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Biomedical subjects

Paulo A M Camargos

Publications and source records attributed to Paulo A M Camargos.

13 recordsLinked to original sources
PubMed2006

Nitric oxide in children with persistent asthma.

OBJECTIVE: To assess the difference in exhaled nitric oxide levels in atopic and nonatopic asthmatic patients treated with anti-inflammatory drugs, and to compare exhaled nitric oxide measurement with lung function tests. METHODS: Cross-sectional study with 45 consecutively selected patients with moderate and severe persistent asthma, aged between 6 and 17 years, and treated with anti-inflammatory drugs for at least 1 year. The patients were split into two groups: atopic ones (with positive skin tests) and nonatopic ones. The clinical and functional assessments and the measurement of exhaled nitric oxide were carried out concomitantly. RESULTS: There was a male predominance (62.5%), with an age range between 6 and 13 years (mean of 10.4 years) in 85% of the patients. Neither the symptoms associated with asthma (p = 0.07), allergic rhinitis (p = 0.17), food allergy (p = 0.09), necessity of systemic corticosteroids (p = 0.10), antileukotrienes (p = 0.20) and antihistamines (p = 0.70), nor the three parameters used to assess lung function (FEV(1), FEV(1)/FVC and FEF(25-75%), p > or = 0.14) were statistically significant. The frequency of eczema (p < 0.005) and exhaled nitric oxide levels (p < 0.001) were higher among atopic patients. CONCLUSION: Results suggest that clinical and functional stability of asthma among atopic patients does not necessarily reflect an efficient control over the inflammatory process and a higher probability for recurrence after discontinuation of anti-inflammatory therapy.

Administration, Inhalation↗
PubMed2006

[Continuing or discontinuing BCG revaccination in adolescents].

BCG revaccination was introduced in Brazil in the mid-90's but no study has evaluated vaccine coverage through direct assessment of the scar. BCG scars were assessed in 2,785 public school adolescents, aged 13 to 14 years, in Southeastern Brazil, between September 2001 and May 2002. The prevalence rate of revaccination was 64.3% (95% CI: 62.5-66.0). Despite the efforts to implement and sustain revaccination, continuing this practice should be reevaluated by public health authorities due to the lack of evidence on its effectiveness.

Adolescent↗
PubMed2006

Susceptibility of Streptococcus pneumoniae to penicillin in the state of Minas Gerais, Brazil from 1997-2004.

We monitored the susceptibility to penicillin of invasive strains of Streptococcus pneumoniae in two reference laboratories; 502 positive cultures from patients with an active invasive infectious process were analyzed. Streptococcus pneumoniae was identified through conventional procedures, and the oxacillin disc diffusion method was used to check for penicillin susceptibility. Statistical analysis included calculations of the frequency distribution, with 95% confidence intervals (CI), as well as chi-square tests and chi-square for linear trend for temporal analysis of susceptibility. The bacterium was isolated from patients less than a year old (40.7% of the isolates), from infants (55.9%), and from individuals less than 15 years old (64.4%). The majority (88.2%, 95% CI = 85.5%-91.1%) of the 502 isolates were susceptible to penicillin. There was no significant temporal trend of elevation of resistance rate during the study period (p=0.56). We conclude that resistance of S. pneumoniae to penicillin is not yet an important clinical-epidemiological concern in the State of Minas Gerais. To provide necessary support for the adoption of therapeutic and prophylactic measures, epidemiological surveillance should be implemented at a national level to monitor the profile of susceptibility/resistance of S. pneumoniae to penicillin and other antimicrobials.

Adolescent↗
PubMed2004

Antigen detection for the diagnosis of pneumonia.

