Abstract Introduction: cystic fibrosis is a disease that causes inflammation, oxidative stress and metabolic changes that lead to nutrient deficiency, such as vitamin D deficiency. On the other hand, it is suggested that vitamin D has anti-inflammatory and antioxidant actions. Objective: to evaluate the prevalence of hypovitaminosis D and the association between serum 25 hydroxyvitamin D levels with markers of oxidative stress and inflammation in patients with cystic fibrosis. Method: a cross-sectional study was carried out with 48 patients with cystic fibrosis including children, adolescents and adults in the northeast region of Brazil. Blood collection was performed for analysis of 25-hydroxyvitamin D, calcium, parathyroid hormone, inflammatory process (C-reactive protein [CRP] and alpha-1-acid glycoprotein-A1 [A1GPA]) and oxidative stress (malondialdehyde (MDA) and total antioxidant capacity [CAOT]). The statistical analysis was performed using the "Statistical Package for the Social Sciences", adopting a significance level of p < 0.05. Results: vitamin D insufficiency/deficiency was found in 64.6 % of patients. After multiple linear regression analysis, MDA showed an inverse association with blood values of 25-hydroxyvitamin D (p < 0.05) conditioned by the presence of inflammatory process markers. When only oxidative stress was evaluated, this association disappeared. Conclusion: in conclusion, there was a high prevalence of hypovitaminosis D, with 25(OH)D levels associated with greater oxidative stress when combined with inflammatory markers. Improved vitamin D levels may be an alternative to reduce the damage caused by excess oxidative stress and inflammation in CF patients.

Resumen Introducción: la fibrosis quística es una enfermedad que cursa con inflamación, estrés oxidativo y cambios metabólicos que conducen a deficiencia de nutrientes como la vitamina D. Por otro lado, se sugiere que la vitamina D tiene acción antiinflamatoria y antioxidante. Objetivo: evaluar la prevalencia de hipovitaminosis D y la asociación entre los niveles séricos de 25 hidroxivitamina D con los marcadores de estrés oxidativo e inflamación en pacientes con fibrosis quística. Método: estudio transversal realizado con 48 pacientes con fibrosis quística, niños, adolescentes y adultos, de la región nordeste de Brasil. Se realizó una extracción de sangre para el análisis de 25-hidroxivitamina D, calcio, hormona paratiroidea, proceso inflamatorio (proteína C-reactiva [PCR] y alfa-1-glucoproteína ácida-A1 [A1GPA]) y estrés oxidativo (malondialdehído [MDA] y capacidad antioxidante total [CAOT]). El análisis estadístico se realizó utilizando el "Paquete Estadístico para las Ciencias Sociales", adoptando un nivel de significancia de p < 0,05. Resultados: se encontró insuficiencia/deficiencia de vitamina D en el 64,6 % de los pacientes. Después de un análisis de regresión lineal múltiple, la MDA mostró una asociación inversa con los valores sanguíneos de 25-hidroxivitamina D (p < 0,05) condicionado a la presencia de marcadores de proceso inflamatorio; cuando solo se evalúa el estrés oxidativo, esta asociación desaparece. Conclusión: en conclusión, hubo una alta prevalencia de hipovitaminosis D, con niveles de 25(OH)D asociados a mayor estrés oxidativo cuando se combina con marcadores inflamatorios. La mejora de los niveles de vitamina D puede ser una alternativa para reducir el daño causado por el exceso de estrés oxidativo y la inflamación en pacientes con FQ.

Resumen: El presente estudio tuvo como objetivo describir la percepción de los cuidadores y el rol de los profesionales en el proceso de reinserción familiar y adopción de niños, niñas y adolescentes con discapacidad en una institución de acogida. La investigación se llevó a cabo en una institución que acoge a niños y adolescentes con discapacidad en la ciudad de Belém/PA. Participaron diez familiares de cinco acogidos y tres profesionales del equipo técnico. Los datos fueron recogidos durante la ejecución del Proyecto Pontes, mediante el registro en un diario de campo, y el análisis se realizó mediante la técnica de análisis de contenido y utilizando el software Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). Los principales hallazgos mostraron la importancia del seguimiento de las familias por parte del equipo, como fundamental para el proceso de reintegración y adopción familiar.

