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BACKGROUND: Invasive mechanical ventilation (IMV) is a common practice in pediatric intensive care unit (PICU). However, the role of oxygenation (OI) and ventilation (VI) indices regarding the time on IMV has not been fully understood. BASIC PROCEDURES: The study was conducted with infants up to 24 months of age, hospitalized in PICU for two consecutive years. The values of ventilatory parameters, OI, VI, and blood gas of infants, collected in the first seven days in IMV, were associated with the time on IMV. IMV was classified into: short (≤seven days) and long time (>seven days). The comparison was made from the first to the seventh day. Alpha=0.05. MAIN FINDINGS: Of 142 infants [mean age=7.51±6.33 months], 59 (41.5%) remained on IMV for a short time and 83 (58.5%) for a long time. Differences in PaO2 values were found on the second day, and PaO2/FiO2 ratio on the second, third and fourth days, with higher values in the short-term IMV. For FiO2 from the second to the fifth day; Pinsp from the first to the seventh day; PEEP from the second to the sixth day; mechanical respiratory frequency from the second to the seventh day, PaCO2 on the second day; Paw from the first to the seventh day, OI from the second to the sixth day, and VI from the first to the seventh day, the values were higher in the long-term IMV. CONCLUSIONS: The OI and VI can be considered as potential predictors of long-term IMV, along with other markers obtained during the IMV.

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OBJECTIVE: Quality of life (QOL), sexual satisfaction (SS) and physical performance have been assessed in the management of numerous chronic diseases. METHODS: In this study, the following tests and surveys were applied: (i) QOL questionnaire [Cystic Fibrosis Questionnaire (CFQ)]; (ii) SS questionnaire (SSQ) [female sexual quotient (FSQ) and male sexual quotient (MSQ)]; (iii) 6-minute walk test (6MWT). Spearman's correlation was used for comparison between the data; the Mann-Whitney test was applied to analyze the difference between genders. A total of 52 adult patients with CF were included in this study. RESULTS: There was a positive correlation between CFQ domains and SSQ questions. The CFQ showed a positive correlation with peripheral oxygen saturation of hemoglobin (SpO2) and the distance walked in the 6MWT, and a negative correlation with the Borg scale. The SSQ showed positive correlation with the distance walked and a negative correlation with the Borg scale. For some markers evaluated in the 6MWT, there was sometimes association with the evaluated domains and questions. Male patients showed better scores in the emotional CFQ domain, better performance in SSQ and physical performance. CONCLUSIONS: There was a correlation between CFQ, SSQ and 6MWT in CF. Finally; we believe that QOL surveys should assess the domain "sexuality" as well as physical performance tests.

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This study was designed to use volumetric capnography to evaluate the breathing pattern and ventilation inhomogeneities in patients with chronic sputum production and bronchiectasis and to correlate the phase 3 slope of the capnographic curve to spirometric measurements. Twenty-four patients with cystic fibrosis (CF) and 21 patients with noncystic fibrosis idiopathic bronchiectasis (BC) were serially enrolled. The diagnosis of cystic fibrosis was based on the finding of at least two abnormal sweat chloride concentrations (iontophoresis sweat test). The diagnosis of bronchiectasis was made when the patient had a complaint of chronic sputum production and compatible findings at high-resolution computed tomography (HRCT) scan of the thorax. Spirometric tests and volumetric capnography were performed. The 114 subjects of the control group for capnographic variables were nonsmoker volunteers, who had no respiratory symptoms whatsoever and no past or present history of lung disease. Compared with controls, patients in CF group had lower SpO(2) (P < 0.0001), higher respiratory rates (RR) (P < 0.0001), smaller expiratory volumes normalized for weight (V(E)/kg) (P < 0.028), smaller expiratory times (Te) (P < 0.0001), and greater phase 3 Slopes normalized for tidal volume (P3Slp/V(E)) (P < 0.0001). Compared with controls, patients in the BC group had lower SpO(2) (P < 0.0001), higher RR (P < 0.004), smaller V(E)/kg (P < 0.04), smaller Te (P < 0.007), greater P3Slp/V(E) (P < 0.0001), and smaller VCO(2) (P < 0.0002). The pooled data from the two patient groups compared with controls showed that the patients had lower SpO(2) (P < 0.0001), higher RR (P < 0.0001), smaller V(E)/kg (P < 0.05), smaller Te (P < 0.0001), greater P3Slp/V(E) (P < 0.0001), and smaller VCO(2) (P < 0.0003). All of the capnographic and spirometric variables evaluated showed no significant differences between CF and BC patients. Spirometric data in this study reveals that the patients had obstructive defects with concomitant low vital capacities and both groups had very similar abnormalities. The capnographic variables in the patient group suggest a restrictive respiratory pattern (greater respiratory rates, smaller expiratory times and expiratory volumes, normal peak expiratory flows). Both groups of patients showed increased phase III slopes compared with controls, which probably indicates the presence of diffuse disease of small airways in both conditions leading to inhomogeneities of ventilation.

