deposition on citrus fruit,which makes possible the reduction of application volumes, however, it is necessary to improve spraying techniques for the top zone of the citrus tree.

RESUMO: A pinta preta ou mancha preta em citros (MPC) está entre as mais importantes doenças da citricultura brasileira. O trabalho teve como objetivo avaliar a interferência de três volumes de pulverização na deposição da calda em frutos cítricos e o efeito do crescimento dos frutos e da precipitação pluviométrica na redução dos depósitos, durante o período de controle da doença. O experimento foi conduzido em pomar comercial com 16 anos, da variedade Valencia, na região de Mogi Guaçu, SP. Os tratamentos consistiram dos volumes de 3,5 (1333L ha-1); 4,5 (1714L ha-1) e 8,5 (3238L ha-1) L planta-1, aplicados por um pulverizador de arrasto com jato transportado, utilizando fungicidas nos períodos recomendados para controle da doença. A quantificação dos depósitos/resíduos foi por espectrofotometria, usando oxicloreto de cobre como traçador. Os frutos foram coletados em três alturas da planta, na região entre plantas da linha de plantio. Os depósitos foram significativamente inferiores na primeira aplicação, como consequência do tamanho reduzido do fruto. As perdas dos depósitos médios de calda, por dia de chuva, variaram de 4,0 a 5,7%. Não ocorreram diferenças significativas entre volumes de aplicação quanto à deposição sobre os frutos, possibilitando a redução de volumes, contudo, torna-se necessário melhorar as técnicas de aplicação na parte superior da planta.

Peanut allergy as a trigger for the deterioration of atopic dermatitis and precursor of staphylococcal and herpetic associated infections - case report.

Atopic dermatitis (AD) is a multifactorial and chronic disease, with genetic, environmental, immunological and nutritional origins. AD may be aggravated by allergies associated with infections. This study aims to describe a paediatric case of AD in which the peanut allergy was the triggering factor to aggravate the disease, and was also the concomitant precursor of staphylococcal (methicillin-sensitive Staphylococcus aureus, carrier of the Panton-Valentine leukocidine (PVL) genes) and herpetic (Herpes Simplex - HSV) infections. The clinical management approach and nursing strategies promoted a favourable evolution during the hospitalization period, besides the family approach, which was essential to control any flare-up of the disease. Adherence to a recommended diet and the use of strategies to prevent any recurrent infections were important to ensure the patient's quality of life.

Immune allergic response in Asperger syndrome.

Asperger's syndrome is a subgroup of autism characterized by social deficits without language delay, and high cognitive performance. The biological nature of autism is still unknown but there are controversial evidence associating an immune imbalance and autism. Clinical findings, including atopic family history, serum IgE levels as well as cutaneous tests showed that incidence of atopy was higher in the Asperger group compared to the healthy controls. These findings suggest that atopy is frequent in this subgroup of autism implying that allergic inflammation might be an important feature in Asperger syndrome.

Anafilaxia: guia prático para o manejo / Anaphylaxis: practical guide for management

Anafilaxia representa uma das mais dramáticas condições clínicas de emergência médica. Tanto pela imprevisibilidade de aparecimento como pelo potencial de gravidade, anafilaxia determina imenso impacto na qualidade de vida das pessoas afetadas, dos seus familiares e circunstantes. O estudo e a avaliação de casos de anafilaxia sempre foi preocupação da especialidade de Imunoalergologia. No dia a dia dos ambulatórios de Alergia e Imunologia Clínica são vistas regularmente pessoas que sofreram reações alérgicas agudas graves e que necessitam de orientação especializada. Não é raro observar-se que algumas sofreram reações repetidas sem receber a orientação de procurar atendimento especializado. Cada crise representa risco, que é variável dependendo das características do paciente e do agente desencadeante. Afalta de informação adequada contribui para aumentar a chance de novas ocorrências. O Manejo prático da anafilaxia tem o objetivo de disseminar o conhecimento sobre anafilaxia entre médicos e profissionais da saúde, pacientes e familiares, escolas e professores, assim como, autoridades de saúde pública. Este documento não é um protocolo de atendimento a pacientes com reações anafiláticas, nem pretende formular rotinas clínicas. Nele está contido de forma concisa o conhecimento atual sobre o tema e a experiência pessoal de especialistas no manejo dessas situações. Aborda-se o diagnóstico e tratamento emergencial, assim como, a avaliação e tratamento pós-crise. Cuidados básicos e atitudes preventivas são também consideradas

O conhecimento de pediatras sobre alergia alimentar: estudo piloto / Pediatricians' knowledge on food allergy: pilot study

OBJETIVO: Avaliar o conhecimento de pediatras sobre alergia alimentar. MÉTODOS: Dados obtidos de questionário padronizado, postado e respondido por pediatras filiados à Sociedade Brasileira de Pediatria (SBP). Digitação dos dados em planilha Excel e análise de freqüência de respostas afirmativas em porcentagem. RESULTADOS: Foram analisados 895 questionários preenchidos por pediatras de todo o país, com predomínio da região Sudeste (61,6 por cento). Segundo os pediatras entrevistados, as manifestações diagnósticas de alergia alimentar são: respiratórias, cutâneas e sistêmicas, em iguais proporções. Ainda segundo estes pediatras, leite de vaca (98,9 por cento), clara de ovo (58,7 por cento) e amendoim (50,9 por cento) são os principais alimentos associados a essas manifestações. Embora 74,8 por cento dos respondedores tivessem identificados os corantes e aditivos alimentares como responsáveis pela alergia alimentar, apenas 19,4 por cento conheciam o código de identificação da tartrazina. CONCLUSÕES: Os dados apresentados reforçam a necessidade de ampliação dos conhecimentos dos profissionais de saúde sobre o diagnóstico e tratamento da alergia alimentar, com o objetivo de garantir o uso de critérios diagnósticos e terapêuticos mais adequados.

