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Impact of COVID-19 social distancing recommendations on pulmonary function, nutritional status, and morbidity in patients with cystic fibrosis
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Bagatini, Maria Amélia

; Heinzmann-Filho, João Paulo

; Vendrusculo, Fernanda Maria

; Pinto, Leonardo Araújo

; Donadio, Márcio Vinícius Fagundes

Revista Paulista de Pediatria

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2024, Volume 42 elocation e2022198

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To evaluate the impact of COVID-19 social distancing recommendations on nutritional status, pulmonary function, and morbidity in patients with cystic fibrosis (CF). Methods: A retrospective cohort study including patients older than six years with a diagnosis of CF was performed. Demographic and clinical data, anthropometric measurements, pulmonary function, days of antibiotic use, and length of hospital stay were recorded. Variables were recorded at three time points relative to the baseline for implementation of social distancing measures: T-1 (14 months before implementation), T0 (baseline), and T1 (14 months after implementation). Delta (Δ) was calculated for each period: Δ1 (pre-pandemic T0-T-1) and Δ2 (pandemic T1-T0). Results: The study included 25 patients, with a mean age of 11.7±4.3 years. The mean forced expiratory volume in the first second (FEV1) was 85.6±23.6%, and body mass index (BMI) was 17.5±3.0 kg/m2. When comparing the two periods (Δ1 and Δ2), there was a significant increase in the FEV1/forced vital capacity (FVC) ratio (p=0.013) and in the forced expiratory flow between 25 and 75% of vital capacity (FEF25–75%) (p=0.037) in the pandemic period. There was also a significant reduction (p=0.005) in the use of antibiotics in the pandemic period compared with the pre-pandemic period. The Δ1 and Δ2 values did not differ significantly for BMI, FEV1, or length of hospital stay. Conclusions: COVID-19 social distancing recommendations had a positive impact (decrease) on morbidity (use of antibiotics) and small airway obstruction (FEF25–75%) in patients with CF.

RESUMO Objetivo: Avaliar o impacto das recomendações de medidas de distanciamento social por COVID-19 sobre estado nutricional, função pulmonar e morbidade em pacientes com fibrose cística (FC). Métodos: Estudo de coorte, retrospectivo, que incluiu pacientes com diagnóstico de FC e idade superior a seis anos. Foram registrados os dados demográficos, antropométricos, clínicos, de função pulmonar e o total de dias de uso de antibiótico e de hospitalizações. As variáveis foram registradas em três momentos relativos ao início das recomendações de distanciamento social: T-1 (14 meses antes), T0 (início das recomendações) e T1 (14 meses depois). Foram calculados deltas (Δ) para cada um dos períodos: Δ1 (pré-pandemia T0-T-1) e Δ2 (pandemia T1-T0). Resultados: Vinte e cinco pacientes, com média de idade de 11,7±4,3 anos, sendo 76% homozigotos para Δf508 e 28% colonizados por Pseudomonas aeruginosa, foram incluídos. A média do volume expiratório forçado no primeiro segundo (VEF1) foi de 85,6±23,6 (% do previsto) e o índice de massa corporal (IMC) foi de 17,5±3,0 kg/m2. Ao compararmos os períodos (Δ1 e Δ2), houve aumento significativo do VEF1/CVF (p=0,013) e do FEF25–75% (p=0,037) no período das recomendações de distanciamento. Também se observou redução significativa (p=0,005) do uso de antibióticos no período da pandemia em comparação ao período anterior a ela. Não houve diferenças significativas nos deltas para o IMC, VEF1 e dias de hospitalização. Conclusões: As recomendações de distanciamento social por COVID-19 tiveram impacto positivo (redução) sobre a morbidade (uso de antibióticos) e a obstrução de vias aéreas de menor calibre (FEF25–75%) em pacientes com FC.