Abstract: The study aimed to describe the perception of caregivers and the role of professionals in the process of family reintegration and adoption of children and adolescents with disabilities in a host institution in Belém/PA. Ten family members of five children and three professionals from the technical team participated. The data were collected during the execution of the Pontes Project, by means of recording in a field diary, and the analysis was carried out with the content analysis technique using the software Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). The main findings showed the importance of the families being monitored by the technical team for the process of family reintegration and adoption.

Resumo: O estudo teve como objetivo descrever a percepção de cuidadores e o papel de profissionais no processo de reintegração familiar e adoção de crianças e adolescentes com deficiência em uma instituição de acolhimento de Belém/PA. Participaram dez familiares de cinco acolhidos e três profissionais da equipe técnica. Os dados foram coletados durante a execução do Projeto Pontes, por meio de registro em diário de campo, e a análise foi realizada por meio da técnica de análise de conteúdo mediante a aplicação do software IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires). Os principais achados demonstraram a importância do acompanhamento das famílias por parte da equipe técnica para o processo de reintegração familiar e adoção.

ABSTRACT Objective To develop and validate a course on basic sciences in Ophthalmology. Methods A methodological study for the development and validation of a teaching and instructional material, an online course through the ADDIE instructional design, was prepared at the Faculdade Pernambucana de Saúde (FPS). The design consists of three steps out of five: Analysis, Design, and Development. Bloom’s revised Taxonomy was used to define the learning objectives. The course was submitted remotely to content validation, through a consensus group of five specialists selected with a score higher than five in the criteria established by the Fehring model, according to the rules of Resolution 510/2016. Results With expected duration of 15 hours, the course has 19 learning objectives distributed in six pedagogical units. It contemplates the programmatic content using several interactive technological resources, such as storytelling videos, simulation with animated cartoons and clickable interactive actors and screens. In addition to having formative evaluation of content sedimentation at the end of each unit. Conclusions The online course of basic sciences in ophthalmology has been validated by specialists and it is expected to provide democratization of ophthalmology teaching to educational institutions accredited by the CBO.

RESUMO Objetivo Elaborar e validar um curso sobre Ciências Básicas em Oftalmologia. Métodos Foi realizado um estudo metodológico para elaboração e validação de material didático, na modalidade à distância, por meio do desenho instrucional ADDIE. O desenho é composto de três de cinco etapas: análise, desenho e desenvolvimento. Foi utilizada a taxonomia revisada de Bloom para definição dos objetivos de aprendizagem. O curso foi submetido à validação do conteúdo, via remota, por meio de grupo de consenso selecionado pelo modelo de Fehring, segundo as normas da resolução 510/2016. Resultados O curso elaborado e validado tem duração prevista de 15 horas e possui 19 objetivos de aprendizagem distribuído em seis unidades pedagógicas. Contempla o conteúdo programático utilizando diversos recursos tecnológicos interativos e apresenta-se com avaliações formativas de sedimentação do conteúdo ao fim de cada unidade. Conclusão O curso de Ciências Básicas em Oftalmologia na modalidade à distância validado promete democratizar o ensino da Oftalmologia às instituições de ensino credenciadas pelo Conselho Brasileiro de Oftalmologia.

ABSTRACT Extrapulmonary tuberculosis associated with immune thrombocytopenia (ITP) is extremely rare. A likely association between ITP and pulmonary and lymph node tuberculosis was reported in a 29-year-old male patient. His platelet count decreased to 4,000/µL. Chest tomography revealed mediastinal adenomegaly, lymph node clusters in the aorta, and consolidation in the left upper lung lobe. Immunoglobulin and methylprednisolone were administered intravenously. The histopathology of the left upper lung lobe confirmed tuberculosis. The rifampicin/isoniazid/pyrazinamide/ethambutol regimen was initiated, and the corticosteroids were tapered off. This case suggests an association of tuberculosis with ITP, since the platelet count effectively normalized after tuberculosis treatment.

