Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Year 2019 - Volume 45  - Number 1  (January/February)

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Editorial

1 - Jornal Brasileiro de Pneumologia and Sociedade Brasileira de Pneumologia e Tisiologia: perspectives for the next four years

Jornal Brasileiro de Pneumologia e Sociedade Brasileira de Pneumologia e Tisiologia: perspectivas para os próximos quatro anos

Bruno Guedes Baldi1,2,a, José Miguel Chatkin3,4,b

J Bras Pneumol.2019;45(1):e20190028

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2 - Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

Devemos utilizar escores prognósticos para tromboembolia pulmonar aguda na prática clínica?

Marcelo Basso Gazzana1,2,3,a, Igor Gorski Benedetto1,2,3,b

J Bras Pneumol.2019;45(1):e20190036

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3 - COPD: more treatment will translate to better breathing. Will it?

DPOC: quanto mais tratar, melhor vai respirar. Será?

Paulo José Zimermann Teixeira1,2,3,a, Marcelo Ferreira Nogueira2,3,b

J Bras Pneumol.2019;45(1):e20190037

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Continuing Education: Imaging

4 - Hyperinflation surrounding a solitary nodule

Nódulo com hiperinsuflação adjacente

Edson Marchiori1,a, Bruno Hochhegger2,b, Gláucia Zanetti1,c

J Bras Pneumol.2019;45(1):e20190013

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Continuing Education : Scientific Methodology

5 - Writing an effective response to reviewers: the goal is to improve the study and get it published!

Como escrever uma resposta eficaz aos revisores: o objetivo é melhorar o estudo e publicá-lo!

Cecilia Maria Patino1,2,a, Juliana Carvalho Ferreira1,3,b

J Bras Pneumol.2019;45(1):e20190020

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Original Article

6 - Management of COPD within the Brazilian Unified Health Care System in the state of Bahia: an analysis of real-life medication use patterns

Gerenciamento da DPOC no Sistema Único de Saúde do estado da Bahia: uma análise do padrão de utilização de medicamentos na vida real

Charleston Ribeiro Pinto1,2,3,a, Antônio Carlos Moreira Lemos3,b, Lindemberg Assunção-Costa4,c, Aramis Tupiná de Alcântara5,d, Laira Lorena Lima Yamamura6,e, Gisélia Santana Souza4,f, Eduardo Martins Netto1,7,g

J Bras Pneumol.2019;45(1):e20170194

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Objective: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. Methods: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient's pharmacological treatment was evaluated by comparing the patient's current treatment with that recommended by national and international guidelines. Results: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. Conclusions: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.

 


Keywords: Pulmonary disease, chronic obstructive/therapy; Drug therapy; Clinical protocols

 

7 - Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil

Validação do Pulmonary Embolism Severity Index para a estratificação de risco após tromboembolia pulmonar aguda em uma coorte no Brasil

Leonardo de Araujo Soriano1,a, Talita Tavares Castro1,b, Kelvin Vilalva1,c, Marcos de Carvalho Borges1,d, Antonio Pazin-Filho1,e, Carlos Henrique Miranda1,f

J Bras Pneumol.2019;45(1):e20170251

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Objective: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. Methods: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. Results: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). Conclusions: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.

 


Keywords: Pulmonary embolism; Severity of illness index; Risk assessment.

 

8 - Prevalence of vitamin D deficiency and its relationship with factors associated with recurrent wheezing

Prevalência de deficiência de vitamina D e sua relação com fatores associados à sibilância recorrente

Mirna Brito Peçanha1,2,a, Rodrigo de Barros Freitas1,b, Tiago Ricardo Moreira1,c, Luiz Sérgio Silva1,2,d, Leandro Licursi de Oliveira3,4,e, Silvia Almeida Cardoso1,2,f

J Bras Pneumol.2019;45(1):e20170431

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Objective: To determine the prevalence of vitamin D deficiency/insufficiency in children 0-18 years of age with recurrent wheezing and/or asthma residing in the microregion of Viçosa, Minas Gerais, Brazil, and treated at a referral center, and to determine its association with major risk factors for wheezing. Methods: A cross-sectional study was performed using a semi-structured questionnaire, which was administered by trained interviewers to the legal guardians of the study participants. Data were obtained regarding general characteristics of recurrent wheezing; general sociodemographic, environmental, and biologic factors; and atopy-related factors. The magnitude of the statistical association was assessed by calculating ORs and their corresponding 95% CIs by using multiple logistic regression. Results: We included 124 children in the study. The prevalence of vitamin D deficiency/insufficiency in the sample was 57.3%. Vitamin D deficiency/insufficiency was found to be associated with wheezing in the first year of life, personal history of atopic dermatitis, environmental pollution, and vitamin D supplementation until 2 years of age. Conclusions: The prevalence of vitamin D deficiency/insufficiency was high in our sample. Vitamin D concentrations were directly associated with vitamin D supplementation until 2 years of age and were inversely associated with wheezing events in the first year of life, personal history of atopic dermatitis, and environmental pollution.

 


Keywords: Vitamin D; Asthma; Respiratory sounds; Minors.

 

9 - Evaluation of bone disease in patients with cystic fibrosis and end-stage lung disease

Avaliação de doença óssea em pacientes com fibrose cística e doença pulmonar terminal

Cécile A. Robinson1,a, Markus Hofer2,b, Christian Benden1,c, Christoph Schmid3,d

J Bras Pneumol.2019;45(1):e20170280

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Objective: Bone disease is a common comorbidity in patients with cystic fibrosis (CF). We sought to determine risk factors and identify potential biochemical markers for CF-related bone disease (CFBD) in a unique cohort of CF patients with end-stage lung disease undergoing lung transplantation (LTx) evaluation. Methods: All of the CF patients who were evaluated for LTx at our center between November of 1992 and December of 2010 were included in the study. Clinical data and biochemical markers of bone turnover, as well as bone mineral density (BMD) at the lumbar spine and femoral neck, were evaluated. Spearman's rho and multivariate logistic regression analysis were used. Results: A total of 102 adult CF patients were evaluated. The mean age was 28.1 years (95% CI: 26.7-29.5), and the mean body mass index was 17.5 kg/m2 (95% CI: 17.2-18.2). Mean T-scores were −2.3 and −1.9 at the lumbar spine and femoral neck, respectively, being lower in males than in females (−2.7 vs. −2.0 at the lumbar spine and −2.2 vs. −1.7 at the femoral neck). Overall, 52% had a T-score of < −2.5 at either skeletal site. The homozygous Phe508del genotype was found in 57% of patients without osteoporosis and in 60% of those with low BMD. Mean T-scores were not particularly low in patients with severe CFTR mutations. Although the BMI correlated with T-scores at the femoral neck and lumbar spine, serum 25-hydroxyvitamin D and parathyroid hormone levels did not. Conclusions: CFBD is common in CF patients with end-stage lung disease, particularly in males and patients with a low BMI. It appears that CF mutation status does not correlate with CFBD. In addition, it appears that low BMD does not correlate with other risk factors or biochemical parameters. The prevalence of CFBD appears to have recently decreased, most likely reflecting increased efforts at earlier diagnosis and treatment.

 


Keywords: Lung transplantation; Cystic fibrosis; Bone density; Osteoporosis.

 

10 - Does everyone who quit smoking gain weight? A real-world prospective cohort study

Todos os que param de fumar ganham peso? Estudo prospectivo de coorte do mundo real

Edna Jeremias-Martins1,2,a, José Miguel Chatkin1,3,b

J Bras Pneumol.2019;45(1):e20180010

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Objective: To evaluate weight changes after 12 months of biochemically confirmed smoking abstinence, comparing patients who lost weight or maintained their baseline weight with those who gained weight. Methods: This was a real-world prospective cohort study conducted at the Outpatient Smoking Cessation Clinic of São Lucas Hospital, in the city of Porto Alegre, Brazil, between 2010 and 2016. The patients evaluated received intensive smoking cessation counseling, focused especially on weight issues, together with pharmacotherapy, and were followed for 12 months. The baseline and final weights were measured. Continuous abstinence was confirmed by determining the concentration of exhaled carbon monoxide (eCO). Results: Of a total of 348 patients evaluated, 161 (46.2%) achieved continuous abstinence (eCO < 10 ppm) over the 12-month follow-up period. Of those 161 patients, 104 (64.6%) maintained their initial weight or had a weight change of no more than 5% in relation to their baseline weight, whereas the remaining 57 (35.4%) had a weight gain of more than 5%, 18 of those patients showing a > 10% increase over their baseline weight. The number needed to harm (i.e., the number of patients required in order to detect one patient with a weight increase) was calculated to be 3.6 (95% CI: 2.8-5.4). Conclusions: Weight gain is not necessarily associated with smoking cessation, and smokers who are motivated to quit should be informed of that fact. This information could also be useful for addressing smokers who are still undecided because of possibility of weight gain.

 


Keywords: Weight loss; Smoking cessation; Tobacco smoking; Treatment outcome.

