Brazilian Journal of Pulmonology

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

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Profile of patients with tuberculosis: evaluation of the Brazilian national tuberculosis control program in Bagé, Brazil

Perfil dos pacientes com tuberculose e avaliação do programa nacional de controle da tuberculose em Bagé (RS)

Marysabel Pinto Telis Silveira, Raquel Fabiane Roscoff de Adorno, Tiago Fontana

J Bras Pneumol.2007;33(2):199-205

Abstract PDF PT PDF EN Portuguese Text

Objective: To present epidemiological data on patients diagnosed with tuberculosis, as well as on associated factors, and to determine the efficacy of the National Tuberculosis Control Program in Bagé, Brazil. Methods: A retrospective study was carried out at the Pablo Barcellos Center, analyzing cases of tuberculosis reported from January 2001 to December 2004. Data were collected through the review of clinical charts and from the National Case Registry database. Results: During this period, of the 4468 sputum smear microscopies performed, 131 were positive, with higher prevalence among males aged 26 to 35 years old. Prevalence was lower among those aged 65 and above. Over 50% of the patients were Caucasian, had only 1 to 3 years of schooling and worked in low-income jobs (mean salary, 265 Brazilian reals/month). There was no significant difference between smokers and former smokers/nonsmokers, and only one of the 131 cases was HIV positive. Conclusion: The number of sputum smear microscopies performed in Bagé increased in the past four years. In 2003 and 2004, it exceeded the goal of the National Tuberculosis Control Program. However, the number of new cases decreased, demonstrating the efficacy of the active search for tuberculosis cases in the city.

 


Keywords: Tuberculosis; Epidemiology; Communicable disease control.

 


Pneumonia por "Pneumocystis carinii" em pacientes com e sem SIDA: reavaliação

"Pneumocystis carinii" pneumonia in patients with and without AIDS: a reappraisal

Carloss Viegas, Ronald FCCP, Collman G

J Bras Pneumol.1997;23(2):79-82

Abstract PDF PT

A pneumonia por Pneumocystis carinii (PPC), que é a infecção oportunista que mais comumente põe em risco a vida de pacientes com síndrome da imunodeficiência adquirida (SIDA), tem sido há bastante tempo associada a outros estados de imunodeficiência. Os relatos iniciais sugeriram que a apresentação clínica da PPC em SIDA difere de sua apresentação em outras situações, embora ambas tenham sofrido modificações nos últimos anos. O objetivo do presente estudo é comparar os achados clínicos e laboratoriais da PPC em SIDA com os de pacientes portadores de PPC sem SIDA. Foram revisados os prontuários médicos de todos os pacientes em nossa instituição que tiveram o diagnóstico confirmado de PPC e SIDA durante o ano de 1994 (17 pacientes) e sem SIDA no período de 1992-1994 (dez pacientes). Quando da apresentação, os pacientes sem SIDA tinham uma duração de sintomas significativamente menor (8,4 ± 7,7 vs 19,5 ± 10,2 dias, p < 0,05), menor PaO2 média a ar ambiente (47 ± 8,2 vs 63 ± 10mmHg, p < 0,05), e mais freqüente infiltrado unilateral no radiograma do tórax (60 vs 6%, p < 0,05). O índice de mortalidade da PPC foi marcadamente maior nos pacientes sem SIDA (40 vs 6%, p < 0,05), e este fato estava associado com retarde no início do tratamento específico nestes pacientes. Devido a seu curso mais agudo, apresentação radiológica atípica e alto índice de mortalidade, concluímos que o diagnóstico de PPC deve ser afastado em pacientes que recebem terapia imunossupressora e que profilaxia anti-PPC deve ser fortemente considerada em pacientes que serão imunossuprimidos.

 


Keywords: PPC-AIDS. PPC não-AIDS.

 


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-e20180052

Abstract PDF PT PDF EN Portuguese Text

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.

 


Therapeutic management of tracheobronchial stenosis with stent application

A correção das estenoses traqueobrônquicas mediante o emprego de órteses

Maurício Guidi Saueressig, Amarílio Vieira de Macedo Neto, Alexandre Heitor Moreschi, Rogério Gastal Xavier, Paulo Roberto Stefani Sanches

J Bras Pneumol.2002;28(2):84-93

Abstract PDF PT

The surgical treatment of patients with tracheobronchial stenosis requires individualized attention due to the complexity of its origin though tracheoplasty is considered to be the ideal procedure. The most common causes of stenosis are tracheal intubation and the development of neoplasias. These are the very conditions that most benefit from endoscopic treatment when surgical correction is not indicated. Today, endoscopic procedures include the application of different kinds of laser and dilators usually delivered with a rigid bronchoscope, as well as radiotherapy and stents that may be used separately or associated. Basically, there are two types of stents, metal or silicone. The metallic ones are more frequently indicated in cases of tracheomalacia and extrinsic compressive stenosis. Silicone are more applicable in cases of tracheobronchial obstruction resultant from acute inflammation or endoluminal tumor. Although these methods can be used interchangeably in some cases, the best way to correct tracheobronchial stenosis is to correctly decide upon the treatment as early as the preliminary steps.

 


Keywords: Tracheal stenosis. Orthopedics fixation devices. Angioplasty.

 


Selective digestive decontamination is superior to oropharyngeal chlorhexidine in preventing pneumonia and reducing mortality in critically ill patients

A descontaminação digestiva seletiva é superior à clorexidina via orofaringe na prevenção de pneumonia e na redução da mortalidade em pacientes criticamente enfermos

Luciano Silvestri, Hendrick K.F. van Saene, Liviano Folla, Marco Milanese

J Bras Pneumol.2010;36(2):270-273

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Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil?

A distância percorrida no teste de caminhada de seis minutos pode predizer a ocorrência de exacerbações agudas da DPOC em pacientes brasileiros?

Fernanda Kazmierski Morakami, Andrea Akemi Morita, Gianna Waldrich Bisca, Josiane Marques Felcar, Marcos Ribeiro, Karina Couto Furlanetto, Nidia Aparecida Hernandes, Fabio Pitta

J Bras Pneumol.2017;43(4):280-284

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Objective: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. Methods: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted.

 


Keywords: Pulmonary disease, chronic obstructive; Risk groups; Exercise.

 


Evolution in the management of non-small cell lung cancer in Brazil

A evolução no manejo do câncer de pulmão de células não pequenas no Brasil

Caio Júlio Cesar dos Santos Fernandes1,2

J Bras Pneumol.2017;43(6):403-404

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Ex vivo lung perfusion in Brazil

A experiência brasileira na perfusão pulmonar ex vivo

Luis Gustavo Abdalla1, Karina Andrighetti de Oliveira Braga1, Natalia Aparecida Nepomuceno1, Lucas Matos Fernandes1, Marcos Naoyuki Samano1, Paulo Manuel Pêgo-Fernandes1

J Bras Pneumol.2016;42(2):95-99

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Objective: To evaluate the use of ex vivo lung perfusion (EVLP) clinically to prepare donor lungs for transplantation. Methods: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. Results: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508). The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029) but not from hour 2 to hour 3 (p = 0.059). Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284). Conclusions: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.

 


Keywords: Lung transplantation; Organ preservation; Brain death; Donor selection.

 


Extubation failure influences clinical and functional outcomes in patients with traumatic brain injury

A falência da extubação influencia desfechos clínicos e funcionais em pacientes com traumatismo cranioencefálico

Helena França Correia dos Reis, Mônica Lajana Oliveira Almeida, Mário Ferreira da Silva, Mário de Seixas Rocha

J Bras Pneumol.2013;39(3):330-338

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Objective: To evaluate the association between extubation failure and outcomes (clinical and functional) in patients with traumatic brain injury (TBI). Methods: A prospective cohort study involving 311 consecutive patients with TBI. The patients were divided into two groups according to extubation outcome: extubation success; and extubation failure (defined as reintubation within 48 h after extubation). A multivariate model was developed in order to determine whether extubation failure was an independent predictor of in-hospital mortality. Results: The mean age was 35.7 ± 13.8 years. Males accounted for 92.3%. The incidence of extubation failure was 13.8%. In-hospital mortality was 4.5% and 20.9% in successfully extubated patients and in those with extubation failure, respectively (p = 0.001). Tracheostomy was more common in the extubation failure group (55.8% vs. 1.9%; p < 0.001). The median length of hospital stay was significantly greater in the extubation failure group than in the extubation success group (44 days vs. 27 days; p = 0.002). Functional status at discharge was worse among the patients in the extubation failure group. The multivariate analysis showed that extubation failure was an independent predictor of in-hospital mortality (OR = 4.96; 95% CI, 1.86-13.22). Conclusions: In patients with TBI, extubation failure appears to lengthen hospital stays; to increase the frequency of tracheostomy and of pulmonary complications; to worsen functional outcomes; and to increase mortality.

 


Keywords: Brain injuries; Ventilator weaning; Intensive care units; Glasgow outcome scale.

 


The image of pulmonary hypertension

A imagem da hipertensão pulmonar

Anton Vonk Noordegraaf

J Bras Pneumol.2011;37(3):-

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The need for a national perspective to improve COPD management

A necessidade de uma perspectiva nacional para melhorar o manejo da DPOC

Fabiano Di Marco1,2,a, Giulia Maria Pellegrino1,3,b, Giuseppe Francesco Sferrazza Papa3,c

J Bras Pneumol.2019;45(6):e20190349-e20190349

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The parting of Jorge Kavakama, a shining star in Brazilian medicine that has flickered out

A partida de Jorge Kavakama, um pixel que se apaga na medicina brasileira

Mário Terra Filho

J Bras Pneumol.2006;32(2):187-

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Perception of asthma control in asthma patients

A percepção do controle dos sintomas em pacientes asmáticos

Eduardo Vieira Ponte, Jaqueline Petroni, Daniela Campos Borges Ramos, Luciana Pimentel, Daise Naiane Freitas, Álvaro A Cruz

J Bras Pneumol.2007;33(6):635-640

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Objective: To determine the proportion of asthma patients with poor perception of asthma control and to evaluate the characteristics of this subgroup. Methods: A cross-sectional study in which consecutive outpatients (over the age of 12) with mild, moderate, or severe asthma were selected. The patients underwent clinical examination, and pulmonary function tests, as well as being assessed for depression and perception of asthma control. The degree of concordance between patients and physicians regarding the perception of asthma control was determined. Patients with good perception of asthma control were compared, in terms of characteristics, with those presenting poor perception. Results: The degree of concordance between patients and physicians regarding the perception of asthma control was low (kappa index = 0.5). Of the 289 patients included, 66 (23%) presented poor perception of asthma control. The preliminary univariate analysis revealed that the patients with poor perception of asthma control were older, had a lower income, and presented a lower degree of asthma severity. Those factors did not change in the multivariate analysis. There were no differences between the groups in terms of gender, frequency of having literate patients, duration of asthma symptoms, having been diagnosed with rhinitis, frequency of depression, pulmonary function, or treatment compliance. Conclusions: The incidence of poor perception of asthma control in asthma patients is high, especially in elderly patients with lower income and a lower degree of asthma severity.

 


Keywords: Asthma; Signs and symptoms; Asthma/therapy.

 


Air pollution and the respiratory system

A poluição do ar e o sistema respiratório

Marcos Abdo Arbex, Ubiratan de Paula Santos, Lourdes Conceição Martins, Paulo Hilário Nascimento Saldiva, Luiz Alberto Amador Pereira, Alfésio Luis Ferreira Braga

J Bras Pneumol.2012;38(5):643-655

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Over the past 250 years-since the Industrial Revolution accelerated the process of pollutant emission, which, until then, had been limited to the domestic use of fuels (mineral and vegetal) and intermittent volcanic emissions-air pollution has been present in various scenarios. Today, approximately 50% of the people in the world live in cities and urban areas and are exposed to progressively higher levels of air pollutants. This is a non-systematic review on the different types and sources of air pollutants, as well as on the respiratory effects attributed to exposure to such contaminants. Aggravation of the symptoms of disease, together with increases in the demand for emergency treatment, the number of hospitalizations, and the number of deaths, can be attributed to particulate and gaseous pollutants, emitted by various sources. Chronic exposure to air pollutants not only causes decompensation of pre-existing diseases but also increases the number of new cases of asthma, COPD, and lung cancer, even in rural areas. Air pollutants now rival tobacco smoke as the leading risk factor for these diseases. We hope that we can impress upon pulmonologists and clinicians the relevance of investigating exposure to air pollutants and of recognizing this as a risk factor that should be taken into account in the adoption of best practices for the control of the acute decompensation of respiratory diseases and for maintenance treatment between exacerbations.

 


Keywords: Respiratory System; Air pollution; Pregnancy; Pulmonary disease, chronic obstructive; Asthma; Respiratory tract Infections.

 


Polymerase chain reaction used to detect Streptococcus pneumoniae resistance to penicillin

A reação em cadeia da polimerase na detecção da resistência à penicilina em Streptococcus pneumoniae

Eduardo Walker Zettler, Rosane M. Scheibe, Cícero A.G. Dias, Patricia Santafé, José da Silva Moreira, Diógenes S. Santos, Carlos Cezar Fritscher

J Bras Pneumol.2004;30(6):521-527

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Background: Streptococcus pneumoniae is the most common etiologic agent of community-acquired respiratory infections. In recent years, S. pneumoniae resistance to antimicrobial agents has increased. Minimum inhibitory concentration (MIC) is routinely used to determine resistance. Polymerase chain reaction (PCR) detects the genes responsible for Streptococcus pneumoniae resistance to penicillin within approximately 8 hours. Objective: To compare the PCR and MIC methods in determining Streptococcus pneumoniae resistance to penicillin. Method: A total of 153 Streptococcus pneumoniae samples, isolated from various anatomical sites, were evaluated in order to detect mutations in the genes encoding pbp1a, pbp2a and pbp2x, which are responsible for Streptococcus pneumoniae penicillin resistance. A correlation was found between mutations and penicillin MIP, as determined by the agar diffusion method. Results: Overal Streptococcus pneumoniae resistance to penicillin was 22.8% (16.3% intermediate resistance and 6.5% high resistance). In a statistically significant finding, we observed no mutations in the penicillin-sensitive samples and only one mutation, typically in the gene encoding pbp2x, among the samples with intermediate resistance, whereas mutations in all three genes studied were observed in the high-resistance samples. Conclusion: For determining Streptococcus pneumoniae resistance to penicillin, PCR is a rapid method of detection that could well be used in clinical practice.

 


Keywords: Streptococcus pneumoniae. Penicillin resistance. Polymerase chain reaction/methods.

 


Latent tuberculosis and the use of immunomodulatory agents.

A tuberculose latente e o uso de imunomoduladores.

Fábio Silva Aguiar1,a, Fernanda Carvalho de Queiroz Mello1,b.

J Bras Pneumol.2019;45(6):e20190361-e20190361

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Is tuberculosis difficult to diagnose in childhood and adolescence?

A tuberculose na infância e na adolescência é difícil de diagnosticar?

João Carlos Coelho Filho, Marwal Araújo Caribé, Simone Castro Couto Caldas, Eduardo Martins Netto

J Bras Pneumol.2011;37(3):288-293

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Objective: To determine the sensitivity of the scoring system proposed by the Brazilian National Ministry of Health in 2002 for the diagnosis of tuberculosis in children and adolescents suspected of having the disease. Methods: This was a retrospective study of 316 children and adolescents (0-14 years of age) diagnosed with pulmonary tuberculosis between 1997 and 2007 at the Brazilian Institute for Tuberculosis Research, located in the city of Salvador, Brazil. After reviewing the medical charts and chest X-rays of the patients, we calculated the tuberculosis scores. Results: The majority of the subjects (80.4%) had a history of close household contact with an AFB-positive adult within the last two years. The tuberculin test was negative in 11 subjects (3.5%). According to the scoring system, 251 (79.4%) were very likely to have tuberculosis (score, ≥ 40), 63 (19.9%) were moderately likely to have tuberculosis (score, 30-35), and 2 (0.7%) were unlikely to have tuberculosis (score, ≤ 25). When a cut-off score of 30 was used, the sensitivity of this scoring system was 99.3%. Conclusions: In our sample, the sensitivity of this scoring system was high when the selected cut-off score was employed. If a cut-off score of 40 had been used, 20% of the subjects would not have been treated. Therefore, scores between 30 and 35 are critical for diagnostic confirmation. Judicious clinical evaluation should prevail in the decision of treating these patients. When the cut-off score of 30 is used, 30% of individuals with other pathologies will be treated for tuberculosis. This highlights the need for improved diagnostic methods for tuberculosis.

 


Keywords: Tuberculosis/diagnosis; Epidemiology; Diagnostic techniques and procedures.

 


Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis?

A ultrassonografia pode reduzir o risco de pneumotórax após toracocentese?

Alessandro Perazzo, Piergiorgio Gatto, Cornelius Barlascini, Maura Ferrari-Bravo, Antonello Nicolini

J Bras Pneumol.2014;40(1):6-12

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Objective: Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions. Methods: A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure. Results: Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960  500 mL vs. 770  480 mL), the difference being statistically significant (p = 0.03). Conclusions: Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/])

 


Keywords: Pneumothorax; Ultrasonography; Thoracic surgical procedures.

 


The utility of molecular biology in the diagnosis of tuberculosis

A utilidade da biologia molecular no diagnóstico da tuberculose

Fernanda Carvalho de Queiroz Mello, Joseane Fonseca-Costa

J Bras Pneumol.2005;31(3):188-190

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Usefulness of chest CT in the diagnosis of pulmonary sequestration

A utilidade da TC de tórax no diagnóstico do sequestro pulmonar

José Gustavo Pugliese, Thiago Prudente Bártholo, Heron Teixeira Andrade dos Santos, Eduardo Haruo Saito, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2010;36(2):260-264

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Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.

 


Keywords: Hemoptysis; Bronchopulmonary sequestration; Tomography, spiral computed.

 


Heimlich valve in the treatment of pneumothorax

A válvula de Heimlich no tratamento do pneumotórax

Ricardo Beytuti, Letícia Engber Odilon Villiger, José Ribas Milanez de Campos, Rodrigo Afonso Silva, Angelo Fernandez, Fábio Biscegli Jatene

J Bras Pneumol.2002;28(3):115-119

Abstract PDF PT

Objective: Heimlich valve has been described as a substitute for water-sealed drainage systems. The objective of this study by the Thoracic Surgery Service of the "Hospital das Clínicas", University of São Paulo Medical Center, is to assess its effectiveness in the treatment of pneumothorax and its ease of operation, safety, and patient toleration. Methods: From June/97 to August/00, 107 patients with pneumotoraxes of different etiologies were analyzed. The majority (76%) were classified radiologically as suffering from moderate or large pneumothorax, three hypertensive pneumothorax, and one was bilateral. The pleural cavity was drained with teflon or polyurethane plastic pig-tail catheters (10.2F, 14F, straight 11F connected to the Heimlich valve or the valve was connected directly to the thoracic drain in post-thoracotomy patients). Results: The valve remained in place for one to 120 days (mean 4 days). Tolerance to the system was good in 89% of cases. There were no serious complication linked to the system. Associated pleural effusion in 20 patients (18.5%) did not prevent the system from functioning well. Only two patients (1.8%) developed subcutaneous emphysema, and therefore, a 36F Tubular drain under water seal was chosen. Thoracotomy for decortication was indicated in one patient (0.9%). Twenty patients (18.5%) were treated on an outpatient basis. Conclusions: The Heimlich valve confirmed its effectiveness in resolving pneumothorax of different etiologies and in postoperative air leaks. Its operation was simpler than that of conventional systems. The good toleration and safety mentioned by the patients was a determining factor in early hospital discharge and a motive for outpatient treatment.

 


Keywords: Pneumothorax. Pleura. Postural drainage.

 


Video-assisted thoracoscopy for the diagnosis of diffuse parenchymal lung disease

A videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar

Renato Tadao Ishie, João José de Deus Cardoso, Rafael José Silveira, Lucas Stocco

J Bras Pneumol.2009;35(3):234-241

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Objective: To evaluate the role of video-assisted thoracoscopy in the diagnosis of diffuse parenchymal lung diseases. Methods: The medical charts of patients suspected of having diffuse parenchymal lung disease were retrospectively reviewed, as were the results of the anatomopathological examination of lung biopsy specimens collected through video-assisted thoracoscopy. Results: Of the 48 patients included in the study, 25 (52.08%) were female and 23 (47.92%) were male. The mean age was 58.77 years (range, 20-76 years). A total of 54 biopsy fragments were submitted to anatomopathological examination: 24 (44.44%) from the lingula; 10 (18.52%) from the left lower lobe; 7 (12.96%) from the right middle lobe; 6 (11.11%) from the right lower lobe; 5 (9.26%) from the left upper lobe; and 2 (3.71%) from the right upper lobe. The mean duration of thoracic drainage was 2.2 days. Adverse events included conversion to thoracotomy, in 2 patients (4.17%), and residual pneumothorax, in 1 (2.08%). The definitive diagnosis was made in 46 patients (95.83%), and idiopathic interstitial pneumonia was the predominant diagnosis (in 54.18%). The most common diagnoses were usual interstitial pneumonia (in 29.27%), nonspecific interstitial pneumonia (in 16.67%) and hypersensitivity pneumonia (in 12.50%). Conclusions: Lung biopsy through video-assisted thoracoscopy is a safe, effective and viable procedure for the diagnosis of diffuse parenchymal lung diseases.

 


Keywords: Lung diseases, interstitial; Thoracoscopy; Diagnosis.

 


Noncompliance with treatment for pulmonary tuberculosis in Cuiabá, in the State of Mato Grosso - Brazil

Abandono do tratamento da tuberculose pulmonar em Cuiabá - MT - Brasil

Silvana Margarida Benevides Ferreira, Ageo Mário Cândido da Silva, Clóvis Botelho

J Bras Pneumol.2005;31(5):427-435

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Objective: To analyze factors predictive of noncompliance with pulmonary tuberculosis treatment. Methods: A historical cohort study involving 481 of the 529 active tuberculosis patients registered with the Tuberculosis Control Program in the city of Cuiabá, located in the state of Mato Grosso, during the 1998-2000 period. Data were obtained by analyzing medical charts and registration records. In the bivariate analysis, the chi-square test was used to calculate noncompliance rate ratios (relative risk), 95% confidence intervals were determined, and Fisher's exact test was used. The choice to estimate the rate of incidence was the method of density and a multivariate logistic regression model was constructed in order to identify the variables that were most predictive of noncompliance, using a level of statistical significance of p < 0.05. Results: The global rate of incidence was 27.3%, equivalent to 5.1 noncompliant patients/100 patients/month, increasing in the second and third months of treatment. In the final logistic regression model, the following were considered predictors of noncompliance: unsupervised treatment (odds ratio: 2.58; 95% confidence interval: 1.64 - 4.06; p < 0.001); having been treated during the 1998-1999 period (odds ratio: 1.43; 95% confidence interval: 1.14 - 1.80; p = 0.002); being male (odds ratio: 1.39; 95% confidence interval: 1.10 - 1.76; p = 0.005) and having been out of compliance with previous treatment regimes (odds ratio: 1.37; 95% confidence interval: 1.06 - 1.78; p < 0.017). Conclusion: The results indicate an elevated incidence of noncompliance and show that unsupervised treatment, year in which treatment was received, male gender and prior noncompliance were predictors of future noncompliance.

 


Keywords: Tuberculosis, pulmonary/therapy; Treatment refusal; Cohort studies

 


Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004

José da Silva Moreira, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Roberto Goldenfun, Ana Luiza Schneider Moreira, Nelson da Silva Porto

J Bras Pneumol.2006;32(2):136-143

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Objective: To relate the experience of the staff at a health care facility specializing in the management of patients with aspiration lung abscess. Methods: Diagnostic aspects and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. Results: Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died. Conclusion: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse). Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

 


Keywords: Lung abscess; Pneumonia, aspiration; Bacteria, anaerobic; Bacterial infections; Drainage, postural

 


Educational camp for children with asthma

Acampamento educacional para crianças asmáticas

Maria do Rosario da Silva Ramos Costa, Maria Alenita Oliveira, Ilka Lopes Santoro,Yara Juliano, José Rosado Pinto, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(4):191-195

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of a 5-day educational camp program for children with asthma in terms of improving their knowledge of asthma and enhancing their performance in the use of inhaled medication and in physical activities. Methods: Every day, the children received 20-min interactive educational sessions, the technique for using the metered-dose inhaler was reviewed, two peak flow readings were recorded, and the children performed physical activities that included breathing and relaxation exercises. A questionnaire regarding knowledge of asthma, as well as asthma triggers, asthma medications, misconceptions regarding asthma, and the use of spacers, was administered before and after the intervention. Correct use of inhaled medication and exercise-related symptoms were also evaluated before and after the intervention. Results: A total of 37 children with asthma, aged 8-10 years (15 females and 22 males), were included in this study. Of those, 25% showed an improvement in the level of knowledge of asthma after the educational camp program, as evidenced by the greater number of correct answers on three of the twelve questions analyzed (p < 0.05). The exercise-related dyspnea scores decreased significantly (p < 0.05). The ability to use inhaled medication correctly was significantly improved after the intervention (p < 0.05). Conclusions: The asthma educational camp program can improve knowledge about specific questions, encourage participation in physical activities, and improve the asthma management skills of children.