https://doi.org/10.1590/1984-0462/2024/42/2022198

BRAZILIAN SOCIETY OF HEPATOLOGY UPDATED RECOMMENDATIONS FOR SYSTEMIC TREATMENT OF HEPATOCELLULAR CARCINOMA
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CHAGAS, Aline Lopes

; LEAL, Cassia Regina Guedes

; MELLO, Vivianne Barreto de

; BARROS, Fábio Marinho Do Rego

; BITTENCOURT, Paulo Lisboa

; MATTOS, Angelo A

; AROUCHA, Dayse

; FONSECA, Leonardo G da

; SILVA, Joyce Roma Lucas de

; DOTTORI, Mariana Fonseca

; TEIXEIRA, Rosangela

; MENDES, Liliana Sampaio Costa

; REZENDE, Rosamar Eulira Fontes

; FILGUEIRA, Norma Arteiro

; COUTINHO, Anelisa K

; ARAÚJO NETO, João Marcello de

; COELHO, Henrique Sergio Moraes

; PESSOA, Mario Guimarães

; CHEINQUER, Hugo

; PARISE, Edison Roberto

; FRANÇA, Alex

; ÁLVARES-DA-SILVA, Mário Reis

; CARRILHO, Flair José

; CORAL, Gabriela P

; PINTO, Paulo de Tarso Aparecida

; PEREIRA, Leila M M Beltrão

; PARANÁ, Raymundo

; ALVES, Rogério Camargo Pinheiro

; BRANDÃO-MELLO, Carlos Eduardo

Arquivos de Gastroenterologia

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jan 2023, Volume 60 N. 1 Pages 106 - 131

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. The Brazilian Society of Hepatology (SBH) published in 2020 the updated recommendations for the diagnosis and treatment of HCC. Since then, new data have emerged in the literature, including new drugs approved for the systemic treatment of HCC that were not available at the time. The SBH board conducted an online single-topic meeting to discuss and review the recommendations on the systemic treatment of HCC. The invited experts were asked to conduct a systematic review of the literature on each topic related to systemic treatment and to present the summary data and recommendations during the meeting. All panelists gathered together for discussion of the topics and elaboration of the updated recommendations. The present document is the final version of the reviewed manuscript containing the recommendations of SBH and its aim is to assist healthcare professionals, policy-makers, and planners in Brazil and Latin America with systemic treatment decision-making of patients with HCC.

RESUMO O carcinoma hepatocelular (CHC) é uma das principais causas de mortalidade relacionada a câncer no Brasil e no mundo. A Sociedade Brasileira de Hepatologia (SBH) publicou em 2020 a atualização das recomendações da SBH para o diagnóstico e tratamento do CHC. Desde então, novas evidências científicas sobre o tratamento sistêmico do CHC foram relatadas na literatura médica, incluindo novos medicamentos aprovados que não estavam disponíveis na época do último consenso, levando a diretoria da SBH a promover uma reunião monotemática on-line para discutir e rever as recomendações sobre o tratamento sistêmico do CHC. Um grupo de experts foi convidado para realizar uma revisão sistemática da literatura e apresentar uma atualização, baseada em evidências científicas, sobre cada tópico relacionado ao tratamento sistêmico e a apresentar os dados e recomendações resumidas durante a reunião. Todos os painelistas se reuniram para discutir os tópicos e elaborar as recomendações atualizadas. O presente documento é a versão final do manuscrito revisado, contendo as recomendações da SBH, e seu objetivo é auxiliar os profissionais de saúde, formuladores de políticas e planejadores no Brasil e na América Latina na tomada de decisões sobre o tratamento sistêmico de pacientes com CHC.

https://doi.org/10.1590/s0004-2803.202301000-14

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association)
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Athanazio, Rodrigo Abensur