 

11 - Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

Incidência e características morfológicas do sinal do halo invertido em pacientes com tromboembolismo pulmonar agudo e infarto pulmonar submetidos a angiotomografia de artérias pulmonares

Alexandre Dias Mançano1,a, Rosana Souza Rodrigues2,3,b, Miriam Menna Barreto2,c, Gláucia Zanetti2,d, Thiago Cândido de Moraes1,e, Edson Marchiori2,f

J Bras Pneumol.2019;45(1):e20170438

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Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

 


Keywords: Pulmonary embolism; Pulmonary infarction; Computed tomography angiography.

 

12 - Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

A baixa escolaridade é um fator limitante para o controle da asma em uma população com acesso a pneumologista e tratamento?

Cassia Caroline Emilio1,a, Cintia Fernanda Bertagni Mingotti1,b, Paula Regina Fiorin1,c, Leydiane Araujo Lima1,d, Raisa Lemos Muniz1,e, Luis Henrique Bigotto1,f, Evaldo Marchi2,g, Eduardo Vieira Ponte1,h

J Bras Pneumol.2019;45(1):e20180052

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Objective: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. Methods: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. Results: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). Conclusions: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

 


Keywords: Asthma; Educational status; Spirometry; Treatment adherence and compliance.

 

13 - Obstructive sleep apnea and quality of life in elderly patients with a pacemaker

Apneia obstrutiva do sono e qualidade de vida em idosos portadores de marca-passo

Tatiana Albuquerque Gonçalves de Lima1,a, Evandro Cabral de Brito2,b, Robson Martins2,c, Sandro Gonçalves de Lima3,d, Rodrigo Pinto Pedrosa2,e

J Bras Pneumol.2019;45(1):e20170333

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Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

 


Keywords: Quality of life; Aged; Sleep apnea, obstructive.

 

14 - Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments

De volta para o futuro: série de casos de reparo minimamente invasivo do pectus excavatum com instrumentos comuns

Miguel Lia Tedde1,a, Silvia Yukari Togoro1,b, Robert Stephen Eisinger2,c, Erica Mie Okumura1,d, Angelo Fernandes1,e, Paulo Manuel Pêgo-Fernandes1,f, Jose Ribas Milanez de Campos1,g

J Bras Pneumol.2019;45(1):e20170373

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Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.

 


Keywords: Funnel chest; Heart injuries; Thoracic wall; Intraoperative complications; Minimally invasive surgical procedures.

 

Review Article

15 - Dysfunctional breathing: what do we know?

Disfunção respiratória: o que sabemos?

Laís Silva Vidotto1,a, Celso Ricardo Fernandes de Carvalho2,b, Alex Harvey1,c, Mandy Jones1,d

J Bras Pneumol.2019;45(1):e20170347

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Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or "air hunger", DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners.

 


Keywords: Hyperventilation; Pulmonary ventilation; Respiratory system; Pulmonary medicine.

 

Letters to the Editor

16 - Pleural effusion caused by infection with Listeria monocytogenes: etiopathogenesis and treatment

Derrame pleural causado por infecção por Listeria monocytogenes: etiopatogenia e tratamento

Patrícia Alexandra Bernardino Silva1,a, Pedro Gonçalo Ferreira1,b

J Bras Pneumol.2019;45(1):e20170426

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17 - Evaluation of the gauge of needles used in the collection of specimens during endobronchial ultrasound-guided transbronchial needle aspiration

Avaliação do calibre das agulhas utilizadas na coleta de espécimes por punção aspirativa por agulha guiada por ultrassom endobrônquico

Goohyeon Hong1,a, Ji Hae Koo2,b

J Bras Pneumol.2019;45(1):e20180090

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18 - Probe-based confocal laser endomicroscopy of the airways: physiological and pathological characteristics of preneoplastic and neoplastic lesions

Endomicroscopia confocal a laser das vias aéreas: características normais e patológicas de lesões pré-neoplásicas e neoplásicas

Juliana Rocha Mol Trindade1,a, Viviane Rossi Figueiredo2,b, Paulo Manuel Pêgo-Fernandes3,c, Ricardo Mingarini Terra1,d

J Bras Pneumol.2019;45(1):e20180103

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19 - Solitary fibrous tumor of the pleura: a rare cause of elevation of the right lung base

Tumor fibroso solitário da pleura: uma causa rara de elevação da base pulmonar direita

Arthur Soares Souza Jr1,2,a, Luciana Volpon Soares Souza1,b, Gláucia Zanetti3,c, Edson Marchiori3,d

J Bras Pneumol.2019;45(1):e20180006

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Correspondence

20 - Use of thrombolytic agents in the treatment of acute pulmonary thromboembolism: things are not as simple as you might think

Uso de trombolíticos no tratamento do tromboembolismo pulmonar agudo: o buraco é mais embaixo

Carlos Henrique Miranda1,a

J Bras Pneumol.2019;45(1):e20180297

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Author's reply

21 - Authors' reply: Reflections on the use of thrombolytic agents in acute pulmonary embolism

Resposta dos autores: Reflexões sobre o uso de trombolítico na embolia pulmonar aguda

Caio Julio Cesar dos Santos Fernandes1,2,a, Carlos Vianna Poyares Jardim1,b, José Leonidas Alves Jr1,2,c, Francisca Alexandra Gavilanes Oleas1,d, Luciana Tamie Kato Morinaga1,e, Rogério de Souza1,f

J Bras Pneumol.2019;45(1):e20180297

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Year 2019 - Volume 45  - Number 2  (March/April)

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Editorial

1 - Tuberculosis series 2019

Série tuberculose 2019

Denise Rossato Silva1,a, Giovanni Battista Migliori2,b, Fernanda Carvalho de Queiroz Mello3,c

J Bras Pneumol.2019;45(2):e20190064

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2 - Management and outcomes of severe childhood tuberculosis in the pediatric intensive care setting: can we identify best practices?

Tratamento e desfechos da tuberculose grave em crianças na unidade de terapia intensiva pediátrica: é possível identificar as melhores práticas?

Svetlana Velizarova1,a, Natalia Gabrovska1,b, Albena Spasova1,c, Ben Marais2,3,d, Elizabeth Page Harausz4,e, Simon Tiberi5,6,f, Giovanni Battista Migliori7,g, Davide Manissero8,h

J Bras Pneumol.2019;45(2):e20190043

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Continuing Education: Imaging

3 - Nodular reversed halo sign

Sinal do halo invertido nodular

Edson Marchiori1,a, Bruno Hochhegger2,b, Gláucia Zanetti1,c

J Bras Pneumol.2019;45(2):e20180335

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Continuing Education : Scientific Methodology

4 - Loss to follow-up and missing data: important issues that can affect your study results

Perda de seguimento e dados faltantes: questões importantes que podem afetar os resultados do seu estudo

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2019;45(2):e20190091

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Continuing Education: Respiratory Physiology

5 - Measuring slow vital capacity to detect airflow limitation in a woman with dyspnea and a preserved FEV1/FVC ratio

Medição da capacidade vital lenta para detectar limitação do fluxo aéreo em uma mulher com dispneia e relação VEF1/CVF preservada

Danilo Cortozi Berton1,a, José Alberto Neder2,b

J Bras Pneumol.2019;45(2):e20190084

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Original Article

6 - Primary bacillary resistance in multidrug-resistant tuberculosis and predictive factors associated with cure at a referral center in São Paulo, Brazil

Resistência bacilar primária em tuberculose multidrogarresistente e fatores preditivos associados à cura, em um centro de referência da cidade de São Paulo

Marcia Telma Guimarães Savioli1,a, Nelson Morrone2,b, Ilka Santoro1,c

J Bras Pneumol.2019;45(2):e20180075

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Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.

 


Keywords: Multidrug-resistant tuberculosis; Drug resistance; Treatment outcome.

 

7 - Smoking and pulmonary tuberculosis treatment failure: a case-control study

Tabaquismo y fracaso del tratamiento de la tuberculosis pulmonar. Un estudio de casos y controles

Juan Pablo Aguilar1,a, María B Arriaga2,3,b, Monica Ninet Rodas1,4,c, Eduardo Martins Netto1,3,5,d

J Bras Pneumol.2019;45(2):e20180359

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the association between smoking and pulmonary tuberculosis treatment failure. Methods: This was a case-control study conducted at the Brazilian Institute for Tuberculosis Research in the city of Salvador, Brazil, between 2007 and 2015. We evaluated 284 patients treated for pulmonary tuberculosis, comparing 50 cases of treatment failure with 234 control cases in which the final outcome was cure. Results: Treatment failure was attributed to smoking and age rather than to gender, income, level of education, alcohol consumption, or marital status. Therefore, even after adjustment for age, the risk of treatment failure was 2.1 times (95% CI: 1.1-4.1) higher among the patients with a history of smoking. In addition, being over 50 years of age was found to increase the likelihood of treatment failure by 2.8 times (95% CI: 1.4-6.0). Conclusions: Smoking and aging are both associated with pulmonary tuberculosis treatment failure. Therefore, as part of a tuberculosis control program, health personnel should be prepared to offer strategies to promote smoking cessation and should be more careful with older patients.