 


Keywords: Asthma; Asthma/prevention & control; Models, educational; Child.

 


Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

Hugo Hyung Bok Yoo, Fabiana Guandalini Mendes, Christine Elisabete Rubio Alem, Alexandre Todorovic Fabro, José Eduardo Corrente, Thaís Thomaz Queluz

J Bras Pneumol.2004;30(5):426-432

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Background: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. Objective: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. Method: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. Results: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p<0.0001), diseases of the digestive system (p=0.0001), neoplasia (p=0.024) and trauma (p=0.005) were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%). Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012) and pelvic veins (p=0.015) were associated with fatal PTE. Conclusion: A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.

 


Keywords: Autopsy. Epidemiology. Pulmonary Thromboembolism.

 


Fiberoptic bronchoscopy findings in patients diagnosed with lung cancer

Achados de fibrobroncoscopia em pacientes com diagnóstico de neoplasia pulmonar

Marcelo Fouad Rabahi, Andréia Alves Ferreira, Bruno Pereira Reciputti, Thalita de Oliveira Matos, Sebastião Alves Pinto

J Bras Pneumol.2012;38(4):445-451

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Objective: To compile fiberoptic bronchoscopy findings in patients diagnosed with lung cancer and to correlate those with histopathological findings. Methods: This was a retrospective study involving 212 patients with a confirmed diagnosis of lung cancer by cytological evaluation of BAL specimens or by histopathological evaluation of endobronchial or transbronchial biopsy specimens. The data were collected at the Respiratory Endoscopy Section of Hospital São Salvador, located in the city of Goiânia, Brazil, between 2005 and 2010. The endoscopic findings were classified as endoscopically visible tumor, endoscopically invisible tumor, and mucosal injury, as well as being classified by the presence/type of secretion. The visible tumors were also classified according to their location in the tracheobronchial tree. Results: Endobronchial mass (64%) and mucosal infiltration (35%) were the main endoscopic findings. The histological type was determined in 199 cases, the most prevalent types being squamous carcinoma, in 78 (39%), adenocarcinoma, in 42 (21%), small cell carcinoma, in 24 (12%), and large cell carcinoma, in 2 (1%). More than 45% of the visible tumors were at the upper bronchi. Squamous carcinoma (n = 78) was most commonly visualized as an endobronchial mass (in 74%), mucosal infiltration (in 36%), luminal narrowing (in 10%), or external compression (in 6%). Conclusions: Our results show that an endobronchial mass is the most common bronchoscopic finding that is suggestive of malignancy. Proportionally, mucosal infiltration is the most common finding in small cell carcinoma. In adenocarcinoma, luminal narrowing, external compression, mucosal injury, and endobronchial secretion prevail.

 


Keywords: Lung neoplasms/diagnosis; Lung neoplasms/classification; Bronchoscopy.

 


Histological features and survival in idiopathic pulmonary fibrosis

Achados histológicos e sobrevida na fibrose pulmonar idiopática

Ester Nei Aparecida Martins Coletta, Carlos Alberto de Castro Pereira, Rimarcs Gomes Ferreira, Adalberto Sperb Rubin, Lucimara Sonja Villela, Tatiana Malheiros, João Norberto Stávale

J Bras Pneumol.2003;29(6):371-378

Abstract PDF PT

Background: Idiopathic pulmonary fibrosis was recently redefined as usual interstitial pneumonia of unknown etiology. Consequently, the prognostic value of histological findings needs to be reassessed. Objective: To correlate clinical, functional and histological findings with survival in patients with idiopathic pulmonary fibrosis. Method: Patients (n = 51; mean age: 66 ± 8 years; gender: 21 females/30 males) were evaluated. Of the 51, 26 were smokers or ex-smokers. Duration of symptoms, forced vital capacity and smoking habits were recorded. All patients presented usual interstitial pneumonia verified through histology. Degree of honeycombing, established fibrosis, desquamation, cellularity, myointimal thickening of blood vessels and number of fibroblastic foci were graded according to the semiquantitative method. Results: Median duration of symptoms was 12 months and initial forced vital capacity was 72 ± 21%. Cox multivariate analysis revealed that survival correlated inversely and significantly (p < 0.05) with duration of symptoms and fibroblastic foci score, as well as with myointimal thickening of blood vessels. Limited numbers of fibroblastic foci, as well as myointimal thickening involving less than 50% of blood vessels, were predictive of greater survival. No correlation with survival was found for gender, age, forced vital capacity, inflammation or degree of cellularity. Conclusion: Semiquantitative analysis of lung biopsies yields relevant prognostic information regarding patients with usual interstitial pneumonia.

 


Keywords: Pulmonary fibrosis. Lung diseases, interstitial. Survival analysis.

 


Radiological findings in patients with obstructive sleep apnea

Achados radiológicos em pacientes portadores de apneia obstrutiva do sono

Carlos Fernando de Mello Junior, Hélio Antonio Guimarães Filho, Camila Albuquerque de Brito Gomes, Camila Caroline de Amorim Paiva

J Bras Pneumol.2013;39(1):98-101

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Resumo

A apneia obstrutiva do sono (AOS) é caracterizada por obstruções recorrentes das vias aéreas superiores durante o sono que ocorrem no nível da faringe. Apesar de a análise cefalométrica ser um importante método no diagnóstico das deformidades craniofaciais, a TC e a ressonância magnética vêm se destacando como os principais métodos de imagem para a investigação das eventuais causas da AOS que, na maioria das vezes, é multifatorial. Esses métodos permitem uma excelente avaliação nos diversos planos anatômicos do eventual sítio da obstrução, o que permite uma melhor avaliação clínica e abordagem cirúrgica. O presente ensaio pictórico tem como objetivo descrever os aspectos que devem ser avaliados no diagnóstico por imagem dos principais fatores predisponentes para a AOS.

 


Palavras-chave: Síndromes da apneia do sono; Imagem por ressonância magnética; Tomografia computadorizada por raios X.

 


Musculoskeletal involvement in sarcoidosis

Acometimento músculo-esquelético na sarcoidose

Akasbi Nessrine, Abourazzak Fatima Zahra, Harzy Taoufik

J Bras Pneumol.2014;40(2):-

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Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren's syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management.

 


Keywords: Sarcoidosis; Joints; Muscles; Bone and Bones.

 


Pulmonary involvement in Behcet's disease: a positive single-center experience with the use of immunosuppressive therapy

Acometimento pulmonar na doença de Behçet: uma boa experiência com o uso de imunossupressores

Alfredo Nicodemos Cruz Santana, Telma Antunes, Juliana Monteiro de Barros, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro de Carvalho, Carmen Silvia Valente Barbas

J Bras Pneumol.2008;34(6):362-366

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Objective: Behcet's syndrome, or Behcet's disease (BD), is a multisystem pathology, and survival is related to pulmonary involvement. However, it appears that different treatments correlate with different prognoses. The aim of this study was to evaluate clinical and tomographic evolution, as well as the survival, of patients with BD-related pulmonary involvement. Methods: A retrospective review of our experience with pulmonary manifestations in patients with BD treated at our institution between January 1, 1988 and April 30, 2006. The clinical, radiological, treatment and survival data were obtained from medical charts. Results: We identified 9 patients with BD-related pulmonary involvement. The mean age was 34 ± 11.5 years, and 7 of the patients were male. The radiological findings were as follows: pulmonary artery aneurysm (PAA) in 8 patients; pulmonary embolism in 3 (translating to an incidence of 5.11 cases/100 patient-years); alveolar hemorrhage in one; and pulmonary hypertension in one. The treatment consisted of immunosuppression with prednisone plus chlorambucil (or cyclophosphamide or mycophenolate mofetil) in all patients, with partial or complete resolution of the PAAs. One patient with a PAA and pulmonary hypertension also received sildenafil and warfarin, with good clinical and tomographic response (the first report in the English literature). In our sample, the mean duration of the follow-up period was 6.52 years. The three-year survival rate was 88.8%, as was the five-year survival rate. Conclusions: Patients with BD-related pulmonary involvement can present good survival with immunosuppressive therapy, and BD should be borne in mind as a possible cause of pulmonary hypertension and alveolar hemorrhage.

 


Keywords: Behcet Syndrome; Lung diseases, interstitial; Pulmonary circulation; Hypertension, pulmonary; Pulmonary embolism; Alveolar.

 


Longitudinal follow-up of cardiac vagal activity in individuals undergoing endoscopic thoracic sympathectomy

Acompanhamento longitudinal da atividade vagal cardíaca de indivíduos submetidos à simpatectomia torácica endoscópica

Ana Paula Ferreira1,2,3,a, Plinio dos Santos Ramos1,2,3,b, Jorge Montessi2,3,4,c, Flávia Duarte Montessi2,3,d, Eveline Montessi Nicolini3,4,e, Edmilton Pereira de Almeida4,f, Djalma Rabelo Ricardo1,2,3,g

J Bras Pneumol.2018;44(6):456-460

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Objective: To conduct a longitudinal investigation of cardiac vagal activity (CVA) by measuring resting HR and calculating the cardiac vagal index (CVI) in individuals undergoing sympathectomy for the treatment of primary hyperhidrosis. Methods: This was a descriptive longitudinal study involving 22 patients, 13 of whom were female. The mean age was 22.5 ± 8.8 years. The palms, soles, and axillae were the most commonly affected sites. Resting HR was measured by an electrocardiogram performed 20 min before the 4-second exercise test (4sET), which was used in order to evaluate CVA at three different time points: before surgery, one month after surgery, and four years after surgery. Results: Resting HR (expressed as mean ± SE) was found to have decreased significantly at 1 month after surgery (73.1 ± 1.6 bpm before surgery vs. 69.7 ± 1.2 bpm at one month after surgery; p = 0.01). However, the HR values obtained at four years after surgery tended to be similar to those obtained before surgery (p = 0.31). The CVI (expressed as mean ± SE) was found to have increased significantly at one month after surgery (1.44 ± 0.04 before surgery vs. 1.53 ± 0.03 at one month after surgery; p = 0.02). However, the CVI obtained at four years after surgery tended to be similar to that obtained before surgery (p = 0.10). Conclusions: At one month after sympathectomy for primary hyperhidrosis, patients present with changes in resting HR and CVA, both of which tend to return to baseline at four years after surgery.

 


Keywords: Hyperhidrosis; Sympathectomy; Autonomic nervous system; Exercise test;

 


Pulmonologists, awake!

Acorda pneumologista !

Geraldo Lorenzi Filho, Flávio Magalhães, Carlos Alberto de Assis Viegas

J Bras Pneumol.2006;32(4):382-384

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Pulmonary actinomycosis as a pseudotumor: A rare presentation

Actinomicose pulmonar na forma pseudotumoral: Uma apresentação rara

Hylas Paiva da Costa Ferreira, Carlos Alberto Almeida de Araújo, Jeancarlo Fernandes Cavalcanti, Roberta Lacerda Almeida de Miranda, Rachel de Alcântara Oliveira Ramalho

J Bras Pneumol.2011;37(5):689-693

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Some lung diseases are true diagnostic challenges due to their various clinical presentations. Actinomycosis is one such disease, potentially affecting various organs and systems. We report the case of a patient with pulmonary actinomycosis as a pseudotumor, which is usually only diagnosed by thoracotomy or thoracoscopy.

 


Keywords: Actinomycosis; Thoracic neoplasms; Bacterial infections and mycoses.

 


Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients

Acurácia diagnóstica do protocolo de ultrassom pulmonar à beira do leito em situações de emergência para diagnóstico de insuficiência respiratória aguda em pacientes com ventilação espontânea

Felippe Leopoldo Dexheimer Neto, Juliana Mara Stormovski de Andrade, Ana Carolina Tabajara Raupp, Raquel da Silva Townsend, Fabiana Gabe Beltrami, Hélène Brisson, Qin Lu, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2015;41(1):58-64

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Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2  14.7 years; APACHE II, 19.2  7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.

 


Keywords: Ultrasonography, interventional; Respiratory insufficiency; Intensive care units.

 


Accuracy of clinical examination findings in the diagnosis of COPD

Acurácia do exame clínico no diagnóstico da DPOC

Waldo Luís Leite Dias de Mattos, Leonardo Gilberto Haas Signori, Fernando Kessler Borges, Jorge Augusto Bergamin, Vivian Machado

J Bras Pneumol.2009;35(5):404-408

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Objective: Simple diagnostic methods can facilitate the diagnosis of COPD, which is a major public health problem. The objective of this study was to investigate the accuracy of clinical variables in the diagnosis of COPD. Methods: Patients with COPD and control subjects were prospectively evaluated by two investigators regarding nine clinical variables. The likelihood ratio for the diagnosis of COPD was determined using a logistic regression model. Results: The study comprised 98 patients with COPD (mean age, 62.3 ± 12.3 years; mean FEV1, 48.3 ± 21.6%) and 102 controls. The likelihood ratios (95% CIs) for the diagnosis of COPD were as follows: 4.75 (2.29-9.82; p < 0.0001) for accessory muscle recruitment; 5.05 (2.72-9.39; p < 0.0001) for pursed-lip breathing; 2.58 (1.45‑4.57; p < 0.001) for barrel chest; 3.65 (2.01-6.62; p < 0.0001) for decreased chest expansion; 7.17 (3.75-13.73; p < 0.0001) for reduced breath sounds; 2.17 (1.01-4.67; p < 0.05) for a thoracic index ≥ 0.9; 2.36 (1.22-4.58; p < 0.05) for laryngeal height ≤ 5.5 cm; 3.44 (1.92-6.16; p < 0.0001) for forced expiratory time ≥ 4 s; and 4.78 (2.13-10.70; p < 0.0001) for lower liver edge ≥ 4 cm from lower costal edge. Inter-rater reliability for those same variables was, respectively, 0.57, 0.45, 0.62, 0.32, 0.53, 0.32, 0.59, 0.52 and 0.44 (p < 0.0001 for all). Conclusions: Various clinical examination findings could be used as diagnostic tests for COPD.

 


Keywords: Physical examination; Diagnosis; Pulmonary disease, chronic obstructive.

 


Adaptation to different noninvasive ventilation masks in critically ill patients

Adaptação a diferentes interfaces de ventilação mecânica não invasiva em pacientes críticos

Renata Matos da Silva, Karina Tavares Timenetski, Renata Cristina Miranda Neves, Liane Hirano Shigemichi, Sandra Sayuri Kanda, Carla Maekawa, Eliezer Silva, Raquel Afonso Caserta Eid

J Bras Pneumol.2013;39(4):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify which noninvasive ventilation (NIV) masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. Methods: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. Results: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%). Total face masks were the most commonly used (in 74.7%), followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively). Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. Conclusions: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.

 


Keywords: Intermittent positive-pressure ventilation; Masks; Respiratory insufficiency.

 


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-e20180332

Abstract PDF PT PDF EN Portuguese Text

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.

 


Lung adenocarcinoma, dermatomyositis, and Lambert-Eaton myasthenic syndrome: a rare combination

Adenocarcinoma pulmonar, dermatomiosite e síndrome miastênica de Lambert-Eaton: uma rara associação

Fernanda Manente Milanez, Carlos Alberto de Castro Pereira, Pedro Henrique Duccini Mendes Trindade, Ricardo Milinavicius, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2008;34(5):333-336

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The incidence of lung neoplasms is increasing in Brazil and in the world, probably as a result of the increase in smoking. Due to the greater number of cases, atypical presentations appear. We report the case of a 66-year-old hypertensive male smoker who presented progressive proximal muscular weakness and, in two months, evolved to dysphagia, dysphonia, and V-shaped skin lesions on the chest. A chest X-ray showed a spiculated pulmonary nodule in the right upper lobe. The biochemical analysis revealed elevated creatine kinase levels. After complementary tests and biopsies, the patient underwent right upper lobectomy. Histopathology showed a moderately differentiated adenocarcinoma. The overall analysis of the case and a review of the literature allow us to suggest that the clinical profile of the patient was a result of an overlap of two paraneoplastic syndromes (dermatomyositis and Lambert-Eaton myasthenic syndrome) secondary to lung adenocarcinoma.

 


Keywords: Lung neoplasms; Paraneoplastic syndromes; Dermatomyositis; Lambert-Eaton myasthenic syndrome; Adenocarcinoma.

 


Adherence to guidelines and its impact on outcomes in patients hospitalized with community- acquired pneumonia at a university hospital

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

Carla Discacciati Silveira, Cid Sérgio Ferreira, Ricardo de Amorim Corrêa

J Bras Pneumol.2012;38(2):148-157

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Objective: To evaluate the agreement between the criteria used for hospitalization of patients with community-acquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. Methods: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. Results: Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age ≥ 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guideline-concordant antibiotic therapy and shorter hospital stay. Conclusions: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.

 


Keywords: Pneumonia/therapy; Pneumonia/mortality; Hospitalization; Guideline adherence.

 


Compliance with maintenance treatment of asthma (ADERE study)

Adesão ao tratamento de manutenção em asma (estudo ADERE)

José Miguel Chatkin, Daniela Cavalet-Blanco, Nóris Coimbra Scaglia, Roberto Guidotti Tonietto, Mário B. Wagner, Carlos Cezar Fritscher

J Bras Pneumol.2006;32(4):277-283

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Objective: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. Methods: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. Results: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. Conclusion: The overall rate of compliance with maintenance treatment of asthma was low.

 


Keywords: Asthma/drug therapy; Asthma/prevention & control; Patient compliance; Patient education; Physician-patient relations

 


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-e20180167

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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

 


Adherence to treatment in patients with cystic fibrosis

Adesão ao tratamento em pacientes com fibrose cística

Jefferson Veronezi, Daiane Scortegagna

J Bras Pneumol.2009;35(3):290-291

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Ethyl 2-cyanoacrylate tissue adhesive in partial lobectomy in rats

Adesivo cirúrgico de etil-2-cianoacrilato em lobectomia parcial em ratos

Ariani Cavazzani Szkudlarek, Paula Sincero, Renato Silva de Sousa, Rosalvo Tadeu Hochmuller Fogaça

J Bras Pneumol.2011;37(6):729-734

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the efficacy of ethyl 2-cyanoacrylate adhesive in repairing the lung parenchyma after partial lobectomy in rats, in terms of hemostasis/aerostasis, scarring, and surgical time. Methods: The study involved 30 Wistar rats, randomly divided into five groups (one control group and four study groups). In the study groups, the lung parenchyma was repaired with either cyanoacrylate adhesive or surgical suture following resection of a small or large fragment (25% or 50%, respectively) of the left caudal lung lobe. Results: Surgical time and hemostasis time were shorter in the two groups treated with the adhesive than in the two submitted to suture. There were no significant differences among the groups regarding specific lung compliance. Adherences and inflammatory reactions were more severe in the groups submitted to suture. Conclusions: In this study, the use of cyanoacrylate adhesive helped reduce the surgical time and the intensity of inflammatory reactions, as well as preserving lung compliance. Cyanoacrylate adhesives should be considered an option for lung parenchyma repair, decreasing the risk of complications after partial lobectomy in humans.

 


Keywords: Lung; Pneumonectomy; Cyanoacrylates.

 


Unilateral pulmonary agenesis

Agenesia pulmonar unilateral

Maura Cavada Malcon, Claudio Mattar Malcon, Marina Neves Cavada, Paulo Eduardo Macedo Caruso, Lara Flório Real

J Bras Pneumol.2012;38(4):526-529

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Pulmonary agenesis is a rare congenital anomaly. We report the case of an 8-year-old boy with left lung agenesis, without any other congenital malformations. When the patient presented symptoms, including cough, wheezing, and dyspnea, with no clinical improvement after a period of 30 days, imaging studies were conducted and the diagnosis was made.

 


Keywords: Congenital abnormalities; Respiratory tract diseases; Bronchoscopy.

 


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-e20180128

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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.

 


Endotracheal tube cuff pressure alteration after changes in position in patients under mechanical ventilation

Alteração da pressão intra-cuff do tubo endotraqueal após mudança da posição em pacientes sob ventilação mecânica

Armando Carlos Franco de Godoy, Ronan José Vieira, Eduardo Mello De Capitani

J Bras Pneumol.2008;34(5):294-297

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Objective: The purpose of this study was to investigate endotracheal tube cuff pressure (Pcuff) alteration in patients under mechanical ventilation after changes in position. Methods: All selected patients were initially placed in the 35° semi-Fowler position, with Pcuff adjusted to 20 mmHg, and randomly divided into two groups. Group A, in which patients were moved to the lateral decubitus position, facing away from the ventilator (measurement designated Pcuff A1), returned to the initial position (measurement designated Pcuff A2), moved to a lateral decubitus position, facing the ventilator (measurement designated Pcuff A3) and then returned to the initial position (measurement designated Pcuff A4); and Group B, in which patients were moved to the lateral decubitus position, facing the ventilator (measurement designated Pcuff B1), returned to the initial position (measurement designated Pcuff B2), moved to the lateral decubitus position; facing away from the ventilator (measurement designated Pcuff B3) and then returned to the initial position (measurement designated Pcuff B4). Results: The study comprised 70 patients, 31 allocated to group A and 39 allocated to group B. Values >22 mmHg were observed in 142(50.7%) of the 280 Pcuff measurements taken, and values <18 mmHg were observed in 14 (5%). When moved from the 35° semi-Fowler position to the lateral decubitus position, facing away from the ventilator, 58 (82.2%) of the patients presented mean Pcuff values in the higher range (>22 mmHg). Conclusions: Changes in body position can cause significant Pcuff variations in patients under mechanical ventilation.

 


Keywords: Pressure; Intubation, intratracheal; Posture; Supine position.

 


Alterations in peak inspiratory pressure and tidal volume delivered by manually operated self-inflating resuscitation bags as a function of the oxygen supply rate

Alterações da pressão de pico inspiratório e do volume corrente fornecidos por reanimadores manuais com balão auto-inflável em função do fluxo de entrada de oxigênio utilizado

Armando Carlos Franco de Godoy, Ronan José Vieira, Eduardo Mello De Capitani

J Bras Pneumol.2008;34(10):817-821

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Objective: To assess possible alterations in the tidal volume and peak inspiratory pressure delivered by seven models of manually operated self-inflating resuscitation bags as a function of the oxygen supply rate used. Methods: The resuscitation bags tested were the following: Oxigel, models A and B; CE Reanimadores; ProtecSolutions; Missouri; Axmed; and Narcosul. For the measurements, a wall oxygen flow meter, a flow meter/respirometer, a resuscitation bag, a sensor (Tracer 5 unit), and a test lung were connected. In addition, the Tracer 5 unit was connected to a notebook computer. Oxygen supply rates of 1, 5, 10, and 15 L/min were used. Results: The tidal volume delivered by the Oxigel model A resuscitation bag when receiving oxygen at a rate of 15 L/min was approximately 99% greater than that delivered when receiving oxygen at a rate of 1 L/min. Similarly, peak inspiratory pressure was approximately 155% greater. Under the same conditions, the tidal volume delivered by the Narcosul resuscitation bag was 48% greater, and peak inspiratory pressure was 105% greater. The remaining resuscitation bags tested showed no significant alterations in the tidal volume or peak inspiratory pressure delivered. Conclusions: Under the resistance and compliance conditions used, the resuscitation bags in which the oxygen inflow is directed to the interior of the bag had the patient valve stuck at the inspiratory position when receiving oxygen at a rate ≥ 5 L/min, significantly increasing the tidal volume and peak inspiratory pressure delivered. This did not occur with the resuscitation bags in which the oxygen inflow is directed to the exterior of the bag.

 


Keywords: Oxygen/administration & dosage; Resuscitation; Equipment and supplies; Pulmonary ventilation; Intensive care.

 


Diffuse abnormalities of the trachea: computed tomography findings

Alterações difusas da traquéia: aspectos na tomografia computadorizada

Edson Marchiori, Aline Serfaty Pozes, Arthur Soares Souza Junior, Dante Luiz Escuissato, Klaus Loureiro Irion, César de Araujo Neto, Jorge Luiz Barillo, Carolina Althoff Souza, Gláucia Zanetti

J Bras Pneumol.2008;34(1):47-54

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The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

 


Keywords: Thoracic diseases; Tracheal diseases; Tomography, X-ray computed; Trachea.

 


Functional respiratory changes in laparoscopic cholecystectomy

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Luciana Dias Chiavegato, José Roberto Jardim, Sonia Maria Faresin, Yara Juliano

J Bras Pneumol.1997;23(2):69-76

Abstract

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

 


Keywords: Laparoscopic surgery, preoperative and postoperative care and respiratory muscle strength.

 


Functional respiratory changes in laparoscopic cholecystectomy

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Luciana Dias Chiavegato, José Roberto Jardim, Sonia Maria Faresin, Yara Juliano

J Bras Pneumol.2000;26(2):69-76

Abstract

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

 


Keywords: Laparoscopic surgery, preoperative and postoperative care and respiratory muscle strength.

 


Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study

Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias

Alexandre de Matos Soeiro, Edwin Roger Parra, Mauro Canzian, Cecília Farhat, Vera Luiza Capelozzi

J Bras Pneumol.2008;34(2):67-73

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Objective: To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF) and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns. Methods: Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. Results: The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age ≥ 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema. Conclusion: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.

 


Keywords: Respiratory insufficiency; Autopsy; Lung diseases, interstitial; Pulmonary edema; Hemorrhage.