; Tanni, Suzana Erico

; Ferreira, Juliana

; Dalcin, Paulo de Tarso Roth

; Fuccio, Marcelo B de

; Esposito, Concetta

; Canan, Mariane Gonçalves Martynychen

; Coelho, Liana Sousa

; Firmida, Mônica de Cássia

; Almeida, Marina Buarque de

; Marostica, Paulo José Cauduro

; Monte, Luciana de Freitas Velloso

; Souza, Edna Lúcia

; Pinto, Leonardo Araujo

; Rached, Samia Zahi

; Oliveira, Verônica Stasiak Bednarczuk de

; Riedi, Carlos Antonio

; Silva Filho, Luiz Vicente Ribeiro Ferreira da

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 2 elocation e20230040

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

RESUMO A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.

https://doi.org/10.36416/1806-3756/e20230040

Management of bronchiolitis and recurrent wheezing in preschoolers
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Herter, Eduardo da Costa

; Xavier, Luiza Fernandes

; Barros, Paula Barros de

; Azevedo, Sofia Prates da Cunha de

; Lumertz, Magali Santos

; Pinto, Leonardo Araujo

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 5 elocation e20230298

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20230298

Management of pneumonia and pleural effusion in children
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Prestes, Laura Menestrino

; Castro, Miguel Ângelo Uflacker Lutz de

; Souza, Gabriela de Azevedo Bastian de

; Barros, Laura Gomes Boabaid de

; Scotta, Marcelo Comerlato

; Pinto, Leonardo Araujo

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 6 elocation e20230370

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20230370

Frequency of CFTR variants in southern Brazil and indication for modulators therapy in patients with cystic fibrosis
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Lima, Eliandra da Silveira

; Pezzin, Luíse Sgarabotto

; Fensterseifer, Ana Carolina

; Pinto, Leonardo Araújo

Genetics and Molecular Biology

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2022, Volume 45 N. 1 elocation e20200275

Abstract: En | Text: En | PDF: En

Abstract This is a descriptive cross-sectional study that aims to determine the distribution of the CFTR causing variant in a group of patients at a cystic fibrosis (CF) center in southern Brazil, as well as to describe causing variants that are treatable with mutation-specific drugs. Ninety-two patients from a CF reference center were assessed in this research, all of them with a clinical diagnosis of CF and both alleles identified with pathogenic variants. The most prevalent causing variants were F508del, R1162X, G542X, and N1303K. As for patients with a mutation-specific drug indication, 69.6 % were candidates for the use of Elexacaftor/Tezacaftor/Ivacaftor (Trikafta®), 44.6 % for the use of Tezacaftor/Ivacaftor (Symdeko®), and 35.9 % for the use of Lumacaftor/Ivacaftor (Orkambi®). For the use of Ivacaftor (Kalydeco®), only two patients (2.2 %) were candidates following the Brazilian agency approval. According to the FDA, 10 patients would be candidates for Ivacaftor (10.9 %). Causing variants of classes I and II, which are related to a major severity of the illness, were identified in 135 of 184 alleles (73.3 %). In this study, more than 2/3 of the patients were candidates for the use of CFTR modulators therapy.

https://doi.org/10.1590/1678-4685-gmb-2020-0275 1 downloads

Association between interleukin-10 polymorphisms and CD4+CD25+FOXP3+ T cells in asthmatic children
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Mocellin, Magáli

; Leitão, Lidiane Alves de Azeredo

; Araújo, Patrícia Dias de

; Jones, Marcus Herbert

; Stein, Renato Tetelbom

; Pitrez, Paulo Márcio

; Souza, Ana Paula Duarte de

; Pinto, Leonardo Araújo

Jornal de Pediatria

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oct 2021, Volume 97 N. 5 Pages 546 - 551

