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OBJECTIVE: to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS: this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS: 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3 ± 2.1 years, mean height was 1.5 ± 0.1 m, and mean weight was 40.8 ± 12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9% ± 19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r = 0.373, p = 0.018) and negative correlation with cardiac rate at the end of the test (r = -0.518, p < 0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r = -0.311, p = 0.051). CONCLUSIONS: asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style. .

OBJETIVO: comparar o desempenho físico e cardiorrespiratório do teste de caminhada de seis minutos (TC 6 min) em crianças asmáticas com valores de referência para saudáveis da mesma faixa etária e correlacioná-los com variáveis intervenientes. MÉTODOS: estudo transversal, prospectivo, em crianças com asma moderada/grave, entre seis e 16 anos, em acompanhamento ambulatorial. Coletaram-se dados demográficos e espirométricos. Os pacientes responderam questionário de qualidade de vida em asma (PAQLQ) e nível de atividade física basal. O TC 6 min foi realizado segundo recomendações da American Thoracic Society. Para comparações de médias usou-se teste t e correlação de Pearson para analisar o TC 6 min com variáveis estudadas. Nível de significância de 5%. RESULTADOS: incluídas 40 crianças, 52,5% meninos, 70% eutróficas e sedentárias. A média deidade 11,3 ± 2,1 anos, altura 1,5 ± 0,1 m e peso 40,8 ± 12,6 Kg. A média da distância percorrida no TC 6 min foi significativamente inferior correspondendo a 71,9% ± 19,7 dos valores previstos, onde as crianças sedentárias exibiram os piores valores. A diferença entre a distância percorrida no teste e os valores preditos mostrou correlação positiva com a idade (r = 0,373, p = 0,018) e negativa com a frequência cardíaca ao final do teste (r = -0,518, p < 0,001). Na avaliação da qualidade de vida, os valores do quesito limitações das atividades físicas, demonstraram pior pontuação com correlação negativa com a diferença das distâncias percorridas (r = -0,311,p = 0,051). CONCLUSÕES: o desempenho do TC6 min em crianças asmáticas avaliado através da distância percorrida é significativamente ...

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OBJECTIVE: to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS: this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS: 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3±2.1 years, mean height was 1.5±0.1 m, and mean weight was 40.8±12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9%±19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r=0.373, p=0.018) and negative correlation with cardiac rate at the end of the test (r=-0.518, p<0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r=-0.311, p=0.051). CONCLUSIONS: asthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.

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BACKGROUND: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil. METHODS: Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA. FINDINGS: 407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia. INTERPRETATION: This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively.

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OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart disease. METHODS: This was a longitudinal and quantitative intervention study, undertaken at a children's hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacity. RESULTS: All patients were aged 8 to 17 years (mean 12.4+/-2.1), they had a mean body mass index of 16.1+/-2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p < or = 0.01), demonstrating gradual improvement up to the last day of assessment, although, with the exception of minute volume which was no longer significantly different from the fourth day onwards (p > 0.01), without returning to baseline levels. CONCLUSION: We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

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OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart diseaseMETHODS: This was a longitudinal and quantitative intervention study, undertaken at a children's hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacityRESULTS: All patients were aged 8 to 17 years (mean 12.4±2.1), they had a mean body mass index of 16.1±2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p < 0.01), demonstrating gradual improvement up to the last day of assessment, although, with the exception of minute volume which was no longer significantly different from the fourth day onwards (p > 0.01), without returning to baseline levels.CONCLUSION: We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

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OBJECTIVES: To describe the prevalence of asthma and asthma variants in schoolchildren from Recife in 2002, and to compare these data with data from 1994-95; to analyze the relationship between maternal schooling and the presence of asthma or worsening asthma; and to evaluate the diagnostic accuracy of the yearly prevalence of wheezing as an asthma indicator. METHODS: Cross-sectional study. A probabilistic sample of 3,086 and 2,774 13- and 14-year-old students answered a written questionnaire in 1994-95 and 2002, as part of the International Study of Asthma and Allergies in Childhood. RESULTS: The following prevalence rates were observed in 1994-95 and 2002, respectively: cumulative prevalence of referred asthma: 21 vs 18.2%; cumulative prevalence of wheezing: 39 vs 38%; yearly prevalence of wheezing: 19.7 vs 19.4%; yearly prevalence of night cough: 31 vs 38%; yearly prevalence of exercise-induced wheezing: 20.6 vs 23.8%. The yearly prevalence of asthma attacks was 16.3 vs 15.2% for 1 to 3 attacks; 2.7% vs 1.2% for 4 to 12 attacks; and 1% vs 0.4% for more than 12 attacks. The yearly prevalence of attacks that disturbed sleep was 13 and 10.3%. The yearly prevalence of attacks with compromised speech was 4.8 and 4.1%. Higher levels of maternal schooling were related to higher cumulative prevalence of referred asthma and to cumulative and yearly prevalence of wheezing. CONCLUSIONS: The prevalence of asthma and its severe forms is high in teenager students in Recife. It is also related to higher levels of maternal schooling.