 


Morphological lesions induced by oleic acid in lungs of rats

Alterações morfológicas induzidas pelo ácido oléico em pulmões de ratos

Thais Helena A.T. Queluz, Júlio Defaveri, Silene El-Fakhouri

J Bras Pneumol.1997;23(5):245-251

Abstract PDF PT

Because it has direct and indirect action on lung tissue, oleic acid (OA) has been used experimentally as a model of fat embolism and acute respiratory distress syndrome (ARDS). The aim of this study was to describe acute and chronic pulmonary lesions induced in rats by intravenous injection of OA. Male Wistar rats were injected a 0.05 ml dose of OA. Groups of 5 animals were sacrificed 2, 24, 48 hours, and 5, 10, 30, and 90 days after injection. Diffuse alveolar edema, foci of intra-alveolar hemorrhage, and foci of ischemic necrosis were observed by light microscopic from 2 to 48 hours. At this period of time, severe endothelial injuries and type II alveolar cell lesions were observed on electron microscopy. After the fifth day, no injury was observed and discrete morphological sequelae were found. The lungs of the animals sacrificed at the thirtieth and ninetieth days were identical to those of the control groups. The present model allows animal to survive, being suitable for studies on fat embolism and on ARDS.

 


Keywords: Oleic acid. Fat embolism. Acute respiratory distress syndrome, ARDS. Experimental model.

 


State-dependent changes in the upper airway assessed by multidetector CT in healthy individuals and during obstructive events in patients with sleep apnea

Alterações nas vias aéreas superiores avaliadas por TC multidetectores durante a vigília e o sono em indivíduos saudáveis e em pacientes com apneia do sono durante eventos obstrutivos

Ula Lindoso Passos1,a, Pedro Rodrigues Genta1,b, Bianca Fernandes Marcondes2,c, Geraldo Lorenzi-Filho2,d, Eloisa Maria Mello Santiago Gebrim1,e

J Bras Pneumol.2019;45(4):e20180264-e20180264

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Objective: To determine whether airway narrowing during obstructive events occurs predominantly at the retropalatal level and results from dynamic changes in the lateral pharyngeal walls and in tongue position. Methods: We evaluated 11 patients with severe obstructive sleep apnea (OSA) and 7 healthy controls without OSA during wakefulness and during natural sleep (documented by full polysomnography). Using fast multidetector CT, we obtained images of the upper airway in the waking and sleep states. Results: Upper airway narrowing during sleep was significantly greater at the retropalatal level than at the retroglossal level in the OSA group (p < 0.001) and in the control group (p < 0.05). The retropalatal airway volume was smaller in the OSA group than in the control group during wakefulness (p < 0.05) and decreased significantly from wakefulness to sleep only among the OSA group subjects. Retropalatal pharyngeal narrowing was attributed to reductions in the anteroposterior diameter (p = 0.001) and lateral diameter (p = 0.006), which correlated with an increase in lateral pharyngeal wall volume (p = 0.001) and posterior displacement of the tongue (p = 0.001), respectively. Retroglossal pharyngeal narrowing during sleep did not occur in the OSA group subjects. Conclusions: In patients with OSA, upper airway narrowing during sleep occurs predominantly at the retropalatal level, affecting the anteroposterior and lateral dimensions, being associated with lateral pharyngeal wall enlargement and posterior tongue displacement.

 


Keywords: Multidetector computed tomography; Oropharynx; Sleep apnea, obstructive; Polysomnography; Diagnostic imaging; Sleep.

 


Lung alterations in a rat model of diabetes mellitus: effects of antioxidant therapy

Alterações pulmonares em um modelo de diabetes mellitus em ratos: o efeito da terapia antioxidante

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Juliana Tieppo, Jaqueline Nascimento Picada, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(5):579-587

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Objective: To evaluate structural alterations of the lung in rats with diabetes mellitus (DM), by quantifying oxidative stress and DNA damage, as well as to determine the effects that exogenous superoxide dismutase (SOD) has on such alterations. Methods: A controlled experimental study involving 40 male Wistar rats, divided into four groups (10 animals each): control; SOD-only (without DM but treated with SOD); IDM-only (with streptozotocin-induced DM but untreated); and IDM+SOD (with streptozotocin-induced DM, treated with SOD). The animals were evaluated over a 60-day period, day 0 being defined as the day on which the streptozotocin-injected animals presented glycemia > 250 mg/dL. The SOD was administered for the last 7 days of that period. At the end of the study period, samples of lung tissue were collected for histopathological analysis, evaluation of tissue oxidative stress, and assessment of DNA damage. Results: There were no significant differences among the groups regarding DNA damage. In the IDM-only group, there was a significant increase in the extracellular matrix and significantly greater hyperplasia of the capillary endothelium than in the SOD-only and control groups. In addition, there were significant changes in type II pneumocytes and macrophages, suggesting an inflammatory process, in the IDM-only group. However, in the IDM+SOD group, there was a reduction in the extracellular matrix, as well as normalization of the capillary endothelium and of the type II pneumocytes. Conclusions: Exogenous SOD can reverse changes in the lungs of animals with induced DM.

 


Keywords: Diabetes mellitus, experimental; Oxidative stress; Lung; DNA damage.

 


Cocaine-induced pulmonary changes: HRCT findings

Alterações pulmonares induzidas pelo uso de cocaína: avaliação por TCAR de tórax

Renata Rocha de Almeida1, Gláucia Zanetti1,2, Arthur Soares Souza Jr.3, Luciana Soares de Souza4, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Klaus Loureiro Irion7, Alexandre Dias Mançano8, Luiz Felipe Nobre9, Bruno Hochhegger10, Edson Marchiori1,11

J Bras Pneumol.2015;41(4):323-330

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Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.

 


Keywords: Cocaine, Cocaine-related disorders; Tomography, X-ray computed; Lung diseases.

 


Respiratory findings in sudden unexpected death in epilepsy: a point of convergence for clinical pulmonologists and neurologists

Alterações respiratórias e morte súbita em epilepsia: um ponto de convergência para pneumologistas clínicos e neurologistas

Fulvio Alexandre Scorza, Vera Cristina Terra, Marly de Albuquerque, Esper Abrão Cavalheiro

J Bras Pneumol.2009;35(6):613-614

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Abnormalities on computed tomography scans of the paranasal sinus in adult patients with allergic rhinitis

Alterações tomográficas de seios paranasais em pacientes adultos com rinite alérgica

Eduardo Vieira Ponte, Fabiana Lima, Glauber Ferraz Aguiar, Fabíola Goyana, Marcelo Benício dos Santos, Álvaro Augusto Cruz

J Bras Pneumol.2005;31(5):421-426

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Objective: To evaluate, using computerized tomography, the frequency of paranasal sinus involvement in patients with allergic rhinitis. Methods: From among outpatients diagnosed with rhinitis and complaining of nasal obstruction, 60 were selected for evaluation. The patients were submitted to anterior rhinoscopy, skin prick test for reactivity to aeroallergens and computed tomography of the paranasal sinuses. In addition, questionnaires designed to evaluate symptom severity were administered. The Lund score was used to evaluate paranasal sinus involvement on computed tomography scans. Results: Computed tomography scans of the paranasal sinuses were abnormal in 31 patients (52%). The sum of the largest diameters of cutaneous reactions to the aeroallergens, symptom severity and anterior rhinoscopy findings did not differ between patients with paranasal sinus involvement and those without. All the patients with paranasal sinus abnormalities also presented osteomeatal complex abnormalities, whereas only 11 patients (38%) without paranasal sinus involvement presented such abnormalities (p < 0.01). Conclusion: In a sample of patients with allergic rhinitis, the frequency of paranasal sinus abnormalities on computed tomography scans was elevated and did not correlate with symptom severity or skin prick test reactivity but was correlated with osteomeatal complex obstruction.

 


Keywords: Rhinitis; Sinusitis; Tomography, X-ray computed; Paranasal sinuses/radiography

 


Indoor air quality, Act 3,523 of the Ministry of Health and Brazilian standards for biological indoor air contaminants

Ambientes climatizados, portaria 3.523 de 28/8/98 do Ministério da Saúde e padrões de qualidade do ar de interiores do Brasil

Paulo Pinto Gontijo Filho, Carlos Roberto Menezes Silva, Afrânio Lineu Kritski

J Bras Pneumol.2000;26(5):254-258

Abstract PDF PT

This article reviews Act 3,523 of the Brazilian Ministry of Health which regulates the indoor air quality of air-conditioned environments, focusing mainly on biological standards for contaminant particles. Additionally, a concise analysis on nosocomial air-borne infections is performed, as well as on nosocomial units where air-borne infectious diseases may be important and a special ventilation system is required. Detailed analysis of the most common biological contaminant particles, differences between countries of both Northern and Southern hemispheres, and the aspects of the methodology used to perform their analysis are considered. The authors conclude that there are no established standards for safe levels of air-borne organisms, and that there is no available data in Brazil to set up standards for biological contaminant particles

 


Keywords: Air pollutants. Air conditioning. Air quality standards. Indoor air pollution. Brazil.

 


Outpatient smoking cessation program in the state of Ceará, Brazil: patient profiles and factors associated with treatment success

Ambulatório de apoio ao tabagista no Ceará: perfil dos pacientes e fatores associados ao sucesso terapêutico

Maria Penha Uchoa Sales, Mara Rúbia Fernandes de Figueiredo, Maria Irenilza de Oliveira, Helano Neiva de Castro

J Bras Pneumol.2006;32(5):410-417

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate patient profiles and factors associated with successful treatment. Methods: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication. Results: Of the 320 patients enrolled, 65.5% were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90% of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8% had achieved treatment success; 17.8% had relapsed, and 31.4% had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60% of the patients were treated with medication. Conclusion: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

 


Keywords: Smoking/therapy; Tobacco use cessation; Bupropion; Nicotine

 


Primary tracheobronchial amyloidosis

Amiloidose traqueobrônquica primária

Gustavo Chatkin, Mauríco Pipkin, José Antonio Figueiredo Pinto, Vinicius Duval da Silva, José Miguel Chatkin

J Bras Pneumol.2008;34(7):528-531

Abstract PDF PT PDF EN Portuguese Text

Amyloidosis is a disease characterized by extracellular deposition of fibrillar protein in organs and tissues. Primary tracheal amyloidosis is rare. We report here a case of a 55-year-old man with tracheal amyloidosis hospitalized for acute respiratory insufficiency and with a history of recent episodes of pneumonia. Chest X-ray and chest computed tomography showed tracheal obstruction due to a tumor. A passage was created in order to relieve the symptoms. Histological examination (Congo red staining) revealed amyloid deposits but no evidence of neoplasia. Although this is a rare clinical condition, its importance is discussed regarding the differential diagnosis of tracheal tumors and the repercussions for therapeutic decision-making.

 


Keywords: Amyloidosis; Respiratory insufficiency; Congo red; Airway obstruction.

 


Primary tracheobronchial amyloidosis

Amiloidose traqueobrônquica primária

José Wellington Alves dos Santos, Ayrton Schneider Filho, Alessandra Bertolazzi, Gustavo Trindade Michel, Lauro Vinícius Schvarcz da Silva, Carlos Renato Melo, Vinícius Dallagasperina Pedro, Daniel Spilmann, Juliana Kaczmareck Figaro

J Bras Pneumol.2008;34(10):881-884

Abstract PDF PT PDF EN Portuguese Text

Tracheobronchial amyloidosis is an uncommon localized form of amyloidosis, characterized by amyloid deposits restricted to the trachea, main bronchi and segmental bronchi. We present the case of a retired 67-year-old man with long-term progressive dyspnea, wheezing and chest pain. A diagnosis of tracheobronchial amyloidosis was made after the third fiberoptic bronchoscopy and histological confirmation through Congo red staining of tissue samples.

 


Keywords: Amiloidose/traquéia; Broncoscopia; Doenças da traquéia/diagnóstico.

 


Aminoguanidine reduces oxidative stress and structural lung changes in experimental diabetes mellitus

Aminoguanidina reduz o estresse oxidativo e as alterações estruturais pulmonares em diabetes mellitus experimental

Fabio Cangeri Di Naso, Luiz Alberto Forgiarini Junior, Luiz Felipe Forgiarini, Marilene Porawski, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(4):-

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We evaluated the effect of aminoguanidine on pulmonary oxidative stress and lung structure in an experimental model of diabetes mellitus. Thiobarbituric acid reactive substances (TBARS), histology and arterial blood gases were evaluated in animals with diabetes mellitus (DM group), animals with diabetes mellitus treated with aminoguanidine (DM+AG group), and controls. The TBARS levels were significantly higher in the DM group than in the control and DM+AG groups (2.90 ± 1.12 vs. 1.62 ± 0.28 and 1.68 ± 0.04 nmol/mg protein, respectively), as was PaCO2 when compared with that of the control group (49.2 ± 1.65 vs. 38.12 ± 4.85 mmHg), and PaO2 was significantly higher in the control group (104.5 ± 6.3 vs. 16.30 ± 69.48 and 97.05±14.02 mmHg, respectively). In this experimental model of diabetes mellitus, aminoguanidine reduced oxidative stress, structural tissue alterations, and gas exchange.

 


Keywords: Oxidative stress; Diabetes mellitus, experimental; Lung.

 


Critical analysis of scoring systems used in the assessment of Cystic Fibrosis severity: State of the art

Análise crítica dos escores de avaliação de gravidade da fibrose cística: Estado da arte

Camila Isabel da Silva Santos, José Dirceu Ribeiro, Antônio Fernando Ribeiro, Gabriel Hessel

J Bras Pneumol.2004;30(3):286-

Abstract PDF PT

This study carries out a descriptive and comparative analysis of the various types of cystic fibrosis severity scores described in the literature and contextualizes the origin and objective of each. A total of 16 scoring systems were found: 8 are used predominantly for clinical evaluation, 5 for radiographic findings, 2 for tomographic findings and 1 for scintigraphic findings. Despite the criticism and controversy regarding these instruments of assessment, they have contributed to a better understanding of the disease and to the development of more effective therapeutic procedures.

 


Keywords: Severity of illness index. Cystic fibrosis. Review literature.

 


Analysis of dry pleural biopsy in 107 patients

Análise da biópsia pleural em 107 pacientes sem líquido pleural

Marcelo Chalhoub, Sérgio Arruda, Ronald Fidélis, Ana Paula Barreto, Manoel Barral Netto

J Bras Pneumol.1999;25(3):141-146

Abstract PDF PT

The clinical-radiographic presentation and tuberculosis prediction in patients that have undergone dry pleural biopsy, as well as its usefulness and complications, have been evaluated in this retrospective study, conducted in the Octávio Mangabeira Hospital (Salvador, Bahia, Brazil), where 107 patients consecutively submitted to this exam have been analyzed. Altogether 108 biopsies have been performed using Cope's needle (biopsies of both hemithoraxes were performed in one patient). The following diagnoses were obtained: a) tuberculosis (n = 66); b) probable tuberculosis (n = 4); c) neoplasm (n = 2); d) parapneumonic (n = 3), and e) not determined (32). Sixty-seven (62.6%) of the patients were male, and mean age was 34.5 ± 15.4 years. Analyses carried out compare patients diagnosed with tuberculosis (whether confirmed or probable) to those with different diagnoses (miscellaneous). Tuberculosis patients were younger (p < 0.01), expectoration was less frequent (p < 0.01), previous tuberculosis was less often reported (p = 0.04) and PPD reactivity was more frequent (p < 0.01). No significant differences were found between the two groups as to the extent of pleural commitment and its variation in the period observed. Presence of acinar infiltrations in the upper lobes was correlated with tuberculosis diagnosis in the 13 patients in which this feature was observed. Pleural fragments were present in 100 out of 108 cases (92.6%) and the diagnosis was made in the first biopsy in 64 out of 108 cases (59.3%). Ten minor complications have occurred (9.3%) in the 108 biopsies: 6 bloody sputums, 3 small pneumothoraxes, and one moderate subcutaneous emphysema. The authors conclude that for the various predictive indicators of tuberculosis analyzed, except for the presence of acinar infiltrations in the upper lobes, there is broad overlap between the two groups compared, meaning that a safe clinical diagnosis cannot be provided and thus reinforcing the need of performing biopsies. Dry pleural biopsy offers a satisfactory diagnostic yield in areas with high prevalence of tuberculosis and proved safe, when performed by experienced personnel.

 


Keywords: Pleural tuberculosis. Pleural thickening. Pleural biopsy. Diagnosis.

 


Oxygen desaturation during the six-minute walk test in COPD patients

Análise da dessaturação de oxigênio durante o teste de caminhada de seis minutos em pacientes com DPOC

Maria Ângela Fontoura Moreira, Gabriel Arriola de Medeiros, Francesco Pinto Boeno, Paulo Roberto Stefani Sanches, Danton Pereira da Silva Júnior, André Frotta Müller

J Bras Pneumol.2014;40(3):222-228

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the behavior of oxygen saturation curves throughout the six-minute walk test (6MWT) in patients with COPD. Methods: We included 85 patients, all of whom underwent spirometry and were classified as having moderate COPD (modCOPD, n = 30) or severe COPD (sevCOPD, n = 55). All of the patients performed a 6MWT, in a 27-m corridor with continuous SpO2 and HR monitoring by telemetry. We studied the SpO2 curves in order to determine the time to a 4% decrease in SpO2, the time to the minimum SpO2 (Tmin), and the post-6MWT time to return to the initial SpO2, the last designated recovery time (RT). For each of those curves, we calculated the slope. Results: The mean age in the modCOPD and sevCOPD groups was 66  10 years and 62  11 years, respectively. At baseline, SpO2 was > 94% in all of the patients; none received supplemental oxygen during the 6MWT; and none of the tests were interrupted. The six-minute walk distance did not differ significantly between the groups. The SpO2 values were lowest in the sevCOPD group. There was no difference between the groups regarding RT. In 71% and 63% of the sevCOPD and modCOPD group patients, respectively, a ≥ 4% decrease in SpO2 occurred within the first minute. We found that FEV1% correlated significantly with the SpO2 (r = −0.398; p < 0.001), Tmin (r = −0.449; p < 0.001), and minimum SpO2 (r = 0.356; p < 0.005). Conclusions: In the sevCOPD group, in comparison with the modCOPD group, SpO2 was lower and the Tmin was greater, suggesting a worse prognosis in the former.

 


Keywords: Pulmonary disease, chronic obstructive; Exercise test; Blood gas monitoring, transcutaneous.

 


Analysis of the stability of housekeeping gene expression in the left cardiac ventricle of rats submitted to chronic intermittent hypoxia

Análise da estabilidade da expressão de genes de referência no ventrículo cardíaco esquerdo de ratos submetidos à hipóxia intermitente crônica

Guilherme Silva Julian1, Renato Watanabe de Oliveira1, Sergio Tufik1, Jair Ribeiro Chagas1,2

J Bras Pneumol.2016;42(3):211-214

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Obstructive sleep apnea (OSA) has been associated with oxidative stress and various cardiovascular consequences, such as increased cardiovascular disease risk. Quantitative real-time PCR is frequently employed to assess changes in gene expression in experimental models. In this study, we analyzed the effects of chronic intermittent hypoxia (an experimental model of OSA) on housekeeping gene expression in the left cardiac ventricle of rats. Analyses via four different approaches-use of the geNorm, BestKeeper, and NormFinder algorithms; and 2−ΔCt (threshold cycle) data analysis-produced similar results: all genes were found to be suitable for use, glyceraldehyde-3-phosphate dehydrogenase and 18S being classified as the most and the least stable, respectively. The use of more than one housekeeping gene is strongly advised.

 


Keywords: Cell hypoxia; Reference standards; Sleep apnea, obstructive; Cardiovascular diseases; Models, animal; Polymerase chain reaction.

 


Analysis of acute and chronic vascular remodeling in an experimental model of pulmonary ischemia

Análise da remodelação vascular na isquemia pulmonar experimental, nas fases aguda e crônica

Wanderley M. Bernardo, Fabio B. Jatene, Lea Maria M. F. Demarchi, Vera Luiza Capelozzi, Rogério Pazetti, Dolores H. R. F. Rivero¸ Rosangela Monteiro, Sérgio A. de Oliveira

J Bras Pneumol.2005;31(1):-

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Background: Structural alterations to the pulmonary circulation characterize the vascular remodeling process and are likely correlated with local variations in flow and ischemia. Objective: To define the histological alterations to the pulmonary circulation seen after experimentally-induced ischemia of the pulmonary artery and to correlate those alterations with known patterns of blood redistribution and vascular remodeling. Method: Wistar rats (n = 48) were randomized into two groups with ligation of the pulmonary artery and without (controls) and were sacrificed on post-ischemia days 1, 7, 30 and 60. Lungs were removed and inspected for signs of parenchymal injury. External diameters, as well as wall thicknesses in the pulmonary, alveolar and bronchial end arterioles, were measured. Internal diameter and wall thickness percentage were calculated. Results: Infarction, necrosis and hemorrhage occurred only in ischemic lungs. In nonischemic lungs, there was a sustained increase in the internal and external arteriolar diameters, with an initial reduction in wall thickness on day 1, and day-60 values were similar to those seen in controls. In ischemic lungs, there was a transitory reduction in the internal and external diameters of the pulmonary and bronchial end arterioles, together with an initial, equally transitory, increase in their wall thickness. The alveolar arterioles presented sustained and progressive increases in external diameter and wall thickness, with concomitant reductions in internal diameter. Conclusion: This model mimics distal arterial disease in patients with chronic pulmonary thromboembolism. The vascular response in nonischemic lungs was consistent with a pattern of flow remodeling, whereas that seen in ischemic lungs was more consistent with flow and ischemia. In the pulmonary and bronchial end arterioles, the response was transitory, in contrast to the sustained and progressive response seen in the alveolar arterioles, which was probably caused by delayed local flow.

 


Keywords: Key-words: Pulmonary embolism. Pulmonary circulation. Vascular remodelling. Pulmonary artery.

 


Analysis of 39 cases of idiopathic chronic interstitial pneumonia

Análise de 39 casos de pneumonia intersticial crônica idiopática

Rogério Rufino, Leonardo Rizzo, Cláudia Henrique da Costa, Roberto José de Lima, Kalil Madi

J Bras Pneumol.2006;32(6):505-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. Methods: Samples from 252 open-lung biopsies of patients with interstitial lung disease, all performed between 1977 and 1999, were reviewed, and 39 cases of idiopathic interstitial lung disease were selected and re-evaluated by two pathologists in accordance with the American Thoracic Society/European Respiratory Society classification system. Results: Among those 39 cases, the diagnoses were maintained in 28 (71.8%). A new pathologic entity, nonspecific interstitial pneumonia, was included in the reclassification, and overlapping patterns were observed in 6 cases. Of the 28 cases in which the diagnosis of chronic idiopathic interstitial pneumonia remained unchanged, idiopathic pulmonary fibrosis was accompanied by cryptogenic organizing pneumonia in 4, cryptogenic organizing pneumonia was accompanied by nonspecific interstitial pneumonia in 1, and desquamative interstitial pneumonia was accompanied by nonspecific interstitial pneumonia in 1. All cases of idiopathic pulmonary fibrosis were confirmed, although 3 of those were found to be accompanied by cryptogenic organizing pneumonia. Virtually all prior diagnoses were maintained in the review of the biopsy samples (p > 0,05). Conclusion: The American Thoracic Society/European Respiratory Society system of classifying interstitial lung disease is a useful tool for pathologists who deal with lung biopsies.

 


Keywords: Pulmonary fibrosis; Lung diseases, interstitial

 


Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Análise de custos de um teste de amplificação de ácido nucleico para o diagnóstico da tuberculose pulmonar sob a perspectiva do Sistema Único de Saúde

Márcia Pinto1, Aline Piovezan Entringer1,Ricardo Steffen2, Anete Trajman2,3

J Bras Pneumol.2015;41(6):536-538

Abstract PDF PT PDF EN Portuguese Text

We estimated the costs of a molecular test for Mycobacterium tuberculosis and resistance to rifampin (Xpert MTB/RIF) and of smear microscopy, within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). In SUS laboratories in the cities of Rio de Janeiro and Manaus, we performed activity-based costing and micro-costing. The mean unit costs for Xpert MTB/RIF and smear microscopy were R$35.57 and R$14.16, respectively. The major cost drivers for Xpert MTB/RIF and smear microscopy were consumables/reagents and staff, respectively. These results might facilitate future cost-effectiveness studies and inform the decision-making process regarding the expansion of Xpert MTB/RIF use in Brazil

 


Keywords: Costs and cost analysis; Tuberculosis; Nucleic acid amplification techniques.

 


Cost analysis of nucleic acid amplification for diagnosing pulmonary tuberculosis, within the context of the Brazilian Unified Health Care System

Análise de custos de um teste de amplificação de ácido nucleico para o diagnóstico da tuberculose pulmonar sob a perspectiva do Sistema Único de Saúde.