Abstract: En | Text: En | PDF: En

Abstract Objective: The aim of this study was to evaluate the association between possible functional interleukin-10 (IL-10) polymorphisms, IL-10 expression and regulatory T cells (Tregs) frequency, and/or asthma severity in a sample of children and adolescents. Methods: This is a nested case-control genetic association study. The study sample consisted of children and adolescents aged 8–14 from public schools. Four polymorphisms of the IL-10 gene (rs1518111, rs3024490, rs3024496, rs3024491) were genotyped in asthmatic subjects and controls using real-time PCR. Tregs cells and IL-10 were analyzed in peripheral blood mononuclear cells by flow cytometry. The severity of asthma was defined according to the Global Initiative for Asthma (GINA) guideline. Results: One hundred twenty-three asthmatic subjects and fifty-eight controls participated in the study. The single nucleotide polymorphism (SNP) rs3024491 (T allele) showed association with asthma severity, presenting a higher frequency in patients in the moderate asthma group. The T allele of variant rs3024491 also showed an association with reduced IL-10 levels (p = 0.01) and with increased Tregs frequency (p = 0.01). The other variants did not present consistent associations. Conclusions: Our results suggest that moderate asthma is associated with a higher frequency of the T allele in the SNP rs3024491. In addition, the variant rs3024491 (TT) was associated with a reduction in IL-10 production and an increased percentage of Tregs cells, suggesting possible mechanisms that influence asthma severity.

https://doi.org/10.1016/j.jped.2020.11.008 24 downloads

Cystic fibrosis in Brazil: achievements in survival
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Vendrusculo, Fernanda Maria

; Donadio, Márcio Vinícius Fagundes

; Pinto, Leonardo Araújo

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 2 elocation e20210140

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20210140 529 downloads

Impact of social distancing in response to COVID-19 on hospitalizations for laryngitis, tracheitis, otitis media, and mastoiditis in children aged 0 to 9 years in Brazil
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Jesus, Clovisa Reck de

; Rosa, Aline Antônia Souto

; Meneses, Amanda da Silva

; Agostini, Angélica Conzati

; Merten, Fernanda Bercht

; Ferrão, Sofia Moreira

; Martins, Luíza Costa Silveira

; Friedrich, Frederico Orlando

; Pinto, Leonardo Araújo

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 6 elocation e20210229

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo O objetivo deste estudo é avaliar o impacto do distanciamento social decorrente da Covid-19 nas internações por infecções das vias aéreas superiores (IVAS), como laringite aguda, traqueíte e otite média em crianças de 0 a 9 anos no Brasil, considerando que compartilham as mesmas formas de transmissão. Métodos Dados sobre internações por alterações agudas das vias aéreas e suas complicações em crianças <9 anos foram obtidos do Banco de Dados do Departamento Brasileiro de Informática em Saúde Pública para o período de 2015 a 2020. Esses dados também foram analisados por macrorregiões do Brasil (Norte, Nordeste, Sudeste, Sul e Centro-Oeste). O efeito da estratégia de distanciamento social no aumento de laringite aguda, traqueíte, otite média e mastite, como reduções absolutas e relativas, foi calculado analisando o cálculo anual de 2015-2019 vs. 2020. Resultados Todas as internações comparadas no Sistema Único de Saúde (SUS) por laringite e traqueíte aguda e otite média diminuíram, considerando todos os estados do Brasil. A maior queda na redução de internações foi na região Norte, com -94% em 2015-2019 vs. 2020 nos casos de laringite e traqueíte aguda, e no Centro-Oeste, com -85% em 2015-2019 vs. 2020 nos casos de otite média. Conclusão As internações por laringite, traqueíte aguda e otite média aguda em crianças <9 anos diminuíram entre março e julho de 2020 no Brasil, quando medidas de distanciamento social foram adotadas devido à pandemia de Covid-19.