 


Keywords: Tobacco use disorder; Tuberculosis; Treatment failure.

 

8 - Pulmonary nontuberculous mycobacterial infections: presumptive diagnosis based on the international microbiological criteria adopted in the state of São Paulo, Brazil, 2011-2014

Micobacterioses pulmonares: diagnóstico presuntivo pelos critérios microbiológicos internacionais adotados no estado de São Paulo, Brasil, 2011-2014

Lilian Regina Macelloni Marques1,a, Lucilaine Ferrazoli2,b, Érica Chimara2,c

J Bras Pneumol.2019;45(2):e20180278

Abstract PDF PT PDF EN Portuguese Text

Objective: Pulmonary nontuberculous mycobacterial infections are caused by nontuberculous mycobacteria (NTM), the microbiological diagnosis of which involves the isolation and identification of the same species in at least two sputum samples, one BAL fluid sample, or one lung biopsy sample. The objective of the present study was to determine the frequency at which the various NTM species are identified among selected individuals and in potential cases of pulmonary nontuberculous mycobacterial infection. Methods: This was a retrospective analysis of the data on species isolated from respiratory specimens collected from 2,843 individuals between 2011 and 2014. Potential NTM infection cases were identified on the basis of the international microbiological criteria adopted in the state of São Paulo. Results: A total of 50 species were identified using the molecular method PCR-restriction enzyme analysis. Samples collected from 1,014 individuals were analyzed in relation to the microbiological criteria, and 448 (44.18%) had a presumptive diagnosis of pulmonary nontuberculous mycobacterial infection, the species identified most frequently being, in descending order, Mycobacterium kansasii, M. abscessus, M. intracellulare, M. avium, and M. szulgai. Conclusions: Although various NTM species were identified among the individuals studied, those presumptively identified most frequently on the basis of the microbiological criteria adopted in the state of São Paulo were the ones that are most commonly associated with pulmonary nontuberculous mycobacterial infection worldwide or in specific geographic regions.

 


Keywords: Nontuberculous mycobacteria/classification; Mycobacterium infections, nontuberculous/diagnosis; Lung.

 

9 - Performance of diagnostic tests for pulmonary tuberculosis in indigenous populations in Brazil: the contribution of Rapid Molecular Testing

Desempenho de testes para o diagnóstico de tuberculose pulmonar em populações indígenas no Brasil: a contribuição do Teste Rápido Molecular

Jocieli Malacarne1,a, Alexsandro Santos Heirich2,b, Eunice Atsuko Totumi Cunha3,c, Ida Viktoria Kolte4,d, Reinaldo Souza-Santos4,e, Paulo Cesar Basta4,f

J Bras Pneumol.2019;45(2):e20180185

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the accuracy of rapid molecular testing as a diagnostic tool and estimate the incidence of smear-positive pulmonary tuberculosis among the indigenous population. Methods: This is an epidemiological study based on secondary data. We calculated the incidence of smear-positive pulmonary tuberculosis between January 1st, 2011 and December 31, 2016, and the performance of bacilloscopy and rapid molecular testing in diagnosing pulmonary tuberculosis compared to sputum culture (standard test). Results: We included 4,048 cases of indigenous people with respiratory symptoms who provided sputum samples for analysis. Among them, 3.7%, 6.7%, and 3.7% had positive results for bacilloscopy, sputum culture, and rapid molecular testing, respectively. The mean incidence of pulmonary tuberculosis was 269.3/100 thousand inhabitants. Rapid molecular testing had 93.1% sensitivity and 98.2% specificity, compared to sputum culture. Bacilloscopy showed 55.1% sensitivity and 99.6% specificity. Conclusions: Rapid molecular testing can be useful in remote areas with limited resources and a high incidence of tuberculosis, such as indigenous villages in rural regions of Brazil. In addition, the main advantages of rapid molecular testing are its easy handling, fast results, and the possibility of detecting rifampicin resistance. Together, these attributes enable the early start of treatment, contributing to reduce the transmission in communities recognized as vulnerable to infection and disease.

 


Keywords: Tuberculosis; Molecular diagnostic testing; Diagnostic tests, routine; Indians, South American.

 

10 - Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil

Adesão ao tratamento de pacientes com paracoccidioidomicose na Região Centro-Oeste do Brasil

Ursulla Vilella Andrade1,a, Sandra Maria do Valle Leone de Oliveira1,b, Marilene Rodrigues Chang1,c, Edy Firmina Pereira1,d, Ana Paula da Costa Marques1,e, Lidia Raquel de Carvalho2,f, Rinaldo Poncio Mendes2,g, Anamaria Mello Miranda Paniago1,h

J Bras Pneumol.2019;45(2):e20180167

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

 


Keywords: Paracoccidioidomycosis; Treatment adherence and compliance; loss to follow-up; mycoses

 

11 - Speeding up the diagnosis of multidrug-resistant tuberculosis in a high-burden region with the use of a commercial line probe assay

Agilizando o diagnóstico da tuberculose multirresistente em uma região endêmica com o uso de um teste comercial de sondas em linha

Angela Pires Brandao1,2,a, Juliana Maira Watanabe Pinhata1,b, Rosangela Siqueira Oliveira1,c, Vera Maria Neder Galesi3,d, Helio Hehl Caiaffa-Filho1,e, Lucilaine Ferrazoli1,f

J Bras Pneumol.2019;45(2):e20180128

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. Methods: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. Results: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. Conclusions: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.

 


Keywords: Tuberculosis, multidrug-resistant; Molecular diagnostic techniques; Microbial sensitivity tests; Mycobacterium tuberculosis.

 

Brief Communication

12 - Accuracy of a rapid molecular test for tuberculosis in sputum samples, bronchoalveolar lavage fluid, and tracheal aspirate obtained from patients with suspected pulmonary tuberculosis at a tertiary referral hospital

Acurácia do teste rápido molecular para tuberculose em amostras de escarro, lavado broncoalveolar e aspirado traqueal obtidos de pacientes com suspeita de tuberculose pulmonar em um hospital de referência terciária

Tatiane Maria da Silva1,a, Valéria Martins Soares2,b, Mariana Gontijo Ramos1,c, Adriana dos Santos1,d

J Bras Pneumol.2019;45(2):e20170451

Abstract PDF PT PDF EN Portuguese Text

Tuberculosis continues to be a major public health problem worldwide. The aim of the present study was to evaluate the accuracy of the Xpert MTB/RIF rapid molecular test for tuberculosis, using pulmonary samples obtained from patients treated at the Júlia Kubitschek Hospital, which is operated by the Hospital Foundation of the State of Minas Gerais, in the city of Belo Horizonte, Brazil. This was a retrospective study comparing the Xpert MTB/RIF test results with those of standard culture for Mycobacterium tuberculosis and phenotypic susceptibility tests. Although the Xpert MTB/RIF test showed high accuracy for the detection of M. tuberculosis and its resistance to rifampin, attention must be given to the clinical status of the patient, in relation to the test results, as well as to the limitations of molecular tests.

 


Keywords: Tuberculosis/diagnosis; Molecular diagnostic techniques; Sputum; Bronchoalveolar lavage fluid.

 

13 - Trends in tuberculosis mortality in Brazil (1990-2015): joinpoint analysis

Tendência da mortalidade por tuberculose no Brasil (1990-2015): análise por pontos de inflexão

Carlos Dornels Freire de Souza1,a, João Paulo Silva de Paiva1,b, Leonardo Feitosa da Silva1,c, Thiago Cavalcanti Leal1,d, Mônica de Avelar Figueiredo Mafra Magalhães2,e

J Bras Pneumol.2019;45(2):e20180393

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to analyze trends in the tuberculosis mortality rate in Brazil (1990-2015) in an ecological time-series analysis. The indicators were obtained from the Brazilian National Ministry of Health. A joinpoint regression model was applied for the temporal analysis, with a level of significance of 5%. During the period in question, there was a trend toward a reduction in mortality in the country as a whole (p < 0.001) and in each of its five regions. The states with the highest tuberculosis mortality rates were Rio de Janeiro (7.0/100,000 population) and Pernambuco (5.0/100,000 population). Eleven states and the Federal District of Brasília showed downward trends. Only the state of Alagoas showed a significant increase (p < 0.001). The temporal behavior observed indicates that tuberculosis continues to be a major public health problem in Brazil.

 


Keywords: Tuberculosis/epidemiology; Tuberculosis/mortality; Mortality/trends; Epidemiologic studies.