Resumo O artigo objetivou descrever a percepção de alunos com deficiência da Universidade Federal do Pará (UFPA) que apresentaram níveis distintos de estresse. Participaram do estudo 11 alunos dos 29 com estresse e 8 dos 21 sem estresse. Um questionário sociodemográfico, a Escala de Estresse Percebido e o roteiro de entrevista foram aplicados para identificar o que causa o estresse no contexto acadêmico. Os alunos com elevados níveis de estresse foram menos positivos do que os estudantes com baixos níveis de estresse. Concluiu-se que tanto os estudantes com níveis elevados de estresse quanto os com níveis baixos estão sujeitos a terem problemas emocionais e físicos quando o contexto universitário não apresenta uma acessibilidade adequada às suas necessidades especiais.

Abstract The article aimed to describe the perception of students with disabilities at the Federal University of Pará who presented different levels of stress. Eleven of the 29 students with stress and 8 of the 21 without stress participated in the study. A sociodemographic questionnaire, the Perceived Stress Scale and the interview script were applied to identify what causes stress in the academic context. Students with high levels of stress were less positive than the ones with low levels of stress. It was concluded that both students with high levels of stress and with low levels of stress have emotional and physical problems when the university context does not provide adequate accessibility to their special educational needs.

RESUMO Objetivo: Analisar o pico de fluxo inspiratório (PFI) e a função pulmonar dinâmica de crianças e adolescentes asmáticos e verificar sua associação com variáveis clínicas. Métodos: Estudo transversal com crianças e adolescentes asmáticos que faziam uso regular de inaladores de pó. O grupo controle foi composto por participantes sem doença pulmonar, pareados por sexo, idade, peso e altura. Foram coletadas variáveis socioeconômicas e clínicas. O PFI e variáveis de função pulmonar dinâmica foram obtidos através de um dispositivo específico. As associações entre os dois grupos foram estudadas utilizando-se o teste t de Student e ANOVA. Realizou-se um modelo de regressão linear múltipla e foram calculados os coeficientes de correlação de Pearson para estimar associações entre o PFI e as demais variáveis. Resultados: Foram incluídos no estudo 88 participantes (44 em cada grupo). Nos asmáticos, os valores do PFI e de força muscular respiratória (S-índex) foram menores que os dos controles. O PFI nos asmáticos apresentou correlações positivas com as variáveis idade, peso, altura e S-índex. Controlando-se a altura, houve um aumento de 0,05 unidades no PFI associado ao aumento de 1 unidade de S-índex nos asmáticos. Conclusões: O PFI é menor em crianças e adolescentes com asma em comparação àqueles sem asma com características antropométricas semelhantes e apresenta correlações positivas com idade, altura, peso e força dos músculos respiratórios.

ABSTRACT Objective: To measure peak inspiratory flow (PIF) and assess dynamic lung function in children and adolescents with asthma, as well as to determine the association of PIF with dynamic lung function and clinical variables. Methods: This was a cross-sectional study of children and adolescents with asthma using dry powder inhalers (DPIs) regularly. The control group included sex-, age-, weight-, and height-matched individuals without lung disease. Socioeconomic and clinical variables were collected. PIF and dynamic lung function variables were obtained with a specific device. Between-group comparisons were made with the Student’s t-test and ANOVA. Multiple linear regression analysis was performed, and Pearson’s correlation coefficients were calculated to assess associations between PIF and the other variables. Results: A total of 88 individuals (44 asthma patients and 44 controls) participated in the study. PIF and respiratory muscle strength (S-index) values were lower in the asthma patients than in the controls. PIF correlated positively with age, weight, height, and S-index in the asthma group. After controlling for height, we found an increase of 0.05 units in PIF associated with an increase of 1 unit in the S-index in the asthma group. Conclusions: PIF appears to be lower in children and adolescents with asthma than in those without asthma, correlating positively with age, height, weight, and respiratory muscle strength.

