Biomedical subjects

Paulo Augusto Moreira Camargos

Publications and source records attributed to Paulo Augusto Moreira Camargos.

7 recordsLinked to original sources

PubMed2006

Treatment of gastroesophageal reflux disease.

OBJECTIVES: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease. SOURCES: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. SUMMARY OF THE FINDINGS: The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e. transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. CONCLUSIONS: The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed2005

Foreign body aspiration: clinical, radiological findings and factors associated with its late removal.

OBJECTIVE: The study was carried out to assess the clinical and radiological findings and factors related to delay in definite diagnosis of foreign body aspiration and its removal. METHODS: Medical charts of 280 bronchoscopic-proven foreign body (FB) inhalators were reviewed. To analyze factors related to late removal, the population studied was divided into two groups according to time elapsed between injury and care-seeking (up to 24h and longer than 24h) followed by FB removal. RESULTS: Most children (69.5%) were under three, most were males (63.1%) and in 47.5%, rigid bronchoscopy was performed 24h after the accident. Organic foreign bodies were found in 63.4% of cases, most frequently peanuts (20.5%). Mortality related to FB aspiration reached 0.7%. In comparison with endoscopic diagnosis, clinical and radiological abnormalities were found in 99.3 and 84.3% (95% CI, 79.5-88.4%) of studied patients, respectively. The number of health services sought until definite diagnosis was the only factor associated with late removal (OR=23.0, 95% CI, 10.7-49.3%, p<0.001). CONCLUSION: The population studied presented a long delay in FB removal, thus demanding actions enhancing parent, physician and health services awareness, aiming at an earlier referral for diagnostic and therapeutic bronchoscopy.

Age Distribution↗

PubMed2005

The burden of asthma in children: a Latin American perspective.

Worldwide, studies on asthma prevalence have shown major rises over the last 30 years. The impact on the burden of asthma is being increasingly recognised. In some countries in Latin America, the prevalence of asthma is among the highest in the world. Asthma admissions are very common in children, leading to high costs for the health systems of those countries. Unfortunately, Latin America has limited resources to pay for appropriate treatment. The main goals of the international guidelines for asthma treatment are not being met. However, asthma programmes operating in some countries are showing promising results in reducing asthma admissions and consequently decreasing the burden of asthma. Local adaptation of international guidelines must be implemented in order to decrease costs and optimise outcomes.

Asthma↗

PubMed2002

Paediatric asthma management in developing countries.

Asthma is a chronic disease that is increasing in prevalence all over the world. The use of inhaled corticosteroids is the main treatment for asthma control. The use of the Global Initiative for Asthma (GINA) guidelines may improve the quality of asthma treatment. Some of the directions in the GINA guidelines may be difficult to apply in developing countries. An important barrier to adequate treatment for asthma in low income countries is the unavailability of inhaled steroids for the general population. Asthma plans must be implemented in these countries with the participation of health systems, medical associations and the pharmaceutical industry. Adaptation of international guidelines to the local situation must occur to make asthma treatment possible for every asthmatic patient. In this paper, we present a review on this subject showing data on the initiatives that significantly improved asthma management.

Age Factors↗

PubMedDate not supplied

Risk factors associated with occurrence of clinical deterioration after cessation of beclomethasone in asthmatic children and adolescents.

Despite 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 Cox's 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 mother's history of asthma [hazard ratio (HR) = 2.19, 95% CI = 1.01-4.76, p = 0.04] and father's 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.

Adolescent↗

PubMedDate not supplied

[Prophylactic treatment of asthma].

OBJECTIVE: To review basic concepts, inhalation therapy, classification of asthma and peculiarities of asthma in developing countries. SOURCES: Direct search in the Medline, HighWire and MD Consult databases. SUMMARY OF THE FINDINGS: Inhaled corticosteroids are the drugs of choice for the treatment of asthma. Alternatively, other drugs, such as long-acting beta-agonists and antileukotrienes could be considered. CONCLUSIONS: At an individual level, asthma treatment presents a satisfactory outcome. However, the great challenge for public health professionals and authorities is to provide treatment for asthmatic patients from low-income families living in developing countries.

English Abstract↗

PubMedDate not supplied

[Asthma and allergic rhinitis as symptoms of the same disease: a paradigm under construction].

OBJECTIVE: To describe current ideas about the relation between upper and lower respiratory tract and to review the epidemiological, immunological, and pathological aspects that support the paradigm of united airways disease. SOURCES: Literature review using the Medline, MD Consult, HighWire, Medscape and Lilacs databases. We used allergic rhinitis and asthma as keywords, and searched articles published in the past 20 years. SUMMARY OF THE FINDINGS: Epidemiological evidence includes prevalence of allergic rhinitis in asthmatic patients and vice-versa, results of cross-sectional studies, bronchial hyperresponsiveness in patients with allergic rhinitis, importance of genetic and environmental factors, and the age of onset of atopic disease. Morphological and physiological aspects show structural differences between the nasal and bronchial mucosa, and the mechanisms that could explain the effect of rhinitis on asthma. Immunological aspects including the participation of bone marrow in the production of inflammatory cells and allergic reactions after allergen challenge are the same in allergic rhinitis and asthma. Finally, the results of the therapy for allergic rhinitis in bronchial hyperresponsiveness and in clinical and functional control of asthma are also reported. CONCLUSIONS: Epidemiological evidence and immunological and pathological aspects suggest that there is a relation between allergic rhinitis and asthma. The paradigm of united airways disease suggests the implementation of an integrated therapeutic approach.

English Abstract↗