 

Review Article

14 - International collaboration among medical societies is an effective way to boost Latin American production of articles on tuberculosis

A colaboração internacional entre sociedades médicas é uma forma eficaz de aumentar a produção de artigos sobre tuberculose na América Latina

Giovanni Battista Migliori1,a, Rosella Centis1,b, Lia D'Ambrosio2,c, Denise Rossato Silva3,d, Adrian Rendon4,e

J Bras Pneumol.2019;45(2):e20180420

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: Most studies of tuberculosis originate from high-income countries with a low incidence of tuberculosis. A review of the scientific production on tuberculosis in Latin American countries, most of which are low- or middle-income countries (some with high or intermediate tuberculosis incidence rates), would improve the understanding of public health challenges, clinical needs, and research priorities. The aims of this systematic review were to determine what has been published recently in Latin America, to identify the leading authors involved, and to quantify the impact of international collaborations. Methods: We used PubMed to identify relevant manuscripts on pulmonary tuberculosis (PTB), drug-resistant tuberculosis (DR-TB), or multidrug-resistant tuberculosis (MDR-TB), published between 2013 and 2018. We selected only studies conducted in countries with an annual tuberculosis incidence of ≥ 10,000 reported cases and an annual MDR-TB incidence of ≥ 300 estimated cases, including Brazil, Peru, Mexico, Colombia, and Argentina. Articles were stratified by country, type, and topic. Results: We identified as eligible 395 studies on PTB and 188 studies on DR/MDR-TB-of which 96.4% and 96.8%, respectively, were original studies; 35.5% and 32.4%, respectively, had an epidemiological focus; and 52.7% and 36.2%, respectively, were conducted in Brazil. The recent Latin American Thoracic Association/European Respiratory Society/Brazilian Thoracic Association collaborative project boosted the production of high-quality articles on PTB and DR/MDR-TB in Latin America. Conclusions: Most of the recent Latin American studies on tuberculosis were conducted in Brazil, Mexico, or Peru. Collaboration among medical societies facilitates the production of scientific papers on tuberculosis. Such initiatives are in support of the World Health Organization call for intensified research and innovation in tuberculosis.

 


Keywords: Tuberculosis, pulmonary; Tuberculosis, multidrug-resistant; Latin America.

 

15 - Managing severe tuberculosis and its sequelae: from intensive care to surgery and rehabilitation

Tratamento da tuberculose grave e suas sequelas: da terapia intensiva à cirurgia e reabilitação

Simon Tiberi1,2,a, Marcela Muñoz Torrico3,b, Ananna Rahman1,c, Maria Krutikov1,d, Dina Visca4,e, Denise Rossato Silva5,f, Heinke Kunst2,g, Giovanni Battista Migliori4,h

J Bras Pneumol.2019;45(2):e20180324

Abstract PDF PT PDF EN Portuguese Text

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) continue to challenge physicians and public health specialists. Global treatment outcomes continue to be unsatisfactory, positive outcomes being achieved in only 54% of patients. Overall outcomes are even worse in patients infected with highly resistant strains. Treating MDR-/XDR-TB is difficult because of frequent adverse events, the long duration of drug regimens, the high costs of second-line drugs, chronic post-infectious sequelae, and loss of organ function. Ongoing research efforts (studies and trials) have various aims: increasing the rates of treatment success; understanding the potentialities of new and repurposed drugs; shortening the treatment duration; and reducing the rates of adverse events. It is hoped that better access to rapid diagnostics, increased awareness, and treatments that are more effective will reduce the rate of complications and of lung function impairment. This article aims to discuss the management of severe tuberculosis (defined as that which is potentially life threatening, requiring higher levels of care) and its sequelae, from intensive care to the postoperative period, rehabilitation, and recovery. We also discuss the nonpharmacological interventions available to manage chronic sequelae and improve patient quality of life. Because the majority of MDR-/XDR-TB cases evolve to lung function impairment (typically obstructive but occasionally restrictive), impaired quality of life, and low performance status (as measured by walk tests or other metrics), other interventions (e.g., smoking cessation, pulmonary rehabilitation, vaccination/prevention of secondary bacterial infections/exacerbations, complemented by psychological and nutritional support) are required.

 


Keywords: Extensively drug-resistant tuberculosis; Tuberculosis, multidrug-resistant; Critical care; Smoking cessation.

 

16 - Latent tuberculosis infection in patients with rheumatic diseases

Infecção latente por tuberculose em pacientes com doenças reumatológicas

Camila Anton1,2,a, Felipe Dominguez Machado1,2,b, Jorge Mario Ahumada Ramirez1,2,c, Rafaela Manzoni Bernardi1,2,d, Penélope Esther Palominos3,e, Claiton Viegas Brenol3,f, Fernanda Carvalho de Queiroz Mello4,g, Denise Rossato Silva1,2,h

J Bras Pneumol.2019;45(2):e20190023

Abstract PDF PT PDF EN Portuguese Text

Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

 


Keywords: Tuberculosis; Latent tuberculosis; Tuberculin skin test; Anti-TNF therapy; Tumor necrosis factor-alpha; Rheumatoid arthritis.

 

Images in Pulmonary Medicine

17 - Calcified intracavitary mass: a rare presentation of aspergilloma

Massa intracavitária calcificada: uma apresentação rara de aspergiloma

Edson Marchiori1,a, Bruno Hochhegger2,b, Gláucia Zanetti1,c

J Bras Pneumol.2019;45(2):e20180396

PDF PT PDF EN Portuguese Text


Letters to the Editor

18 - Tuberculosis surveillance in an endemic area of northeastern Brazil. What do the epidemiological indicators reveal?

Vigilância da tuberculose em uma área endêmica do Nordeste brasileiro: O que revelam os indicadores epidemiológicos?

Carlos Dornels Freire de Souza1,2,a, Thais Silva Matos3,4,b, Victor Santana Santos5,c, Franklin Gerônimo Bispo Santos2,d

J Bras Pneumol.2019;45(2):e20180257

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19 - Serum pyrazinamide concentrations in patients with pulmonary tuberculosis

Níveis sanguíneos de pirazinamida no tratamento da tuberculose pulmonar

Stefania de Medeiros Araujo Lucena1,a, Carlos Augusto Abreu Alberio2,b, Ana Carla Godinho Pinto3,c, José Luiz Fernandes Vieira2,4,d

J Bras Pneumol.2019;45(2):e20180254

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20 - Palmar telangiectasia is associated with the intensity of smoking

Telangiectasia palmar está associada à intensidade do tabagismo

Dragica Petar Pesut1,2,a, Ana Milan Samardzic2,b, Milica Vojin Bulajic3,c, Tijana Tatjana Cvok-Debeljak2,d

J Bras Pneumol.2019;45(2):e20180273-e2018273

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Correspondence

21 - Reflections on the article "Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome"

Reflexões sobre o artigo

Andressa Silva Figueira1,a, Marina Esteves1,b, Luiz Alberto Forgiarini Júnior2,c

J Bras Pneumol.2019;45(2):e20180327

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Author's reply

22 - Authors' reply - Reflections on the article "Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome"

Resposta dos autores sobre o artigo Reflexões sobre o artigo

Thays Maria da Conceição Silva Carvalho1,a, Anísio Francisco Soares2,b, Danielle Cristina Silva Climaco3,c, Isaac Vieira Secundo3,d, Anna Myrna Jaguaribe de Lima2,e

J Bras Pneumol.2019;45(2):e20180327

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Erratum

23 - 2018 recommendations for the management of community acquired pneumonia

Recomendações para o manejo da pneumonia adquirida na comunidade 2018

J Bras Pneumol.2019;45(2):

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Year 2019 - Volume 45  - Number 3  (May/June)

App

Editorial

1 - Celebrating World Asthma Day in Brazil: is the glass half full or half empty?

Celebrando o Dia Mundial da Asma no Brasil: o copo está meio cheio ou meio vazio?

Marcia Margaret Menezes Pizzichini1,a, Álvaro Augusto Cruz2,3,b

J Bras Pneumol.2019;45(3):e20190130

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2 - Should the diaphragm be evaluated after abdominoplasty?

Deve-se avaliar o diafragma após a abdominoplastia?

Antonella LoMauro1,a

J Bras Pneumol.2019;45(3):e20190146

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3 - The importance of molecular characterization in lung cancer

A importância da caracterização molecular no câncer de pulmão

Gilberto de Castro Junior1,2,a, Guilherme Harada2,b, Evandro Sobroza de Mello3,c

J Bras Pneumol.2019;45(3):e20190139

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Continuing Education: Imaging

4 - Pulmonary cysts associated with calcified nodules

Cistos pulmonares associados a nódulos calcificados

Edson Marchiori1,a, Bruno Hochhegger2,b, Gláucia Zanetti1,c

J Bras Pneumol.2019;45(3):e20190099

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Continuing Education : Scientific Methodology

5 - How to prepare and present a poster at a conference and communicate your research findings effectively

Como preparar e apresentar um pôster em uma conferência e comunicar resultados de pesquisa de forma eficaz

Juliana Carvalho Ferreira1,2,a, Cecilia Maria Patino1,3,b

J Bras Pneumol.2019;45(3):e20190167

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Continuing Education: Respiratory Physiology

6 - Uncovering the beneficial effects of inhaled bronchodilator in COPD: beyond forced spirometry

Revelando os efeitos benéficos do broncodilatador inalatório na DPOC: além da espirometria forçada

José Alberto Neder1,a, Danilo Cortozi Berton2,b, Denis E O'Donnell1,c

J Bras Pneumol.2019;45(3):e20190168

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Original Article

7 - Multidisciplinary education with a focus on COPD in primary health care

Perfil molecular do carcinoma pulmonar de células não pequenas no Nordeste brasileiro

Ana Claudia da Silva Mendes de Oliveira1,a, Antonio Vinicios Alves da Silva2,b, Marclesson Alves3,c, Eduardo Cronemberger3,d, Benedito Arruda Carneiro4,e, Juliana Carneiro Melo5,f, Francisco Martins Neto6,g, Fabio Tavora1,7,h

J Bras Pneumol.2019;45(3):e20180181

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.