Streptococcus pneumoniae and Haemophilus influenzae type b are the main agents of bacterial community-acquired pneumonia in developing countries, although a definite etiologic diagnosis cannot be established in most cases. This study was carried out to assess the performance of a latex particle agglutination test (LPAT) from a commercial kit (Slidex Méningite Kit trade mark, BioMérieux, France) in diagnosing pneumococcal and H. influenzae type b pneumonia. One hundred and seven children (45 ill subjects and 62 healthy controls) were enrolled. All 45 cases had a presumptive diagnosis of bacterial pneumonia based on clinical (WHO criteria), laboratory (white blood cell count > or = 15.000/mm3, polymorphonuclear leukocytes > or = 70%, bands > or = 500/mm3, and C-reactive protein > or = 40 mg/l), and radiological findings, i.e., two or more positive points in the scoring system described by Khamapirad and Glezen (Semin Respir Infect 1987;2:130-144). Clinical, laboratory, and radiological assessments were performed in a blinded manner. LPAT was performed in urine samples after concentration through an ethanol-acetone solution. Sensitivity, specificity, and positive and negative predictive values were 77.3% (95% CI, 61.8-88.0%), 90.3% (95% CI, 79.5-96.0%), 85.0% (95% CI, 69.5-93.8%), and 84.8% (95% CI, 73.4-92.1%), respectively. Results suggest that LPAT is a useful diagnostic tool for the etiologic diagnosis of S. pneumoniae and H. influenzae type b pneumonia, especially in the developing world.

Antigens, Bacterial↗
PubMed2004

Simultaneous treatment of asthma and allergic rhinitis.

Asthma and allergic rhinitis (AR) form a well-recognized comorbidity. This study aims at assessing the efficacy of nasally inhaled beclomethasone dipropionate (BDP) in their simultaneous treatment. A randomized controlled trial was conducted with 78 allergic rhinitis and asthma patients aged 5-17 years. Seventy-five individuals completed the study. During 8 weeks, 38 subjects received BDP-CFC aerosol (>or= 500 mcg/day) exclusively via nasal inhalation through a facemask attached to a plastic valved spacer. The control group (37 patients) received 200 mcg/day of aqueous intranasal beclomethasone plus oral inhalation of BDP-CFC (>or= 500 mcg/day) through a mouthpiece connected to the same spacer. Primary outcomes analyzed in order to assess the response to treatment were clinical scoring for allergic rhinitis and measurements of nasal inspiratory peak flow (NIPF). AR clinical scoring and NIPF did not differ in the two groups at admission or at nearly all follow-up visits. Nasal inhalation of beclomethasone dipropionate provides AR symptom relief while maintaining control of asthma by delivering it to the lungs. Therefore, this therapeutic strategy might be considered for patients suffering from this comorbidity, especially in low-resource countries, since it is less expensive than the conventional treatment.

Anti-Asthmatic Agents↗
PubMedDate not supplied

Peak expiratory flow monitoring in asthmatic children.

OBJECTIVE: To correlate forced expiratory volume in 1 second (VEF(1)) and peak expiratory flow (PEF) with clinical parameters in children with moderate and severe asthma. METHODS: This was a non-concurrent cohort study, carried out at a pediatric pneumology clinic, in Belo Horizonte, MG, Brazil, between March and October 2002. The study enrolled children aged 5 to 16 years, with persistent asthma, being treated with a minimum of 500 mcg/day beclomethasone, and with symptoms under control for at least 3 months. Seventy-five patients (96.1%) were selected by simple randomization and monitored for 3 months, via a clinical severity scale and pulmonary function tests (PEF and VEF(1)). Results were analyzed using Pearson's coefficient. RESULTS: Correlations between absolute and percentage PEF figures and clinical severity score were negative and very close to zero, signifying a weak correlation with no statistical significance. The same relationship was observed between VEF(1) and clinical severity score. The correlation between VEF(1) and PEF had a positive value with statistical significance (p = 0.000). CONCLUSIONS: Since the best parameter for evaluating airway obstruction is VEF(1), the finding that there is a positive correlation between this measure and absolute PEF reinforces the importance of its use and allows for the recommendation that PEF be measured as part of the management of asthmatic children, particularly in severe cases.

Adolescent↗
PubMedDate not supplied

[Use of asthma controller drugs at admission to a pediatric pulmonology outpatient clinic].

OBJECTIVE: Inhaled corticosteroids are widely used in developed countries. On the other hand, due to its high cost, this kind of drug is underused in asthmatic patients living in developing countries. The present study aims at verifying the use of controller medication in children with moderate or severe persistent asthma at admission to a specialized outpatient facility. METHODS: Descriptive study with 560 children aged 4 to 14, with diagnosed asthma, who were admitted between April 1996 and December 2000. The patients were randomly selected. RESULTS: Of 560 patients, 61.8% were male; 69.5% were between 4 and 9 years old. The first acute attack occurred before the first year of life in 55.8% of the cases, and 70.5% had physician-diagnosed persistent moderate asthma. In the previous 12 months, 42.7% of the children had been admitted to the hospital and 92.7% were assisted in emergency rooms. Considering those living in the metropolitan area of Belo Horizonte, the average use of some kind of controller drug was 27.3%, and 17.1% of inhaled corticosteroids. The use of oral corticosteroids decreased from 14.3% in 1996 to 4.2% in 2000. CONCLUSIONS: the rate of inhaled corticosteroid therapy was higher than that found in Brazilian studies and it is comparable to the results of some international studies. A decrease in the use of oral corticosteroids was also observed. Both findings may be related to the implementation of an asthma program in the public health system of Belo Horizonte, which began in 1996.