Márcia Pinto1; Aline Piovezan Entringer1; Ricardo Steffen2; Anete Trajman2; 3

J Bras Pneumol.2016;42(1):79-79

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Restriction enzyme analysis of the hsp65 gene in clinical isolates from patients suspected of having pulmonary tuberculosis in Teresina, Brazil

Análise de restrição enzimática do gene hsp65 de isolados clínicos de pacientes com suspeita de tuberculose pulmonar em Teresina, Piauí

Maria das Graças Motta e Bona, Maria José Soares Leal, Liline Maria Soares Martins, Raimundo Nonato da Silva, José Adail Fonseca de Castro, Semiramis Jamil Hadad do Monte

J Bras Pneumol.2011;37(5):628-635

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify mycobacterial species in the sputum of patients suspected of having pulmonary tuberculosis and to determine the impact that the acquisition of this knowledge has on the therapeutic approach. Methods: We evaluated 106 patients suspected of having pulmonary tuberculosis and referred to the pulmonology department of a public hospital in the city of Teresina, Brazil. Morning sputum specimens were evaluated for the presence of mycobacteria by sputum smear microscopy and culture. We used PCR and restriction enzyme analysis of the hsp65 gene (PRA-hsp65) to identify the strains of mycobacteria isolated in culture. Results: A total of 206 sputum samples were analyzed. Patient ages ranged from 15 to 87 years, and 67% were male. There was cough in 100% of the cases. The predominant radiographic pattern was moderate disease, observed in 70%. Smear positivity was 76%, and isolation in culture occurred in 91% of the cultures. Traditional tests identified nontuberculous mycobacteria (NTM) in 9% of the isolates. The PRA-hsp65 method confirmed these data, showing seven band patterns that were able to identify the isolated species of NTM: Mycobacterium kansasii; M. abscessus 1; M. abscessus 2; M. smegmatis; M. flavescens 1; M. gordonae 5; and M. gordonae 7. All of the patients with NTM were over 60 years of age, and bronchiectasis was seen in 88% of the X-rays. There were two cases of reinfection, initially attributed to M. abscessus and M. kansasii. Conclusions: In immunocompetent patients, NTM can infect the lungs. It is important to identify the specific NTM in order to establish the correct diagnosis and choose the most appropriate therapeutic regimen. The PRA-hsp65 method is useful in identifying NTM species and can be implemented in molecular biology laboratories that do not specialize in the identification of mycobacteria. Keywords:

 


Keywords: Tuberculosis; Mycobacteria, atypical; Polymerase chain reaction; Brazil.

 


Subgroup analysis and interaction tests: why they are important and how to avoid common mistakes

Análise de subgrupos e testes de interação: por que são importantes e como evitar erros comuns

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2017;43(3):162-162

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Analysis of three different equations for predicting quadriceps femoris muscle strength in patients with COPD

Análise de três diferentes fórmulas de predição de força muscular do quadríceps femoral em pacientes com DPOC

Aline Gonçalves Nellessen¹, Leila Donária¹, Nidia Aparecida Hernandes¹, Fabio Pitta¹

J Bras Pneumol.2015;41(4):305-312

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare equations for predicting peak quadriceps femoris (QF) muscle force; to determine the agreement among the equations in identifying QF muscle weakness in COPD patients; and to assess the differences in characteristics among the groups of patients classified as having or not having QF muscle weakness by each equation. Methods: Fifty-six COPD patients underwent assessment of peak QF muscle force by dynamometry (maximal voluntary isometric contraction of knee extension). Predicted values were calculated with three equations: an age-height-weight-gender equation (Eq-AHWG); an age-weight-gender equation (Eq-AWG); and an age-fat-free mass-gender equation (Eq-AFFMG). Results: Comparison of the percentage of predicted values obtained with the three equations showed that the Eq-AHWG gave higher values than did the Eq-AWG and Eq-AFFMG, with no difference between the last two. The Eq-AHWG showed moderate agreement with the Eq-AWG and Eq-AFFMG, whereas the last two also showed moderate, albeit lower, agreement with each other. In the sample as a whole, QF muscle weakness (< 80% of predicted) was identified by the Eq-AHWG, Eq-AWG, and Eq-AFFMG in 59%, 68%, and 70% of the patients, respectively (p > 0.05). Age, fat-free mass, and body mass index are characteristics that differentiate between patients with and without QF muscle weakness. Conclusions: The three equations were statistically equivalent in classifying COPD patients as having or not having QF muscle weakness. However, the Eq-AHWG gave higher peak force values than did the Eq-AWG and the Eq-AFFMG, as well as showing greater agreement with the other equations.

 


Keywords: Pulmonary disease, chronic obstructive; Muscle strength; Quadriceps muscle; Reference values.

 


Descriptive analysis of and overall survival after surgical treatment of lung metastases

Análise descritiva e sobrevida global do tratamento cirúrgico das metástases pulmonares

Giana Balestro Poletti, Ivan Felizardo Contrera Toro, Thais Ferreira Alves, Eliana Cristina Martins Miranda, José Cláudio Teixeira Seabra, Ricardo Kalaf Mussi

J Bras Pneumol.2013;39(6):650-658

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. Methods: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. Results: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). Conclusions: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

 


Keywords: Neoplasm metastasis; Survival analysis; Thoracic surgery; Metastasectomy.

 


Bronchoalveolar lavage analysis in victims of severe facial burns

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves

Eucir Rabello, Vera Flores Batista, Patrícia Martins Lago, Renata de Azevedo Gameiro Alvares, Cesônia de Assis Martinusso, José Roberto Lapa e Silva

J Bras Pneumol.2009;35(4):343-350

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Objective: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. Methods: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. Results: Of the 18 patients submitted to bronchoscopy, 8 (44.4%) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1% of the total body surface area, compared with 26.1% in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1%) showed endoscopic signs of smoke inhalation injury, and 4 (36.4%) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1%) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6% vs. 1.4%; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. Conclusions: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns.

 


Keywords: Burns; Smoke inhalation injury; Bronchoalveolar lavage; Epithelial cells; Macrophages;Tumor necrosis factor-alpha.

 


Analysis of the Tuberculosis Control Program in the city of Cáceres, Brazil, prior to and after the implementation of a Family Health Program

Análise do Programa de Controle da Tuberculose em Cáceres, Mato Grosso, antes e depois da implantação do Programa de Saúde da Família

Eliane Ignotti, Beatriz Fátima Alves de Oliveira, Shaiana Hartwig, Hellen Caroline de Oliveira, João Henrique Gurtler Scatena

J Bras Pneumol.2007;33(3):287-294

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Objective: To analyze the effectiveness of the Tuberculosis Control Program, in conjunction with the recently incorporated Family Health Program, in the city of Cáceres, Brazil, between 1999 and 2004. Methods: This was a descriptive epidemiological study, based on the registry of tuberculosis cases diagnosed and treated in Cáceres, according to the characteristics of the cases diagnosed, whether or not the protocol for diagnosis, treatment, and monitoring of patients was followed, as well as the type of health care facility involved. Results: The incidence of tuberculosis was reduced from 99.4 to 49.8 (per 100,000 inhabitants) between 1999 and 2004. The patients presented characteristics similar to those of patients from other regions of Brazil, with a predominance of males during their most economically productive years. Among the patients presenting pulmonary forms and treated via the Family Health Program, there was a reduction in the number of sputum smear microscopies performed at the moment of diagnosis (OR = 0.33; 95%CI: 0.16-0.66) and prior to discharge (OR = 0.32; 95%CI: 0.18‑0.59). The patients monitored via the Family Health Program presented a 16.4% lower cure rate than did those treated at the referral center, as well as being more likely to abandon treatment (OR = 2.93; 95%CI: 1.15-7.46) and to die (OR = 5.71; 95%CI: 1.85‑18.1). Conclusion: The decentralization of the treatment services to the family health clinics did not improve the treatment or monitoring of tuberculosis cases in the city of Cáceres.

 


Keywords: Tuberculosis/epidemiology; Community Health Services; Health care reform/Brazil.

 


Analysis of the treatment of pulmonary tuberculosis in elderly patients at a university hospital in Rio de Janeiro, Brazil

Análise do tratamento da tuberculose pulmonar em idosos de um hospital universitário do Rio de Janeiro, RJ, Brasil

João Paulo Cantalice Filho, Márcio Neves Bóia, Clemax Couto Sant`Anna

J Bras Pneumol.2007;33(6):691-698

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Objective: To describe the clinical and therapeutic aspects of pulmonary tuberculosis and compare the adverse effects of the treatment and its outcome in elderly and nonelderly patients. Methods: This was a case-control study of 117 elderly individuals (over the age of 60 years) and 464 nonelderly individuals (aged 15-49 years). All subjects presented pulmonary tuberculosis that had been diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 1980 and 1996. Results: In the elderly group, pulmonary tuberculosis was found to be correlated with diabetes (OR = 3.98; 95% CI = 2.07-7.65; p = 0.001), lung disease (OR = 7.24; 95% CI = 3.64‑14.46; p = 0.001) and heart disease (OR = 5.86; 95% CI = 2.88-11.95; p = 0.001). Smoking (OR = 2.07; 95% CI = 1.26‑3.42; p = 0.002) and alcohol abuse (OR = 1.63; 95% CI = 1.01-2.68; p = 0.041) were also more common in the elderly group. In the elderly group, the treatment more frequently resulted in adverse reactions (OR = 1.62; 95% CI = 1.04-2.54; p = 0.024), especially gastrointestinal reactions (OR = 1.64; 95% CI = 1.01-2.77; p = 0.047), and treatment efficacy was lower: cure rate, 51%; mortality rate, 24%. Treatment adherence was low (approximately 77%) in both groups. Conclusions: In the elderly group, adverse reactions were more common, treatment outcomes were less favorable, there was a greater frequency of clinical complications and deaths related to drug toxicity, and the prevalence of concomitant diseases was higher.

 


Keywords: Tuberculosis, pulmonary; Aged; Drug therapy; Treatment outcome.

 


Analysis and validation of probabilistic models for predicting malignancy in solitary pulmonary nodules in a population in Brazil

Análise e validação de modelos probabilísticos de malignidade de nódulo pulmonar solitário em uma população no Brasil

Cromwell Barbosa de Carvalho Melo, João Aléssio Juliano Perfeito, Danilo Félix Daud, Altair da Silva Costa Júnior, Ilka Lopes Santoro, Luiz Eduardo Villaça Leão

J Bras Pneumol.2012;38(5):559-565

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Objective: To analyze clinical and radiological findings that influence the pathological diagnosis of solitary pulmonary nodule (SPN) and to compare/validate two probabilistic models for predicting SPN malignancy in patients with SPN in Brazil. Methods: This was a retrospective study involving 110 patients diagnosed with SPN and submitted to resection of SPN at a tertiary hospital between 2000 and 2009. The clinical characteristics studied were gender, age, presence of systemic comorbidities, history of malignancy prior to the diagnosis of SPN, histopathological diagnosis of SPN, smoking status, smoking history, and time since smoking cessation. The radiological characteristics studied, in relation to the SPN, were presence of spiculated margins, maximum transverse diameter, and anatomical location. Two mathematical models, created in 1997 and 2007, respectively, were used in order to determine the probability of SPN malignancy. Results: We found that SPN malignancy was significantly associated with age (p = 0.006; OR = 5.70 for age > 70 years), spiculated margins (p = 0.001), and maximum diameter of SPN (p = 0.001; OR = 2.62 for diameters > 20 mm). The probabilistic model created in 1997 proved to be superior to that created in 2007-area under the ROC curve, 0.79 ± 0.44 (95% CI: 0.70 0.88) vs. 0.69 ± 0.50 (95% CI: 0.59-0.79). Conclusions: Advanced age, greater maximum SPN diameter, and spiculated margins were significantly associated with the diagnosis of SPN malignancy. Our analysis shows that, although both mathematical models were effective in determining SPN malignancy in our population, the 1997 model was superior.

 


Keywords: Solitary Pulmonary Nodule; Risk Factors; Carcinoma, Non-Small-Cell Lung.

 


Spatial analysis of hospitalizations for pneumonia in the Vale do Paraíba region of Brazil

Análise espacial das internações por pneumonia na região do Vale do Paraíba (SP)

Adriana de Oliveira Mukai, Kátia de Souza Costa Alves, Luiz Fernando Costa Nascimento

J Bras Pneumol.2009;35(8):753-758

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Objective: To identify spatial patterns in hospitalizations for pneumonia in infants under one year of age in the Vale do Paraíba region of Brazil. Methods: This was an ecological exploratory study using a georeferencing technique based on data from the Information Technology Department of the Brazilian Unified Health Care System on the number of hospitalizations for pneumonia among infants under one year of age in the Vale do Paraíba region between 2004 and 2005. Based on the distribution of the rates of hospitalizations for pneumonia per 1,000 live births, thematic maps were created. Moran's spatial autocorrelation coefficient was estimated, and the cities with the highest rates were identified using box maps. Results: During the study period, 2,227 infants under one year of age were hospitalized for pneumonia. Moran's coefficient was 0.37 (p = 0.02), demonstrating a spatial autocorrelation for these hospitalizations. Eight cities deserving special attention for future interventions were identified. Conclusions: The spatial analysis was successful in determining the spatial autocorrelation, as well as in identifying the cities in which an intervention is necessary regarding the number of hospitalizations for pneumonia in infants under one year of age.

 


Keywords: Pneumonia; Geographic information systems; Child health (Public health); Infant.

 


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-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.

 


Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo

Análise exploratória de solicitações de autorização para dispensação de medicação de alto custo para portadores de DPOC:

Regina Maria Carvalho-Pinto11,a, Ingredy Tavares da Silva1,2,b, Lucas Yoshio Kido Navacchia1,c, Flavia Munhos Granja1,2,d, Gustavo Garcia Marques1,2,e, Telma de Cassia dos Santos Nery1,f, Frederico Leon Arrabal Fernandes1,g, Alberto Cukier1,h, Rafael Stelmach1,i

J Bras Pneumol.2019;45(6):e20180355-e20180355

Abstract PDF PT PDF EN Portuguese Text

Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.

 


Keywords: Pulmonary disease, chronic obstructive; Clinical protocols; Drug costs; Tiotropium bromide.

 


Molecular analysis of Mycobacterium tuberculosis strains from an outpatient clinic in Porto Alegre, (RS)

Análise molecular de cepas de Mycobacterium tuberculosis provenientes de um centro de saúde ambulatorial em Porto Alegre, (RS)

Michele Borges; Patrícia Izquierdo Cafrune; Lia Gonçalves Possuelo; Andréia Rosane de Moura Valim; Marta Osório Ribeiro; Maria Lucia Rosa Rossetti

J Bras Pneumol.2004;30(4):448-454

Abstract PDF PT PDF EN

Background: Tuberculosis is an ancient disease, which still remains one of the major ills faced by mankind in the 21st century. In recent decades, new technologies employing the knowledge gained from molecular biology studies have allowed for more accurate detection of tuberculosis and increased investigation of the etiology and epidemiology of the disease. Aim: Evaluating the degree of similarity among strains of Mycobacterium tuberculosis provided by the Phthisiology Sector of Centro de Saúde Navegantes (Navegantes Health Clinic) in Porto Alegre, RS, Brazil. Method: A retrospective study was performed involving RFLP typing of 55 sputum samples from outpatients examined at the Centro de Saúde Navegantes. The results of the genotyping were correlated to the conventional epidemiology data. Results: A single pattern was seen in 39 (70.9%) of the isolates, whereas 16 isolates (29.1%) showed clustering patterns and were grouped into 8 clusters of 2 patients each. An epidemiological link was found for 6 (37.5%) of the 16 patients in the clusters. Conclusion: The appropriate combination of conventional epidemiology and genotyping of M. tuberculosis contributes to a better understanding of the dynamics of tuberculosis transmission even when such a study is performed in a single, isolated health clinic.

 


Keywords: Mycobacterium tuberculosis. Transmission. Polymorphism, Restriction Fragment Length. Epidemiology.

 


Semiquantitative analysis of surgical biopsies of distinct lung lobes of patients with usual interstitial pneumonia/idiopathic pulmonary fibrosis

Análise semiquantitativa de biópsias cirúrgicas de diferentes lobos pulmonares de pacientes com pneumonia intersticial usual/fibrose pulmonar idiopática

José Júlio Saraiva Gonçalves, Luiz Eduardo Villaça Leão, Rimarcs Gomes Ferreira, Renato Oliveira, Luiz Hirotoshi Ota, Ricardo Sales dos Santos

J Bras Pneumol.2009;35(7):676-682

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the differences between surgical biopsies of distinct lung lobes in terms of the histopathological features of usual interstitial pneumonia, using a semiquantitative score. Methods: We selected all of the patients diagnosed with idiopathic pulmonary fibrosis and submitted to surgical biopsy in two distinct lobes between 1995 and 2005 at the Hospital São Paulo and other hospitals operated by the Federal University of São Paulo. In the histological evaluation of the specimens, we used a semiquantitative method based on previous studies, assigning a score to each of the biopsied sites. Results: In this sample of patients, we found no statistically significant differences that would alter the stage of the disease, based on the score used. This finding was independent of the biopsy site (middle lobe or lingular segment). Conclusions: No significant histological differences were found between the lung lobes studied. The definitive histological diagnosis of usual interstitial pneumonia did not alter the stage of the disease.

 


Keywords: Lung diseases, interstitial; Pulmonary fibrosis; Thoracic surgery; Pathology; Thoracic surgery, ­video-assisted.

 


Sequential analysis as a tool for detection of amikacin ototoxicity in the treatment of multidrug-resistant tuberculosis

Análise sequencial como ferramenta na detecção da ototoxicidade da amicacina no tratamento da tuberculose multirresistente

Karla Anacleto de Vasconcelos1, Silvana Maria Monte Coelho Frota2, Antonio Ruffino-Netto3, Afrânio Lineu Kritski4

J Bras Pneumol.2018;44(2):85-92

Abstract PDF PT PDF EN Portuguese Text

Objetivo: Verificar a detecção precoce de ototoxicidade causada pelo uso de amicacina numa população tratada para tuberculose multirresistente (TBMR) por meio da realização de três testes distintos: audiometria tonal liminar (ATL), audiometria de altas frequências (AAF) e pesquisa de emissões otoacústicas por produto de distorção (EOAPD). Métodos: Estudo longitudinal de coorte prospectiva incluindo pacientes de ambos os sexos, com idade entre 18 e 69 anos, com diagnóstico de TBMR pulmonar e que necessitaram utilizar amicacina por seis meses em seu esquema medicamentoso antituberculose pela primeira vez. A avaliação auditiva foi realizada antes do início do tratamento e depois de dois e seis meses do início do tratamento. A análise dos resultados foi realizada por meio de análise estatística sequencial. Resultados: Foram incluídos 61 pacientes, mas a população final foi constituída de 10 pacientes (7 homens e 3 mulheres), em razão da análise sequencial. Ao se comparar os valores das respostas dos testes com aqueles encontrados na avaliação basal, foram verificadas mudanças nos limiares auditivos compatíveis com ototoxicidade após dois meses de tratamento através da AAF e após seis meses de tratamento através da ATL. Entretanto, essas mudanças não foram verificadas através da pesquisa de EOAPD. Conclusões: Ao se considerar o método estatístico utilizado nessa população, é possível concluir que mudanças nos limiares auditivos foram associadas ao uso da amicacina no período de seis meses por meio de AAF e ATL e que a pesquisa de EOAPD não se mostrou eficiente na identificação dessas mudanças.

 


Keywords: Tuberculosis; Hearing loss; Aminoglycosides/toxicity.

 


Anemia in hospitalized patients with pulmonary tuberculosis

Anemia em pacientes internados com tuberculose pulmonar

Marina Gribel Oliveira, Karina Neves Delogo, Hedi Marinho de Melo Gomes de Oliveira, Antonio Ruffino-Netto, Afranio Lineu Kritski, Martha Maria Oliveira

J Bras Pneumol.2014;40(4):403-410

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the prevalence of anemia and of its types in hospitalized patients with pulmonary tuberculosis. Methods: This was a descriptive, longitudinal study involving pulmonary tuberculosis inpatients at one of two tuberculosis referral hospitals in the city of Rio de Janeiro, Brazil. We evaluated body mass index (BMI), triceps skinfold thickness (TST), arm muscle area (AMA), ESR, mean corpuscular volume, and red blood cell distribution width (RDW), as well as the levels of C-reactive protein, hemoglobin, transferrin, and ferritin. Results: We included 166 patients, 126 (75.9%) of whom were male. The mean age was 39.0  10.7 years. Not all data were available for all patients: 18.7% were HIV positive; 64.7% were alcoholic; the prevalences of anemia of chronic disease and iron deficiency anemia were, respectively, 75.9% and 2.4%; and 68.7% had low body weight (mean BMI = 18.21 kg/m2). On the basis of TST and AMA, 126 (78.7%) of 160 patients and 138 (87.9%) of 157 patients, respectively, were considered malnourished. Anemia was found to be associated with the following: male gender (p = 0.03); low weight (p = 0.0004); low mean corpuscular volume (p = 0.03);high RDW (p = 0; 0003); high ferritin (p = 0.0005); and high ESR (p = 0.004). We also found significant differences between anemic and non-anemic patients in terms of BMI (p = 0.04), DCT (p = 0.003), and ESR (p < 0.001). Conclusions: In this sample, high proportions of pulmonary tuberculosis patients were classified as underweight and malnourished, and there was a high prevalence of anemia of chronic disease. In addition, anemia was associated with high ESR and malnutrition.

 


Keywords: Tuberculosis, pulmonary; Anemia; Malnutrition; Iron.

 


Pulmonary artery aneurysm as a manifestation of Behçet disease: case report and review

Aneurisma de artéria pulmonar como manifestação da doença de Behçet

Marcos Naoyuki Samano, Renata Teixeira Ladeira, Luiz Pedro Meirelles, Paulo Manuel Pêgo-Fernandes

J Bras Pneumol.2002;28(3):150-154

Abstract PDF PT

Behçet disease has been associated to pulmonary manifestations and may be lethal if not treated correctly. The authors describe a case of a 53 year-old male with aneurysmatic pulmonary artery dilatation, pulmonary hypertension, and hemoptysis. A review is presented about the diagnosis and the medical and surgical treatment of this disease.

 


Keywords: Behcet's syndrome. Pulmonary artery. Pulmonary hypertension. Aneurysm. Hemoptysis.

 


Giant pulmonary artery aneurysm in a patient with schistosomiasis-associated pulmonary arterial hypertension

Aneurisma gigante da artéria pulmonar em paciente com hipertensão arterial pulmonar associada à esquistossomose

Francisca Gavilanes1,a, Bruna Piloto1,b, Caio Julio Cesar Fernandes1,c

J Bras Pneumol.2018;44(2):167-167

PDF PT PDF EN Portuguese Text



Pulmonary artery aneurysms in Behçet's disease: regression after immunosuppressive treatment

Aneurismas das artérias pulmonares na doença de Behçet: regressão após tratamento imunossupressor

Isabela Fernandes de Magalhães, Iugiro R. Kuroki, Agnaldo José Lopes, Elisa M.N. Albuquerque, Evandro Mendes Klumb, Aline Elisa Goulart

J Bras Pneumol.1999;25(3):176-180

Abstract PDF PT

Behçet's disease is a systemic disease with clinical manifestations, whose underlying histopathologic lesion is a non-specific vasculitis. Pulmonary artery aneurysms and, more rarely, pleuropulmonary manifestations may be found. Some reports are available in the literature about the use of immunosuppressive agents in these conditions. The authors describe a case in whom clinical remission and radiologic resolution were observed after corticosteroid and cyclophophamide therapy.

 


Keywords: Behçet's disease. Pulmonary artery aneurysms.

 


Angiosarcoma of the lung

Angiossarcoma pulmonar

Mónica Grafino1, Paula Alves1, Margarida Mendes de Almeida2, Patrícia Garrido1, Direndra Hasmucrai1, Encarnação Teixeira1, Renato Sotto-Mayor1

J Bras Pneumol.2016;42(1):68-70

Abstract PDF PT PDF EN Portuguese Text

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

 


Keywords: Hemangiosarcoma; Lung neoplasms; Sarcoma.

 


Anxiety and depression in asthma patients: impact on asthma control

Ansiedade e depressão em pacientes com asma: impacto no controle da asma

Aline Arlindo Vieira, Ilka Lopes Santoro, Samir Dracoulakis, Lilian Ballini Caetano, Ana Luisa Godoy Fernandes

J Bras Pneumol.2011;37(1):13-18

Abstract PDF PT PDF EN Portuguese Text

Objective: There is evidence that asthma is associated with an increase in psychiatric symptoms and mental disorders. This association can make it difficult to achieve asthma control. The purpose of this study was to determine whether the level of asthma control is associated with anxiety and depression. Methods: A cross-sectional study involving 78 patients with confirmed moderate or severe asthma and under regular treatment at the Asthma Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. The patients were divided into two groups by asthma control status, as assessed by the asthma control test, and were subsequently compared in terms of demographic, clinical, and spirometric data, as well as scores for asthma quality of life and hospital anxiety/depression. Results: The sample was predominantly female. Of the 78 patients, 49 (63%) were classified as having uncontrolled asthma. The prevalence of anxiety and of anxiety+depression was significantly higher among patients with uncontrolled asthma than among those with controlled asthma (78% and 100%; p = 0.04 and p = 0.02, respectively), whereas there were no differences between the two groups in terms of the prevalence of depression, spirometry results, or quality of life score. Conclusions: In this sample, the prevalence of anxiety symptoms was higher in the patients with uncontrolled asthma than in those with controlled asthma.In the evaluation of asthma patients, the negative impact of mood states ought to be taken into consideration when asthma control strategies are being outlined.

