Lillian Sanchez Lacerda Moraes

Risk factors, clinical and laboratory aspects of asthma in children

OBJETIVO: avaliar os aspectos clinicos, laboratoriais, e os fatores de risco associados a asma em criancas atendidas no Ambulatorio de Pediatria, do Hospital Universitario Julio Muller. Metodo: estudo de caso-controle, incluindo 59 criancas asmaticas (casos) e 104 nao-asmaticas (controles). Os seguintes fatores foram considerados para analise de risco: escolaridade dos pais, exposicao aos alergenos domiciliares, tabagismo passivo, aleitamento materno, renda e antecedentes familiares alergicos. Foram coletadas amostras de sangue para hemograma e dosagem de IgE total e especifica para alergenos. Realizou-se teste cutâneo de hipersensibilidade imediata pelo metodo de puntura para os seguintes alergenos: acaros, animais, fungos e baratas com controles positivo (histamina) e negativo (solucao fisiologica).Um modelo de regressao logistica foi usado para calcular odds ratio (OR) e intervalo de confianca (IC) 95% ajustado para outros fatores de risco e confundidores. RESULTADOS: dentre os fatores de risco estudados, sexo, baixa escolaridade, baixa renda, tempo de aleitamento materno e tabagismo passivo nao estiveram associados a ocorrencia de asma. A exposicao aos alergenos foi semelhante nos dois grupos, a nao ser pela maior frequencia de animais nos domicilios dos controles (c2=16,9; P < 0,05). Rinite paterna foi o unico antecedente familiar associado a asma (OR=3,33; IC 95%:1,03-11,17; P < 0,05). As criancas asmaticas apresentaram maior frequencia de positividade do teste cutâneo que os controles, principalmente para acaros: Dermatophagoides pteronyssinus (69,5%), Dermatophagoides farinae (59,3%) e Blomia tropicalis (59,3%); baratas: Periplaneta americana (59,3%) e gato: Felis domesticus (37,3%); com OR variando de 11,2-21,0; p < 0,05. Eosinofilia e niveis sericos de IgE total foram mais elevados no grupo de asmaticos (p < 0,05). A positividade do teste de IgE especifica para Dermatophagoides pteronyssinus e Blomia tropicalis foi maior nos casos em relacao aos controles (P < 0,05). A analise multivariada mostrou que sensibilizacao as baratas (OR=9,26, 95%IC:2,59-33,4), animais (OR=3,93, 95%IC:1,05-14,67) e acaros (OR=3,74, 95%IC:1,18-11,8) foram os mais importantes fatores de risco para asma. CONCLUSOES: a sensibilizacao aos alergenos domiciliares, principalmente acaros, barata e animais mostrou uma forte associacao com asma neste estudo.

Risk factors associated with wheezing in infants

OBJECTIVE to identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil. METHODS this was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS the written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46). CONCLUSIONS the study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.

Prevalência e fatores de risco para asma em adolescentes de 13 a 14 anos do Município de Cuiabá, Mato Grosso, Brasil

The objective of this study was to estimate the prevalence of active asthma and identify associated risk factors in adolescents 13 to 14 years of age in Cuiabá, Mato Grosso State, Brazil. A cross-sectional population-based and a subsequently a nested case-control study was conducted in 2008 using the protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). Risk factor analysis used the chi-square test, Fishers exact test, and binary logistic regression. Variables with p < 0.20 in the bivariate analysis entered the logistic regression model, with six variables remaining in the final model (p < 0.05). Prevalence of active asthma was 19.1%. Risk factors for active asthma (p = 0.01) were: smoking during pregnancy, exclusive breastfeeding < 6 months, family income < 3 minimum wages, female gender, pets currently in the home, and absence of fish in the diet. Prevalence of active asthma was high, but with a significant reduction compared to 1998.

Doctors' awareness concerning primary immunodeficiencies in Brazil

BACKGROUND PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

Objective: To evaluate the prevalence and the clinical characteristics of wheezing in 12-15 months old infants in the city of Cuiaba, Mato Grosso State, Midw...OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil. METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010. RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found. CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity.

Paternal gonadal mosaicism as cause of a puzzling inheritance pattern of activated PI3-kinase delta syndrome