Adolescent↗
PubMedDate not supplied

[Foreign body aspiration]

OBJECTIVE: To review the main publications on foreign body aspiration. SOURCES: A bibliographic search was carried out in Medline (1966-2000) and Lilacs (1979-1999), in Portuguese, Spanish and English, using the keywords "aspiration, foreign body, children, adolescents". SYNTHESIS OF DATA: The universal distribution of these accidents was confirmed. This condition is predominant in males (51.0-73.0% of the cases) and in children aged under 3 years (65.8-85.0% of the accidents). By analyzing clinical history and physical examination together, we found a sensitivity and specificity of approximately 80% and 40%, respectively. The radiological examination was very useful for diagnosis, showing a sensitivity between 57.9% and 100%. Nuts are the most common inhaled objects, amounting to approximately 70% of the episodes. CONCLUSIONS: Rigid bronchoscopy is the procedure of choice and requires specialized professional training and well-equipped services. However, the preventive aspects of these accidents were not sufficiently emphasized in the context of this condition. This review has a specific section on these aspects.

Journal Article↗
PubMedDate not supplied

[Peak expiratory flow rate in the management of cystic fibrosis]

OBJECTIVE: To verify the role of peak expiratory flow, measured through portable meters, as an alternative test to assess pulmonary disease in cystic fibrosis. METHODS: Forty-nine patients aged five to 19 years old in stable health condition and able to perform the peak expiratory flow maneuver were included. In the same visit, Shwachman-Kulczycki score was recorded. Linear regression was used to assess the correlation between the Shwachman-Kulczycki score and the peak expiratory flow rate. A P value of 0.05 was considered to be significant. RESULTS: A slight, but statistically significant correlation between absolute and percent values for this functional parameter and the Shwachman-Kulczycki score (r = 0.31, P = 0.02 and r = 0.30, P = 0.03, respectively) was found. CONCLUSIONS: Although this correlation was statistically significant, these findings are not clinically relevant, i.e., the lung involvement in this disease should be assessed by classic pulmonary function tests, such as spirometry.

Journal Article↗
PubMedDate not supplied

[Hydrofluoroalkane as a propellant for pressurized metered-dose inhalers: history, pulmonary deposition, pharmacokinetics, efficacy and safety].

OBJECTIVE: To review the literature about hydrofluoroalkane as a propellent of pressurized metered-dose inhalers containing anti-asthma drugs. SOURCES OF DATA: Bibliographic search in electronic databases (MEDLINE, MDConsult, HighWire, Medscape and LILACS) and direct search referring to the past 15 years, using the key words hydrofluoroalkane, asthma and childhood were carried out. SUMMARY OF THE FINDINGS: 43 original articles on the replacement of chlorofluorcarbon by hydrofluoralkane were selected. Hydrofluoralkane showed to be a safe propellent, with pulmonary deposition ranging from 50 to 60%, and to have significant efficacy, when compared with placebo (p < or = 0.003) in controlled clinical trials. Most works using hydrofluoralkane included beclomethasone diproprionate. Approximate annual cost of a treatment with beclomethasone diproprionate/hydrofluoralkane was lower than with beclomethasone diproprionate/clorofluorcarbon. Some studies assessed salbutamol, fluticasone, flunisolide and the association fluticasone-salmeterol, with hydrofluoralkane as propellent in pressurized metered-dose inhalers. CONCLUSIONS: Efficacy and safety of hydrofluoralkane as propellent of bronchodilators and inhaled corticosteroids in adults was evidenced. In general, there was a better pulmonary deposition of particles. However, literature data on the use of hydrofluoralkane in the pediatric age group are still scarce and further studies with children and adolescents would be of great importance.

Adult↗