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OBJECTIVE: To investigate the long-term effect of oral magnesium supplementation on clinical symptoms, bronchial reactivity, lung function and allergen-induced skin responses in children and adolescents with moderate persistent asthma. DESIGN: A double-blind randomized parallel placebo-controlled study. SETTING AND SUBJECTS: The patients were recruited from the Pediatric Outpatient Clinic, Division of Pulmonology, Allergy and Immunology, and followed at the Center for Investigation in Pediatrics at State University of Campinas Hospital, Brazil. Thirty-seven out of 72 patients met the study criteria. There were no dropouts. INTERVENTION: The 37 patients (aged 7-19 years, 19 males) were randomized in two groups: magnesium (n=18, 300 mg/day) and placebo (n=19), during 2 months. Both patient groups received inhaled fluticasone (250 microg twice a day) and salbutamol as needed. The primary outcome was bronchial reactivity evaluated with methacholine challenge test (PC20). RESULTS: After a follow-up of 2 months, the methacholine PC20 for testing bronchial reactivity has augmented significantly in the magnesium group only. The skin responses to recognized antigens have also decreased in patients treated with magnesium. The forced vital capacity (FVC), the forced expiratory volume at first second (FEV1), the forced expiratory flow at 25-75 and the FEV1/FVC ratio were similar in both groups. The magnesium group presented fewer asthma exacerbations and used less salbutamol compared to the placebo group. CONCLUSIONS: Oral magnesium supplementation helped to reduce bronchial reactivity to methacholine, to diminish their allergen-induced skin responses and to provide better symptom control in pediatric patients with moderate persistent asthma treated with inhaled fluticasone.

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The relationship between wheezing or asthma and serum immunoglobulin (Ig)E levels in early life is unclear. The aim of this study was to follow-up the IgE immune response in infants that did, or did not, develop recurrent wheezing during their first year of life. One-hundred and two randomised term neonates were included, in which IgE levels were quantified in cord blood samples, at 3, 6, 9 and 12 months of age. Specific IgE levels for food and inhalant allergens and the skin-prick test for inhalant allergens were also assessed at 6 and 12 months. During clinical follow-up, 32 (31%) infants presented with two or more wheezing episodes, while 70 (69%) had no wheezing. Total IgE levels were significantly higher up to 12 months in wheezing infants when compared to nonwheezing group. At 12 months, the specific IgE levels to cow's milk, egg white and mites were higher in infants with recurrent wheezing. There was no influence of family history for atopy on IgE levels. The skin-prick tests were positive in 14% and 23% in wheezing infants at 6 and 12 months, respectively. These results indicate an early allergic sensitisation in wheezing infants, suggesting an altered immunoregulatory T-cell role in immunoglobulin E production.

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OBJECTIVE: To evaluate the effect of cisapride and chest physical therapy on the gastroesophageal reflux of wheezing babies. METHODS: We prospectively assessed the presence of technetium ((99)Tc) in the upper, middle, and lower esophagus of 25 wheezing babies (13 with GERD and 12 without GERD) using scintigraphy. Both groups underwent clinical investigation, including laboratory, X-ray and scintigraphy tests, for the etiology of the wheezing baby syndrome (WBS) and GERD. Expiratory Flow Acceleration (EFA) was performed before and after treatment with cisapride. The total time of GER episodes was accounted for each portion of the esophagus during scintigraphy and during EFA. RESULTS: Cisapride significantly reduced the total reflux time in the upper esophagus (P<0.05), but showed no influence during EFA. After cisapride therapy, EFA increased the total reflux time in the upper and medium esophagus; however, no statistical significance was found. Infants with GERD presented a shorter total reflux time in the distal esophagus (P<0.05) during EFA. After cisapride treatment, no statistical significance was found. Infants without GERD also presented reduced total reflux time in the distal esophagus during EFA (P<0.05). Those with GERD had increased total reflux time in the distal esophagus (P<0.05) before and after cisapride treatment during EFA and scintigraphy. CONCLUSIONS: Cisapride was effective in reducing the total reflux time, mainly in the upper esophagus. EFA apparently increased the number of episodes of GER, without achieving statistical significance. Further studies are necessary to investigate the effects of chest physical therapy according to body positions.

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The purpose of our study was to carry out a prospective follow-up of 114 newborns at term (including three pairs of twins), regarding clinical manifestations for atopy during the first year of life. Their IgE levels in cord blood samples, at 3, 6, 9 and 12 months of age were measured and the influence of race, sex, breast-feeding, maternal smoking, family income, month of birth, family history and personal manifestations of atopic disease were evaluated. Total serum immunoglobulin E was quantified by microparticle enzyme immuno-assay (MEIA). The study group consisted of 60 (53%) male neonates, 67 (59%) Caucasians and 47 (41%) blacks. In the clinical follow-up, 32 (28.1%) infants developed obvious atopic disease: 29 infants presented recurrent wheezing, two had cow's milk allergy and one had atopic dermatitis. Probable atopic disease developed in 12 (10.5%) infants, whereas 70 (61.4%) infants showed no manifestations. Cord blood IgE levels in infants with obvious atopic disease was higher when compared to those without (p = 0.024), with 70.97% sensitivity and 46.2% specificity. IgE levels were also significantly different up to 12 months in these groups (p = 0.0001), when the sensitivity was 82.1% and the specificity 54.1%. At this age, the IgE levels were higher in infants with obvious atopy than nonatopic disease in relation to male sex (p = 0.015), black race (p = 0.009), breast-feeding for less than 6 months (p = 0.011) and when the family income was less than three times the minimum wage (about US $300) (p = 0.006). There was no association between IgE levels and family history of atopy. We concluded that immune response for atopy was in a large degree influenced by environmental factors and serum IgE at 12 months was a good marker for identifying infants with risk of atopic disease in early life.

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Batch fermentations of sugar cane bagasse hemicellulosic hydrolysate treated for removing the inhibitors of the fermentation were performed by Candida guilliermondii FTI20037 for xylitol production. The fermentative parameters agitation and aeration rate were studied aiming the maximization of xylitol production from this agroindustrial residue. The maximal xylitol volumetric productivity (0.87 g/L h) and yield (0.67 g/g) were attained at 400/min and 0.45 v.v.m. (K(L)a 27/h). According to the results, a suitable control of the oxygen input permitting the xylitol formation from sugar cane bagasse hydrolysate is required for the development of an efficient fermentation process for large-scale applications.