ABSTRACT Prior research on sugarcane showed increment of productivity following molybdenum (Mo) fertilization and some indication of the potential role either on nitrate reductase activity (NRA). However, this increment can depend on sugarcane variety and nitrogen (N) fertilization. This study aimed to evaluate the effect of Mo fertilization on Mo uptake, on NRA, nitrate (NO3--N), and ammonium (NH4+-N) contents in leaves and roots of sugarcane, and the accumulation of N and biomass across two sugarcane varieties (RB 867515 and RB 92579). The varieties were subjected to two rates of N fertilization (without N fertilization and 60 kg ha-1 of N) and two rates of Mo fertilization (without Mo fertilization and 200 g ha-1 of Mo). At 70, 100, 130, 200, and 365 days after planting (DAP), the following parameters were determined: Mo, NO3--N and NH4+-N contents, NRA in the leaves and roots, and the accumulation of N, as well as shoot dry matter (SDM). Molybdenum fertilization increased N accumulation in 36 and 44 % in the varieties RB 867515 and RB 92579, respectively. This increase in N accumulation was associated with NRA stimulation of 13 % in the leaves and 42 % in the roots. The maximum NRA occurred around 100 DAP, and its contents in the leaves and roots of the RB 92579 were 0.83 and 0.46 µmol NO2- g-1 h-1 of fresh matter, respectively, and in RB 867515 these values were 0.61 and 0.43 µmol NO2- g-1 h-1 of fresh matter, respectively. The assimilation of NO3--N was increased with Mo application, both with and without N fertilization, suggesting that Mo fertilization is indicated in nutrition management of sugarcane. This study provides insight into how Mo fertilization interacts with N fertilization and sugarcane varieties, altering N accumulation and dry matter production.

ABSTRACT Background: Breast cancer is the neoplasm with both the highest incidence and mortality rate among women worldwide. Given the known snake venom cytotoxicity towards several tumor types, we evaluated the effects of BthTX-I from Bothrops jararacussu on MCF7, SKBR3, and MDAMB231 breast cancer cell lines. Methods: BthTX-I cytotoxicity was determined via MTT 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazoliumbromide assay. Cell death was measured by a hypotonic fluorescent solution method, annexin-V-FITC/propidium iodide staining and by apoptotic/autophagic protein expression. Cancer stem cells (CSCs) were quantified by flow cytometry using anti-CD24-FITC and anti-CD44-APC antibodies and propidium iodide. Results: BthTX-I at 102 µg/mL induced cell death in all cell lines. The toxin induced apoptosis in MCF7, SKBR3, and MDAMB231 in a dose-dependent manner, as confirmed by the increasing number of hypodiploid nuclei. Expression of pro-caspase 3, pro-caspase 8 and Beclin-1 proteins were increased, while the level of the antiapoptotic protein Bcl-2 was diminished in MCF7 cells. BthTX-I changed the staining pattern of CSCs in MDAMB231 cells by increasing expression of CD24 receptors, which mediated cell death. Conclusions: BthTX-I induces apoptosis and autophagy in all breast cancer cell lines tested and also reduces CSCs subpopulation, which makes it a promising therapeutic alternative for breast cancer.

Abstract: The increase of N fertilization in sugarcane can negatively influence the technological quality of the crop for sugar and alcohol production. The use of Mo in fertilization combined with N can reduce this effect and increase agricultural and sugar yield. The objective of this study was to evaluate the levels of Mo in soil, roots and leaves of sugarcane fertilized with N and Mo, to measure agricultural and sugar productivity and to evaluate quality of the technological attributes for production of sugar and alcohol. Two varieties were cultivated (RB867515 and RB92579) under field conditions, submitted to two doses of N (0 and 60 kg ha-1) and two doses of Mo (0 and 200 g ha-1) both applied to the soil. The source of N used was urea and the source of Mo was sodium molybdate. RB867515 was influenced by Mo and agricultural and sugar productivity increased by 21%. N fertilization did not increase agricultural productivity but reduced the technological quality of sugarcane, and Mo did not change this reduction. It is suggested that N fertilization should be reduced in first crop cycle and Mo fertilization should be stimulated.