ABSTRACT Objective The objective of this study is to evaluate the impact of social distancing resulting from COVID-19 in hospitalizations for infections of the upper airways (URTI), such as acute laryngitis, tracheitis, and otitis media in children aged 0 to 9 years in Brazil, considering that they share the same forms of transmission. Methods Data on hospitalizations for acute airway changes and their complications in children <9 years old were obtained from the Database of the Brazilian Department of Public Health Informatics for the period 2015 to 2020. These data were also analyzed by macroregions of Brazil (North, Northeast, Southeast, South, and Midwest). The effect of the social distancing strategy on the increase of acute laryngitis, tracheitis, otitis media, and mastitis, as absolute and relative reductions, was calculated by analyzing the annual calculation of 2015-2019 vs 2020. Results All the hospitalizations compared in the Unified Health System (SUS) for laryngitis and acute tracheitis and otitis media decreased, considering all states of Brazil. The largest reduction in hospitalization reduction was in the North, with -94% in 2015-2019 vs 2020 in cases of laryngitis and acute tracheitis, and in the Midwest, with - 85% in 2015-2019 vs 2020 in cases of otitis media. Conclusion Hospitalizations for laryngitis, acute tracheitis, and acute otitis media in children <9 years old decreased between March and July 2020 in Brazil, when social distancing measures were adopted due to the COVID-19 pandemic.

https://doi.org/10.36416/1806-3756/e20210229 1 downloads

10.

Upper Airway Findings and Markers of Lung Disease Progression in Patients with Cystic Fibrosis
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Steffen, Luciane Mazzini

; Pezzin, Luise Sgarabotto

; Sulis, Natassia

; Steffen, Nedio

; Pinto, Leonardo Araujo

International Archives of Otorhinolaryngology

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dec 2020, Volume 24 N. 4 Pages 434 - 437

Abstract: En | Text: En | PDF: En

Abstract Introduction Cystic fibrosis (CF) is a genetic disease that limits the quality of life mainly due to respiratory symptoms. The relationship between findings of the upper airways and CF lung disease is not yet completely understood. Objective The aim of the present study is to describe the most frequent nasal findings and pathogens in patients with CF and investigate the association between the findings of the upper respiratory tract and markers of lung disease progression. Methods Retrospective study in patients with CF from the Pediatric Pulmonology Department who underwent otorhinolaryngological evaluation between 2015 and 2017. Nasal endoscopy and nasal swab collection were part of the evaluation. The severity markers used were: percentage of predicted forced expiratory volume in the first second (FEV1%), body mass index (BMI) and the Shwachman-Kulczycki (SK) clinical score. Results A total of 48 patients with CF were included. The mean of the predicted percentage of FEV1% was 83.36 ± 30.04. The average 14 and SK score 89.11 ± 10.50. The bacteriology of the nasal swab was positive in 27 (54.1%) patients. Staphylococcus aureus was positive in 18 patients, Pseudomonas aeruginosa in 5, Pseudomonas cepacea in 3 and Stenotrophomonas maltophila in 1 patient. Nasal polyps were found in nine participants. Nasal polyps were found in nine participants and were associated with lower SK score. Conclusion The pathogens found in the upper airway were, in order: S. aureus, P. aeruginosa, P. cepacea e S. maltophila. The presence of polyps in the nasal cavity showed statistical significance and appears to have association with the prognostic factor measured by the SK score.

https://doi.org/10.1055/s-0039-3402434 313 downloads

11.

Reference values for spirometry in Brazilian children
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Jones, Marcus Herbert