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OBJETIVOS: Descrever a prevalência atual (2002) de asma e suas variantes em escolares da cidade do Recife, comparando os dados com o período de 1994-95; analisar a relação entre instrução materna e o surgimento ou o agravamento da asma; e avaliar a acurácia diagnóstica da prevalência anual de sibilância como indicador de asma. MÉTODO: Em um corte transversal, estudou-se, por questionário escrito, uma amostra probabilística de escolares de 13 e 14 anos em Recife, em 1994-95 (n = 3.086) e 2002 (n = 2.774), como parte do projeto ISAAC (International Study of Asthma and Allergies in Childhood). RESULTADOS: Em 1994-95 e 2002, as prevalências foram, respectivamente: cumulativa de asma referida, 21 e 18,2 por cento; cumulativa de sibilância, 39 e 38 por cento; anual de sibilância, 19,7 e 19,4 por cento; anual de tosse equivalente de asma, 31 e 38 por cento; anual de sibilância desencadeada por exercício, 20,6 e 23,8 por cento. A prevalência anual de crises, estratificada em 1 a 3, 4 a 12 e mais de 12 foi: 16,3, 2,7 e 1 por cento em 1994-95 e 15,2, 1,2 e 0,4 por cento em 2002. A prevalência anual de crises que comprometeram o sono foi, respectivamente, de 13 e 10,3 por cento; a prevalência de crises com prejuízo da fala foi de 4,8 e 4,1 por cento. Nível mais elevado de instrução materna associou-se a maior prevalência cumulativa de asma referida, prevalência cumulativa e anual de sibilância. CONCLUSÕES: A prevalência de asma e suas formas graves é elevada em escolares adolescentes do Recife e está associada a maior instrução materna.

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Entre 147 espécimes respiratórios (114 escarros e 33 swabs faríngeos) coletados de 36 portadores de fibrose cística durante consultas de rotina ou na exacerbação de seus sintomas respiratórios, no período de dezembro de 2000 a dezembro de 2002, isolaram-se: Pseudomonas aeruginosa (65,3%), Staphylococcus aureus (29,9%), Burkholderia cepacia (29,2%) e Haemophilus influenzae (20,4%). Entre os isolados de S. aureus e H. influenzae, 6,8% foram resistentes à oxacilina e 6,7% foram produtores de beta-lactamase, respectivamente. Das 96 linhagens de P. aeruginosa encontradas, 59,4% foram do fenótipo mucóide. Em 12 espécimes, ambos os biótipos, mucóide e não-mucóide, estiveram presentes. Bactérias gram-negativas emergentes, tais como Stenotrophomonas maltophilia e Achromobacter xylosoxidans, foram isoladas em pequeno número. Com exceção do H. influenzae, mais freqüente nas crianças entre seis e 12 anos, não se encontrou diferença entre espécie bacteriana isolada e grupo etário.

Of 147 respiratory specimens (114 sputum and 33 pharyngeal swabs) collected from 36 cystic fibrosis patients during routine visits or exacerbation of their respiratory symptoms, from December 2000 to December 2002, the following bacterial species were recovered: Pseudomonas aeruginosa (65,3%), Staphylococcus aureus (29,9%), Burkholderia capacia (29,2%), and Haemophilus influenzae (20,4%). Among the S. aureus and H. influenzae isolates, 6,8% were oxacillin resistant and 6,7% were b-lactamase producers, respectively. Of 96 isolates of P. aeruginosa, 59.4% belonged to the mucoid phenotype. Both mucoid and non-mucoid morphotypes were simultaneously found in 12 specimens. Emerging gram-negative bacteria, such as Stenotrophomonas maltophilia and Achromobacter xylosoxidans, were present at a low number. H. influenzae was more prevalent in the cystic fibrosis children between six and 12 years old. Concerning the other bacterial species there was not preference for age groups.

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Herein we report a case of a cystic fibrosis child who was simultaneously infected with Burkholderia cepacia genomovar III and Burkholderia vietnamiensis. After antimicrobial therapy only B. cepacia genomovar III persisted.

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