Resumo Objetivos: avaliar a independência funcional, capacidade funcional e força muscular respiratória (FMR) em indivíduos com mucopolissacaridose (MPS) tipo VI. Métodos: neste estudo transversal, as escalas Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e Medida de Independência Funcional (MIF) foram utilizadas para avaliar a independência funcional. A capacidade funcional e a FMR foram avaliadas por teste de caminhada de 6 minutos (6MWT) e Manovacuometria, respectivamente. As associações entre FMR e 6MWD foram analisadas usando modelos de regressão linear simples. Além disso, t-test foi usado para comparar diferenças entre grupos. Resultados: vinte e quatro pacientes com MPS VI foram incluídos no estudo, a média da idade foi 8 anos (2-38 anos). A PEDI apresentou desempenho funcional abaixo das expectativas nos domínios de autocuidado e mobilidade em 33,3% quando comparada com grupos de crianças brasileiras com desenvolvimento típico da mesma idade avaliada. A diminuição da função social foi encontrada em apenas um único caso. De acordo com a MIF, dos 12 pacientes avaliados (idade> 7,5 anos), 58,3% foram classificados como dependência modificada e 41,7% como independência modificada. A distância média no 6MWTfoi significativamente menor do que o previsto, 263 m em G1 (crianças, n = 7) e 336 m em G2 (adolescentes e adultos, n = 6), p<0,001. A FMR também foi menor do que o previsto em ambos os grupos, com exceção em G1. Conclusões: a capacidade funcional e a FMR foram signif icativamente reduzidas em indivíduos com MPS VI, com diminuição da independência funcional em um terço dos pacientes. Portanto, o seguimento multidisciplinar no acompanhamento dessa população é essencial para prevenir, diagnosticar e tratar complicações precocemente.

Abstract Objectives: to assess the functional independence, functional capacity and respiratory muscle strength (RMS) in individuals with mucopolysaccharidosis (MPS) type VI. Methods: in this cross-sectional study, the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure (FIM) scales were used to assess the functional independence. The functional capacity and the RMS were assessed by a 6-minute walk test (6MWT) and Manovacuometry, respectively. The associations between RMS and 6MWD were analyzed by using the adjusted simple linear regression models. And besides, the T-test was used to compare the differences among the groups. Results: twenty-four patients with MPS VI were included, the median age was 8 (ranged from 2-38 years old). The PEDI presented a functional performance below the expectations at the self-care and mobility domains of 33.3% when compared to groups of Brazilian children at the same age assessed with typical development. The decreased social function was found in only one single case. According to the FIM, of the 12 patients evaluated (age> 7.5 years), 58.3% were classified as modified dependence and 41.7% as modified independence. The mean distance in the 6MWT was significantly lower than predicted, 263m in G1 (children, n= 7) and 336m in G2 (adolescents and adults, n=6), p<0.001. The RMS was also lower than predicted in both groups, except for the RMS in G1. Conclusions: the functional capacity and the RMS were significantly reduced in individuals with MPS VI, with a decreased functional independence in one-third of the patients. However, a multidisciplinary follow-up in this population is essential to prevent, diagnose and treat early complications.

Resumo Objetivos: descrever dados preliminares referentes às crises epilépticas e à probabilidade de ocorrência dessas crises nos primeiros meses de vida em crianças com síndrome congênita do Zika vírus (ZIKV). Métodos: estudo de coorte concorrente incluindo recém-nascidos e lactentes com síndrome congênita do Zika vírus, atendidos no ambulatório especializado do IMIP, Recife, Pernambuco durante o período de outubro 2015 a maio 2016. Resultados: foram analisados dados de 106 lactentes com diagnóstico confirmado ou provável associação da infecção pelo ZIKV. Quarenta crianças (38,7%) apresentaram crise epiléptica, classificada em 43,3% dos casos como sendo espasmo, 22,7% como crise generalizada tônica, 20,5% parcial e 4,5% crises epilépticas de outros tipos. A mediana dos dias até o primeiro relato de ocorrência de crise epiléptica foi 192 dias de vida. Conclusões: crianças com síndrome congênita do Zika vírus apresentaram elevada incidência de crises epilépticas de aparecimento precoce, antes do final do primeiro semestre de vida, sendo o espasmo o tipo de crise mais observado.