; Vidal, Paula Cristina Vasconcellos

; Lanza, Fernanda Cordoba

; Silva, Danielle Corrêa França de Melo Franco

; Pitrez, Paulo Márcio

; Olmedo, Ana Paula Bigliardi de Freitas

; Burity, Edjane Figueiredo

; Schisler, Kennedy Long

; Pinto, Leonardo Araújo

; Winck, Aline Dill

; Souza, Edna Lúcia Santos de

; Oliveira, Anick Augustin

; Ribeiro, Maria Ângela Gonçalves de Oliveira

; Torres, Lidia Alice Gomes Monteiro Marin

; March, Maria de Fátima Bazhuni Pombo

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 3 elocation e20190138

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Gerar valores de referência para espirometria em crianças brasileiras de 3-12 anos de idade e comparar os resultados obtidos com as equações em uso no Brasil. Métodos: Foram incluídas crianças sadias de 3-12 anos recrutadas em 14 centros (dados primários) e resultados de espirometria de crianças com as mesmas características de seis bancos de dados (dados secundários). As equações quantílicas foram geradas após transformações logarítmicas dos dados espirométricos e antropométricos. A classificação por cor da pele foi autodeclarada. Os resultados obtidos foram comparados com os previstos nas equações em uso no Brasil para testar sua adequação. Resultados: Foram incluídos 1.990 indivíduos de 21 fontes de dados primários e secundários, sendo 1.059 (53%) do sexo feminino. Equações para VEF1, CVF, VEF1/CVF, FEF25-75% e FEF25-75%/CVF foram geradas para crianças brancas e para crianças negras e pardas. Os logaritmos da estatura e da idade e a cor da pele foram os melhores preditores para VEF1 e CVF. Os resultados obtidos foram significativamente maiores do que as estimativas geradas pelas equações em uso no Brasil, tanto para valores previstos quanto para o limite inferior da normalidade, particularmente em crianças negras e pardas. Conclusões: Novas equações espirométricas foram geradas para crianças brasileiras de 3-12 anos de cor branca, negra e parda. As equações atualmente em uso no Brasil parecem subestimar a função pulmonar de crianças brasileiras menores de 12 anos de idade e deveriam ser substituídas pelas equações propostas neste estudo.

ABSTRACT Objective: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. Methods: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. Results: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. Conclusions: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.

https://doi.org/10.36416/1806-3756/e20190138 957 downloads

12.

TEMPORAL TREND OF HOSPITALIZATIONS FOR ACUTE BRONCHIOLITIS IN INFANTS UNDER ONE YEAR OF AGE IN BRAZIL BETWEEN 2008 AND 2015
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Tumba, Kanama

; Comaru, Talitha

; Machado, Camila

; Ribeiro, Manoel

; Pinto, Leonardo Araújo

Revista Paulista de Pediatria

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2020, Volume 38 elocation e2018120

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a tendência de hospitalização por bronquiolite aguda (BA) em lactentes menores de um ano de idade nos últimos oito anos no Brasil e, secundariamente, após a implementação do programa de imunização por palivizumabe. Métodos: Análise retrospectiva dos dados de lactentes menores de um ano de idade, hospitalizados com diagnóstico de BA entre 2008 e 2015 no Brasil, utilizando o banco de dados do Sistema Único de Saúde (SUS). Foram avaliadas as taxas de hospitalização nos períodos pré-implementação (2008-2012) e pós-implementação (2014-2015) do programa de imunização por palivizumabe. O número total de internações no mesmo período foi utilizado como comparação. Resultados: Entre janeiro de 2008 e dezembro 2015 foram registradas 263.679 internações por bronquiolite em lactentes menores de um ano de idade, 60% representado por meninos. A incidência de hospitalização por bronquiolite aumentou em 49% ao longo desse período (8,5 para 12,7 por mil habitantes/ano). Entre 2013 e 2014, a taxa de incidência de hospitalização por BA diminuiu 8% (12,5 para 11,5 por mil habitantes/ano). Porém, no segundo ano do programa, a taxa de internação aumentou novamente em 10% (12,7 por mil habitantes/ano). Conclusões: A BA apresentou taxas de hospitalização crescente ao longo do período estudado. A incidência de hospitalizações de BA apresentou declínio um ano após a implementação de palivizumabe e retornou à tendência crescente no segundo ano do programa.