 


Keywords: Asthma; Anxiety; Depression; Cross-sectional studies.

 


Long-acting muscarinic antagonists vs. long-acting &#946;2 agonists in COPD exacerbations: a systematic review and meta-analysis

Antagonistas muscarínicos de longa duração vs. β2-agonistas de longa duração em exacerbações da DPOC: revisão sistemática e meta-análise

Israel Silva Maia1, Mariângela Pimentel Pincelli1, Victor Figueiredo Leite2, João Amadera3, Anna Maria Buehler4

J Bras Pneumol.2017;43(4):302-312

Abstract PDF PT PDF EN Portuguese Text Appendix

The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.

 


Keywords: Respiratory aspiration; Tomography, X-ray computed; Lung.

 


Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma

Anticorpos IgE específicos para superantígenos estafilocócicos: grau de sensibilização e associação com a gravidade da asma

José Elabras Filho1,2, Fernanda Carvalho de Queiroz Mello2, Omar Lupi1,3, Blanca Elena Rios Gomes Bica1, José Angelo de Souza Papi1, Alfeu Tavares França1

J Bras Pneumol.2016;42(5):356-361

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. Results: The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Conclusions: Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma.

 


Keywords: Asthma; Immunoglobulin E; Superantigens; Bacterial toxins; Staphylococcus aureus.

 


Applicability of the London Chest Activity of Daily Living scale in patients on the waiting list for lung transplantation

Aplicabilidade da escala London Chest Activity of Daily Living em pacientes em lista de espera para transplante de pulmão

Jocimar Prates Muller, Patrícia Ayres Guterres Gonçalves, Fabrício Farias da Fontoura, Rita Mattiello, Juliessa Florian

J Bras Pneumol.2013;39(1):92-97

Abstract PDF PT PDF EN Portuguese Text

Resumo

Objetivo: Avaliar a aplicabilidade da escala London Chest Activity of Daily Living (LCADL), em pacientes em lista de transplante pulmonar. Métodos: Estudo transversal com 26 pacientes em lista de espera para transplante de pulmão, de ambos os sexos, entre maio e setembro de 2010 tratados no Programa de Reabilitação Pulmonar, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, em Porto Alegre, RS. Todos os pacientes foram submetidos ao teste de caminhada de seis minutos (TC6) e a teste de função pulmonar e foram obtidos os escores das escalas LCADL e de Borg modificada para dispneia e fadiga das pernas. O teste alfa de Cronbach foi utilizado para verificar a consistência interna da escala LCADL. A análise de regressão linear foi utilizada para identificar associações entre o escore total em porcentagem da escala LCADL e as variáveis estudadas. Resultados: Segundo os resultados da LCADL, 69% dos pacientes indicaram que suas atividades de vida diária são muito comprometidas pela dispnéia. A consistência interna da escala LCADL foi de 0,89. Houve associações negativas estatisticamente significativas entre o escore total da escala LCADL e distância percorrida no TC6 (β = −0,087; p < 0,001) e trabalho realizado no TC6 (β = −0,285; p < 0,001), quando os dados foram ajustados por idade e VEF1. Conclusões: Esses achados sugerem que a escala LCADL é um instrumento útil para avaliar o desempenho funcional dos pacientes em listas de transplante pulmonar.

 


Palavras-chave: Atividades cotidianas; Transplante de pulmão; Dispneia.

 


Applicability of the 12-Item Short-Form Health Survey in patients with progressive systemic sclerosis

Aplicabilidade do questionário de qualidade de vida relacionada à saúde - the 12-Item Short-Form Health Survey - em pacientes portadores de esclerose sistêmica progressiva

Thamine Lessa Andrade, Aquiles Assunção Camelier, Fernanda Warken Rosa, Marcia Pina Santos, Sérgio Jezler, Jorge Luiz Pereira e Silva

J Bras Pneumol.2007;33(4):414-422

Abstract PDF PT PDF EN Portuguese Text

To evaluate the applicability of the 12-Item Short-Form Health Survey (SF-12) as an instrument to measure health-related quality of life in a sample of patients with progressive systemic sclerosis (PSS) through the analysis of its reproducibility and its correlation with functional and clinical parameters. Methods: A test-retest reproducibility study for the comparative analysis of the intraclass correlation coefficients (ICCs) of the SF-12 and the SF-36. A total of 46 patients diagnosed with PSS were studied, regardless of the presence of respiratory symptoms. Results: The physical component summary 12 (PCS-12) score had an ICC of 0.47 (95%CI: 0.05-0.71; p < 0.02), whereas the mental component summary (MCS-12) score had an ICC of 0.72 (95%CI: 0.49-0.84; p < 0.001). The PCS-36 score had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001), and the MCS-36 score also had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001). Conclusion: The SF-12 is a reliable instrument for measuring health-related quality of life in patients with PSS, since it has been proven to be reproducible. However, this version of the SF-12 should only be used in clinical research settings.

 


Keywords: Quality of life; Questionnaires; Statistics; Scleroderma, systemic.

 


Clinical application of serum tumor markers in patients with non-small cell lung carcinoma

Aplicação clínica dos marcadores tumorais séricos em carcinoma não-pequenas células do pulmão

Jefferson Luiz Gross, Riad Naim Younes, José Alexandre Marzagão Barbuto, Fabio José Haddad, Daniel Dehenzelin

J Bras Pneumol.2000;26(4):175-182

Abstract PDF PT

The usefulness of serum tumor markers in lung cancer is not well defined. Objective: The aim of this study is to examine the correlation between serum tumor markers and tumor extension and its prognostic value. Patients and method: From February 1995 to September 1997, 103 patients with non-small cell lung carcinoma were evaluated at the Department of Thoracic Surgery. Serum levels of CEA, CYFRA21.1, CA15.3, CA19.9, CA72.4, and NSE were determined before treatment. Results: The serum level of CYFRA21.1 was the most frequent elevated tumor marker (55%). Patients with advanced tumor had higher mean serum level of CEA (90.8 ng/ml), CYFRA21.1 (20.3 ng/ml) and CA15.3 (56.5%) than those with localized carcinoma, respectively 10.2 ng/ml, 12.6 ng/ml and 22.2 ng/ml. Considering all serum tumor markers evaluated in this study, only patients with elevated CEA had greater chance (5.6) of presenting with advanced non-small lung carcinoma than patients with normal CEA. Overall survival was influenced by performance status (p = 0.001), tumor extension (p = 0.006), elevated serum level of CEA (p = 0.043), more than two elevated serum tumor markers (p < 0.001), and type of treatment (p < 0.001). The prognostic value of anatomical tumor extension reached the limit of significance (p = 0.052); however, two or more elevated serum tumor markers and type of treatment had independent prognostic value (respectively, p = 0.035 and p = 0.005). Conclusion: None of these serum tumor markers had clinical value in the management of NSCLC patients.

 


Keywords: biological tumor markers, neoplasm staging, non-small cell lung carcinoma, prognosis

 


Application of the anthropometric index for the assessment of Pectus excavatum in patients submitted to the Nuss technique: two cases

Aplicação do índice antropométrico para avaliação do Pectus excavatum em pacientes submetidos à técnica de Nuss: relato de 2 casos

Rodrigo Ribeiro Brigato, José Ribas Milanez de Campos, Fabio Biscegli Jatene

J Bras Pneumol.2007;33(3):347-350

Abstract PDF PT PDF EN Portuguese Text

Pectus excavatum (PEX) is the most frequent congenital deformity of the anterior chest wall and is defined as the dislocation of the medial or inferior portion of the sternal region toward the spinal column. There are various ways to measure the deformity. In this study, we present an objective method of assessing such deformity, the anthropometric index for PEX (AI-PEX). The AI-PEX was developed in the Thoracic Surgery Department of the Heart Institute - University of São Paulo School of Medicine Hospital das Clínicas. The anthropometric measurements are taken during the physical examination. We herein report two cases involving patients with PEX assessed using the AI-PEX and treated with the minimally invasive Nuss technique. The measurements were always taken at the point of greatest deformity. The patients were assessed on the day of the operation and again at 60 days after the surgery. The AI-PEX allowed us to obtain a satisfactory assessment of the defect. In both patients, the post-operative evolution was favorable.

 


Keywords: Thoracic wall; Thoracic surgery, Video-assisted; Funnel chest.

 


Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia

Aplicação do Sarcoidosis Health Questionnaire em pacientes com sarcoidose na Sérvia

Violeta Mihailović-Vučinić1,2, Branislav Gvozdenović3, Mihailo Stjepanović2, Mira Vuković4, Ljiljana Marković-Denić5, Aleksandar Milovanović6, Jelica Videnović-Ivanov2, Vladimir Zugić1,2, Vesna Skodrić-Trifunović 1,2, Snezana Filipović2, Maja Omčikus2

J Bras Pneumol.2016;42(2):99-105

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

 


Keywords: Sarcoidosis; Health status; Validation studies; Questionnaires; Self report; Serbia.

 


Metered-dose inhaler technique learning after explanation given by pulmonologist

Aprendizado do uso do inalador dosimetrado após explicação por pneumologista

Alessandra Sandrini, Andréia Jacomossi, Sonia Maria Farensin, Ana Luisa Godoy Fernandes, José Roberto Jardim

J Bras Pneumol.2001;27(1):7-10

Abstract PDF PT

Introduction: The use of inhaled drugs through metered-dose inhaler has been advocated for years. Nonetheless, a small number of patients are routinely treated by this technique. Prescriptions of inhaled drugs by healthcare providers are not frequent, usually because they anticipate patients will not be able to perform the technique correctly. In addition, healthcare providers do not usually take their time to appropriately teach patients how to use metered-dose inhalers correctly. Objective: To evaluate the percentage of uninstructed patients that learn how to use a metered-dose inhaler correctly after being taught by a pneumologist. Patients and methods: One hundred and nineteen patients from a private clinic were prospectively studied in São Paulo, southeastern Brazil. Patients were exhaustively taught how to use the metered-dose inhaler at the first consultation and were told to return after 10 days, when they were asked to perform the technique exactly the way they were doing it at home. Their performance was classified as correct, slightly incorrect, intermediately incorrect, and totally incorrect. Results: Twenty-six patients were excluded for not coming to the second appointment. The final sample comprised 93 patients. Age ranged from 9 to 81 years (mean age 42.6 ± 21); 59.2% of the patients were male and 40.8% female. Considering all patients, only 16.25 of them used the metered-dose inhaler totally incorrectly and 19.3% performed the technique intermediately incorrectly. The most frequent mistakes were: metered-dose inhaler device was placed inside the mouth; inspiration before jet was activated; fast aspiration; inspiration through the nose. Thirty-three percent of patients who were under 15 and over 75 years performed the technique correctly. Conclusion: This study has demonstrated that the majority of the patients learned how to use the metered-dose inhaler correctly after being properly and extensively taught.

 


Keywords: Nebulizers and vaporizers. Inhalation administration. Learning.

 


Clinical presentation of cow milk allergy symptoms

Apresentação clínica da alergia ao leite de vaca com sintomatologia respiratória

Fábio Ferreira de Carvalho Junior

J Bras Pneumol.2001;27(1):17-24

Abstract PDF PT

Cow milk allergens are the first antigens children have contact with. The symptoms, which are frequently multi-systemic, may be related to the gastrointestinal tract, to the skin and, more rarely, to the respiratory tract. Objective: To describe some clinic and epidemiological characteristics of children who have cow milk allergy and present respiratory symptoms. Patients and method: This retrospective study included 17 children who presented respiratory problems immediately after ingesting cow milk, showed no symptoms as cow milk was excluded from their diets for a period of 4 to 6 weeks, and presented recurrent symptoms as cow milk was reintroduced into their diet in a hospital environment. Results: No difference was observed between genders. Family atopic antecedents were present in 14 of the 17 children. Mean exclusive breast-feeding period was 2.9 months and the onset of symptoms occurred at an average of 3.6 months. Eight of the ten tests conducted to evaluate immediate cutaneous hypersensitivity to cow milk were positive. Clinical manifestations observed were: wheezing infants (9), asthma (5), repetition otitis (2), selective IgA deficiency related to wheezing and allergic rhinoconjunctivitis (1). Conclusion: Regarding wheezing infants, cow milk allergy should be included as a differential diagnosis and exclusive breast-feeding should be stimulated in cases of atopic family antecedents. However, a precise diagnosis is vital to prevent unnecessary food deprivation.

 


Keywords: Milk hipersensitivity. Milk substitutes. Respiratory signs and symptoms. Respiratory diseases.

 


New perspectives in lung transplantation: from conventional preservation to ex vivo lung perfusion and lung reconditioning

As novas perspectivas do transplante de pulmão: da preservação convencional à perfusão pulmonar ex vivo com recondicionamento pulmonar

Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2009;35(11):1057-1059

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Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.

 


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.

 


Comparing asthma and chronic obstructive pulmonary disease in terms of symptoms of anxiety and depression

Asma e doença pulmonar obstrutiva crônica: uma comparação entre variáveis de ansiedade e depressão

Neide Suzane Carvalho, Priscila Robles Ribeiro, Marcos Ribeiro, Maria do Patrocínio Tenório Nunes, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2007;33(1):1-6

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the presence and severity of symptoms of anxiety and depression in individuals with asthma or chronic obstructive pulmonary disease. Methods: In order to evaluate symptoms of anxiety and depression, specific instruments of quantification (the State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively) were administered to patients at an outpatient clinic for the treatment of asthma and chronic obstructive pulmonary disease. The population comprised 189 randomly and prospectively selected patients that were divided into three study groups (each with a different therapeutic objective): 40 patients with controlled asthma, 100 patients with uncontrolled asthma, and 49 patients with chronic obstructive pulmonary disease. Included among the variables studied, as part of the methodology, were symptoms of anxiety and depression. The data obtained were compared taking into consideration demographic and functional aspects, as well as the severity of the symptoms of anxiety and depression. Results: Among the asthma patients, the prevalence of moderate or severe anxiety was significantly higher than that observed among those with chronic obstructive pulmonary disease (p <  0.001). The uncontrolled asthma group presented significantly higher rates of depressive symptoms than did the controlled asthma group (p < 0.05). Conclusion: The frequency of symptoms of anxiety and depression is greater among asthma patients than among patients with chronic obstructive pulmonary disease, which can make clinical control difficult.

 


Keywords: Anxiety; Depression; Asthma; Pulmonary disease; Chronic obstructive

 


Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil

Asma e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos no Sul do Brasil

Moema Nudilemon Chatkin, Ana Maria Baptista Menezes, Silvia Elaine Cardozo Macedo, Edgar Fiss

J Bras Pneumol.2008;34(10):-

Abstract PDF PT PDF EN Portuguese Text

Objective: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. Methods: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. Results: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. Conclusions: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

 


Keywords: Asthma; Respiratory function tests; Respiratory sounds; Signs and symptoms, respiratory.

 


Asthma and Churg-Strauss syndrome

Asma e síndrome de Churg-Strauss

Soloni Afra Pires Levy, Alfeu Tavares França, Denise de La Reza, Solange Oliveira Rodrigues Valle, Ana Helena Pereira Correia

J Bras Pneumol.2006;32(4):367-370

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 25-year-old woman with Churg-Strauss syndrome, the symptoms of which had first appeared soon after she began taking oral contraceptive at the age of sixteen. The clinical profile evolved rapidly to severe persistent asthma, nasal polyposis, perennial obstructive rhinitis, eosinophilia (peripheral/tissue) and mononeuritis. Churg-Strauss syndrome is the type of disease that demands early detection, accurate diagnosis, aggressive treatment and periodic monitoring. It should be considered in the differential diagnosis of moderate and severe persistent asthma. The case reported calls attention to possibility that there is a hormonal component and that the disease can present early onset.

 


Keywords: Asthma; Churg-Strauss syndrome; Eosinophilia; Nasal polyps; Vasculitis; Case reports [publication type]

 


Asthma in children under five years of age: problems in diagnosis and in inhaled corticosteroid treatment

Asma em menores de cinco anos: dificuldades no diagnóstico e na prescrição da corticoterapia inalatória

Maria Jussara Fernandes Fontes, Maria Teresa Mohallem Fonseca, Paulo Augusto Moreira Camargos, Alessandra Gazire Alves Affonso, Geralda Magela Costa Calazans

J Bras Pneumol.2005;31(3):244-253

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature, focusing on difficulties encountered in asthma diagnosis and in the establishment of initial inhaled corticosteroid treatment in children under five years of age. The search was limited to studies published between 1991 and 2002 in Portuguese, Spanish, or English and included in the LILACS and MEDLINE databases. Symptoms of asthma, the most common chronic childhood disease, typically appear in the first years of life. There are currently no diagnosis means of making a certain diagnosis of asthma in children under the age of five. Clinical manifestations, when present in toddlers and preschoolers, may require treatment such as that given for asthma, assuming that it is preceded by a critical evaluation. We can conclude that diagnosis of asthma in the first years of life is complex and predominantly clinical. Inhaled corticosteroid treatment is an effective tool, although its risks and benefits must be carefully evaluated.

 


Keywords: Asthma. Adrenal cortex hormones. Infant. Preschool.

 


Asma grave: uma questão de prescrição ou de diagnóstico?

Afrânio Kritski

J Bras Pneumol.2003;29(4):248-250

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Asthma, a chronic disease whose manifestations go beyond respiratory distress, physical limitation and impaired quality of life

Asma, uma doença crônica cujas manifestações vão além do desconforto respiratório, limitação física e redução da qualidade de vida

Ana Luisa Godoy Fernandes

J Bras Pneumol.2009;35(4):293-294

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Clinical aspects of pulmonary tuberculosis in elderly patients from a university hospital in Rio de Janeiro, Brazil

Aspectos clínicos da tuberculose pulmonar em idosos atendidos em hospital universitário do Rio de Janeiro, RJ, Brasil

João Paulo Cantalice Filho, Clemax Couto Sant`Anna, Márcio Neves Bóia

J Bras Pneumol.2007;33(6):699-706

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate clinical aspects and the diagnosis of pulmonary tuberculosis (PT) in the aged. Methods: We compared 117 patients over 60 years of age (elderly group) and 464 patients aged 15 to 49 years old (nonelderly group) treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, from 1980 to 1996. Results: Previous history of PT was predominant in the elderly group (OR = 2.09; 95% CI = 1.26-3.45; p = 0.002), whereas household contact with PT was predominant in the nonelderly group (OR = 0.26; 95% CI = 0.10-0.66; p = 0.002). Mean time for diagnosis was 90 days in the elderly group and 60 days in the nonelderly group. In the elderly group, dyspnea (OR = 1.64; 95% CI = 1.06-2.53; p = 0.018) and weight loss (OR = 1.66; 95% CI = 1.01-2.82; p = 0.047) were predominant. In the nonelderly group, hemoptysis (OR = 0.51; 95% CI = 0.32-0.81; p = 0.002), chest pain (OR = 0.62; 95% CI = 0.40-0.97; p = 0.027) and fever (OR = 0.55; 95% CI = 0.35-0.86; p = 0.006) were more common. The most common radiological abnormalities were infiltrates and cavitations. Bilateral involvement was more common in the elderly patients (OR = 1.76; 95% CI = 1.12-2.78; p = 0.009). There were no differences between the two groups regarding positivity for Mycobacterium tuberculosis identified through tuberculin skin testing, sputum smear microscopy and culture. Conclusions: There are few clinical and laboratory differences between the age groups. The delayed diagnosis in the elderly group can be explained by the low clinical suspicion in these patients.

 


Keywords: Tuberculosis, pulmonary; Aged; Signs and symptoms, respiratory; Diagnosis.

 


Clinical aspects in patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex, in the Brazilian Amazon

Aspectos clínicos em pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus na Amazônia brasileira

José Tadeu Colares Monteiro1, Karla Valéria Batista Lima2, Adriana Rodrigues Barretto3, Ismari Perini Furlaneto1,2, Glenda Moraes Gonçalves3, Ana Roberta Fusco da Costa2, Maria Luiza Lopes2, Margareth Pretti Dalcolmo4,5

J Bras Pneumol.2018;44(2):93-98

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical manifestations of patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC), and to compare these manifestations with those of patients infected with other nontuberculous mycobacteria (NTM). Methods: This was a retrospective cohort study involving 43 patients divided into two groups: the MABSC group, consisting of patients with pulmonary infection caused by MABSC (n = 17); and the NTM group, consisting of patients with pulmonary infection caused by NTM other than MABSC (n = 26). Patients were previously treated with a regimen of rifampin, isoniazid, pyrazinamide, and ethambutol before the diagnosis of NTM was confirmed by two culture-positive sputum samples. The nucleotide sequences of the hsp65, 16S rRNA, and/or rpoB genes were analyzed to identify the mycobacteria. Data were collected on demographic, clinical, and radiological characteristics, as well as on treatment responses and outcomes. Results: Loss of appetite was the only clinical manifestation that was significantly more common in the MABSC group than in the NTM group (p = 0.0306). The chance of having to use a second treatment regimen was almost 12 times higher in the MABSC group than in the NTM group. Treatment success was significantly higher in the NTM group than in the MABSC group (83.2% vs. 17.6%; p < 0.0001). The chance of recurrence was approximately 37 times higher in the MABSC group than in the NTM group. Conclusions: In the study sample, treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other NTM.

 


Keywords: Nontuberculous mycobacteria/classification; Nontuberculous mycobacteria/drug effects; Lung diseases.

 


Epidemiological aspects of human immunodeficiency virus/tuberculosis co-infection in Ribeirão Preto, Brazil from 1998 to 2003

Aspectos epidemiológicos da co-infecção tuberculose e vírus da imunodeficiência humana em Ribeirão Preto (SP), de 1998 a 2003

Jordana de Almeida Nogueira, Antônio Ruffino-Netto, Tereza Cristina Scatena Villa, Mellina Yamamura, Ricardo Arcencio, Roxana Isabel Cardozo-Gonzales

J Bras Pneumol.2006;32(6):529-534

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to characterize the epidemiological profile of tuberculosis cases reported in the city of Ribeirão Preto between 1998 and 2003, according to patient HIV status, gender, age bracket and treatment outcome. Methods: This was a descriptive epidemiological study that employed the Brazilian National Tuberculosis Notification Database as an instrument of data collection. The study sample consisted of all cases of human immunodeficiency virus/tuberculosis co-infection occurring in residents of Ribeirão Preto and reported between 1998 and 2003. Results: During this period, 1273 new cases of tuberculosis were reported, 377 of which were in HIV-positive individuals, for a co-infection rate of 30%. Of the cases of co-infection, 76% were in men, and the majority occurred in individuals in the 20-59 age bracket. In terms of treatment outcome, cure was achieved in 52%, treatment abandonment was reported in 11%, and death occurred in 32%. The predominant clinical form of tuberculosis was the pulmonary form, which accounted for 58% of the cases. Conclusion: A high prevalence of co-infection was observed in the community studied. The treatment outcomes seen among the cases in our study sample underscore the need to adopt special strategies to monitor this clientele. Comparing the cases of tuberculosis in isolation with the cases of co-infection, no gender-related or age-related differences were observed.

 


Keywords: Tuberculosis; HIV infections; Comorbidity

 


Epidemiological aspects of pleural tuberculosis in the state of São Paulo, Brazil (1998-2005)

Aspectos epidemiológicos da tuberculose pleural no estado de São Paulo (1998-2005)

Márcia Seiscento, Francisco Suso Vargas, Maria Josefa Penon Rujula, Sidney Bombarda, David Everson Uip, Vera Maria Nedes Galesi

J Bras Pneumol.2009;35(6):548-554

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the epidemiological characteristics of and trends regarding the incidence of pleural TB. Methods: This was a retrospective descriptive study of TB cases reported between 1998 and 2005 and compiled from the Epidemiological Surveillance Tuberculosis System (Epi-TB database). Results: A total of 144,347 new cases of TB were reported during the period studied. Pulmonary TB was the predominant form (118,575 cases; 82.2%). Among the extrapulmonary forms (25,773 cases; 17.8%), pleural TB was the form most often reported (12,545 cases; 48.7%). For all forms, the incidence (per 100,000 population) decreased (from 49.7 in 1998 to 44.6 in 2005; R2 = 0.898; p < 0.001), whereas the incidence of pleural TB remained stable (4.1 in 1998 and 3.8 in 2005; R2 = 0.433; p = 0.076). The highest incidence of pleural TB was found among males (2:1) aged from 30 to 59 years. Of the 12,545 patients with pleural TB, 4,018 (32.0%) presented comorbidities: alcoholism (9.5%); HIV (8.0%); diabetes (3.3%); and mental illness (1.2%). The diagnosis was based on bacteriological (14.2%) and histological (30.2%) methods, as well as on unspecified methods (55.6%). Conclusions: Pleural TB was the predominant extrapulmonary form of TB in the state of São Paulo, with a stable incidence between 1998 and 2005, although there was a trend toward a decrease in the incidence of the pulmonary forms. The diagnosis of pleural TB was confirmed through histology and bacteriology in 44.4% of the cases.

 


Keywords: Pleural effusion; Tuberculosis, pleural; HIV.