 


Keywords: Anaplastic lymphoma kinase; ErbB receptors; B7-H1 antigen; Carcinoma, non-small-cell lung; Brazil.

 

8 - Lipoabdominoplasty: repercussions for diaphragmatic mobility and lung function in healthy women

Lipoabdominoplastia: repercussão na mobilidade diafragmática e função pulmonar em mulheres saudáveis

Sandra Fluhr1,a, Armèle Dornelas de Andrade1,b, Emanuel José Baptista Oliveira2,c, Taciano Rocha1,d, Ana Irene Carlos Medeiros1,e, Amanda Couto1,f, Juliana Netto Maia1,g, Daniella Cunha Brandão1,h

J Bras Pneumol.2019;45(3):e20170395

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of lipoabdominoplasty on diaphragmatic mobility (DM) and lung function in healthy women. Methods: This was a prospective cohort study using high-resolution ultrasound and forced spirometry to assess DM and lung function, respectively, prior to lipoabdominoplasty, as well as on postoperative day (POD) 10 and POD 30. DM was measured under two conditions: during tidal volume breathing and during a VC maneuver. Results: The sample consisted of 20 women, with a mean age of 39.85 ± 7.52 years and a mean body mass index of 26.21 ± 2.0 kg/m2. Comparing the preoperative and postoperative periods, we found that DM and lung function values were significantly lower after lipoabdominoplasty, the mean DM on POD 10 being 17% and 15% lower during tidal volume breathing and during the VC maneuver, respectively, in comparison with the preoperative mean (p = 0.009 and p < 0.001, respectively). In addition, FEV1, FVC, and PEF were significantly lower on POD 10 than in the preoperative period (p = 0.046, p = 0.002, and p < 0.001, respectively), returning to preoperative values by POD 30. Conclusions: Lipoabdominoplasty appears to have negative short-term repercussions for DM and lung function in healthy women. However, lung function and DM are both apparently restored to preoperative conditions by POD 30. (ClinicalTrials.gov identifier: NCT02762526 [http://www.clinicaltrials.gov/])

 


Keywords: Abdominoplasty; Lipectomy; Ultrasonography; Diaphragm/physiology; Diaphragm/physiopathology; Lung/physiology; Lung/physiopathology; Respiratory mechanics; Spirometry; Respiratory function tests.

 

9 - Melatonin effects on pulmonary tissue in the experimental model of Hepatopulmonary Syndrome

Efeitos da melatonina sobre o tecido pulmonar no modelo experimental de Síndrome Hepatopulmonar

Adriane Dal Bosco1,a, Filipe Boeira Schedler2,b, Josieli Raskopf Colares2,c, Elisângela Gonçalves Schemitt2,3,d, Renata Minuzzo Hartmann2,3,e, Luiz Alberto Forgiarini Junior4,f, Alexandre Simões Dias2,3,g, Norma Possa Marroni2,3,h

J Bras Pneumol.2019;45(3):e20170164

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the pulmonary alterations of animals with Hepatopulmonary Syndrome (HPS) submitted to Biliary Duct Ligature (BDL), as well as the antioxidant effect of Melatonin (MEL). Methods: Sixteen male Wistar rats, divided into four Sham groups: BDL group, Sham + MEL group and BDL + MEL. The pulmonary and hepatic histology, lipoperoxidation and antioxidant activity of lung tissue, alveolar-arterial O2 difference and lung / body weight ratio (%) were evaluated. Results: When comparing the groups, could be observed an increase of vasodilation and pulmonary fibrosis in the BDL group and the reduction of this in relation to the BDL + MEL group. It was also observed significant changes in the activity of catalase, ApCO2, ApO2 in the LBD group when compared to the other groups. Conclusion: The use of MEL has been shown to be effective in reducing vasodilation, fibrosis levels and oxidative stress as well as gas exchange in an experimental HPS model.

 


Keywords: Bile duct; Hepatopulmonary Syndrome; Melatonin; Lung.

 

10 - Effects of manual chest compression on expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure maneuver in patients on mechanical ventilation

Efeitos da compressão torácica manual sobre o flow bias expiratório durante a manobra positive end-expiratory pressure-zero end-expiratory pressure em pacientes sob ventilação mecânica invasiva

Ana Carolina Otoni Oliveira1,a, Daiane Menezes Lorena1,b, Lívia Corrêa Gomes2,c, Bianca Lorrane Reges Amaral2,d, Márcia Souza Volpe3,e

J Bras Pneumol.2019;45(3):e20180058

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.

 


Keywords: Physical therapy modalities; Critical care; Respiration, artificial; Bodily secretions.

 

11 - Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem

Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

Barbara Riquena1,a, Luciana de Freitas Velloso Monte2,b, Agnaldo José Lopes3,c, Luiz Vicente Ribeiro Ferreira da Silva-Filho4,5,d, Neiva Damaceno6,e, Evanirso da Silva Aquino7,f, Paulo Jose Cauduro Marostica8,9,g, José Dirceu Ribeiro10,h

J Bras Pneumol.2019;45(3):e20170351

Abstract PDF PT PDF EN Portuguese Text

Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

 


Keywords: Cystic fibrosis; Pseudomonas aeruginosa; Nebulizers and vaporizers; Equipment contamination; Decontamination.

 

12 - Reference values for pulmonary volumes by plethysmography in a Brazilian sample of white adults

Valores de referência para volumes pulmonares por pletismografia em uma amostra brasileira de adultos da raça branca

Thamine Lessa1,a, Carlos Alberto de Castro Pereira2,b, Maria Raquel Soares2,c, Renato Matos3,d, Virgínia Pacheco Guimarães4,e, Giancarlo Sanches5,f, Roberto Helou Rassi6,g, Israel Maia7,h

J Bras Pneumol.2019;45(3):e20180065

Abstract PDF PT PDF EN Portuguese Text

Objective: To derive reference values for healthy white Brazilian adults who have never smoked and to compare the obtained values with reference values derived by Crapo and by Neder. Methods: Reference equations by quantile regressions were derived in 122 men and 122 women, non-obese, living in seven cities in Brazil. Age ranged from 21 to 92 years in women and from 25 to 88 years in men. Lung function tests were performed using SensorMedics automated body plethysmographies according ATS/ERS recommendations. Lower and upper limits were derived by specific equations for 5 and 95 percentiles. The results were compared to those suggested by Crapo in 1982, and Neder in 1999. Results: Median values for total lung capacity (TLC) were influenced only by stature in men, and by stature and age in women. Residual volume was influenced by age and stature in both genders. Weight was directly related to inspiratory capacity and inversely with functional residual capacity and expiratory reserve volume in both genders. A comparison of observed TLC data with values predicted by Neder equations showed significant lower values by the present data. Mean values were similar between data from present study and those derived by Crapo. Conclusion: New predicted values for lung volumes were obtained in a sample of white Brazilians. The values differ from those derived by Neder, but are similar to those derived by Crapo.

 


Keywords: Pulmonary volumes; Pulmonary function tests; Reference values; Pulmonary plethysmography

 

13 - Effects of exercise on sleep symptoms in patients with severe obstructive sleep apnea

Efeitos do exercício nos sintomas do sono em pacientes com apneia obstrutiva do sono

Roberto Pacheco da Silva1,a, Denis Martinez1,2,3,b, Kelly Silveira da Silva Bueno1,c, Jhoana Mercedes Uribe-Ramos2,d

J Bras Pneumol.2019;45(3):e20180085

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To investigate the extent to which exercise is associated with symptoms in patients with severe obstructive sleep apnea (OSA). Methods: We included subjects with an apnea-hypopnea index (AHI) > 30 events/h who completed validated sleep and exercise questionnaires. We compared symptom frequency/scores between exercisers and nonexercisers, adjusting for the usual confounders. Results: The sample included 907 nonexercisers and 488 exercisers (mean age, 49 ± 14 years; mean AHI, 53 ± 20 events/h; 81% men). Nonexercisers and exercisers differed significantly in terms of obesity (72% vs. 54%), the mean proportion of sleep in non-rapid eye movement stage 3 sleep (9 ± 8% vs. 11 ± 6%), and tiredness (78% vs. 68%). Nonexercisers had a higher symptom frequency/scores and poorer sleep quality. Adjustment for exercise weakened the associations between individual symptoms and the AHI, indicating that exercise has a mitigating effect. In binary logistic models, exercise was associated with approximately 30% lower adjusted questionnaire1 score > 2, tiredness; poor-quality sleep, unrefreshing sleep, and negative mood on awakening. Although the odds of an Epworth Sleepiness Scale score > 10 were lower in exercisers, that association did not withstand adjustment for confounders. Conclusions: Exercise is associated with lower frequency/intensity of symptoms in patients with severe OSA. Because up to one third of patients with severe OSA might exercise regularly and therefore be mildly symptomatic, it is important not to rule out a diagnosis of OSA in such patients.