Abstract Objectives: to describe preliminary data referred to epileptic seizures and the probability of occurring these epileptic seizures in the infants' first months of life with congenital Zika virus (ZIKV) syndrome. Methods: concurrent cohort study including newborns and infants with congenital Zika virus syndrome attended at the specialized outpatient clinic at IMIP, Recife, Pernambuco, from October 2015 to May 2016. Results: data on 106 infants were analyzed with confirmed or suspected association to ZIKV infection. Forty children (38.7%) presented an epileptic seizure, classified at 43.3% of the cases as being spasms, 22.7% as generalized tonic seizures, 20.5% as partial and 4.5% other types of seizures. The median of days until the first report on the occurrence of epileptic seizure was 192 days of life. Conclusions: children with congenital Zika virus syndrome presented a high incidence of epileptic seizures before the end of the first semester of life, and spasm was the epileptic seizure mostly observed.

Resumo Introdução: a infecção pelo vírus chikungunya apresenta manifestações clínicas variáveis, particularmente em lactentes, nos quais parece haver uma multiplicidade de manifestações cutâneas. Descrição: foi feito um estudo tipo de série de casos de caráter analítico com 14 lactentes (>28 dias a < 2 anos) internados entre novembro de 2015 e janeiro de 2016 como caso suspeito de infecção por chikungunya com sorologia IgM específica reagente. Excluídos pacientes com exame positivo para dengue, Zika vírus, infecção bacteriana e outras doenças exantemáticas. As manifestações clínicas mais frequentes foram febre e alterações cutâneas em 100% dos casos, irritabilidade (64,3%), vômitos e artralgia/artrite em 35,7% cada. Três crianças apresentaram alterações liquóricas compatíveis com meningite. A frequência de anemia foi de 85,7%. A mediana de leucometria foi de 7.700/mm3 (2.600 a 20.300/mm3). Níveis aumentados de aminotransferases foram observados em três casos (230 a 450 U/L). Antibioticoterapia foi indicada em 64,3% dos casos. Dois lactentes necessitaram de derivados de opioides para analgesia fixa, enquanto os demais, paracetamol e/ou dipirona. Discussão: o estudo evidencia envolvimento multisistêmico da infecção por chikungunya em lactentes. O tratamento permanece de suporte, com atenção a hidratação, analgesia, cuidados com a pele e ao uso racional de antibioticoterapia.

Abstract Introduction: the infection of chikungunya virus presents clinical manifestations variables, particularly in infants in which may present multiple cutaneous manifestations. Description: a case series study was carried out in an analytical character of 14 infants (>28 days to < 2 years old) admitted in a hospital between November 2015 and January 2016 with suspected case of chikungunya, by a specific IgM reactive serology. Patients positive for dengue fever, Zika virus, bacterial infections and other exanthematic diseases were excluded. Fever and cutaneous alterations were the most frequent clinical manifestations in 100% of the cases, followed by irritability (64.3%), vomits and arthralgia/arthritis in 35.7% each. Three children presented alterations in the cerebrospinal fluid compatible to meningitis. Anemia frequency was 85.7%. The median white blood cells count was 7.700/mm3 (2.600 to 20.300/mm3). High levels of aminotransferases were observed in three cases (230 to 450 U/L). Antibiotic therapy was indicated in 64.3% of the cases. Two infants needed opioid derivatives for analgesia while others took acetaminophen and/or dipyrone. Discussion: the study shows evident multi-systemic involvement of chikungunya infection in infants. The treatment is supportive, giving special attention to hydration, analgesia, skin care, and rational use of antibiotic therapy.