 


Epidemiological aspects of and risk factors for wheezing in the first year of life

Aspectos epidemiológicos e fatores de risco para sibilância no primeiro ano de vida

Hamilton Rosendo Fogaça, Fernando Augusto de Lima Marson, Adyléia Aparecida Dalbo Contrera Toro, Dirceu Solé, José Dirceu Ribeiro

J Bras Pneumol.2014;40(6):617-625

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine, in a sample of infants, the prevalence of and risk factors for occasional wheezing (OW) and recurrent wheezing-wheezy baby syndrome (WBS). Methods: Parents of infants (12-15 months of age) completed the International Study of Wheezing in Infants questionnaire. Results: We included 1,269 infants residing in the city of Blumenau, Brazil. Of those, 715 (56.34%) had a history of wheezing, which was more common among boys. The prevalences of OW and WBS were 27.03% (n = 343) and 29.31% (n = 372), respectively. On average, the first wheezing episode occurred at 5.55 ± 2.87 months of age. Among the 715 infants with a history of wheezing, the first episode occurred within the first six months of life in 479 (66.99%), and 372 (52.03%) had had three or more episodes. Factors associated with wheezing in general were pneumonia; oral corticosteroid use; a cold; attending daycare; having a parent with asthma or allergies; mother working outside the home; male gender; no breastfeeding; and mold. Factors associated with WBS were a cold; physician-diagnosed asthma; ER visits; corticosteroid use; pneumonia; bronchitis; dyspnea; attending daycare; bronchodilator use; having a parent with asthma; no breastfeeding; mother working outside the home; and a dog in the household. Conclusions: The prevalence of wheezing in the studied population was high (56.34%). The etiology was multifactorial, and the risk factors were intrinsic and extrinsic (respiratory tract infections, allergies, attending daycare, and early wheezing). The high prevalence and the intrinsic risk factors indicate the need and the opportunity for epidemiological and genetic studies in this population. In addition, mothers should be encouraged to prolong breastfeeding and to keep infants under six months of age out of daycare.

 


Keywords: Asthma; Prevalence; Risk factors.

 


Allergic bronchopulmonary aspergillosis presenting a glove-finger shadow in radiographic images

Aspergilose broncopulmonar alérgica com imagem radiológica em "dedo de luva"

Marta Elizabeth Kalil, Ana Luiza Godoy Fernandes, Aline Cristinane da Silva Curzel, Márcio Zamuner Cortez, Gláucia Cristina Godinho Alves Lima

J Bras Pneumol.2006;32(5):472-475

Abstract PDF PT PDF EN Portuguese Text

Allergic bronchopulmonary aspergillosis is a lung disease occurring in patients with asthma or cystic fibrosis, triggered by a hypersensitivity reaction to the presence of Aspergillus fumigatus in the airways. We report herein the case of a patient presenting a clinical profile suggestive of asthma and meeting the clinical, laboratory testing and radiological criteria for a diagnosis of allergic bronchopulmonary aspergillosis. The importance of such findings is that early diagnosis can reduce the risk of respiratory exacerbations and fibrosis.

 


Keywords: Asthma; Bronchiectasis; Aspergillus fumigatus; Aspergillosis, allergic bronchopulmonary

 


Chronic necrotizing pulmonary aspergillosis

Aspergilose pulmonar necrotizante crônica

Eduardo Felipe Barbosa Silva, Melânio de Paula Barbosa, Marco Antônio Alves de Oliveira, Rosane Rodrigues Martins, Jefferson Fontinele e Silva

J Bras Pneumol.2009;35(1):95-98

Abstract PDF PT PDF EN Portuguese Text

Chronic necrotizing pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. We report the case of a female patient with complaints of chronic productive cough, fever and asthenia. She reported previous corticosteroid use. Computed tomography of the chest revealed consolidation with interposed cavitation in the right upper lobe. Fiberoptic bronchoscopy revealed purulent fluid within the tracheobronchial tree and an endobronchial exophytic lesion. The results of the biopsy of that lesion and the transbronchial biopsy were consistent with aspergillosis. Based on the clinical, radiological and histopathological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis. Treated with itraconazole, the patient presented a favorable clinical-radiological evolution.

 


Keywords: Aspergillosis; Lung diseases, fungal; Itraconazole. Resumo

 


Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico

Andrea de Melo Alexandre Fraga, Marcelo Conrado dos Reis, Mariana Porto Zambon, Ivan Contrera Toro, José Dirceu Ribeiro, Emilio Carlos Elias Baracat

J Bras Pneumol.2008;34(2):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusion: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher the risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention programs aimed at children younger than 3 years of age.

 


Keywords: Foreign bodies; Bronchoscopy; Pediatrics.

 


Sequelae of foreign body aspiration in the respiratory tract of children

Aspiração de corpo estranho na árvore traqueobrônquica em crianças: avaliação de seqüelas através de exame cintilográfico

João Antônio Bonfadini Lima, Gilberto Bueno Fischer, José Carlos Felicetti, José Antônio Flores, Christina N. Penna, Eduardo Ludwig

J Bras Pneumol.2000;26(1):20-24

Abstract PDF PT

Objective: The aim of this study was to detect late sequelae of foreign body aspiration in the respiratory tract of children. Methods: This study included children admitted from 1987 to 1999 to Hospital da Criança Santo Antônio, of Porto Alegre, with clinical symptoms of foreign body aspiration to the respiratory tract confirmed by chest X-ray and bronchoscopy. Thirty days after the extraction of the foreign body a perfusion lung scan with technetium was performed. Results: 77% of the foreign bodies were organic materials. In 65% of children the aspiration event occurred at least 7 days before referral. The main location of foreign body was in the right lower lobe bronchus. Perfusion lung scans were performed in 24 patients. In 67% of them reduction in lung perfusion was detected. A chance of sequelae was 3.8 times greater in those patients who had the foreign body removed after 7 days from the aspiration event. Conclusion: This study showed that children that have had foreign body aspiration may have perfusion sequelae in their lungs even after removal of the foreign body. These sequelae were more frequent if the removal was delayed in 7 days of aspiration. Pediatricians must keep this in mind at the follow-up of children that have had foreign body aspiration.

 


Keywords: foreign bodies; aspiration; bronchi; prognosis

 


Foreign body aspiration in children and adolescents: experience of a Brazilian referral center

Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

Sílvia Teresa Evangelista Vidotto de Sousa, Valdinar Sousa Ribeiro, José Mário de Menezes Filho, Alcione Miranda dos Santos, Marco Antonio Barbieri, José Albuquerque de Figueiredo Neto

J Bras Pneumol.2009;35(7):653-659

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of São Luís, Brazil. Methods: This was a descriptive study using data from the medical charts of patients treated for foreign body aspiration at the Hospital Universitário Materno Infantil between 1995 and 2005. We investigated 72 confirmed cases of foreign body aspiration, evaluating the place of residence, as well as biological, clinical, radiological and endoscopic variables. We used the chi-square test to identify statistically significant differences in frequency among the variables studied. Results: The majority of the patients were from outlying areas (55.6%). The following variables presented the highest frequencies: 0-3 year age bracket (81.9%); male gender (63.9%); evolution > 24 h (66.7%); hypotransparency on chest X-ray (57.7%); foreign body in the right lung (41.2%) or in the larynx (20.5%); organic nature of the foreign body (83.3%); complication in the form of localized inflammation (59.4%); glottal edema as an endoscopic complication (47.6%); and seeds (46.6%), fish bone (28.3%) or plastics (25.5%) as the type of foreign body. There were no deaths. Conclusions: Preventive care should be a priority for male children under the age of 3 living in outlying areas. Such children should not be given access to substances that can be aspirated, including certain foodstuffs. Simple and easily accessible radiological tests have been underused, which jeopardizes the quality of the initial treatment.

 


Keywords: Foreign bodies; Inhalation; Bronchoscopy.

 


Patient-ventilator asynchrony

Assincronia paciente-ventilador

Marcelo Alcantara Holanda1,2,a, Renata dos Santos Vasconcelos2,b, Juliana Carvalho Ferreira3,c, Bruno Valle Pinheiro4,d

J Bras Pneumol.2018;44(4):321-333

Abstract PDF PT PDF EN Portuguese Text

Patient-ventilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.

 


Keywords: Respiration, artificial; Respiratory insufficiency; Interactive ventilatory support.

 


Patient-ventilator asynchrony. Ahead of print

Assincronia paciente-ventilador. Versão ahead of print

Marcelo Alcantara Holanda1,2,a, Renata dos Santos Vasconcelos2,b, Juliana Carvalho Ferreira3,c, Bruno Valle Pinheiro4,d

J Bras Pneumol.2018;44(4):339-339

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Postinfectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in childhood

Associação de bronquiolite obliterante pós-infecciosa e hemossiderose pulmonar na infância

Leonardo Araújo Pinto, Anick Oliveira, Sintia Collaziol, Paulo Márcio Pitrez, Marcus Jones, João Carlos Prolla, Marisa Dolhnikoff, Renato T. Stein

J Bras Pneumol.2006;32(6):587-591

Abstract PDF PT PDF EN Portuguese Text

In the present report, we describe an unusual presentation of post-infectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in a nine-year-old boy with persistent respiratory symptoms subsequent to an episode of acute bronchiolitis occurring at the age of seven months. After the episode, the persistent respiratory symptoms worsened significantly, and, by the age of seven, the patient began to have difficulty breathing after minimal exertion. Computed tomography of the chest presented findings consistent with bronchiolitis obliterans. Open lung biopsy revealed numerous hemosiderin-laden macrophages, as well as other findings consistent with bronchiolitis obliterans. Pulmonary hemosiderosis can occasionally be accompanied by bronchiolitis obliterans in children with severe sequelae after an episode of viral infection.

 


Keywords: Bronchoalveolar lavage; Bronchiolitis obliterans; Hemosiderosis; Case reports [Publication type]

 


Association of bronchogenic carcinoma with Pancoast's syndrome and acquired immunodeficiency syndrome

Associação de carcinoma broncogênico com síndrome de Pancoast e síndrome da imunodeficiência adquirida

A.C. Frohlich, D. Chiesa, M. Ronsani, L.A. Henn, S.S. Menna Barreto

J Bras Pneumol.2000;26(5):269-272

Abstract PDF PT

A case of a patient with Pancoast's syndrome associated with acquired immunodeficiency syndrome is reported. This association is rare and Kaposi's sarcoma and non-Hodgkin lymphoma are the most recurrent tumors in AIDS. The patient was an IV drug user and was admitted to the hospital for diagnosis of apex lung mass with signs of Pancoast's syndrome. HIV serology was positive and pathology of lung mass showed non-small cell lung cancer.

 


Keywords: Pancoast's syndrome. HIV. Bronchogenic carcinoma. Lung neoplasms. Acquired immunodeficiency syndrome.

 


Silicosis associated with systemic lupus erythematosus

Associação de silicose e lúpus eritematoso sistêmico

Shirley Castro Holanda, Maria do Socorro T.M. Almeida, Antônio de Deus Filho

J Bras Pneumol.2003;29(4):221-224

Abstract PDF PT

The hypothesis that exposure to silica might be associated with a wide range of autoimmune diseases including SLE (systemic lupus erythematosus) has been discussed over the last decade, but only few cases of silicosis and SLE were described in the literature. The authors report the case of a male patient in his fifth decade of life, with previous exposure to silica, who worked as a well digger for ten years. The patient's clinical picture started with articular symptoms, sporadic peaks of fever, anemia, positive antinuclear factor, peripheral (1/10) and homogeneous (1/500) standard, and productive cough. Computed tomography of the chest showed a diffuse interstitial process, bilateral nodules, para-aortic and para-tracheal hilar calcifications, compatible with pulmonary and ganglial silicosis. He developed acute respiratory distress syndrome (ARDS) and died.

 


Keywords: Systemic lupus erythematosus. Silicosis. Autoimmune diseases.

 


Association between the display of cigarette packs at the point of sale and smoking susceptibility among adolescents in Brazil

Associação entre a exposição a maços de cigarros em pontos de venda e susceptibilidade ao tabagismo entre adolescentes brasileiros

Ana Luiza Curi Hallal1, Andreza Madeira Macario1, Roberto Hess de Souza2, Antônio Fernando Boing1, Lúcio Botelho1, Joanna Cohen3

J Bras Pneumol.2018;44(1):49-51

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This was a cross-sectional study aimed at determining the association between exposure to tobacco displays at the point of sale and susceptibility to smoking in schoolchildren in the 14- to 17-year age bracket. Of the participating students, 69.0%, 21.3%, and 9.7% were classified as never smokers, experimenters, and smokers, respectively. Of the participants who were classified as being exposed to smoking, 18.9% were susceptible to smoking. Of the participants who were classified as being unexposed to smoking, 12.9% were susceptible to smoking (OR = 1.56; 95% CI: 1.04 -2.35; p = 0.029). Exposure to point-of-sale tobacco displays is associated with smoking susceptibility in Brazilian adolescents.

 



Correlation of lung function and respiratory muscle strength with functional exercise capacity in obese individuals with obstructive sleep apnea syndrome

Associação entre função pulmonar, força muscular respiratória e capacidade funcional de exercício em indivíduos obesos com síndrome da apneia obstrutiva do sono

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.2018;44(4):279-284

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate lung function and inspiratory muscle strength, correlating them with exercise tolerance, in obese individuals with obstructive sleep apnea syndrome (OSAS). Methods: The sample comprised 31 adult subjects with moderate-to-severe OSAS diagnosed by polysomnography. We used spirometry to measure FVC, FEV1, and FVC/FEV1 ratio, using pressure manometry to measure MIP and MEP. The incremental shuttle walk test (ISWT) and the six-minute walk test (6MWT) were used in order to determine functional exercise capacity. Results: In this sample, the mean values for FVC (% of predicted), FEV1 (% of predicted): MIP, and MEP were 76.4 ± 12.3%, 80.1 ± 6.3%, 60.0 ± 21.9 cmH2O, and 81.3 ± 22.2 cmH2O, respectively. The mean distances covered on the ISWT and 6MWT were 221 ± 97 m and 480.8 ± 67.3 m, respectively. The ISWT distance showed moderate positive correlations with FVC (r = 0.658; p = 0.001) and FEV1 (r = 0.522; p = 0.003). Conclusions: In this sample of obese subjects with untreated OSAS, lung function, inspiratory muscle strength, and exercise tolerance were all below normal. In addition, we found that a decline in lung function, but not in respiratory muscle strength, was associated with exercise tolerance in these patients.

 


Keywords: Sleep apnea syndromes; Exercise tolerance; Respiratory function tests; Respiratory muscles.

 


Association between physical activity in daily life and pulmonary function in adult smokers

Associação entre o nível de atividade física na vida diária e a função pulmonar em tabagistas adultos

Miriane Lilian Barboza1, Alan Carlos Brisola Barbosa1, Giovanna Domingues Spina1, Evandro Fornias Sperandio1, Rodolfo Leite Arantes2, Antonio Ricardo de Toledo Gagliardi2, Marcello Romiti2, Victor Zuniga Dourado1

J Bras Pneumol.2016;42(2):130-135

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the level of physical activity in daily life (PADL) is associated with pulmonary function in adult smokers. Methods: We selected 62 adult smokers from among the participants of an epidemiological study conducted in the city of Santos, Brazil. The subjects underwent forced spirometry for pulmonary function assessment. The level of PADL was assessed by the International Physical Activity Questionnaire and triaxial accelerometry, the device being used for seven days. The minimum level of PADL, in terms of quantity and intensity, was defined as 150 min/week of moderate to vigorous physical activity. Correlations between the studied variables were tested with Pearson's or Spearman's correlation coefficient, depending on the distribution of the variables. We used linear multiple regression in order to analyze the influence of PADL on the spirometric variables. The level of significance was set at 5%. Results: Evaluating all predictors, corrected for confounding factors, and using pulmonary function data as outcome variables, we found no significant associations between physical inactivity, as determined by accelerometry, and spirometric indices. The values for FVC were lower among the participants with arterial hypertension, and FEV1/FVC ratios were lower among those with diabetes mellitus. Obese participants and those with dyslipidemia presented with lower values for FVC and FEV1. Conclusions: Our results suggest that there is no consistent association between physical inactivity and pulmonary function in adult smokers. Smoking history should be given special attention in COPD prevention strategies, as should cardiovascular and metabolic comorbidities.

 


Keywords: Smoking; Respiratory function tests; Motor activity; Accelerometry.

 


Association of MBL2, TGF-&#946;1 and CD14 gene polymorphisms with lung disease severity in cystic fibrosis

Associação entre os polimorfismos dos genes MBL2, TGF-β1 e CD14 com a gravidade da doença pulmonar na fibrose cística

Elisangela Jacinto de Faria, Isabel Cristina Jacinto de Faria, José Dirceu Ribeiro, Antônio Fernando Ribeiro, Gabriel Hessel, Carmen Sílvia Bertuzzo

J Bras Pneumol.2009;35(4):334-342

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify associations between genetic polymorphisms (in the MBL2, TGF-β1 and CD14 genes) and the severity of the lung disease in patients with cystic fibrosis (CF), as well as between the presence of ΔF508 alleles and lung disease severity in such patients. Methods: This was a cross-sectional cohort study, based on clinical and laboratory data, involving 105 patients with CF treated at a university hospital in the 2005-2006 period. We included 202 healthy blood donors as controls for the determination of TGF-β1 and CD14 gene polymorphisms. Polymorphisms in the MBL2 and TGF-β1 genes at codon 10, position +869, were genotyped using the allele-specific PCR technique. The C-159T polymorphism in the CD14 gene was genotyped using PCR and enzymatic digestion. Results: Of the 105 CF patients evaluated, 67 presented with severe lung disease according to the Shwachman score. The MBL2 gene polymorphisms were not associated with disease severity in the CF patients. Analysis of the T869C polymorphism in the TGF-β1 gene showed an association only between TC heterozygotes and mild pulmonary disease. Although patients presenting the TT genotype of the C159T polymorphism in the CD14 gene predominated, there was no significant difference regarding lung disease severity. Conclusions: There was an association between the TC genotype of the T869C polymorphism (TGF-β1) and mild pulmonary disease in CF patients. In the CD14 gene, the TT genotype seems to be a risk factor for pulmonary disease but is not a modulator of severity. We found no association between being a ΔF508 homozygote and presenting severe lung disease.

 


Keywords: Cystic fibrosis; Polymorphism, genetic; Severity of illness index; Mannose-binding lectin; Transforming growth factor beta.

 


Association between paracoccidioidomycosis and cancer

Associação entre paracoccidioidomicose e câncer

Gustavo da Silva Rodrigues, Cecília Bittencourt Severo, Flávio de Mattos Oliveira, José da Silva Moreira, João Carlos Prolla, Luiz Carlos Severo

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the association between paracoccidioidomycosis (Pcm) and cancer in a series of 25 cases and to review the literature on this topic. Methods: A retrospective review of 25 cases diagnosed with Pcm and cancer, retrieved from a series of 808 consecutive adult patients diagnosed with Pcm based on tests conducted in the Mycology Laboratory of the Santa Casa Complexo Hospitalar, in the city of Porto Alegre, Brazil, between 1972 and 2007. The diagnosis of Pcm was confirmed by means of direct microscopic examination, histopathological examination or immunodiffusion test. All cancer cases were confirmed by histopathological or cytopathological examination. Results: Respiratory symptoms were the principal complaints of the patients evaluated. Pulmonary involvement predominated, followed by skin and lymph node involvement. The most prevalent tumor was bronchial carcinoma, in 15 patients, followed by other types of carcinoma, and 1 patient had Hodgkin's lymphoma. In 16 patients (64%), the site of the Pcm was the same as that of the tumor. In most cases, Pcm treatment consisted of the isolated administration of sulfanilamide, sulfamethoxazole-trimethoprim, ketoconazole, itraconazole or amphotericin B. The most common treatment for cancer was surgery, followed by radiotherapy and chemotherapy. Of the 25 patients, 12 were cured of Pcm, and 4 died. In 9 patients, the final outcome was unknown. In the general population of the area under study, the prevalence of lung cancer was significantly higher in smokers with Pcm than in smokers without Pcm (p < 0.001). Conclusions: A diagnosis of Pcm appears to increase the risk of lung cancer.

 


Keywords: Paracoccidioides; Paracoccidioidomycosis; Neoplasms.

 


Association between serum selenium level and conversion of bacteriological tests during antitu-berculosis treatment

Associações entre níveis de selênio sérico e conversão de testes bacteriológicos durante o tratamento antituberculose

Milena Lima de Moraes, Daniela Maria de Paula Ramalho, Karina Neves Delogo, Pryscila Fernandes Campino Miranda, Eliene Denites Duarte Mesquita, Hedi Marinho de Melo Guedes de Oliveira, Antônio Ruffino-Netto, Paulo César de Almeida, Rachel Ann Hauser-Davis, Reinaldo Calixto Campos, Afrânio Lineu Kritski, Martha Maria de Oliveira

J Bras Pneumol.2014;40(3):269-278

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Objective: To determine whether serum selenium levels are associated with the conversion of bacteriological tests in patients diagnosed with active pulmonary tuberculosis after eight weeks of standard treatment. Methods: We evaluated 35 healthy male controls and 35 male patients with pulmonary tuberculosis, the latter being evaluated at baseline, as well as at 30 and 60 days of antituberculosis treatment. For all participants, we measured anthropometric indices, as well as determining serum levels of albumin, C-reactive protein (CRP) and selenium. Because there are no reference values for the Brazilian population, we used the median of the serum selenium level of the controls as the cut-off point. At 30 and 60 days of antituberculosis treatment, we repeated the biochemical tests, as well as collecting sputum for smear microscopy and culture from the patients. Results: The mean age of the patients was 38.4  11.4 years. Of the 35 patients, 25 (71%) described themselves as alcoholic; 20 (57.0%) were smokers; and 21 (60.0%) and 32 (91.4%) presented with muscle mass depletion as determined by measuring the triceps skinfold thickness and arm muscle area, respectively. Of 24 patients, 12 (39.2%) were classified as moderately or severely emaciated, and 15 (62.5%) had lost > 10% of their body weight by six months before diagnosis. At baseline, the tuberculosis group had lower serum selenium levels than did the control group. The conversion of bacteriological tests was associated with the CRP/albumin ratio and serum selenium levels 60 days after treatment initiation. Conclusions: Higher serum selenium levels after 60 days of treatment were associated with the conversion of bacteriological tests in pulmonary tuberculosis patients.

 


Keywords: Selenium; Nutritional status; Tuberculosis; Immunity.

 


Pharmaceutical care for patients with persistent asthma: assessment of treatment compliance and use of inhaled medications

Atenção farmacêutica ao portador de asma persistente: avaliação da aderência ao tratamento e da técnica de utilização dos medicamentos inalatórios

Daiane de Oliveira Santos, Maria Cleusa Martins, Sonia Lucena Cipriano, Regina Maria Carvalho Pinto, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2010;36(1):14-22

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate treatment compliance and use of inhaled medications of patients with asthma receiving complementary pharmaceutical care. Methods: A controlled prospective parallel study involving a study group and a control group. We selected 60 patients with persistent asthma and using metered-dose inhalers (MDIs), dry powder inhalers (DPIs) or both. The patients were evaluated three times over 60 days. Instructions were provided to the patients in the study group at all visits but only at the first visit to those in the control group. The patients using < 80% or > 120% of the total number of prescribed doses were classified as noncompliant. The inhalation technique was quantified by a scoring system. A satisfactory technique was defined as a score higher than 7 (maximum, 9) for MDIs and higher than 4 (maximum, 5) for DPIs. Results: The final study sample comprised 28 study group patients and 27 control group patients, of whom 18 (64.3%) and 20 (74.7%), respectively, were considered treatment compliant. From the first to the third visits, there were increases, in the study and control groups, in the median MDI-use score (from 3 [range, 0-5] to 8 [range, 8-9]; p < 0.001; and from 5 [range, 2-6] to 7 [range, 6-8]), as well as in the median DPI-use score (from 3 [range, 2-4] to 5 [range, 4-5] and from 3 [range, 2-4] to 4 [range, 3-5]). Conclusions: The counseling provided by the pharmacist to the patient was important to assist in the implementation of the appropriate inhalation technique, especially for MDI use.

 


Keywords: Asthma; Pharmaceutical services; Administration, inhalation;Metered dose inhalers; Medication adherence.

 


Meeting the assumptions of statistical tests: an important and often forgotten step to reporting valid results

Atender as premissas dos testes estatísticos: um passo importante e muitas vezes negligenciado na comunicação de resultados válidos

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

J Bras Pneumol.2018;44(5):353-353

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Physical therapy in the immediate postoperative period after abdominal surgery

Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

Luiz Alberto Forgiarini Junior, Alexandra Torres de Carvalho, Tatiane de Souza Ferreira, Mariane Borba Monteiro, Adriane Dal Bosco, Marisa Pereira Gonçalves, Alexandre Simões Dias

J Bras Pneumol.2009;35(5):455-459

Abstract PDF PT PDF EN Portuguese Text

A series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.

 


Keywords: Physical therapy (specialty); Postoperative period; Surgery/abdomen.