 


Keywords: Sleep apnea syndromes; Exercise; Sleepiness; Polysomnography.

 

14 - Pediatric Asthma Control and Communication Instrument: translation into Portuguese and cross-cultural adaptation for use in Brazil

Pediatric Asthma Control and Communication Instrument: tradução e adaptação transcultural para a língua portuguesa falada no Brasil

Thayla Amorim Santino1,a, João Carlos Alchieri2,b, Raquel Emanuele de França Mendes1,c, Ada Cristina Jácome1,d, Tácito Zaildo de Morais Santos1,e, Linda Kahn-D'Angelo3,f, Cecilia M. Patino4,g, Karla Morganna Pereira Pinto de Mendonça1,h

J Bras Pneumol.2019;45(3):e20180169

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Pediatric Asthma Control and Communication Instrument (PACCI) to Portuguese and adapt it for use in Brazil, ensuring the cultural validity of the content and semantic equivalence of the target version. Methods: The Brazilian Portuguese-language version of the PACCI was developed according to the most commonly used methodology, which included the following steps: translation; synthesis of the translation; review by the author of the original questionnaire; back-translation; synthesis of the back-translation; review by a native external researcher who is a native speaker of English; approval of the author of the original questionnaire; review by a specialist in Portuguese; review by a multidisciplinary committee of experts to determine the agreement of the items, considering the clarity of each and its appropriateness in the cultural context; cognitive debriefing; and development of the final version. The cognitive debriefing involved 31 parents/legal guardians of children 1-21 years of age with a clinical diagnosis of asthma, as defined by the Global Initiative for Asthma, with the objective of determining the comprehensibility and clarity of the items for the target population. Results: The multidisciplinary committee of experts indicated that the items on the questionnaire were clear and comprehensible, with kappa values above 0.61, indicating substantial agreement. In the cognitive debriefing, the parents/legal guardians presented no difficulties in understanding any of the items (agreement > 0.90); therefore, no further changes were needed.Conclusions: The translation and cross-cultural adaptation of the PACCI for use in Brazil were successful.

 


Keywords: Surveys and questionnaires; Translating; Asthma; Child; Adolescent.

 

15 - Temporal evolution of and factors associated with asthma and wheezing in schoolchildren in Brazil

Evolução temporal e fatores associados a asma e sibilância em escolares no Brasil

Gabriela Ávila Marques1,2,a, Andrea Wendt2,b, Fernando César Wehrmeister2,c

J Bras Pneumol.2019;45(3):e20180138

Abstract PDF PT PDF EN Portuguese Text

Objective: To estimate the evolution of the prevalence of asthma and wheezing among schoolchildren in Brazil from 2012 to 2015, as well as to identify factors associated with both conditions. Methods: This was a cross-sectional study using data from the Brazilian National School-Based Adolescent Health Survey for 2012 and 2015. To characterize the evolution of the prevalence of asthma and wheezing, we used linear regression with weighted-least-squares estimation and presented the annual percent change (APC). Results: During the study period, there was a reduction in the prevalence of wheezing, from 23.2% in 2012 to 22.4% in 2015 (APC, −0.27). The prevalence of asthma increased from 12.4% in 2012 to 16.0% in 2015 (APC, 1.20). The increase in the prevalence of asthma was greatest in the southern region of the country (APC, 2.17). Having any history of smoking and having consumed alcohol in the last 30 days were factors that influenced the prevalence of wheezing and the prevalence of a self-reported diagnosis of asthma during the two years evaluated. Conclusions: There has been an increase in the prevalence of asthma in recent years in Brazil. Our data underscore the importance of improving health strategies and policies aimed at the control of asthma.

 


Keywords: Asthma/epidemiology; Respiratory sounds; Students.

 

Brief Communication

16 - Translation of the quality-of-life measure for adults with primary ciliary dyskinesia and its application in patients in Brazil

Tradução do questionário de qualidade de vida para pacientes adultos com discinesia ciliar primária no Brasil

Ana Paula Lima de Queiroz1,a, Rodrigo Abensur Athanazio2,b, Mary Anne Kowal Olm3,c, Bruna Rubbo4,5,d, Yuri Reis Casal1,e, Jane Lucas4,5,f, Laura Behan4,5,6,g

J Bras Pneumol.2019;45(3):e20170358

Abstract PDF PT PDF EN Portuguese Text Appendix

Primary ciliary dyskinesia (PCD) is a genetic disorder that is typically inherited in an autosomal recessive manner. It is clinically characterized by recurrent respiratory infections. However, its repercussions for patient quality of life should not be overlooked. Studies have shown that PCD has a significant impact on the lives of patients, although there are as yet no PCD-specific markers of quality of life. To address that problem, researchers in the United Kingdom developed a quality-of-life questionnaire for patients with PCD. The present communication focuses on the process of translating that questionnaire into Brazilian Portuguese, through a partnership between researchers in Brazil and those in the United Kingdom, as well as its subsequent application in patients in Brazil.

 


Keywords: Quality of life; Kartagener syndrome; Surveys and questionnaires.

 

Special Article

17 - Update on the approach to smoking in patients with respiratory diseases

Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

Maria Penha Uchoa Sales1,a, Alberto José de Araújo2,b, José Miguel Chatkin3,c, Irma de Godoy4,d, Luiz Fernando Ferreira Pereira5,e, Maria Vera Cruz de Oliveira Castellano6,f, Suzana Erico Tanni4,g, Adriana Ávila de Almeida7,h, Gustavo Chatkin3,i, Luiz Carlos Côrrea da Silva8,j, Cristina Maria Cantarino Gonçalves9,k, Clóvis Botelho12,13,l, Ubiratan Paula Santos14,m, Carlos Alberto de Assis Viegas15,n, Maristela Rodrigues Sestelo16,o, Ricardo Henrique Sampaio Meireles10,11,p, Paulo César Rodrigues Pinto Correa17,q, Maria Eunice Moraes de Oliveira18,r, Jonatas Reichert19,s, Mariana Silva Lima6,t, Celso Antonio Rodrigues da Silva20,u

J Bras Pneumol.2019;45(3):e20180314

Abstract PDF PT PDF EN Portuguese Text

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

 


Keywords: Respiratory tract diseases/therapy; Respiratory tract diseases/drug therapy; Tobacco use disorder/epidemiology; Smoking cessation; Counseling; Lung neoplasms.

 

Letters to the Editor

18 - Endobronchial ultrasound in esophageal cancer - when upper gastrointestinal endoscopy is not enough

Ultrassonografia endobrônquica no câncer de esôfago - quando a endoscopia digestiva alta não é suficiente

Lília Maia Santos1,2,a, Márcia Jacomelli1,b, Paulo Rogério Scordamaglio1,c, Paulo Francisco Guerreiro Cardoso3,d, Viviane Rossi Figueiredo1,e

J Bras Pneumol.2019;45(3):e20180312

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19 - Lung cancer and parenchymal lung disease in a patient with neurofibromatosis type

Câncer de pulmão e doença pulmonar parenquimatosa em um paciente com neurofibromatose tipo 1

Alessandro Severo Alves de Melo1,a, Sérgio Ferreira Alves Jr2,b, Paulo de Moraes Antunes1,c, Gláucia Zanetti2,d, Edson Marchiori2,e

J Bras Pneumol.2019;45(3):e20180285

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20 - False-negative newborn screening result for immunoreactive trypsinogen: a major problem in children with chronic lung disease

Resultado falso-negativo de tripsinogênio imunorreativo no teste de triagem neonatal: um problema relevante a considerar em crianças com doença pulmonar crônica

Magali Santos Lumertz1,a, Thaiane Rispoli2,b, Katiana Murieli da Rosa3,c, Leonardo Araújo Pinto3,4,d

J Bras Pneumol.2019;45(3):e20180062

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Year 2019 - Volume 45  - Number 4  (July/August)

App

Continuing Education: Imaging

1 - Pneumomediastinum

Pneumomediastino

Edson Marchiori1,a, Bruno Hochhegger2,b, Gláucia Zanetti1,c

J Bras Pneumol.2019;45(4):e20190169

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Original Article

2 - Disability and its clinical correlates in pulmonary hypertension measured through the World Health Organization Disability Assessment Schedule 2.0: a prospective, observational study

Deficiência e seus correlatos clínicos na hipertensão pulmonar medidos pelo World Health Organization Disability Assessment Schedule 2.0: um estudo prospectivo e observacional

Abílio Reis1,a, Mário Santos1,2,3,b, Inês Furtado4,c, Célia Cruz4,d, Pedro Sa-Couto5,e, Alexandra Queirós6,7,f, Luís Almeida8,g, Nelson Rocha7,9,h

J Bras Pneumol.2019;45(4):e20170355

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To characterise the degree of disability in pulmonary hypertension (PH) patients based on the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Method: A prospective and observational study of patients with documented PH (N = 46). Patients completed the WHODAS 2.0 questionnaire during a scheduled routine clinical visit, and their demographic and clinical characteristics were retrieved from electronic medical records (EMR). In subsequent visits, selected clinical variables were registered to assess disease progression. Results: WHODAS 2.0 scores were indicative of mild to moderate disability for the domains of mobility (22.0 ± 23.2), life activities (23.7 ± 25.5), and participation in society (17.2 ± 15.9), as well as total WHODAS 2.0 score (15.3 ± 15.2). For the domains of cognition (9.1 ± 14.1), self-care (8.3 ± 14.4), and interpersonal relationships (11.7 ± 15.7), scores were lower. Disability scores were, generally, proportional to the PH severity. The main baseline correlates of disability were World Health Organisation (WHO) functional class, fatigue, dyspnoea, 6-minute walking distance (6MWD), and N-terminal pro b-type natriuretic peptide (NT-proBNP). Baseline WHODAS 2.0 scores showed significant associations with disease progression. However, this effect was not transversal to all domains, with only a few domains significantly associated with disease progression variables. Conclusions: This PH population shows mild disability, with higher degree of disability in the domains of mobility and life activities. This study is the first one to assess disability in PH using WHODAS 2.0. Further studies should apply this scale to larger PH populations with suitable representations of more severe PH forms.