Birth defects caused by de novo chromosomal abnormalities resulting in single-gene defects occur in approximately 5% of all live births.1 Affected offspring have a broad range of illnesses, including primary immunodeficiency diseases, a genetically heterogeneous group of disorders presenting with a clinical spectrum of mild to severe infections, often complicated by autoimmunity and malignancies.2 Most primary immunodeficiency diseases are monogenic diseases with a Mendelian inheritance pattern.2 Recently, heterozygous gain-of-function mutations in PIK3CD, encoding the catalytic p110d subunit of phosphatidylinositol 3-kinase (PI3K), were identified in patients presenting with recurrent respiratory tract infections, hepatosplenomegaly, polyadenopathy, CD4 lymphopenia, and decreased numbers of class-switched memory B cells, a phenotype referred to as activated PI3K delta syndrome type 1 (APDS1).3,4 Patients with APDS1 exhibit increased basal and stimulation-dependent activation of the AKT-mTOR pathway. Similar clinical findings and PI3K signaling activation have been observed in patients with heterozygous mutations in the PIK3R1 gene, encoding the regulatory subunit of PI3K, referred to as APDS2.5 We identified a kinship that included 3 half-siblings with symptoms typical for APDS1. The index case (II.4 in Fig 1A) had 10 episodes of pneumonia, 2 episodes of sepsis, several upper respiratory infections, and oral moniliasis within the first year of life. He subsequently developed hepatosplenomegaly, lymphadenopathy, and an axillary abscess owing to Candida albicans. At 3 years of age, laboratory investigation showed increased immunoglobulin (Ig) M (368 mg/dL) and IgG (1,450 mg/dL) levels, normal IgA level (107 mg/dL), low CD4 (330/mm3) and increased CD8 (1,229/mm3) counts, and low CD19 B cells (17/mm3). IgG subclasses showed normal absolute levels of IgG1 (1,020 mg/dL), IgG2 (79.0 mg/dL), IgG3 (78.3 mg/dL), and IgG4 (28.1 mg/dL); however, their ratio showed a proportional decrease of IgG2. Based on the clinical symptoms, APDS1 was suspected and a heterozygous PIK3CD hotspot mutation (c.3061G/A, p.E1021K) was identified by Sanger sequencing. He was treated with intravenous immunoglobulin, cotrimoxazole prophylaxis, and rapamycin, resulting in marked decrease of hepatosplenomegaly and alleviation of his other symptoms. The patient’s father (I.4), a truck driver, reported that in addition to the index case, he had 4 additional children with 3 other women living in different Brazilian cities along his truck route and that 2 of these children (II.4 and II.5) had symptoms similar to the index case (Fig 1A). Of his 5 children, 1 had died at 3 years of age (II.1) with

Intraoperative anafilaxis investigation in doctor's office

Background Drugs administered during the anaesthetic procedure and postoperative period belong to different pharmacological groups and are to ensure the best possible conditions for surgery and maximum safety of patients. Their adverse side effects are often dependent on immune responses. The diversity and number of the agents administered hinder precise determination of the drug eliciting the adverse drug reaction.

51 Prevalence of Wheezing and Risk Factors Associated to Wheezing in Infants in the First Year of Life, Cuibá, MT, Brazil

Background The purpose of this study was to evaluate the prevalence of wheezing and risk factors related to wheezing in infants (12–15 month-old) in the city of Cuiabá, Mato Grosso State, Brazil. Methods Cross-sectional study by applying a standardized written questionnaire from “Estudio Internacional de sibilancia en lactentes” (EISL) phase III. Parents and/or guardians of infants were interviewed at a primary health care clinic or at home from August 2009 to November 2010. Signed written informe consent was obtained from parents and/or guardians of all subjects. Factors associated to wheezing were studied using bivariate and multivariate analysis (SPSS v.18.0) and expressed as odds ratio (OR) and confidence interval 95% (95% CI). Results One thousand sixty parents were interviewed (N = 1060), 27.7% (N = 294) infants had at least one wheezing episode in their first year of life, with onset at 5.8 ± 3.0 months (mean ± standard deviation), and 45.9% (N = 135) had had 3 or more episodes (recurrent wheezing). The use of inhaled &bgr;2-agonists, oral corticosteroids or leukotriene receptor antagonist, nocturnal symptoms, respiratory distress, hospitalization and medical diagnose of asthma were significantly more frequent in the group with recurrent wheezing (P < 0.05). Independent risk factors associated with wheezing in the first year of life were: history of previous pneumonia (OR = 10.80; 95% CI, 4.52-25.77); to have more than 6 upper respiratory infections (URI) (OR = 2.95; 95% CI, 2.11-4.14); asthma in sibling (OR = 2.13; 95% CI, 1.18-3.87); asthma in father (OR = 1.98; 95% CI, 1.22-3.23); asthma in mother (OR = 1.62; 95% CI, 1.07-2.43); exposure to paracetamol in the first year of life for URI (OR = 2.13; 95% CI, 1.54-2.95); exposure to moderate air pollution from traffic (OR = 1.59; 95% CI, 1.08-2.33); and a first URI before of third month of age (OR = 1.50; 95% CI, 1.04-2.17). Conclusions The prevalence of wheezing episodes among one year-old infants living in Cuiabá was high and early in life. Risk factors for wheezing are similar to risk factors for asthma. Exposure to paracetamol was associated with wheezing but more researches are required to clarify this potential association.