OBJECTIVE: To evaluate the knowledge of Brazilian pediatricians about food allergy. METHODS: Data was obtained from a sent back posted written questionnaire. It was filled in by Brazilian pediatricians, affiliated to the Brazilian Society of Pediatrics. Data was transcript to an Excel spread sheet and the frequency of affirmative responses was reported as percentages. RESULTS: Data from 895 written questionnaire of pediatricians from all over Brazil, (mainly from the southeastern region - 61.6 percent), were analyzed. The main clinical expressions of food allergy determined by the pediatricians were: respiratory, cutaneous and systemic symptoms (equal proportions). According to these pediatricians, cow's milk (98.9 percent), egg white (58.7 percent) and peanuts (50.9 percent) were the main allergens related to food allergy symptoms. Although 74.8 percent of the responders have indicated food dyes and food additives as associated to food allergies, only 19.4 percent of them knew the identification code of tartrarzine. CONCLUSIONS: The presented data reinforce the need to improve the pediatricians' knowledge about the diagnosis and treatment of food allergy, in order to assure the use of appropriate diagnostic and treatment criteria.

Anafilaxia e reações alérgicas / Anaphylaxis and allergic reactions

Objetivo: Revisar os fatores etiológicos, a fisiopatologia e principalmente o manejo terapêutico das reações anafiláticas. Métodos: A revisão bibliográfica foi baseada em livros-textos de alergia e terapia intensiva e referências do Medline. Resultados: As reações anafiláticas, que resultam da rápida liberação de potentes mediadores farmacologicamente ativos de mastóocitos e basófitos, podem acometer vários órgãos e sistemas, podendo levar o indivíduo à morte. Comentários: A anafilaxia é uma síndrome clínica com uma significativa taxa de mortalidade. Existem muitos fatores etiológicos desencadeantes do processo e múltiplos mecanismos fisiopatológicos envolvidos. O diagnóstico precoce permite, através de medicação efetiva, um melhor prognóstico. Na maioria dos casos, medidas profiláticas se tornam necessárias para que outros episódios não ocorram

Asma brônquica: mecanismos de defesa / Bronchic Asthma - Defense Mechanisms

Durante muitos anos os estudos relativos a asma nos esclareciam e valorizavam tao somente a participacao de alergenos na eclosao de uma crise asmatica. Atualmente sao varios os mecanismos que podem desencadear broncoespasmo, edema e hipersecrecao bronquica, o que faz da asma realmente uma doenca multifatorial e extremamente complexa no que diz respeito a sua etiopatogenia. Inalacao de gases, infeccao viral respiratoria, medicamentos, aditivos quimicos, alimentos, poluentes, exercicio sao outros fatores desencadeantes. Nestes casos, o desequilibrio do sistema nervoso autonomo parece ter papel fundamental no aparecimento do broncoespasmo, seja por bloqueio beta adrenergico ou por estimulo colinergico. Poderiamos concluir dizendo que a condicao genetica, a hiperreatividade bronquica, a regulacao neurohormonal, a liberacao de mediadores quimicos sao alguns dos fenomenos importantes na patogenese da asma e ressaltar que os incessantes estudos que vem sendo realizados nesta area poderao nos esclarecer ainda mais sobre esta doenca por demais estigmatizante

Concentraçöes séricas de teofilina em crianças tratadas com cápsulas abertas e fechadas de uma teofilina de açäo prolongada: teolong / Theophylline blood level concentrations in children treated with open and closed capsules of a sustained release theophylline: teolong

Este estudo avalia as concentraçöes séricas da teofilina na monitorizaçäo dos pacientes pediátricos. Quarenta crianças (de três a 12 anos) com asma comprovada foram admitidas ao acaso num grupo de tratamento com as cápsulas abertas ou num grupo de cápsulas fechadas de uma teofilina de açäo retardada, durante oito dias. A dose diária foi de 8 a 10 mg/Kg/dia, administradas de 12 em 12 horas. No último dia da investigaçäo, as concentraçöes séricas de teofilina foram obtidas antes da dose matinal, 4 e 8 horas mais tarde. Os resultados näo indicaram diferenças com significaçäo estatística entre as duas formas de adminsitraçäo, nas concentraçöes médias de teofilina. As concentraçöes séricas de teofilina permaneceram entre 10 e 20 mcg/ml, na maioria dos casos. Devido as variaçöes individuais na absorçäo e no metabolismo, os níveis sangüineos de teofilina deveriam ser realizados regularmente, ao se usar a droga. Os autores näo puderam correlacionar as reaçöes adversas com as concentraçöes séricas de teofilina. A aderência e a tolerância medicamentosas foram boas, sugerindo que os microgrânulos de açäo prolongada da teofilina säo úteis no manuseio clínico a longo prazo da asma brônquica. Novos estudos com maior número de casos säo também recomendados