 


Congenital bronchial atresia: report of two cases. Contribution of CT scan to diagnosis

Atresia brônquica congênita: relato de dois casos. Contribuição da tomografia computadorizada ao diagnóstico

Alecsandra Calil Moyses Faure, Ana Paula Andrade Barreto, Carlos Alberto de Castro Pereira, Clystenes Odyr Soares Silva

J Bras Pneumol.2000;26(3):142-144

Abstract PDF PT

Bronchial atresia is a rare, congenital anomaly characterized by the presence of bronchocele with distal hyperinflation. The authors report two cases of segmental bronchial atresia and describe the clinical and roentgenographic findings supporting the diagnosis in the absence of other invasive diagnostic modalities or surgical exploration.

 


Keywords: pulmonary atresia; bronchi; X-ray computed tomography

 


Treatment of antineutrophil cytoplasmic antibody-associated vasculitis: update

Atualização do tratamento das vasculites associadas a anticorpo anticitoplasma de neutrófilos

Alfredo Nicodemos Cruz Santana, Viktoria Woronik, Ari Stiel Radu Halpern, Carmen S V Barbas

J Bras Pneumol.2011;37(6):809-816

Abstract PDF PT PDF EN Portuguese Text

In its various forms, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is characterized by a systemic inflammation of the small and medium-sized arteries (especially in the upper and lower respiratory tracts, as well as in the kidneys). The forms of AAV comprise Wegener's granulomatosis (now called granulomatosis with polyangiitis), microscopic polyangiitis, renal AAV, and Churg-Strauss syndrome. In this paper, we discuss the phases of AAV treatment, including the induction phase (with cyclophosphamide or rituximab) and the maintenance phase (with azathioprine, methotrexate, or rituximab). We also discuss how to handle patients who are refractory to cyclophosphamide.

 


Keywords: Anti-neutrophil cytoplasmic antibody-associated vasculitis; Wegener granulomatosis; Antibodies, antineutrophil cytoplasmic.

 


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-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.

 


Control measures to trace &#8804; 15-year-old contacts of index cases of active pulmonary tuberculosis

Atualização no diagnóstico e tratamento da fibrose pulmonar idiopática

José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6

J Bras Pneumol.2015;41(5):454-466

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Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.

 


Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Idiopathic pulmonary fibrosis/rehabilitation.

 


Environmental assessment of an asthma education program: Relationship between airborne fungi and IgE levels in children and adults

Avaliação ambiental de um programa de educação em asma: Relação dos fungos do ar e os níveis de IgE em crianças e adultos

Geusa Felipa de Barros Bezerra, Maria do Desterro Soares, Maria do Rosário da Silva Ramos Costa, Graça Maria de Castro Viana, Marcos Davi Gomes de Sousa

J Bras Pneumol.2011;37(2):281-282

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Audiometric evaluation of patients treated for pulmonary tuberculosis

Avaliação audiométrica de pacientes em tratamento para tuberculose pulmonar

Karla Anacleto de Vasconcelos, Afrânio Lineu Kritski, Antonio Ruffino-Netto, Silvana Frota, Marco Antonio de M Tavares de Lima

J Bras Pneumol.2012;38(1):81-87

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Objective: To evaluate the hearing status of patients being treated for pulmonary tuberculosis at referral hospitals in Brazil. Methods: This was a descriptive study involving 97 male and female inpatients/outpatients between 18 and 60 years of age who were undergoing treatment for active pulmonary tuberculosis at one of two referral hospitals in the state of Rio de Janeiro. After being interviewed, all of the patients underwent pure tone audiometry. Results: Of the 97 patients studied, 65 (67%) were male, 52 (54%) were receiving first-line treatment, and 45 (46%) were receiving second-line treatment, which included aminoglycosides. Smoking, alcohol consumption, exposure to noise, and ototoxic medication use were identified in 65 (67%), 51 (53%), 53 (55%), and 45 (46.4%) of the patients, respectively. The most common auditory and vestibular complaints were dizziness, in 28 patients (28.8%); tinnitus, in 27 (27.8%); and hypoacusis, in 23 (23.7%). Conclusions: Due to the great number of patients with hearing loss in the present study, we recommend that all patients with active pulmonary tuberculosis be submitted to auditory monitoring.

 


Keywords: Audiometry; Hearing loss; Tuberculosis; Drug toxicity.

 


Clinical, functional, and cytological evaluation of sputum in postinfectious bronchiolitis obliterans: a possible overlap with asthma?

Avaliação clínica, funcional e da citologia de escarro em bronquiolite obliterante pós-infecciosa: é possível a coexistência com asma?

Sarah Angélica Maia1,a, Denise Eli2,b, Roberta Cunha2,c, Elessandra Bitencourt2,d, Carlos Antônio Riedi1,e, Herberto José Chong Neto1,f, Débora Carla Chong e Silva1,g, Nelson Augusto Rosário Filho1,h

J Bras Pneumol.2019;45(5):e20190060-e20190060

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Clinical, nutritional and spirometric evaluation of patients with cystic fibrosis after the implementation of multidisciplinary treatment

Avaliação clínica, nutricional e espirométrica de pacientes com fibrose cística após implantação de atendimento multidisciplinar

Lídia Torres, Jenny Libeth Jurado Hernandez, Giseli Barbiero de Almeida, Liana Barbaresco Gomide, Valéria Ambrósio, Maria Inez Machado Fernandes

J Bras Pneumol.2010;36(6):731-737

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Objective: Cystic fibrosis (CF) is a chronic multisystemic hereditary disease for which a multidisciplinary approach must be taken. The objective of this study was to show the evolution of a group of patients with CF after the implementation of multidisciplinary treatment. Methods: A retrospective study involving 19 patients (6-29 years of age) under clinical follow-up treatment at the University of São Paulo at Ribeirão Preto School of Medicine Hospital das Clínicas, located in the city of Ribeirão Preto, Brazil. The patients were divided into two groups: 6-12(6-12 years of age) and 13+ (> 12 years of age). We collected data regarding body mass index (BMI), Zscore, Shwachman score (SS), number of exacerbations/year, chronic colonization by Pseudomonas aeruginosa, and spirometric measurements (FVC, FEV1, FEV1%, and FEF25-75%). Data were collected at two different time points (before and after the implementation of the multidisciplinary treatment) and were analyzed with the Wilcoxon signed rank test. Results: The median age at the onset of symptoms was 10 months. In the 6-12 group, only BMI and FVC increased significantly. Although the other spirometric values increased, the differences were not significant. In the 13+ group, there were no significant differences between the two time points. There was a borderline significant decrease in SS and less than significant decreases in the spirometric measurements. However, the number of patients with alterations in volumes and flows decreased in both groups. Conclusions: Although our patient sample was small, the lack of changes in the spirometric parameters might reflect clinical and functional stability. In all of the patients evaluated, clinical, functional, and nutritional parameters remained stable throughout the study period. The implementation of a multidisciplinary approach might have contributed to this result.

 


Keywords: Cystic fibrosis; Spirometry; Body mass index; Physical therapy modalities.

 


Computer-assisted evaluation of pulmonary emphysema in CT scans: comparison between a locally developed system and a freeware system

Avaliação computacional de enfisema pulmonar em TC: comparação entre um sistema desenvolvido localmente e um sistema de uso livre

John Hebert da Silva Felix, Paulo César Cortez, Rodrigo Carvalho Sousa Costa, Simone Castelo Branco Fortaleza, Eanes Delgado Barros Pereira, Marcelo Alcantara Holanda

J Bras Pneumol.2009;35(9):868-876

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Objective: To present a locally developed system of computer vision for use with HRCT images, designated SIStema para a Detecção e a quantificação de Enfisema Pulmonar (SISDEP, System to Detect and Quantify Pulmonary Emphysema), and to compare this system with a freeware system tool. Methods: Thirty-three HRCT images scanned at the apex, hilum and base of the lungs of 11 patients with COPD were analyzed. The SISDEP was compared with the Osiris Medical Imaging Software Program regarding lung parenchyma segmentation, precision of the measurement of the cross-sectional area of the lungs in mm2, mean lung density (MLD), relative area (RA) of the lung occupied by voxels with attenuation values < −950 Hounsfield units (RA −950), 15th percentile point (Perc15) and visualization of hyperinflated areas using a color mask. Results: Although both computational systems were efficient in segmenting the lungs, the SISDEP performed this task automatically and more rapidly. There were significant correlations between the two systems in terms of the results obtained for lung cross-sectional area, MLD, RA −950 and Perc15 (r2 = 0.99, 0.99, 0.99 and 1.00, respectively). The color mask tool of the SISDEP allowed excellent visualization of hyperinflated areas, discriminating them from normal areas. Conclusions: The SISDEP was efficient in segmenting the lungs and quantifying lung hyperinflation, presenting an excellent correlation with the Osiris system. The SISDEP constitutes a promising computational tool for diagnosing and assessing the progression of emphysema in HRCT images of COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; Emphysema; Tomography, X-ray computed; Decision making, computer-assisted.

 


Critical appraisal of the literature. Why do we care?

Avaliação crítica da literatura. Por que nos importamos?

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

J Bras Pneumol.2018;44(6):448-448

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Evaluation of the treatment provided to patients with asthma by the Brazilian Unified Health Care System

Avaliação da assistência ao paciente asmático no Sistema Único de Saúde

Carla Discacciati Silveira, Flávia de Barros Araújo, Luiz Fernando Ferreira Pereira, Ricardo de Amorim Corrêa

J Bras Pneumol.2009;35(7):628-634

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Objective: To determine, based on international guidelines for asthma management, the appropriateness of the treatment that the Unified Health Care System provides to patients with asthma. Methods: This was a cross-sectional study involving patients suspected of having asthma and referred to the Pulmonology Clinic of the Federal University of Minas Gerais Hospital das Clínicas, Brazil, between November of 2006 and October of 2007. Results: A total of 102 patients were included, and 70 were diagnosed with asthma. The previous treatment was consistent with the guidelines in 18.6% of the patients; 50.0% of the patients had previously been submitted to spirometry, and 34.3% had previously been submitted to PEF. The most frequently prescribed medication was short-acting β2 agonists (90.3%). Conclusions: The results show that the majority of non-specialized physicians working within the public health care system do not manage the treatment of patients with asthma in accordance with the guidelines. This situation calls for continuing medical education programs that prioritize primary care.

 


Keywords: Asthma; Guideline adherence; Therapeutics; Public health.

 


Evaluating physical capacity in patients with chronic obstructive pulmonary disease: comparing the shuttle walk test with the encouraged 6-minute walk test

Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento

Fernanda Warken Rosa, Aquiles Camelier, Anamaria Mayer, José Roberto Jardim

J Bras Pneumol.2006;32(2):106-113

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Objective: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. Methods: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. Results: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). Conclusion: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise test; Motor activity; Reproducibility of results;

 


Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test

Avaliação da capacidade funcional: equações de referência para o teste Glittre Activities of Daily Living

Cardine Martins dos Reis1,2,a, Manuela Karloh1,3,b, Fernanda Rodrigues Fonseca1,2,c, Roberta Rodolfo Mazzali Biscaro1,2,d, Giovana Zarpellon Mazo4,5,e, Anamaria Fleig Mayer1,2,3,5,f

J Bras Pneumol.2018;44(5):370-377

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Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

 


Keywords: Activities of daily living; Exercise test; Reference values.

 


Evaluation of the exhaled carbon monoxide levels in smokers with COPD

Avaliação da concentração de monóxido de carbono no ar exalado em tabagistas com DPOC

Gustavo Chatkin, José Miguel Chatkin, Gabriel Aued, Guilherme Oliveira Petersen, Edna Thais Jeremias, Flávia Valladão Thiesen

J Bras Pneumol.2010;36(3):-

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Objective: To measure exhaled carbon monoxide (COex) levels in smokers with and without COPD. Methods: Smokers treated at outpatient clinics of São Lucas Hospital in the city of Porto Alegre, Brazil, between September of 2007 and March of 2009 were invited to participate in this study. The participants completed a questionnaire regarding demographic and epidemiologic characteristics and were submitted to spirometry, as well as to determination of COex and urinary cotinine levels. The participants were divided into two groups: those with COPD and those without COPD. Results: The study involved 294 smokers, of whom 174 (59.18%) had been diagnosed with COPD. All of the participants presented with urinary cotinine levels > 50 ng/mL. Smokers with COPD presented significantly higher median values for age and pack-years than did those without COPD (p < 0.001 and p = 0.026, respectively). No other statistically significant differences were found. When adjusted for gender, age at smoking onset, number of cigarettes/day and urinary cotinine level, the mean values of COex were higher, but not statistically so, in the COPD group than in the non-COPD group (17.8 ± 0.6 ppm and 16.6 ± 0.7 ppm, respectively; p = 0.200). The differences remained nonsignificant when plotted logarithmically. A wide dispersion of COex values was found when the participants were classified by FEV1 level (r = −0.06; p = 0.53) or by Global Initiative for Chronic Obstructive Lung Disease classification (r = 0.08; p = 0.34). The proportions of false-negative results for smoking were 18.4% and 6.7%, respectively, in the COPD and non-COPD groups (p = 0.007). Conclusions: Since COex values did not differ significantly between smokers with COPD and those without, there seem to be no major contraindications to their use in smokers with COPD.

 


Keywords: Carbon monoxide; Smoking cessation; Pulmonary disease, chronic obstructive.

 


Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal® versus Miflasona Aerolizer®

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma : Pulvinal versus Aeroliser.

Jussara Fiterman, Waldo Mattos, Alberto Cukier, Márcia Pizzichinni, Rodnei Frare e Silva, Fabiane Kahan, José Roberto Jardim, Armando Brancatelli

J Bras Pneumol.2004;30(5):413-418

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Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal versus Miflasona Aerolizer Background: Approximately half of all asthmatic patients adhere to their prescribed treatment regimen, which makes noncompliance with treatment one of the main problems associated with the disease. It is possible that inhalation devices combining technological advances with comfort and simplicity of use could increase treatment compliance. Objective: To compare the acceptability of and preference for two inhalation devices (Pulvinal and Aerolizer), as well as to evaluate the efficacy of and tolerance for beclomethasone dipropionate when delivered by these two systems. Method: A multicenter, randomized, crossover parallel study was carried out involving 83 patients with stable asthma. Patients received 500-1000 g/day of beclomethasone dipropionate. After a 2-week run in, the patients were randomized to begin a 4-week crossover treatment period with equivalent doses of Clenil Pulvinal (CP) or Miflasona Aerolizer (MA). Results: Both groups showed improvement in dyspnea and FEV1, and acceptability was considered good or excellent in both groups. Of the patients studied, 50.6% preferred CP, and 39% preferred MA. In their future treatment regimes, 54.5% would choose the CP and 37.7% the MA. Conclusion: Clinical efficacy and acceptability were comparable between CP and MA.

 


Keywords: Asthma/therapy. Beclomethasone/ administration & dosage. Randomized controlled trials. Treatment Outcome.

 


Evaluation of the efficacy and safety of a fixed-dose, single-capsule budesonide-formoterol combination in uncontrolled asthma: a randomized, double-blind, multicenter, controlled clinical trial

Avaliação da eficácia e segurança da associação de budesonida e formoterol em dose fixa e cápsula única no tratamento de asma não controlada: ensaio clínico randomizado, duplo-cego, multicêntrico e controlado

Roberto Stirbulov, Carlos Cezar Fritscher, Emilio Pizzichini, Márcia Margaret Menezes Pizzichini

J Bras Pneumol.2012;38(4):431-437

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Objective: To evaluate the efficacy and safety of a fixed-dose, single-capsule budesonide-formoterol combination, in comparison with budesonide alone, in patients with uncontrolled asthma. Methods: This was a randomized, double-blind, multicenter, phase III, parallel clinical trial, comparing the short-term efficacy and safety of the combination of budesonide (400 μg) and formoterol (12 μg), with those of budesonide alone (400 μg), both delivered via a dry powder inhaler, in 181 patients with uncontrolled asthma. The age of the patients ranged from 18 to 77 years. After a run-in period of 4 weeks, during which all of the patients received budesonide twice a day, they were randomized into one of the treatment groups. The treatment consisted of the administration of the medications twice a day for 12 weeks. The primary outcome measures were FEV1, FVC, and morning PEF. We performed an intention-to-treat analysis of the data. Results: In comparison with the budesonide-only group patients, those treated with the budesonide-formoterol combination showed a significant improvement in FEV1 (0.12 L vs. 0.02 L; p  =   0.0129) and morning PEF (30.2 L/min vs. 6.3 L/min; p  = 0.0004). These effects were accompanied by good tolerability and safety, as demonstrated by the low frequency of adverse events, only minor adverse events having occurred. Conclusions: The single-capsule combination of budesonide-formoterol appears to be efficacious and safe. Our results indicate that this formulation is a valid therapeutic option for obtaining and maintaining asthma control. (ClinicalTrials.gov Identifier: NCT01676987 [http://www.clinicaltrials.gov/])

 


Keywords: Asthma; Budesonide; Adrenergic beta-2 receptor agonists.

 


Assessment of fatigue using the Identity-Consequence Fatigue Scale in patients with lung cancer

Avaliação da fadiga utilizando a Escala de Identificação e Consequências da Fadiga em pacientes com câncer de pulmão

Ingrid Correia Nogueira1,2, Amanda Souza Araújo1,2, Maria Tereza Morano1,2,3, Antonio George Cavalcante1, Pedro Felipe de Bruin1, Johana Susan Paddison4, Guilherme Pinheiro da Silva1,3, Eanes Delgado Pereira1,2

J Bras Pneumol.2017;43(3):169-175

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. Methods: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. Results: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. Conclusions: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue.

 


Keywords: Fatigue; Lung neoplasms; Symptom assessment.

 


Assessment of pulmonary function and quality of life in patients submitted to pulmonary resection for cancer

Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia

Luciana Nunes Titton Lima, Rodrigo Afonso da Silva, Jefferson Luiz Gross, Daniel Deheinzelin, Elnara Márcia Negri

J Bras Pneumol.2009;35(6):521-528

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Objective: To evaluate the effects that pulmonary resection has on pulmonary function and quality of life (QoL) in patients with primary or metastatic lung cancer. Methods: This was a prospective cohort study involving all patients submitted to pulmonary resection for cancer between September of 2006 and March of 2007 at the A. C. Camargo Hospital in São Paulo, Brazil. Patients underwent spirometry in the preoperative period and at six months after the surgical procedure. After a postoperative period of six months, the patients completed an overall QoL questionnaire (the Medical Outcomes Study 36-item Short-form Health Survey) and another one, specific for respiratory symptoms (the Saint George's Respiratory Questionnaire). The scores obtained in our study were compared with those previously obtained for a general population and for a population of patients with COPD. Results: We included 33 patients (14 males and 19 females), ranging in age from 39 to 79 years. All of the patients, smokers and nonsmokers alike, presented significant worsening of pulmonary function. The mean scores on the overall QoL questionnaire were approximately 5% lower than those obtained for the general population. The scores of various domains of the symptom-specific QoL questionnaire were 50-60% lower than those obtained for the general population and approximately 20% higher than those obtained for the population with COPD. Conclusions: Pulmonary resection has a direct negative impact on pulmonary function and QoL, especially on the QoL related to aspects directly linked to pulmonary function. We highlight the importance of preoperative assessment of pulmonary function in patients undergoing pulmonary resection, in order to predict their postoperative evolution.

 


Keywords: Thoracic surgery; Lung neoplasms/surgery; Spirometry; Quality of life; Questionnaires.

 


Evaluation of pulmonary function and respiratory symptoms in pyrochlore mine workers

Avaliação da função pulmonar e sintomas respiratórios em trabalhadores da mineração de pirocloro

Ritta de Cássia Canedo Oliveira Borges, José Cerqueira Barros Júnior, Fabrício Borges Oliveira, Marisa Andrade Brunherotti, Paulo Roberto Veiga Quemelo

J Bras Pneumol.2016;42(4):279-285

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Objective: To identify respiratory symptoms and evaluate lung function in mine workers. Methods: This was a cross-sectional observational study involving production sector workers of a pyrochlore mining company. The subjects completed the British Medical Research Council questionnaire, which is designed to evaluate respiratory symptoms, occupational exposure factors, and smoking status. In addition, they underwent pulmonary function tests with a portable spirometer. Results: The study involved 147 workers (all male). The mean age was 41.37 ± 8.71 years, and the mean duration of occupational exposure was 12.26 ± 7.09 years. We found that 33 (22.44%) of the workers had respiratory symptoms and that 26 (17.69%) showed abnormalities in the spirometry results. However, we found that the spirometry results did not correlate significantly with the presence of respiratory symptoms or with the duration of occupational exposure. Conclusions: The frequencies of respiratory symptoms and spirometric changes were low when compared with those reported in other studies involving occupational exposure to dust. No significant associations were observed between respiratory symptoms and spirometry results.

 


Keywords: Spirometry; Mining; Niobium; Occupational exposure.

 


Evaluation of Pulmonary Function in Class I and II Obesity

Avaliação da função pulmonar na obesidade graus I e II

Zied Rasslan, Roberto Saad Junior, Roberto Stirbulov, Renato Moraes Alves Fabbri, Carlos Alberto da Conceição Lima

J Bras Pneumol.2004;30(6):508-514

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Background: Obesity can effect the thorax, diphragm and abdominal muscles, thereby resulting in altered respiratory function. Objective: To evaluate the effects of obesity and to determine whether body mass index (BMI) and waist circumference correlate with spirometry values in obese individuals. Method: We studied 96 non-smokers of both sexes, 48 suffering from class I and class II obesity and ranging in age rom 18 to 75. All participants presented a BMI between 30 kg/m2 and 40 kg/m2 and none had a history of morbidity. Spirometry was performed, and waist circumferences were measured. Results: No significant differences were found between the spirometric values of men with class I or II obesity and those of non-obese men. In obese women, forced vital capacity and forced expiratory volume in one second (FEV1) were significantly lower than in women who were not obese. Obese individuals of both sexes presented significantly lower expiratory reserve volume (ERV) than did non-obese individuals. Although inspiratory capacity was greater in obese men and women, the difference was significant only for the men. In obese men, there was a significant negative correlation, not seen in the women, between waist circumference and FEV1. Conclusion: Pulmonary function is altered in women suffering from class I and II obesity. In obese men, although pulmonary function is unaffected by BMI, we observed a significant negative correlation between BMI and ERV. We can conclude that pulmonary function is influenced by waist circumference in men suffering from class I and II obesity.

 


Keywords: Respiratory function tests. Spirometry. Body mass index. Obesity.

 


Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents

Avaliação da hiperresponsividade brônquica à solução salina hipertônica em crianças e adolescentes

Paulo Kussek, Nelson Augusto Rosário Filho, Mônica Cat

J Bras Pneumol.2006;32(3):195-201

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Objective: To assess airway hyperresponsiveness to 4.5% hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. Methods: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15% was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. Results: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4%. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9%. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80% and 92%, respectively. Conclusion: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing hyperresponsiveness in children and adolescents.

 


Keywords: Bronchial provocation tests; Bronchial hyperreactivity; Saline solution, hypertonic; Administration, inhalation;

 


Airway inflammation in asthmatic patients after methacholine challenge

Avaliação da inflamação de vias aéreas em asmáticos após o teste de broncoprovocação com metacolina

Fabrício Lino de Matos, João Terra Filho, José Antonio Baddini Martinez, Tatiana Furlan Sala, Elcio Oliveira Vianna

J Bras Pneumol.2001;27(4):171-176

Abstract PDF PT

Background: The methacholine challenge test is commonly used to evaluate bronchial responsiveness in diagnosis and follow-up of asthmatic patients. Objective: To investigate late effects of methacholine challenge on induced sputum. Methods: Ten non-smoker patients with mild or moderate stable asthma were recruited. At 12:00 p.m., patients were randomly assigned to inhale either methacholine (challenge) or physiologic saline. At 6:00 p.m., sputum induction was performed. On the second visit, one week apart, patients completed their participation in the study by undergoing another inhalation and sputum induction. Results: After methacholine, 8.6 ± 9 g of sputum were expectorated with 8.6 ± 6 million cells, 78 ± 10% were viable, and 6.8 ± 7% eosinophils. These data were not different from results obtained after saline: sputum amount = 7.6 ± 6 g, total cell count = 12.4 ± 12 million, viability = 82 ± 10%, and eosinophils = 6.6 ± 9%. Expiratory flow (PF) peak fall during sputum induction was not different: 21.4 ± 12% after methacholine and 18.4 ± 15% after saline. The PF fall observed during induction correlated with the amount of expectorated sputum (p = 0.018) and eosinophil relative number (p = 0.003). No other significant correlation between lung function measurements and sputum characteristics was found. Conclusion: A methacholine challenge carried out six hours before sputum induction does not significantly alter the cellular constituents or amount of sputum.

 


Keywords: Asthma. Methacholine chloride. Bronchial provocation tests.

 


Evaluation of the limited participation by university students in a smoking cessation program

Avaliação da participação de pequeno número de estudantes universitários em um programa de tratamento do tabagismo

Wilson Paloschi Spiandorello, Liliana Zugno Filippini, Angélica Dal Pizzol, Fernanda Kreische, Diogo Sandri Soligo, Tiago Spiandorello, Raquel Boff, Mauricio Michele

J Bras Pneumol.2007;33(1):69-75

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Objective: To evaluate the limited participation by university students in a smoking cessation program. Methods: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. Results: Of the 108 student who did not enroll in the program, 102 (94.4%) stated that they had no intention to quit smoking (95% confidence interval: 88.29-97.93%. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100% vs. 58.5%, p = 0.047); believing oneself able to stop smoking at any time (7.1% vs. 22.6%, p = 0.02); having no knowledge of any reasons to quit smoking (37.5% vs. 12%, p = 0.03); having suffered discrimination (42.9% vs. 9.3%, p < 0.01). Conclusion: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5% did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.

