Sergio Luis Amantea

Low Concentrations of Selenium and Zinc in Nails are Associated with Childhood Asthma

The purpose of this study was to investigate possible associations between Zn, Se, Cu, Mn, and Co concentrations in nails and asthma in a young population from a Southern Brazil city. Additionally, correlations between these chemical elements among asthmatic and non-asthmatic children were evaluated. Before nail collection (n = 165), children were asked to complete the International Study of Asthma and Allergies in Childhood questionnaire. The concentrations of trace elements were determined by inductively coupled plasma mass spectrometry. The chi-square test was used to evaluate the association between element concentrations in nails and the respiratory outcome. To evaluate correlations between the elements, we used the Spearman correlation test. For all tests, the significance level was set at 95% (P ≤ 0.05). Children included in the highest quartile of nail Se and Zn concentration presented a fivefold decrease in the prevalence ratio of asthma while children in the lowest Se range presented an almost 2.5-fold increase in the asthma prevalence ratio. There were weak to strong correlations between Cu vs. Zn, Cu vs. Co, Cu vs. Se, Zn vs. Se, Zn vs. Mn, and Mn vs. Co in both asthmatic and non-asthmatic children. Interestingly, non-asthmatics also presented correlations between Co vs. Se and Zn. Taken together, our results clearly demonstrated an association between concentrations of selenium and zinc and childhood asthma and the usefulness of nail as a noninvasive matrix to detect minerals imbalance in asthma patients.

Treatment of pulmonary arterial hypertension.

OBJECTIVE To perform a review of the diagnostic and therapeutic management of pulmonary hypertension in the pediatric population, with emphasis on pharmacological factors. SOURCES Electronic search of publications on the MEDLINE/PubMed, LILACS and Cochrane Collaboration databases. The search strategy adopted gave priority to the identification of clinical trials (controlled or uncontrolled), systematic reviews and directives published during the last 10 years. SUMMARY OF THE FINDINGS Many advances have been incorporated into our understanding of pulmonary hypertension during recent years. Issues related to differences in the pathophysiological mechanism of the disease between different age groups have altered both the treatment and prognosis of patients. The combined effect of more selective vasodilatory properties and antiproliferative action and the employment of new drugs are the basic principles of new treatment proposals. In order to be able to gauge the benefits associated with the use of these new therapies, it is of fundamental importance that all patients have their disease correctly diagnosed, the degree of functional compromise classified and their vascular reactivity capacity established, which is more difficult with pediatric patients. CONCLUSIONS To date there is no treatment that can be considered ideal for the management of pulmonary hypertension. With reference to the possibility of employing new drugs, the majority of studies that have been published were undertaken with adult populations. Few data are available on children, and the majority of studies are uncontrolled trials or case series. Taking into account differences that have already been established between different age groups in terms of disease mechanisms and prognostic aspects, it is difficult to claim that these drugs can be incorporated into the treatment of childhood pulmonary hypertension with the same indications and results.

Impact of antibiotic therapy on laboratory analysis of parapneumonic pleural fluid in children.

OBJECTIVE The therapeutic management of parapneumonic pleural effusions (PPE) is controversial in children. Decision-making often relies on parameters such as gross appearance of pleural fluid and on bacteriologic and biochemical analyses. Our goal was to describe the laboratory profile of PPE in children and to assess the influence of previous administration of antibacterial agents on culture and biochemical results. PATIENTS AND METHODS This was a prospective study including children (age, 1 month to 16 years) with a diagnosis of PPE. Two groups were evaluated: children with or without antibiotic treatment up to 48 hours before analysis of pleural fluid. Results were analyzed using the χ(2) or Mann-Whitney test (α = .05). Odds ratio and 95% confidence intervals (95% CIs) were calculated, with control of previous antibiotic therapy using multivariate logistic regression analysis, to determine the risk of empyema associated with specific biochemical parameters. RESULTS One hundred ten children were selected. Fifty percent had received antibiotics at least 48 hours before pleural fluid analysis. Differences were observed between the groups in terms of PPE gross appearance (P = .033) and identification of bacteriologic agent by culture or Gram stain (P = .023). Biochemical parameters (pH ≤7.1 and glucose ≤40 mg/dL) were associated with increased odds of receiving a more invasive treatment. For pH, the odds ratio was 9.614 (95% CI, 1.952-47.362; P = .005); and for glucose, 9.201 (95% CI, 1.333-63.496; P = .024). CONCLUSIONS Previous use of antibacterial agents affected the bacteriologic analysis of pleural fluid in this pediatric sample admitted for PPE. However, it did not interfere significantly with biochemical parameters of pleural fluid.

