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The Parsing System "Palavras": Aarhus University Press, The Handbook of Cognition and Emotion. Language, Thought and Logic. Northwestern University Press, An Electronic Lexical Database. Annotating opinions in a book review corpus. Cambridge Scholars Publishing, Mercado de Letras, Communications of the ACM , v. International Journal of Corpus Linguistics , v.
Mapeamento de aspectos afetivos em um ambiente virtual de aprendizagem. Sobre verdade e mentira no sentido extra-moral. Nova Cultura, []. Language has a heart. Opinion Mining and Sentiment Analysis.
Foundations and Trends in Information Retrieval , v. Computational Processing of the Portuguese Language. Springer Berlin Heidelberg, Lecture Notes in Computer Science, Lexicon-Based Methods for Sentiment Analysis. To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma STRA treated at a referral center in southern Brazil.
We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results. We analyzed 21 patients mean age, 9. Most had uncontrolled asthma and near-normal baseline lung function. Of the 8 patients receiving treatment with omalizumab an anti-IgE antibody , 7 Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab.
In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms. This occurs specifically in individuals with uncontrolled asthma and is more closely related to cases that are more severe, resulting in substantial costs to society.
In children, difficult-to-control asthma is the greatest clinical challenge, its estimated prevalence being 0. In addition, difficult-to-control asthma results in school absenteeism, hospitalizations, and financial costs to families and society. Children with difficult-to-control asthma are defined as those in whom the disease remains uncontrolled despite the use of high-dose inhaled corticosteroids and other control drugs.
In such patients, the most complex and difficult-to-treat clinical presentation is severe therapy-resistant asthma STRA , which requires a thorough approach. Children with STRA require systematic evaluation to rule out other chronic lung diseases, correct the inhalation technique, evaluate adherence to treatment, and manage comorbidities and important environmental factors. The only treatment options for such patients are omalizumab an anti-IgE antibody and continuous oral corticosteroid use.
We retrospectively analyzed children and adolescents followed for at least 6 months at monthly visits to a referral center in a tertiary care hospital in southern Brazil; all of the patients had been diagnosed with STRA. Children and adolescents diagnosed with other diseases cystic fibrosis, post-infectious bronchiolitis obliterans, immunodeficiency, and congenital heart disease, among others and those with significant cognitive impairment were excluded.
Sweat tests were performed, and blood samples were collected for blood workup, platelet counts, determination of immunoglobulin levels, and HIV testing. Patients with a body mass index above the 95th percentile on the US Centers for Disease Control and Prevention clinical growth charts were considered obese. Spirometry was performed at all visits, provided that the patients had no symptoms of exacerbation or viral respiratory infection. The first spirometry performed at the referral center and another, performed 6 months after treatment optimization, were chosen, provided that the patients had no symptoms of viral respiratory infection.
The tests were performed on the forearm, with single drops of saline and histamine, as well as of dilutions of Dermatophagoides pteronyssinus, D. Subsequently, for each allergen, a skin prick test was performed with a device that limits skin penetration. The reading was performed min later.
Atopic patients were defined as those with a positive response to at least one allergen. Sputum induction was performed at baseline and at months of follow-up. The procedure was controlled by spirometry.
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Nebulization with hypertonic saline 4. Patients were instructed to cough and expectorate the sputum into a container after each nebulization. After centrifugation at 2, rpm for 2 min, the supernatant was removed and the precipitate was resuspended in 1 mL of Dulbecco's PBS. A total of cells were counted, and the results were expressed as percentages. During clinical follow-up, all patients underwent chest CT as recommended by the medical treatment team and were evaluated by a radiologist.
Esophageal pH monitoring was requested by the treatment team, and all results were interpreted by the same pediatric gastroenterologist. Gastroesophageal reflux disease GERD was defined as the presence of at least one of the following: Categorical variables were presented as absolute and relative frequencies. Continuous variables were presented as mean and standard deviation or as median and interquartile range, depending on the distribution of the variable of interest.