 


Keywords: Pulmonary hypertension; International Classification of Functioning, Disability and Health; Disability evaluation; Quality of Life.

 

3 - Prevalence of smoking and reasons for continuing to smoke: a population-based study

Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

Simone Aparecida Vieira Rocha1,a, Andréa Thives de Carvalho Hoepers1,b, Tânia Silvia Fröde2,c, Leila John Marques Steidle3,d, Emilio Pizzichini3,e, Márcia Margaret Menezes Pizzichini3,f

J Bras Pneumol.2019;45(4):e20170080

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

 


Keywords: Smoking/epidemiology; Tobacco use disorder/psychology; Smoking cessation/methods; Prevalence.

 

4 - Pulmonary arteriovenous malformations: diagnostic and treatment characteristics

Malformações arteriovenosas pulmonares: características diagnósticas e de tratamento

William Salibe-Filho1,a, Bruna Mamprim Piloto1,b, Ellen Pierre de Oliveira1,c, Marcela Araújo Castro1,d, Breno Boueri Affonso2,e, Joaquim Maurício da Motta-Leal-Filho2,f, Edgar Bortolini2,g, Mário Terra-Filho1,h

J Bras Pneumol.2019;45(4):e20180137

Abstract PDF PT PDF EN Portuguese Text

Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.

 


Keywords: Telangiectasia, hereditary hemorrhagic; Arteriovenous malformations/diagnosis; Arteriovenous malformations/therapy.

 

5 - Evaluating the extremely elderly at a pulmonary function clinic for the diagnosis of respiratory disease: frequency and technical quality of spirometry

Velhice extrema em um centro diagnóstico respiratório: frequência e qualidade técnica da espirometria

Saulo Maia d'Avila Melo1,a, Larissa Alves de Oliveira2,b, José Lucas Farias Wanderley3,c, Rodrigo dos Anjos Rocha4,d

J Bras Pneumol.2019;45(4):e20180232

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the frequency of spirometry in elderly people, by age group, at a pulmonary function clinic, to assess the quality of spirometry in the extremely elderly, and to determine whether chronological age influences the quality of spirometry. Methods: This was a cross-sectional retrospective study evaluating information (spirometry findings and respiratory questionnaire results) obtained from the database of a pulmonary function clinic in the city of Aracaju, Brazil, for the period from January of 2012 to April of 2017. In the sample as a whole, we determined the total number of spirometry tests performed, and the frequency of the tests in individuals ≥ 60 years of age, ≥ 65 years of age, and by decade of age, from age 60 onward. In the extremely elderly, we evaluated the quality of spirometry using criteria of acceptability and reproducibility, as well as examining the variables that can influence that quality, such a cognitive deficit. Results: The sample comprised a total of 4,126 spirometry tests. Of those, 961 (23.30%), 864 (20.94%), 102 (2.47%), and 26 (0.63%) were performed in individuals ≥ 60, ≥ 65, ≥ 86, and ≥ 90 years of age (defined as extreme old age), respectively. In the extremely elderly, the criteria for acceptability and reproducibility were met in 88% and 60% of the spirometry tests (95% CI: 75.26-100.00 and 40.80-79.20), respectively. The cognitive deficit had a negative effect on acceptability and reproducibility (p ≤ 0.015 and p ≤ 0.007, respectively). Conclusions: A significant number of elderly individuals undergo spirometry, especially at ≥ 85 years of age, and the majority of such individuals are able to perform the test in a satisfactory manner, despite their advanced age. However, a cognitive deficit could have a negative effect on the quality of spirometry.

 


Keywords: Spirometry; Aging; Aged, 80 and over.

 

6 - Translation and cultural adaptation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Lung Cancer Module for quality of life assessment in patients with lung cancer in Brazil

Tradução e adaptação cultural do Quality of Life Questionnaire-Lung Cancer Module da European Organisation for Research and Treatment of Cancer para avaliação da qualidade de vida relacionada à saúde em pacientes com câncer de pulmão no Brasil

Ana Paula Ramos Marinho1,2,a, Gracielle Fin3,4,b, Antuani Rafael Baptistella3,c, Rudy José Nodari Júnior3,d, Magnus Benetti4,e

J Bras Pneumol.2019;45(4):e20170458

Abstract PDF PT PDF EN Portuguese Text

Objective: To translate the European Organisation for Research and Treatment of Cancer (EORTC) 29-item Quality of Life Questionnaire-Lung Cancer Module (QLQ-LC29, developed for the assessment of quality of life in patients with lung cancer) to Portuguese, conducting a pilot study of the Portuguese-language version and adapting it for use in Brazil. Methods: For the translation, cultural adaptation, and pilot testing of the QLQ-LC29, we followed the guidelines established by the EORTC. The translation (English → Portuguese) and back-translation (Portuguese → English) were both carried out by translators, working independently, who were native speakers of one language and fluent in the other. After review, a draft version was created for pilot testing in lung cancer patients in Brazil. Results: A total of 15 patients diagnosed with lung cancer completed the Portuguese-language version of the questionnaire. At the end of the process, we conducted a structured interview to identify any patient difficulty in understanding any of the questions. The final versions were sent to the EORTC and were approved. Conclusions: The Portuguese-language version of the EORTC QLQ-LC29 appears to be a useful, important, reliable questionnaire that is a valid tool for assessing quality of life in patients with lung cancer in Brazil.

 


Keywords: Surveys and Questionnaires; Lung neoplasms; Quality of Life; Brazil; Translations.

 

7 - Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography

Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

Juliana Fischman Zampieri1,a, Gabriel Sartori Pacini1,b, Matheus Zanon1,c, Stephan Philip Leonhardt Altmayer1,2,d, Guilherme Watte1,2,e, Marcelo Barros1,2,f Evandra Durayski2,g, Gustavo de Souza Portes Meirelles3,h, Marcos Duarte Guimarães4,5,i, Edson Marchiori6,j, Arthur Soares Souza Junior7,k, Bruno Hochhegger1,2,l

J Bras Pneumol.2019;45(4):e20180168

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

 


Keywords: Calcification, physiologic; Thorax/diagnostic imaging; Tomography, X-ray computed; Magnetic resonance imaging.

 

Brief Communication

8 - Effect of vaporized perfluorocarbon on oxidative stress during the cold ischemia phase of lung graft preservation

Efeito do perfluorocarbono vaporizado sobre o estresse oxidativo no período de isquemia fria durante a preservação pulmonar

Renata Salatti Ferrari1,a, Leonardo Dalla Giacomassa Rocha Thomaz2,b, Lucas Elias Lise Simoneti2,c, Jane Maria Ulbrich1,3,d, Cristiano Feijó Andrade1,3,e

J Bras Pneumol.2019;45(4):e20170288

Abstract PDF PT PDF EN Portuguese Text

Liquid perfluorocarbon (PFC) instillation has been studied experimentally as an adjuvant therapy in the preservation of lung grafts during cold ischemia. The objective of this study was to evaluate whether vaporized PFC is also protective of lung grafts at different cold ischemia times. We performed histological analysis of and measured oxidative stress in the lungs of animals that received only preservation solution with low-potassium dextran (LPD) or vaporized PFC together with LPD. We conclude that vaporized PFC reduces the production of free radicals and the number of pulmonary structural changes resulting from cold ischemia.

 


Keywords: Ischemia; Reperfusion; Fluorocarbons; Lung transplantation; Oxidative stress.

