Maria Teresa Mohallem Fonseca

Adherence rate to inhaled corticosteroids and their impact on asthma control

Background:  Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control.

Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test

OBJECTIVES Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Diagnóstico precoce das faringoamigdalites estreptocócicas: avaliação pelo teste de aglutinação de partículas de látex

OBJECTIVES: Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS: Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS: We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS: The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

A morbidade associada a asma e elevada,principalmente nos paises em desenvolvimento, e as falhas naadesaoaousodecorticoideinalatoriocontribuemparaestaelevacao.Este estudo objetiva comparar as taxas de adesao ao uso debeclometasonarelatadaspelosresponsaveiseasmensuradaspelosregistros de dispensacao farmaceutica do medicamento.

Asma em menores de cinco anos: dificuldades no diagnóstico e na prescrição da corticoterapia inalatória

The objective of this study was to review the literature, focusing on difficulties encountered in asthma diagnosis and in the establishment of initial inhaled corticosteroid treatment in children under five years of age. The search was limited to studies published between 1991 and 2002 in Portuguese, Spanish, or English and included in the LILACS and MEDLINE databases. Symptoms of asthma, the most common chronic childhood disease, typically appear in the first years of life. There are currently no diagnosis means of making a certain diagnosis of asthma in children under the age of five. Clinical manifestations, when present in toddlers and preschoolers, may require treatment such as that given for asthma, assuming that it is preceded by a critical evaluation. We can conclude that diagnosis of asthma in the first years of life is complex and predominantly clinical. Inhaled corticosteroid treatment is an effective tool, although its risks and benefits must be carefully evaluated.

Interobserver agreement in assessing plain radiographs of maxillary sinus

Interrater agreement of six observers in interpreting maxillary sinus plain X-ray films was assessed. Patients aged 1-15 years old were enrolled and X-rays in the Caldwell and Waterss views were requested to confirm diagnosis of sinusitis or after antimicrobial therapy for a pre-existing sinusitis. One-hundred and one pairs of maxillary sinus radiographs from 101 patients were submitted to an independent and blind interpretation by three radiologists and three pediatricians. Each maxillary sinus was separately analyzed. Kappa statistic was used to measure interobserver agreement. A fair degree of agreement among the six raters was found on analyzing these films: 0.39 (95% CI, 0.36-0.41) for the right maxillary sinus and 0.37 (95% CI, 0.34-0.39) for the left one. These results stress literature data on the limits of plain radiographs for diagnosing maxillary sinusitis. The necessity of knowing the clinical findings while interpreting the exams also was depicted.

Risk Factors Associated with Occurrence of Clinical Deterioration After Cessation of Beclomethasone in Asthmatic Children and Adolescents

Despite of recent advances in the treatment of asthma using inhaled corticosteroids, the outcome for children after its discontinuation is not well known. This study aims to analyze the rate of clinical deterioration and related risk factors after beclomethasone withdrawal in asthmatic children and adolescents. One hundred two subjects with moderate or severe persistent asthma, who had started treatment with beclomethasone at the age of 2–11 years, were followed for 1 year after drug cessation. Depending on the occurrence of clinical deterioration, they were allocated to two groups, and then comparisons were made with respect to clinical criteria and skin prick test results. Statistical analysis was undertaken by using descriptive statistics and Coxs regression model. Treatment with beclomethasone had to be restarted in 28 patients (27.5%) because of relapse. There was a significant association with the risk of clinical deterioration with mothers history of asthma [hazard ratio (HR) = 2.19, 95% CI = 1.01–4.76, p = 0.04] and fathers history of asthma and/or allergic rhinitis (HR = 2.34, 95% CI = 1.06–5.26, p = 0.03). A period shorter than 6 months without symptoms before prophylaxis cessation (HR = 2.26, 95% CI = 0.98–5.26, p = 0.05) and atopy (RH = 2.75, 95% CI = 0.94–7.69, p = 0.06) were also associated with risk of relapse but with marginal statistical significance. Results suggest that clinical benefits were maintained for at least 1 year in the majority of the children after the cessation of prophylaxis. Special attention must be given to those with atopy and a parental history of asthma and rhinitis because of the risk of clinical deterioration.

Atualização sobre a abordagem da fisioterapia respiratória nas doenças vneuromusculares - doi:10.5020/18061230.2010.p92

Objective: To assess the role of physiotherapy in approaching neuromuscular disease (NMD), with emphasis on preventive and therapeutic aspects of respiratory therapy. Methods: A nonsystematic literature review covering the past twenty years, using the databases MEDLINE and LILACS through the following descriptors: neuromuscular diseases, physical therapy, vital capacity and respiratory failure. Results: The studies reviewed show the need to establish a routine periodic evaluation of respiratory function in order to introduce physical therapy measures relevant to each stage of the disease. The monitoring should include pulmonary function tests and specific techniques of chest physiotherapy, in order to avoid complications such as respiratory failure. Conclusion: The introduction of regular monitoring and preventive physiotherapy measures have helped to increase survival and improve quality of life of patients with neuromuscular diseases