The challenges and consolidation of a scientific journal

1. Editor do Jornal de Pediatria. 2. Editores associados do Jornal de Pediatria. 3. Membro do Conselho Editorial do Jornal de Pediatria. Existem atualmente cerca de vinte mil revistas médicas no mundo e, mesmo assim, este é um mercado ainda em expansão. Trata-se de um mercado exigente, competitivo e pouco tolerante ou complacente com equívocos. Isto explica o surgimento e também a saída de circulação de revistas médicas a cada mês. Mas que mercado é este? Quais são as regras que o regulamentam? Quais são seus componentes? Os clientes de uma revista médica estão distribuídos em pelo menos três grupos: os leitores, os colaboradores e os patrocinadores. Conquistar e harmonizar os interesses destes grupos permite que uma revista científica torne-se respeitada, lida e auto-sustentável. O desequilíbrio conseqüente ao predomínio dos interesses de um destes grupos sobre os demais poderá acarretar problemas tais como: elitização, perda de credibilidade, dúvidas quanto à isenção e falta de impacto. Atingir tal equilíbrio é o grande desafio para a estabilidade e o crescimento de uma revista científica. Inicialmente, o corpo editorial precisa descobrir e atrair seus clientes. No caso do Jornal de Pediatria, devemos intuir (antever, imaginar) os interesses dos quase 15.000 assinantes, para que se tornem realmente leitores. Ao mesmo tempo, obter o reconhecimento e nos tornarmos atraentes para que os pesquisadores dos mais diversos centros de pesquisa do país veiculem preferentemente seus trabalhos em nossa revista. Por outro lado, precisamos viabilizar o custo de produção e distribuição, que se tem mantido constante nos últimos anos: ao redor de quarenta mil dólares americanos por tiragem; o que significa mais de trezentos mil dólares anuais (seis números regulares e dois suplementos). Para que tenhamos uma qualidade editorial mantida, este aporte financeiro é vital. Identificados os componentes (clientes), como avaliar sua satisfação? Quais os marcadores para verificar seu interesse e a qualidade do produto oferecido? Os desafios e a afirmação de uma revista científica

Treatment of Severe Acute Asthma in the Child

The admission of children with respiratory insufficiency, mainly by compromise of the lower airways is a common finding in our ICUs [1, 2,3]. The obstruction of the lower airways may be a consequence of many processes: congenital (cystic fibrosis), viral infectious disease (bronchopneumonia, bronchiolitis), microaspirations (pneumopathy by gastroesophageal reflux and/or sinusitis), pulmonary sequelae (bronchopulmonary dysplasia, post viral disease bronchiolopathy), chronic inflammation (asthma), and others [3].

A Comparison of the Human Buccal Cell Assay and the Pollen Abortion Assay in Assessing Genotoxicity in an Urban-Rural Gradient

Air pollution is exacerbated near heavy traffic roads in cities. Air pollution concentration and composition vary by region and depend on urban-rural gradients. The aim of this study was to evaluate the distribution of air pollution in areas of varying population densities and to compare plant biomonitoring with an established biomarker of human exposure to traffic-related air pollution in children. The areas of study were selected near a major street in 3 different regions. Areas A, B and C represent high, intermediate and low population densities, respectively. Micronucleus assay, an established biomarker of human exposure, was performed in children from these areas. For a plant biomonitoring assay, the pollen abortion assay was performed on Bauhinia variegata in these areas. NO2 and O3 concentrations were determined by passive sampling. We report here that the pollen abortion frequency in Bauhinia variegata is correlated with NO2 concentration (P = 0.004) and is strongly associated with vehicular flow and population density in the studied areas. Micronuclei frequency in buccal cells of children was higher in the regions with more degree of urbanization (P < 0.001) following the same pattern of O3 concentrations (P = 0.030). In conclusion, our results demonstrate that high concentrations of air pollutants in Porto Alegre are related to both human and plant genotoxicity. Areas with different concentration of pollutants demonstrated to have an urbanization gradient dependent pattern which also reflected on genotoxic damage among these areas.