A Student's t-test for dependent samples was used in order to compare lung function variables, according to the distribution of the variable of interest. The objectives of the study were explained to the patients and their parents or legal guardians, and written informed consent was obtained from all participants.
The study was approved by the local research ethics committee. A total of 21 children and adolescents with STRA were selected. Of those, 10 The mean age was 9. The characteristics of the patients are presented in Table 1. Of the 21 patients, 2 9. All participants had asthma symptoms nearly every day including nocturnal symptoms and symptoms during exercise , as well as frequent exacerbations.
Half of the participants had a history of more than one hospitalization for asthma, their quality of life and that of their family members being severely impaired. Total serum IgE levels varied widely; 12 Omalizumab was used in 8 patients The remaining patients showed significant clinical improvement, with no further hospitalizations or frequent exacerbations.
Of the 8 patients who received omalizumab, 3 There were no reports of adverse events in those patients. Because they were not atopic, because they were under 6 years of age, or because their total serum IgE levels were outside the recommended range, 13 of the 21 participants did not receive omalizumab.
Only 1 participant was receiving continuous macrolide antibiotic therapy.
Mild bronchiectasis was found in only 1 patient. Of the 21 patients, 2 9. The first spirometry performed at the referral center and another, performed 6 months after treatment optimization, were chosen, provided that the patients had no symptoms of viral respiratory infection. Computational Processing of the Portuguese Language. Alguns adjetivos, como infantil ou descritivo , podem ser descritores ou classificadores.
That participant was under 6 years of age and therefore did not receive omalizumab. Nevertheless, despite being atopic, the participant showed clinical improvement with the use of continuous azithromycin three times a week. The most common allergens were house dust mite and cockroach allergens. Cat and dog allergens were uncommon. The skin prick test for sensitivity to A. With regard to lung function, all patients had flow-volume curves within normal limits or mild obstructive lung disease.
This variation was found in the same patients in the second spirometry, performed approximately 6 months after the first, when pre-bronchodilator curves were evaluated. Among lung function variables, FVC was found to be lower after treatment optimization. There was no significant difference between the two measurements regarding the variables most closely related to bronchial obstructive disease Figure 2. Esophageal pH monitoring was performed in 10 patients. In the remaining patients, the sample was insufficient or originated from the upper airways.
Of the 13 patients in whom sputum induction was successful, 2 had a paucigranulocytic inflammatory phenotype, 4 had an eosinophilic inflammatory phenotype, and 7 had a neutrophilic inflammatory phenotype Figure 3. Sputum induction did not result in significant adverse events in any of the patients. Chest CT scans were performed in 16 patients. Mild bronchiectasis was found in only 1 patient.
Air trapping, atelectasis, and bronchial wall thickening were found in Ground-glass opacities were found in 2 patients, and hiatal hernia was an incidental finding in 1 patient. Chest CT scans were normal in 3 With regard to the ACT, 6 patients were over 12 years of age and were administered the questionnaire more than five consecutive times.
Ours is the first study to describe the clinical phenotype of STRA in children and adolescents in urban areas of a large city in southern Brazil. Cat, dog, and fungal allergens were uncommon, a finding that was reported by our research group in a previous study of children with asthma in the same region. Although chest CT is formally recommended for all asthma patients, this recommendation has been questioned in children with STRA.
The most interesting findings of our study were those related to the lung function of the patients and the airway inflammatory profile.
The spirometry tests performed when the patients had no exacerbations showed mild obstructive changes in most cases. In adults, severe asthma is closely associated with major lung function changes, which are not observed in children, as previously described. This does not mean that histopathological changes, such as bronchial remodeling, do not appear early in life, particularly in preschool-age children, and are already present in school-age children and adolescents, as demonstrated in previous studies involving transbronchial biopsies.
One hypothesis to explain this finding is that children with STRA have excessively labile bronchomotor tone, which might explain the lack of significant spirometric changes in patients with frequent symptoms. Induced sputum allows noninvasive evaluation of lower airway inflammation in asthma patients and has been used in studies of children with asthma.