 

Letters to the Editor

9 - Pulmonary benign metastasizing leiomyoma presenting as small, diffuse nodules

Leiomioma metastático benigno pulmonar apresentando padrão de pequenos nódulos difusos

Jean-Michel Dossegger1,a, Leonardo Hoehl Carneiro1,b, Rosana Souza Rodrigues1,2,c, Miriam Menna Barreto1,d, Edson Marchiori1,e

J Bras Pneumol.2019;45(4):e20180318

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10 - Video-assisted thoracoscopic thoracic duct ligation with near-infrared fluorescence imaging with indocyanine green

Fluorescência com verde de indocianina para auxiliar na ligadura do ducto torácico por videotoracoscopia

Benoit Jacques Bibas1,a, Rafael Lucas Costa-de-Carvalho1,b, Flavio Pola-dos-Reis1,c, Leticia Leone Lauricella1,d, Paulo Manoel Pêgo-Fernandes1,e, Ricardo Mingarini Terra1,f

J Bras Pneumol.2019;45(4):e20180401

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Images in Pulmonary Medicine

11 - A mobile calcified nodule in the pleural cavity: thoracolithiasis

Nódulo calcificado móvel na cavidade pleural: toracolitíase

Dante Luiz Escuissato1,a, Gláucia Zanetti2,b, Edson Marchiori2,c

J Bras Pneumol.2019;45(4):e20190113

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Year 2019 - Volume 45  - Number 5  (September/October)

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Original Article

1 - Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position

Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

Jose Roberto Fioretto1,a, Rafaelle Batistella Pires2,b, Susiane Oliveira Klefens1,c, Cilmery Suemi Kurokawa1,d, Mario Ferreira Carpi1,e, Rossano César Bonatto1,f, Marcos Aurélio Moraes1,g, Carlos Fernando Ronchi1,3,h

J Bras Pneumol.2019;45(5):e20180067

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Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.

 


Keywords: Respiration, artificial/adverse effects; Prone position; Lung/physiopathology; Pneumonia; Respiratory distress syndrome, adult; Acute lung injury; Disease models, animal; Rabbits.

 

2 - Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis

Efeitos da implementação de um programa de educação de higienização das mãos entre profissionais de uma UTI: análise de séries temporais interrompidas

Diana Marcela Prieto Romero1,a, Maycon Moura Reboredo1,2,b, Edimar Pedrosa Gomes1,2,c, Cristina Martins Coelho1,d, Maria Aparecida Stroppa de Paula1,e, Luciene Carnevale de Souza1,f, Fernando Antonio Basile Colugnati2,g, Bruno Valle Pinheiro1,2,hDiana Marcela Prieto Romero1,a, Maycon Moura Reboredo1,2,b, Edimar Pedrosa Gomes1,2,c, Cristina Martins Coelho1,d, Maria Aparecida Stroppa de Paula1,e, Luciene Carnevale de Souza1,f, Fernando Antonio Basile Colugnati2,g, Bruno Valle Pinheiro1,2,h

J Bras Pneumol.2019;45(5):e20180152

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Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

 


Keywords: Hand disinfection; Health personnel; Pneumonia, ventilator-associated; Respiration, artificial; Guideline adherence.

 

3 - Familial pulmonary fibrosis: a heterogeneous spectrum of presentations

Fibrose pulmonar familiar: um espectro heterogêneo de apresentações

Ana Beatriz Hortense1,a, Marcel Koenigkam dos Santos2,b, Danilo Wada3,c, Alexandre Todorovic Fabro4,d, Mariana Lima5, Silvia Rodrigues5,e, Rodrigo Tocantins Calado2,f, José Baddini-Martinez2,g

J Bras Pneumol.2019;45(5):e20180079

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Objective: To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods: We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as undergoing pulmonary function tests and HRCT of the chest. In 6 cases, lung tissue samples were obtained: from surgical biopsies in 5 cases; and from an autopsy in 1 case. Results: A history of smoking and a history of exposure to birds or mold were reported in 45.7% and 80.0% of the cases, respectively. Cough and marked dyspnea were reported by 62.8% and 48.6% of the patients, respectively. Fine crackles were detected in 91.4% of the patients. In 4 patients, the findings were suspicious for telomere disease. The median FVC and DLCO, as percentages of the predicted values, were 64.9% (range, 48.8-105.7%) and 38.9% (range, 16.0-60.0%), respectively. Nine patients had reduced DLCO despite having normal spirometry results. Regarding HRCT, patterns typical of usual interstitial pneumonia were found in 6 patients (17.1%). In 25 cases (71.5%), the HRCT features were consistent with a diagnosis other than idiopathic pulmonary fibrosis. In 11 cases (31.4%), the radiological patterns were uncharacteristic of interstitial lung disease. Of the six lung tissue samples analyzed, four showed interstitial pneumonia with bronchiolocentric accentuation, and, on the basis of the clinical and radiological data, the corresponding patients were diagnosed with hypersensitivity pneumonitis. Conclusions: Patients with FPF can present with a wide variety of clinical features. Most HRCT scans of these patients exhibit patterns not typical of usual interstitial pneumonia. The family history of fibrotic lung diseases should be investigated in all patients under suspicion, regardless of their age.

 


Keywords: Idiopathic pulmonary fibrosis; Respiratory function tests; Tomography, X-ray computed.

 

4 - Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery

Acurácia da ausculta torácica na detecção de mecânica respiratória anormal no pós-operatório imediato de cirurgia cardíaca

Glaciele Xavier1,2,a, César Augusto Melo-Silva1,3,b, Carlos Eduardo Ventura Gaio dos Santos1,4,c, Veronica Moreira Amado1,4,d

J Bras Pneumol.2019;45(5):e20180032

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Objective: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics. Methods: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation. Results: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B. Conclusions: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.

 


Keywords: Diagnostic tests, routine; Physical examination; Respiratory sounds; Respiratory mechanics; Data accuracy; Respiration, artificial.

 

Letters to the Editor

5 - Prescribing trends in and perceptions of the treatment of asthma: a survey among pulmonologists in Brazil

Tendências prescritivas e percepções no tratamento da asma: um inquérito entre pneumologistas brasileiros

José Eduardo Delfini Cançado1,a, Rodrigo Abensur Athanazio2,b, Luis Fernando Rensi Cunha3,c, Marcia Margaret Menezes Pizzichini4,d

J Bras Pneumol.2019;45(5):e20190083

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Year 2019 - Volume 45  - Number 6  (November/December)

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1 - Multidisciplinary education with a focus on COPD in primary health care

Educação multiprofissional com foco na DPOC na atenção primária à saúde

Erikson Custódio Alcântara1,2,a, Krislainy de Sousa Corrêa2,3,b, José Roberto Jardim4,c, Marcelo Fouad Rabahi5,d

J Bras Pneumol.2019;45(6):e20180230

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Objective: To evaluate the use of video lessons on the topic of COPD as a training tool for a multidisciplinary team working in the primary health care sector. Methods: This was a quasi-experimental study involving a multidisciplinary team working at a primary health care clinic. The level of knowledge about COPD was measured by applying a specific, 16-item questionnaire - before, immediately after, and three months after the video lessons. In a set of six structured video lessons, the training focused on the prevention, case-finding, treatment, and monitoring of cases of COPD. The data were analyzed with the Friedman test, the Kruskal-Wallis test, Tukey's post hoc test, Dunnett's test, and the Bonferroni test. Results: There was a significant difference between the periods before and immediately after the training in terms of the scores on 15 of the 16 items on the questionnaire regarding the level of knowledge about COPD. The median total score of the participants increased significantly, from 60 points before the training to 77 points immediately thereafter and 3 months thereafter (p < 0.001 for both). Before the training, 23 (63.9%) and 13 (36.1%) of the members of the multidisciplinary team presented strong and very strong levels of agreement, respectively, among the 16 questionnaire items. After the training, 100% of the individuals presented a very strong degree of agreement. Conclusions: Multidisciplinary education through video lessons increased the knowledge of COPD on the part of a primary health care team, and the knowledge acquired was retained for at least three months after the intervention.

 


Keywords: Instructional films and videos; Pulmonary disease, chronic obstructive; Inservice training; Primary health care; Education, medical.

 

2 - Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study

Análise evolutiva antropométrica em indivíduos com DPOC na cidade de São Paulo - estudo de base populacional

Josiane Marchioro1,a, Mariana Rodrigues Gazzotti1,b, Graciane Laender Moreira1,c, Beatriz Martins Manzano1,d, Ana Maria Baptista Menezes2,e, Rogélio Perez-Padilla3,f, José Roberto Jardim1,g, Oliver Augusto Nascimento1,4,h; PLATINO Team

J Bras Pneumol.2019;45(6):e20170157

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Objective: To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). Methods: This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. Results: Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = −1.7 ± 8.1 and ΔBMI = −0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = −0.5 ± 5.4 and ΔBMI = −0.8 ± 3.3). Conclusions: Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

 


Keywords: Pulmonary disease, chronic obstructive; Body mass index; Obesity; Waist circumference.

 

3 - Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia

Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

Claudio Villaquirán1,2,a, Socorro Moreno3,b, Rubén Dueñas4,c, Paola Acuña5,d, Juan Ricardo Lutz2,e, Jeanette Wilburn6,f, Alice Heaney6,g

J Bras Pneumol.2019;45(6):e20180332

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Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

 


Keywords: Quality of life; Hypertension, pulmonary; Pulmonary embolism; Psychometrics.

 

 


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