Clinical and epidemiologic profile of lower respiratory tract infections associated with human bocavirus.

Acute viral bronchiolitis (AVB) remains the leading cause of lower respiratory tract infection (LRTI) in infants under 2 years of age. Advances in molecular methods for virus detection have led to the identification of new infectious agents implicated in the development of AVB, such as human bocavirus (HBoV).

Use of helium-oxygen mixture (Heliox®) in the treatment of obstructive lower airway disease in a pediatric emergency department

OBJECTIVE To determine whether the use of salbutamol, in a helium-oxygen mixture (80:20), can modify outcome and risk of hospitalization of pediatric patients. METHODS A controlled cohort study including patients aged 2 months to 12 years with diagnoses of asthmatic crisis or viral bronchiolitis. Intensity was characterized from moderate to severe, as measured by clinical score (pulmonary index, PI) for obstructive disease. Scores > 8 were considered eligible. The Heliox® group was composed of 20 patients and the Oxygen group of 40 patients. Patients received sequentially, at 20-min intervals, until six nebulization cycles were completed (2-h period): salbutamol 0.15 mg/kg/dose (maximum 5 mg). The nebulized drug was driven either by Heliox® mixture (80:20) or 100% oxygen. Patients diagnosed with acute asthmatic crisis received, additionally, prednisolone (2 mg/kg) orally. RESULTS Eleven patients in the Heliox® group still required treatment at 6 h, against 38 patients in the group receiving oxygen-driven nebulization (p = 0.034). At 12 h, 7 patients in the Heliox® group remained under observation, against 27 in the Oxygen group. Differences regarding the need for supplemental oxygen were observed only at 6 h of treatment (p = 0.02). CONCLUSIONS Heliox® (80:20), for salbutamol administration, is effective in the treatment of pediatric obstructive disease that responds to bronchodilator therapy. Compared to usual aerosol delivery technique, Heliox®-driven salbutamol nebulization is associated with shorter stay in the observation room after 6 h of treatment.

Rapid airway access

OBJECTIVE: To review the steps involved in safe airway management in critically ill children. SOURCES OF DATA: Review of articles selected through Medline until April 2003 using the following key words: intubation, children, sedation. SUMMARY OF THE FINDINGS: Airway compromise is rare, but whenever it occurs, the situation depends on professionals trained to carry out safe, early, and rapid airway management, with no harm to the patient. The method currently advocated for airway management is rapid sequence intubation, which requires preparation, sedation and neuromuscular block. We observed that it is not possible to apply one single intubation protocol to all cases, since the selection of the most adequate procedure depends on indication and patient conditions. We defined the drug doses most commonly used in our setting, since little is know so far about the real effect of sedatives and analgesics. In most situations, the association of an opioid (fentanyl at 5-10 µg/kg) with a sedative (midazolam at 0.5 mg/kg) and a neuromuscular blocking agent are sufficient for tracheal intubation. CONCLUSIONS: Training, knowledge, and skill in airway management are of fundamental importance for pediatric intensive caregivers and are vital for the adequate treatment of critically ill children. We present an objective and dynamic text aimed at offering a theoretical basis for the generation of new protocols, to be implemented according to the strengths and difficulties of each service.

Controvérsias no manejo farmacológico da asma aguda infantil

Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children. Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases. Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of s2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. Conclusions: Inhaled s2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. Either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. Patients who are refractory to conventional treatment and develop severe acute asthma should receive s2-agonist drugs intravenously, provided they are properly monitored. Methylxanthine and magnesium sulfate should be considered a second choice for selected patients.