Racional: Através de variações rítmicas, o diafragma influencia a pressão do EEI, atuando como um esfíncter externo. O registro manométrico da sua pressão caracteriza-se por aumento de pressão na inspiração resultante da contração da crura diafragmática que envolve o esfíncter. Objetivo: Descrever um método de medida da pressão do esfíncter esofágico inferior (EEI) durante manobras inspiratórias padronizadas, com cargas crescentes. Métodos: Oito voluntários sadios (sexo feminino, média de idade de 31,5 anos) participaram do estudo. Uma manometria esofágica de alta resolução e impedanciometria mediram a pressão do EEI durante manobras inspiratórias com o Threshold sob cargas de 12, 24 e 48 cm H2O. Resultados: Comparando-se as médias houve diferença significativa entre a pressão máxima do EEI e a sua pressão basal máxima durante o primeiro (diferença de 76,19±17,92, p=0,0008), segundo (diferença 86,92±19,01, p=0,0004) e terceiro segundos da manobra (diferença 90,86±17,93, p=0,0002), tanto com carga de 12 cm de H2O, quanto com 24 e 48 cm. Conclusão: Esta manobra é uma padronização da pressão inspiratória do EEI e pode diferenciar melhor pacientes com doença do refluxo de indivíduos sadios, podendo também ser útil na monitorização do tratamento desses pacientes por meio do treinamento muscular inspiratório.

Background: Through rhythmic variations, the diaphragm influence lower esophageal sphincter (LES) pressure acting as an external sphincter. LES pressure recording is characterized by increased pressure in inspiration due to contraction of the diaphragmatic crura that involves the sphincter. Aim: To describe a method of measuring LES pressure during standardized inspiratory maneuvers with increasing loads. Methods: The study population comprised of eight healthy female volunteers (average age of 31.5 years). An esophageal high-resolution manometry and impedance system was used for measuring the LES pressure during 3-second inspiratory efforts under 12, 24 and 48 cm H2O loads (Threshold maneuvers). Results: There was a significant difference between the average maximum LES pressure and the average maximum basal LES pressure during the first (76.19±17.92 difference, p=0.0008), second (86.92±19.01 difference, p=0.0004), and third seconds of the maneuver (90.86±17.93 difference, p=0.0002), with 12, 24 and 48 cmH2O loads. Conclusion: This maneuver is a standardization of the inspiratory LES pressure and may better differentiate patients with reflux disease from healthy individuals, and may also be useful for monitoring the treatment of these patients through inspiratory muscle training.

OBJETIVO: O conhecimento sobre o manejo da asma aguda em crianças é um tema pouco explorado. O objetivo deste estudo foi avaliar o conhecimento de profissionais de saúde do Recife (PE) sobre o assunto. MÉTODOS: Estudo transversal de tipo inquérito com 27 médicos e 7 enfermeiros, com mais de 2 anos de trabalho, de dois grandes hospitais-escola de pediatria do Recife, avaliados através de questionários autoaplicáveis com questões fechadas. RESULTADOS: Tanto os pediatras quanto os enfermeiros apresentaram conhecimento inadequado sobre o uso de inaladores dosimetrados, nebulização, tipo e dosagem dos medicamentos, assim como técnicas de descontaminação e desinfecção do material. CONCLUSÕES: O conhecimento inadequado do manejo da asma aguda em crianças pode refletir em um tratamento menos efetivo nesses hospitais. Medidas educativas são necessárias para minimizar o problema.

OBJECTIVE: Knowledge of acute asthma management in children is a subject that has rarely been explored. The objective of this study was to assess the level of such knowledge among health professionals in the city of Recife, Brazil. METHODS: This was a cross-sectional survey involving 27 pediatricians and 7 nurses, all with at least two years of professional experience, at two large pediatric teaching hospitals in Recife. The participants completed a self-administered multiple-choice questionnaire. RESULTS: The pediatricians and nurses all possessed insufficient knowledge regarding the use of metered dose inhalers, nebulization, and types/doses of medications, as well as techniques for decontamination and disinfection of the equipment. CONCLUSIONS: Insufficient knowledge of acute asthma management in children can lead to less effective treatment in hospitals such as those evaluated here. Educational programs should be developed in order to minimize this problem.