ABSTRACT Objective: To evaluate the trend of hospitalization for acute bronchiolitis in infants under one year of age, in the past eight years and after the implementation of the palivizumab immunization program in Brazil. Methods: The study is a retrospective analysis of data on infants younger than one year of age, who were hospitalized with acute bronchiolitis between 2008 and 2015 in Brazil. The Brazilian National Health System database was used. The rates of hospitalization in the pre-implementation (2008-2012) and post-implementation (2014-2015) periods of the palivizumab immunization program were evaluated. The total number of admissions in the same period was used as a comparison. Results: Between January 2008 and December 2015, 263,679 hospitalizations for bronchiolitis were recorded in infants younger than one year of age, 60% represented by boys. The incidence of hospitalization for bronchiolitis increased by 49% over this period (8.5 to 12.7 per 1,000 inhabitants per year). Between 2013 and 2014, the incidence rate of hospitalization for acute bronchiolitis decreased by 8% (12.5 to 11.5 per 1,000 inhabitants per year). However, in the second year of the program, hospitalization rate increased again by 10% (12.7 per 1,000 inhabitants per years). Conclusions: Acute bronchiolitis presented increasing rates of hospitalization over the study period. Hospitalization incidence for acute bronchiolitis declined one year after the implementation of palivizumab but increased again in the second year of the program.

https://doi.org/10.1590/1984-0462/2020/38/2018120 1947 downloads

13.

A azitromicina administrada para bronquiolite aguda pode ter um efeito de proteção na sibilância recorrente
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Luisi, Fernanda

; Roza, Clarissa Aires

; Silveira, Victória d’Azevedo

; Machado, Camila Correia

; Rosa, Katiana Murieli da

; Pitrez, Paulo Márcio

; Jones, Marcus Herbert

; Stein, Renato Tetelbom

; Leitão, Lidiane Alves de Azeredo

; Comaru, Talitha

; Mocellin, Magáli

; Pinto, Leonardo Araújo

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 3 elocation e20180376

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Uma proporção significativa de lactentes desenvolve sibilância recorrente após um evento de bronquiolite aguda (BA). Estudos recentes demonstraram proteção para sibilância recorrente e menor morbidade respiratória em lactentes tratados com azitromicina durante uma crise de sibilância. O objetivo do presente estudo foi testar a hipótese de que a administração de azitromicina durante um evento BA reduz sibilos e reinternações hospitalares subsequentes. Métodos Trata-se de uma análise secundária de um estudo randomizado, duplo-cego, controlado por placebo, incluindo dados não publicados de sibilância e hospitalizações durante os seis meses iniciais após a internação por bronquiolite aguda. O estudo foi realizado em um hospital universitário terciário. Os bebês (<12 meses de idade) hospitalizados com BA foram randomizados para receber azitromicina ou placebo, administrados por via oral, por sete dias. As famílias foram contatadas por telefone aos três e seis meses após o evento agudo inicial, e responderam a um questionário padronizado para identificar sibilos recorrentes e reinternações hospitalares. Resultados Cento e quatro pacientes foram incluídos (grupo Azitromicina, n=50; grupo Placebo, n=54). Considerando o total de pacientes contatados com sucesso três meses após a hospitalização (n=70), a taxa de recorrência de sibilância no grupo da azitromicina foi significativamente menor do que no grupo placebo (RR=0,48; CI=0,24-0.98; p=0,038). Conclusões A azitromicina reduziu significativamente o risco de sibilância subsequente entre zero e três meses após a admissão hospitalar por bronquiolite aguda.

ABSTRACT Objective A significant proportion of the infants developed recurrent wheezing after an acute bronchiolitis (AB) event. Recent studies have demonstrated protection for recurrent wheeze and lower respiratory morbidity in infants treated with azithromycin during an acute respiratory wheezing. The aim of the present study was to test the hypothesis that administration of azithromycin during an AB event reduces subsequent wheezing and hospital re-admissions. Methods This is a secondary analysis of a randomized, double-blinded, placebo-controlled trial, including unpublished data of wheezing and hospitalizations during the initial 6 months following admission for acute viral bronchiolitis. The study was performed in a tertiary University hospital. Infants (<12 months of age) hospitalized with AB were randomized to receive either azithromycin or placebo, administered orally, for 7 days. Families were contacted by telephone at 3 and 6 months after the initial acute event and answered to a standardized questionnaire in order to identify recurrent wheezing and hospital readmissions. Results One hundred and four patients were included (Azithromycin group, n= 50; placebo group, n=54). Considering the total of patients contacted 3 months after hospitalization (n=70), the recurrence rate of wheezing in the azithromycin group was significantly lower than in the placebo group (RR = 0.48; CI = 0.24-0.98; p = 0.038). Conclusion Azithromycin significantly reduces the risk of subsequent wheezing between 0 and 3 months after hospital admission due to acute bronchiolitis irrespective of the presence of respiratory syncytial virus.

