This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

A labilidade do grupo NO+ em complexos [TpRuCl2(NO)]q (Tp = BL(pirazol-1-il)3) foi avaliada à luz da análise de decomposição de energia (Su-Li EDA). Os efeitos eletrônicos de diferentes substituintes pseudo-axiais (L = H, ânion pirazolato, pirazol, isoxazol e isotiazol) na natureza das ligações Ru-NO foram avaliados considerando-se os complexos no estado fundamental (GS) e nos estados meta-estáveis (MS1 e MS2). Os resultados da Su-Li EDA revelam que a natureza das ligações {Ru-NO}6 nos complexos [TpRuCl2(NO)]q (Tp = BL(pirazol-1-il)3) é essencialmente covalente, mas apresenta ainda um caráter eletrostático significativo. A natureza dos substituintes pseudoaxiais tem um efeito direto na magnitude das ligações {Ru-NO}6.

The lability of NO+ group in [TpRuCl2(NO)]q (Tp = BL(pyrazol-1-yl)3) complexes was evaluated at the light of energy decomposition analysis (Su-Li EDA). The electronic effects of different pseudoaxial substituents (L = H, pyrazolyl anion, pyrazole, isoxazole and isothiazole) on the nature of Ru-NO bonding were evaluated considering complexes in ground (GS) and in metastable (MS1 and MS2) states. {Ru-NO}6 bond nature in [TpRuCl2(NO)]q (Tp = BL(pyrazol-1-yl)3) complexes is in essence covalent, but with a still significant electrostatic character. The nature of pseudoaxial substituents has a direct effect on the magnitude of {Ru-NO}6 bonds.

Interações de alguns compostos di-imínicos de cobre(II) com albumina de soro bovino (BSA) foram investigadas por técnicas espectroscópicas, visando comparar a estabilidade dos complexos e verificar a sua capacidade de causar danos oxidativos à proteína. Os ligantes imínicos tri- e tetradentados utilizados neste trabalho contêm grupamentos piridina, pirazina ou imidazol, frequentemente encontrados no meio biológico. A estabilidade termodinâmica relativa de cada um dos complexos foi determinada através de dicroísmo circular (CD), usando a própria BSA como ligante competitivo. Os valores estimados das constantes de equilíbrio aparentes foram muito semelhantes entre si e ao da espécie Cu(BSA), para a qual log K Cu(BSA) = 12.9 já foi relatado na literatura, mostrando que os complexos estudados são bastante estáveis em condições fisiológicas. Dois diferentes sítios de coordenação do íon cobre foram verificados nestes estudos, evidenciados por medidas espectroscópicas (UV-Vis, CD e EPR), dependendo do ligante e da proporção estequiométrica [CuL]/[BSA] utilizada. Entretanto, a inserção do íon cobre em qualquer dos sítios ligantes ocasionou danos oxidativos significativos à proteína, especialmente em presença de peróxido de hidrogênio, indicando um processo oxidativo com formação de espécies reativas de oxigênio (EROs). Um tripeptídeo amidado, Asp-Thr-His-NH2, mimético do sítio N-terminal da BSA, foi sintetizado e a investigação de sua interação com os complexos de cobre permitiu uma compreensão melhor do sistema cobre-BSA. Cálculos de estrutura eletrônica empregando a teoria do funcional de densidade (DFT) foram efetuados para determinar as energias de ligação do cobre em cada complexo e no sítio N-terminal da proteína, buscando correlacioná-las com os dados de estabilidade termodinâmica.

Interactions of some diimine copper(II) complexes with bovine serum albumin (BSA) were investigated by spectroscopic techniques in order to compare the stability of the complexes and their capability of causing oxidative damage to the protein. The tri- and tetradentate imine ligands employed in this work contain pyridine, pyrazine or imidazole moieties, which are ubiquitous in biological systems. The relative thermodynamic stabilities of the copper(II) complexes were estimated by circular dichroism (CD) using BSA as the competitive ligand. The apparent stability constants determined for the complexes are very similar to one another and to that of the Cu(BSA) complex itself, for which log K Cu(BSA) = 12.9 has already been described in the literature, indicating that the complexes are quite stable under physiological conditions. Two different copper binding sites were evidenced on BSA by spectroscopic measurements (CD, UV-Vis and EPR), depending on the ligand and on the [CuL]:[protein] stoichiometric ratio. Metal binding to any of the sites gives rise to significant protein oxidative damage, especially in the presence of hydrogen peroxide, indicating an oxidative process based on reactive oxygen species (ROS). A small amidated peptide, Asp-Thr-His-NH2, corresponding to the N-terminal region of BSA was synthesized, and its interaction with all the diimine-copper(II) complexes was also investigated in order to clarify the copper imine complex-albumin interactions. Electronic structure calculations at the density functional theory (DFT) level were made to compare the copper-ligand binding energies for each complex with that of the metal coordinated at the N-terminal site of the protein.

Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction aof a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters. Results: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders. Conclusion: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Objetivo: La combinación de dos parámetros antropométricos ha sido descrita como una manera más apropiada para determinar la composición y proporciones del cuerpo en niños, con especial atención para el índice de masa corporal (IMC), pues relaciona el peso y la estatura. Sin embargo, los valores del IMC para el periodo neonatal no han sido determinados todavía. Este estudio muestra el IMC para recién nacidos de diversas edades gestacionales presentados en una curva de percentiles suavizados. Métodos: En un estudio retrospectivo incluyendo 2.406 recién nacidos apropiados para la edad gestacional según la curva de Alexander y cols. (1996), entre 29 y 42 semanas de edad gestacional. El peso y la estatura fueron medidos según los procedimientos estándares. Para la construcción de la referida curva fueron determinados los siguientes percentiles: 3, 5, 10, 25, 50, 75, 90 y 95. El modelo matemático de ajuste sinusoidal fue aplicado para establecer una curva que estimase los parámetros biológicos del crecimiento. Resultados: Los valores del IMC para las edades gestacionales en todos los percentiles demostraron aumento constante hasta 38 semanas, estabilización hasta 40 semanas, seguida por una leve disminución hasta 42 semanas en ambos los sexos. Conclusión: Los resultados demuestran una correlación directa entre la edad gestacional y el IMC para ambos sexos en todos los percentiles estudiados, y pueden proporcionar una herramienta útil para determinar un crecimiento intrauterino proporcional.

We assessed the risk factors associated with death in patients hospitalized for juvenile systemic lupus erythematosus (JSLE) and evaluated the autopsy reports. A total of 57,159 hospitalizations occurred in our institution from 1994 to 2003, 169 of them involving 71 patients with JSLE. The most recent hospitalization of these patients was evaluated. Patients were divided into two groups based on mortality during hospitalization: those who survived (N = 53) and those who died (N = 18). The main causes of hospitalization were JSLE activity associated with infection in 52% and isolated JSLE activity in 44%. Univariate analysis showed that a greater risk of death was due to severe sepsis (OR = 17.8, CI = 4.5-70.9), systemic lupus erythematosus disease activity index (SLEDAI) ³8 (OR = 7.6, CI = 1.1-53.8), general infections (OR = 6.1, CI = 1.5-25), fungal infections (OR = 5.4, CI = 3.2-9), acute renal failure (OR = 5.1, CI = 2.5-10.4), acute thrombocytopenia (OR = 3.9, CI = 1.9-8.4), and bacterial infections (OR = 2.3, CI = 1.2-7.5). Stratified analysis showed that severe sepsis and SLEDAI ³8 were not confounder variables. In the multivariate analysis, logistic regression showed that the only independent variable in death prediction was severe sepsis (OR = 98, CI = 16.3-586.2). Discordance between clinical diagnosis and autopsy was observed in 6/10 cases. Mortality of hospitalized JSLE patients was associated with severe sepsis. Autopsy was important to determine events not detected or doubtful in dead patients and should always be requested.

OBJETIVOS: Avaliar a prevalência das doenças alérgicas na região oeste de São Paulo entre escolares de 6 a 7 anos e comparar os dados obtidos com aqueles da fase I da região centro-sul, através do questionário padronizado do International Study of Asthma and Allergies in Childhood. MÉTODOS: Foram enviados 5040 questionários escritos com resposta de 3.312 alunos. As diferenças entre proporções foram avaliadas pelo Teste do Qui-quadrado ou Teste Exato de Fisher, se calculado a Razão das Chances, intervalo de confiança 95% entre os sexos e doenças alérgicas. Os valores de p < 0,05 foram considerados como significantes. RESULTADOS: As prevalências corrigidas encontradas foram: asma 24,4%, diagnóstico médico de asma 5,7%, rinite 25,7%, rinoconjuntivite 11,3%, diagnóstico médico de rinite 20%, eczema atópico 9,2%. Houve associação significativa entre asma e rinite (OR=3,3), asma e eczema (OR=2,2) e rinite e eczema atópico (OR=2,8). O sexo masculino foi predominante para asma e rinite. Comparando-se os dados da fase I, observou-se prevalência mais elevada dos sintomas e gravidade de asma e valores menores para rinite e eczema. CONCLUSÕES: As prevalências de asma e rinite neste estudo mostraram valores elevados em comparação ao diagnóstico médico. Houve predomínio do sexo masculino para asma e rinite. As associações mais freqüentes foram entre asma e rinite e asma e eczema. Em relação à região centro-sul de São Paulo, observou-se que na região oeste houve maior prevalência dos sintomas e gravidade da asma e menor prevalência de rinite e eczema.

The aims of the present work were the evaluation of allergic disease prevalence among 6 and 7 year-old students from the western districts of São Paulo city and the comparison of these data with those obtained in the International Study of Asthma and Allergies in Childhood (ISAAC) phase I, performed in the central-southern districts of São Paulo, using the ISAAC standardized written questionnaire. METHODS: 5,040 questionnaires were distributed and 3,312 were returned. Proportional differences were estimated by Chi square or Fisher exact tests. Odds Ratio and 95% confidence intervals between genders and allergic diseases were calculated. Values of p<0.05 were considered statistically significant. RESULTS: The corrected prevalences found were: asthma 24.4%, medical diagnosis of asthma 5.7%, rhinitis 25.7%, rhinoconjunctivitis 11.3%, medical diagnosis of rhinitis 20.0%, atopic eczema 9.2%. Significant associations between asthma and rhinitis (OR=3.3), asthma and eczema (OR=2.2), and rhinitis and eczema (OR=2.8) occurred. The male gender was prevalent regarding asthma and rhinitis. Compared to data from ISAAC phase I, higher asthma prevalence and severity, and lower values for rhinitis and eczema were observed in this study. CONCLUSIONS: The present study evidenced high prevalences for asthma and rhinitis compared to the children's medical diagnosis. The male gender predominated in all positive responses regarding asthma and rhinitis. The most frequent associations observed were between asthma and rhinitis and asthma and eczema. In the western districts of São Paulo, a higher prevalence of asthma symptoms and severity and lower prevalences for rhinitis and eczema occurred compared to the central-southern districts of the city.