https://doi.org/10.36416/1806-3756/e20180376 2348 downloads

14.

Assessment of theoretical and practical knowledge of asthma among guardians of children treated in primary care
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Banhos, Cathiana Carmo Dalto

; Roncada, Cristian

; Pinto, Leonardo Araújo

; Pitrez, Paulo Márcio

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 1 elocation e20190147

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1806-3713/e20190147 864 downloads

15.

OM-85 BV for primary prevention of recurrent airway infections: a pilot randomized, double-blind, placebo-controlled study
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Souza, Fátima Cleonice de

; Mocellin, Magáli

; Ongaratto, Renata

; Leitão, Lidiane Alves de Azeredo

; Friedrich, Frederico Orlando

; Silveira, Victória d’A

; Scotta, Marcelo Comerlato

; Pitrez, Paulo Márcio

; Pinto, Leonardo Araújo

einstein (São Paulo)

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2020, Volume 18 elocation eAO5262

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Comparar a frequência de infecções do trato respiratório em crianças tratadas com OM-85 BV e placebo durante o período de terapia de 3 meses, e observação por mais 3 meses após o tratamento. Métodos Foi realizado estudo randomizado, duplo-cego, controlado por placebo com 54 crianças (6 meses a 5 anos) sem história prévia de infecções respiratórias recorrentes, que frequentavam creches. Os membros da família foram instruídos a administrar uma cápsula por dia durante 10 dias consecutivos, durante 3 meses, de OM-85 BV ou placebo. Entrevistas telefônicas foram realizadas a cada 30 dias. Resultados Não houve diferença significativa no número de infecções respiratórias entre os grupos. O número médio de infecções do trato respiratório no Grupo OM-85 BV nos primeiros 3 meses foi de 0,92±0,87 e, no Grupo Placebo, de 0,74±1,02, e aos 6 meses foi de 1,62±1,47 e 1,03±1,34, respectivamente. Conclusão O OM-85 BV não foi eficaz na prevenção primária de infecções do trato respiratório. Embora a maioria dos autores recomende o uso deste imunoestimulante em crianças com história de infecções respiratórias recorrentes, mais estudos são necessários para definir sua utilidade na prevenção primária de infecções respiratórias em crianças saudáveis expostas a poucos fatores de risco.

ABSTRACT Objective To compare the frequency of respiratory tract infections in children treated with OM-85 BV and placebo during the 3-month therapy period, and observation for a further 3 months after treatment. Methods A randomized, double-blind, placebo-controlled trial was conducted with 54 children (6 months to 5 years old) with no past history of recurrent respiratory infections attending daycare center. Family members were instructed to administer one capsule per day for 10 consecutive days, for 3 months of OM-85 BV or placebo. Telephone interviews were conducted every 30 days. Results There was no significant difference in the number of respiratory infections between the groups. The mean number of respiratory tract infection in the OM-85 BV Group in the first 3 months was 0.92±0.87, and in the Placebo Group was 0.74±1.02, and at 6 months it was 1.62±1.47 and 1.03±1.34, respectively. Conclusion OM-85 BV was not effective in the primary prevention of respiratory tract infections. Although most authors recommend the use of this immunostimulant in children with a history of recurrent respiratory infections, more studies are needed to define its usefulness in the primary prevention of respiratory infections in healthy children exposed to few risk factors.

https://doi.org/10.31744/einstein_journal/2020ao5262 1128 downloads

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