 


Keywords: Smoking; Students; Smoking cessation

 


Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel

Avaliação da qualidade de vida de pacientes com carcinoma pulmonar de células não pequenas em estágio avançado, tratados com carboplatina associada a paclitaxel

Camila Uanne Resende Avelino, Rafael Marques Cardoso, Suzana Sales de Aguiar, Mário Jorge Sobreira da Silva

J Bras Pneumol.2015;41(2):133-142

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Objective: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL) of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. Methods: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. Results: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. Conclusions: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC.

 


Keywords: Carcinoma, non-small-cell lung; Quality of life; Palliative care; Carboplatin; Paclitaxel.

 


Quality of life assessment in patients with cystic fibrosis by means of the Cystic Fibrosis Questionnaire

Avaliação da qualidade de vida de pacientes com fibrose cística por meio do Cystic Fibrosis Questionnaire

Milena Antonelli Cohen, Maria Ângela Gonçalves de Oliveira Ribeiro, Antonio Fernando Ribeiro, José Dirceu Ribeiro, André Moreno Morcillo

J Bras Pneumol.2011;37(2):184-192

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Objective: To assess the quality of life (QoL) of patients with cystic fibrosis (CF) followed at a university referral center for CF. Methods: A cross-sectional study involving application of the Cystic Fibrosis Questionnaire (CFQ) and Shwachman score in CF patients between April of 2008 and June of 2009. Results: The sample consisted of 75 patients. The mean age was 12.5 ± 5.1 years (range, 6.1-26.4 years). The patients were divided into three groups by age in years: group I (< 12), II (12-14), and III (≥ 14). The highest and lowest CFQ scores were for the nutrition domain in group III (89.3 ± 16.2) and the social domain in group II (59.5 ± 22.3), respectively. Groups I and III differed significantly regarding the treatment domain (p = 0.001). Regarding Shwachman scores, there were significant differences between patients scoring ≤ 70 and those scoring > 70 in the social (group I; p = 0.045), respiratory (group II; p = 0.053), and digestive (p = 0.042) domains. In group III, severity did not correlate with QoL. In groups I and II, patients with an FEV1 < 80% of predicted did not differ from other patients for any CFQ domain. However, in group III, values for the following domains were significantly lower in patients with an FEV1 < 80%: physical (p = 0.012); body image (p = 0.031); respiratory (p = 0.023), emotional (p = 0.041); and social role (p = 0.024). Conclusions: It is important to assess QoL in CF patients, because it can improve treatment compliance.

 


Keywords: Cystic fibrosis; Quality of life; Questionnaires.

 


Assessment of the quality of life of patients with lung cancer using the Medical Outcomes Study 36-item Short-Form Health Survey

Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey

Juliana Franceschini, Alecssandra Aparecida dos Santos, Inás El Mouallem, Sergio Jamnik, César Uehara, Ana Luisa Godoy Fernandes, Ilka Lopes Santoro

J Bras Pneumol.2008;34(6):387-393

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Objective: To assess the quality of life of patients with lung cancer and to compare it with that of individuals without cancer. Methods: The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was administered to 57 patients diagnosed with lung cancer, treated at the Lung Cancer Outpatient Clinic of the Hospital São Paulo, and to a control group of 57 individuals recruited from the Extra Penha workout group. The Mann-Whitney test was used to compare the groups, domain by domain. The first model of logistic regression was adjusted for male gender, nonsurgical treatment, Karnofsky performance status and smoking, which were included as predictors. The second model was adjusted for each SF-36 domain in order to identify increases in the proportions of patients in stage IIIB or IV. Results: The lung cancer group and the control group presented the following mean scores, respectively, for the SF-36 domains: role limitations due to physical health problems, 29.39 ± 36.94 and 82.89 ± 28.80; role limitations due to emotional problems, 42.78 ± 44.78 and 86.55 ± 28.77; physical function, 56.49 ± 28.39 and 89.00 ± 13.80; vitality, 61.61 ± 23.82 and 79.12 ± 17.68; bodily pain, 62.72 ± 28.72 and 81.54 ± 19.07; general health, 62.51 ± 25.57 and 84.47 ± 13.47; emotional well-being, 68.28 ± 23.46 and 82.63 ± 17.44; and social functioning, 72.87 ± 29.20 and 91.67 ± 17.44. The logistic regression model showed that role limitations due to physical health problems, physical function and emotional well-being were predictors of stages IIIB and IV. Conclusions: The patients with lung cancer had a poorer quality of life, especially regarding physical aspects, than did the control subjects.

 


Keywords: Lung neoplasms; Quality of life; Health status.

 


Evaluation of quality of life of patients submitted to pulmonary resection due to neoplasia

Avaliação da qualidade de vida em pacientes submetidos a ressecção pulmonar por neoplasia

Ivete Alonso Bredda Saad, Neury José Botega, Ivan Felizardo Contrera Toro

J Bras Pneumol.2006;32(1):10-15

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the health-related quality of life of patients submitted to resection of the pulmonary parenchyma due to neoplasia. Methods: The Medical Outcomes Study 36-item Short-Form Health Survey was used to evaluate patients in the preoperative period and on postoperative days 30, 90 and 180. We used the GEE statistical model, in which the dependent variable (quality of life) changes for each patient over the course of the evaluation. Independent variables were gender, age, educational level, type of surgery, radiotherapy, chemotherapy, forced vital capacity and 6-minute walk test. The level of significance adopted was 5%. Results: The final study sample comprised 36 patients, 20 of whom were men. Of those 36 patients, 17 were submitted to lobectomy, 10 to pneumonectomy, 6 to segmentectomy, and 3 to bilobectomy. Chemotherapy was used in 15 patients, radiotherapy in 2, and a combination of radiotherapy and chemotherapy in 2. Improved quality of life was seen in the following domains: social (on postoperative day 90); physical/functional (some patients presenting better forced vital capacity and 6-minute walk test performance); and physical (in patients undergoing smaller resections). Lowered quality of life was seen in the following domains: social (for female patients); physical/social (resulting from radiotherapy, chemotherapy or both); and physical/functional (by postoperative day 30). Conclusions: It is important that studies evaluating the various determinants of quality of life, as well as the impact that cancer treatment modalities have on such variables, be conducted. The knowledge provided by such studies can contribute to improving the quality of life of patients undergoing pulmonary resection due to neoplasia.

 


Keywords: Lung neoplasms/surgery; Pneumonectomy; Quality of life; Questionnaires

 


Avaliação da qualidade de vida na asma

Ana Luisa Godoy Fernandes, Maria Alenita de Oliveira

J Bras Pneumol.1997;23(3):148-152

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Using the Saint George's Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil

Avaliação da qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória em portadores de doença pulmonar obstrutiva crônica: validação de uma nova versão para o Brasil

Aquiles Camelier, Fernanda Warken Rosa, Christine Salim, Oliver Augusto Nascimento, Fábio Cardoso, José Roberto Jardim

J Bras Pneumol.2006;32(2):114-122

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Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months. Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart. Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001). Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Reproducibility of results; Cross-cultural comparison; Questionnaires

 


Evaluating the efficiency of polymerase chain reaction in diagnosing pulmonary tuberculosis in indigenous and non-indigenous patients

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

Afrânio Lineu Kritski

J Bras Pneumol.2006;32(3):13-14

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Lung ultrasound assessment of response to antibiotic therapy in cystic fibrosis exacerbations: a study of two cases

Avaliação da resposta à antibioticoterapia durante exacerbação na fibrose cística por ultrassom pulmonar: estudo de dois casos

Andressa Oliveira Peixoto1,2,3,a, Fernando Augusto Lima Marson1,2,4,5,b, Tiago Henrique Souza1,6,c, Andrea de Melo Alexandre Fraga1,3,d, José Dirceu Ribeiro1,3,e

J Bras Pneumol.2019;45(6):e20190128-e20190128

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Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility

Avaliação da resposta ao broncodilatador em pacientes pediátricos com bronquiolite obliterante pós-infecciosa: uso de diferentes critérios de identificação de reversibilidade das vias aéreas

Rita Mattiello1, Paula Cristina Vidal2, Edgar Enrique Sarria3, Paulo Márcio Pitrez1, Renato Tetelbom Stein1, Helena Teresinha Mocelin4, Gilberto Bueno Fischer4, Marcus Herbert Jones1, Leonardo Araújo Pinto1

J Bras Pneumol.2016;42(3):174-178

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Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25‑75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications.

 


Keywords: Bronchiolitis obliterans; Infection/complications; Airway obstruction; Bronchodilator agents.

 


Evaluation of pantoprazol treatment response of patients with asthma and gastroesophageal reflux: a randomized prospective double-blind placebo-controlled study

Avaliação da resposta de pacientes asmáticos com refluxo gastroesofágico após terapia com pantoprazol: estudo prospectivo, randomizado, duplo cego e placebo-controlado

Leandro Heusi dos Santos, Iana Oliveira e Silva Ribeiro, Pablo Gerardo Sánchez, Jorge Lima Hetzel, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2007;33(2):119-127

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Objectives: To determine the effect that the treatment of GERD has on the clinical management, as well as the respiratory function, of patients with asthma and to evaluate the clinical characteristics of this group of patients. Methods: Patients with asthma and concomitant GERD, documented using 24 h pH-metry, were evaluated by means of quality of life questionnaires, as well as questionnaires related to respiratory and digestive symptoms. In addition, esophageal manometry, spirometry and the determination of peak expiratory flow were also performed prior to and after the study. Forty-nine individuals who were diagnosed with GERD by means of 24 h esophageal pH-metry were selected and participated in a clinical randomized double-blind placebo-controlled study, involving the administration of 40 mg/day of pantoprazol for 12 consecutive weeks. Results: Forty-four individuals completed the study (n = 22 per group). There was significant improvement in the scores for respiratory symptoms and quality of life only in the group that received pantoprazol (p = 0.01 and p = 0.001, respectively). No respiratory function parameters changed in either group. Conclusions: In this study, the effective treatment of GERD improved patient quality of life, and the symptoms of asthma significantly decreased in the group that received the medication. There were no changes in pulmonary function parameters.

 


Keywords: Asthma; Gastroesophageal reflux/treatment; Diagnosis; Antacids.

 


Evaluation of acute bacterial rhinosinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem

Alecsandra Calil Moises Faure, Ilka Lopes Santoro, Luc Louis Maurice Weckx, Henrique Manoel Lederman, Artur da Rocha Correa Fernandes, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(6):340-346

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Objective: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. Methods: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. Results: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. Conclusions: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.

 


Keywords: Asthma; Sinusitis; Radiography; Tomography, X-ray computed; Endoscopy.

 


Assessment of inhaler techniques employed by patients with respiratory diseases in southern Brazil: a population-based study

Avaliação da técnica de utilização de dispositivos inalatórios no tratamento de doenças respiratórias no sul do Brasil: estudo de base populacional

Paula Duarte de Oliveira, Ana Maria Baptista Menezes, Andréa Dâmaso Bertoldi, Fernando César Wehrmeister, Silvia Elaine Cardozo Macedo

J Bras Pneumol.2014;40(5):513-520

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Objective: To identify incorrect inhaler techniques employed by patients with respiratory diseases in southern Brazil and to profile the individuals who make such errors. Methods: This was a population-based, cross-sectional study involving subjects ≥ 10 years of age using metered dose inhalers (MDIs) or dry powder inhalers (DPIs) in 1,722 households in the city of Pelotas, Brazil. Results: We included 110 subjects, who collectively used 94 MDIs and 49 DPIs. The most common errors in the use of MDIs and DPIs were not exhaling prior to inhalation (66% and 47%, respectively), not performing a breath-hold after inhalation (29% and 25%), and not shaking the MDI prior to use (21%). Individuals ≥ 60 years of age more often made such errors. Among the demonstrations of the use of MDIs and DPIs, at least one error was made in 72% and 51%, respectively. Overall, there were errors made in all steps in 11% of the demonstrations, whereas there were no errors made in 13%.Among the individuals who made at least one error, the proportion of those with a low level of education was significantly greater than was that of those with a higher level of education, for MDIs (85% vs. 60%; p = 0.018) and for DPIs (81% vs. 35%; p = 0.010).Conclusions: In this sample, the most common errors in the use of inhalers were not exhaling prior to inhalation, not performing a breath-hold after inhalation, and not shaking the MDI prior to use. Special attention should be given to education regarding inhaler techniques for patients of lower socioeconomic status and with less formal education, as well as for those of advanced age, because those populations are at a greater risk of committing errors in their use of inhalers.

 


Keywords: Asthma; Pulmonary disease, chronic obstructive; Dry powder inhalers; Metered dose inhalers.

 


Evaluation of the clinical utility of new diagnostic tests for tuberculosis: the role of pragmatic clinical trials

Avaliação da utilidade clínica de novos testes diagnósticos em tuberculose: o papel dos ensaios clínicos pragmáticos

Gisele Huf, Afrânio Kritski

J Bras Pneumol.2012;38(2):237-245

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Tuberculosis is one of the major infectious diseases in developing countries, and the length of time for which the chain of transmission is maintained has been implicated as a major factor in the perpetuation of the disease. In this context, regulatory agencies in such countries have approved new diagnostic tools, which have been almost immediately incorporated into the national tuberculosis control programs. Health interventions have been increasingly investigated in clinical trials, including explanatory trials (in order to evaluate the beneficial effects of such interventions) and pragmatic trials (in order to aid in the decision-making process). We argue that the evaluation of new diagnostic techniques for the detection of tuberculosis should not escape this same logic of evaluation.

 


Keywords: Tuberculosis/diagnosis; Tuberculosis/prevention & control; Controlled clinical trial as topic.

 


Evaluation of the diagnostic utility of fiberoptic bronchoscopy for smear-negative pulmonary tuberculosis in routine clinical practice

Avaliação da utilidade diagnóstica da fibrobroncoscopia óptica na tuberculose pulmonar BAAR negativa na prática clínica de rotina

Alonso Soto, Daniela Salazar, Vilma Acurio, Patricia Segura, Patrick Van der Stuyft

J Bras Pneumol.2012;38(6):761-765

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We evaluated the diagnostic yield of fiberoptic bronchoscopy for the diagnosis of smear-negative pulmonary tuberculosis in patients treated at a referral hospital in Lima, Peru. Of the 611 patients who underwent the procedure, 140 (23%) were diagnosed with tuberculosis based on the analysis of BAL samples. Being young and being male were significantly associated with positive cultures. In addition, 287 patients underwent post-bronchoscopic sputum smear testing for AFB, the results of which increased the diagnostic yield by 22% over that obtained through the analysis of BAL samples alone. We conclude that the analysis of BAL samples and post-bronchoscopic sputum samples provides a high diagnostic yield in smear-negative patients suspected of having pulmonary tuberculosis.

 


Keywords: Tuberculosis, pulmonary/diagnosis; Bronchoscopy; Sputum.

 


Evaluation of the use of transbronchial biopsy in patients with clinical suspicion of interstitial lung disease

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

Cristiano Claudino Oliveira, Alexandre Todorovic Fabro, Sérgio Marrone Ribeiro, Julio Defaveri, Vera Luiza Capelozzi, Thais Helena Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2011;37(2):168-175

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Objective: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital. Methods: We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil. Results: The study included 56 patients. Of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01). Conclusions: For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions.

 


Keywords: Lung diseases, interstitial; Diagnosis, differential; Bronchoscopy.

 


Evaluation of surveillance of contacts of new tuberculosis cases in the state of Mato Grosso - Brazil

Avaliação da vigilância de contatos de casos novos de tuberculose no Estado de Mato Grosso - Brasil

Shaiana Vilella Hartwig, Eliane Ignotti, Beatriz Fátima Alves de Oliveira, Hellen Caroline de Oliveira Pereira, João Henrique Scatena

J Bras Pneumol.2008;34(5):298-303

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Objective: To evaluate surveillance of contacts of new tuberculosis cases in the state of Mato Grosso from 1999 to 2004. Methods: This was a descriptive epidemiological study based on data from the Tuberculosis Case Registry Database. The number of new tuberculosis cases, the number of contacts (estimated, investigated, and uninvestigated), and the tuberculosis incidence rate were analyzed by age bracket. The mean rate of contacts investigated for each case of tuberculosis by age bracket was calculated per year of study. The cases of pulmonary tuberculosis with and without contacts investigated were analyzed by sputum smear microscopy results. Results: In 2004, there were 41.3 cases of tuberculosis per 100,000 inhabitants in the state of Mato Grosso. The south-central region presented the highest incidence rate (57 cases/100,000 inhabitants) and a 15% rate of contacts investigated. Among those younger than 15 years, 63 contacts (60.5%) were investigated, whereas among those aged 15 or older, 389 (8.9%) were investigated. In 1999, the mean rate of contacts investigated statewide was 0.02 (0.5%), and, in 2004, it reached 0.42 (10.5%). The percentage of contacts investigated was 40% higher among the contacts of contagious cases (OR = 1.4; 95% CI: 1.08-1.83). Conclusions: The percentage of contacts investigated is very low, principally among adults. The adoption of the standards for investigation of tuberculosis contacts proposed by the Brazilian National Ministry of Health Department of Health Surveillance has not ensured that this group at highest risk of developing active tuberculosis be given priority at health care facilities in the state of Mato Grosso.

 


Keywords: Contact tracing; Epidemiologic surveillance; Tuberculosis/prevention & control.

 


Evaluation of atopy in patients with COPD

Avaliação de atopia em portadores de DPOC

Margarida Célia Lima Costa Neves, Yuri Costa Sarno Neves, Carlos Mauricio Cardeal Mendes, Monalisa Nobre Bastos, Aquiles Assunção Camelier, Cleriston Farias Queiroz, Bernardo Fonseca Mendoza, Antônio Carlos Moreira Lemos, Argemiro D'Oliveira Junior

J Bras Pneumol.2013;39(3):296-305

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Objective: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. Methods: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. Results: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. Conclusions: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood.

 


Keywords: Pulmonary disease, chronic obstructive; Allergy and immunology; Nasal lavage fluid; Asthma; Rhinitis, allergic, perennial.

 


Evaluation of criteria for the diagnosis of asthma using an epidemiological questionnaire

Avaliação de critérios para o diagnóstico de asma através de um questionário epidemiológico

Neusa Falbo Wandalsen, Cássia Gonzalez, Gustavo Falbo Wandalsen, Dirceu Solé

J Bras Pneumol.2009;35(3):199-205

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Objective: To evaluate criteria for the diagnosis of asthma in an epidemiological survey. Methods: Adolescents (13-14 years of age) and legal guardians of schoolchildren (6-7 years of age) in the city of Santo André, Brazil, completed the International Study of Asthma and Allergies in Childhood (ISAAC) standard written questionnaire. Affirmative responses regarding wheezing within the last 12 months, asthma ever, bronchitis ever (question added at the end of the questionnaire), as well as the overall ISAAC score above the predefined cutoff points, were considered indicative of asthma. Results: The legal guardians of 2,180 schoolchildren and 3,231 adolescents completed the questionnaires properly. Depending on the criterion adopted, the prevalence of asthma ranged from 4.9% to 26.8% for the schoolchildren and from 8.9% to 27.9% for the adolescents. The criteria with the lowest and highest prevalences were, respectively, physician-diagnosed asthma and physician-diagnosed bronchitis. When compared with other criteria, physician-diagnosed bronchitis showed concordance levels between 71.9% and 79.4%, positive predictive values between 0.16 and 0.63 and poor concordance (kappa: 0.21-0.46). Strong concordance levels were found only between wheezing within the last 12 months and the overall ISAAC score (kappa: 0.82 and 0.98). Conclusions: The prevalence of asthma varied significantly, depending on the criterion adopted, and there was poor concordance among the criteria. Wheezing within the last 12 months and the overall ISAAC score are the best criteria for the diagnosis of asthma, whereas the question regarding bronchitis ever did not improve the questionnaire. Modifications in this instrument can make it difficult to draw comparisons and should therefore be carefully evaluated.

 


Keywords: Asthma; Bronchitis; Diagnosis; Epidemiology; Child; Adolescent.

 


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-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.

 


Two-year evaluation of an educational program for adult outpatients with asthma

Avaliação de dois anos de um programa educacional para pacientes ambulatoriais adultos com asma

Luciene Angelini, Priscila Games Robles-Ribeiro, Regina Maria de Carvalho-Pinto, Marcos Ribeiro, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2009;35(7):618-627

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Objective: To evaluate the understanding of asthma and the clinical improvement in patients with moderate or severe persistent asthma prior to and after their participation in an educational program presented during the routine outpatient visits. Methods: This was a prospective pilot study involving 164 patients over a two-year period. The educational program, presented to small groups on outpatient visit days, consisted of lectures divided into three parts: pathophysiology; environmental control; and treatment, including training in the inhalation technique. The program was evaluated using standardized questionnaires on clinical improvement and understanding of the disease. Results: By the end of the first year, 120 patients had completed three visits, and 51 of those patients were revaluated at the end of the second year. The mean age of the patients was 44 years, 70% were female, and 43% had up to eight years of schooling. The educational intervention significantly increased the understanding of the disease (p < 0.001), and allowed greater clinical improvement (p < 0.05) with a decrease in the use of oral corticosteroids, fewer visits to the emergency room and fewer days missed from work or school. Conclusions: The educational program offered during the routine outpatient visits of adult patients with asthma at our clinic resulted in a progressive long-term increase in knowledge, as well as in clinical improvement.

 


Keywords: Asthma; Adult; Patient education as topic.

 


Evaluation of the histological parameters in usual interstitial pneumonia (idiopathic pulmonary fibrosis)

Avaliação de parâmetros histológicos na pneumonia intersticial usual (fibrose pulmonar idiopática)

Rimarcs Gomes Ferreira, Ester Nei Aparecida Martins Coletta, Osvaldo Giannotti Filho

J Bras Pneumol.2000;26(6):279-285

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Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) is a progressive interstitia pulmonary disease of unknown etiology. Since Hamman's and Rich's (1944) reports, many studies have tried to find a histological marker for the correlation between prognosis and response to therapy. However, there are many doubts regarding pathogenesis. In addition, it is generally accepted that response to therapy is related to the relative degree of cellularity and fibrosis. The purpose of this study is to describe the results of inflammatory/exudative changes, fibrotic/reparative changes, and airway alterations, using a semi-quantitative method by independent evaluation of two pathologists, in 24 open lung biopsies with the diagnosis of idiopathic pulmonary fibrosis. Fourteen histological features were analyzed using the 0 to 5 scale for interstitial alterations and the 0 to 2 scale for the airway changes. There was significant interobserver agreement for all histological features with Kw (Kappa) variations between 0.47 and 0.92. There was significant disagreement only for septal inflammatory intensity analysis, suggesting that these features must be discussed by the pathologists. The semi-quantitative method assessment was effective.

 


Keywords: Idiopathic pulmonary fibrosis (IPF). Usual interstitial pneumonia (UIP). Semi-quantitative method assessment.

 


Evaluation of manual resuscitators used in ICUs in Brazil

Avaliação de reanimadores manuais utilizados em UTIs brasileiras

Tatiana de Arruda Ortiz, Germano Forti Junior, Márcia Souza Volpe, Marcelo do Amaral Beraldo, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro Carvalho, Mauro Roberto Tucci

J Bras Pneumol.2013;39(5):595-603

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Objective: To analyze psychological morbidity as a moderator of the relationship between smoking representations and quality of life in smokers and former smokers, as well as to determine which psychological variables discriminate between smokers with and without the intention to quit smoking. Methods: This was a quantitative, correlational cross-sectional study involving a convenience sample of 224 smokers and 169 former smokers. Results: In smokers and former smokers, psychological morbidity had a moderating effect on the relationship between mental/physical quality of life and smoking representations (cognitive representations, emotional representations, and comprehensibility). Smokers with the intention to quit smoking more often presented with low comprehensibility, threatening emotional representations, behavioral beliefs, and perceived behavioral control, as well as with normative/control beliefs, than did those without the intention to quit. Conclusions: The results of this study underscore the importance of the moderating effect exerted by psychological morbidity, as well as that of sociocognitive variables, among smokers who have the intention to quit smoking.

 



Assessment of ICU readmission risk with the Stability and Workload Index for Transfer score

Avaliação de riscos de readmissão em UTI através do escore Stability and Workload Index for Transfer

Daiane Ferreira Oakes, Ingrid Nemitz Krás Borges, Luiz Alberto Forgiarini Junior, Marcelo de Mello Rieder

J Bras Pneumol.2014;40(1):69-72

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We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

 


Keywords: Empyema, pleural; Pneumonia, pneumococcal; Pneumococcal infections.

 


Evaluation of rapid microplate assays using cellular-viability indicators to determine patterns of susceptibility to isoniazid and rifampin in Mycobacterium tuberculosis strains

Avaliação de testes rápidos em microplacas usando indicadores de viabilidade celular para determinação da susceptibilidade de cepas de Mycobacterium tuberculosis à isoniazida e rifampicina

Marta Osório Ribeiro; Marlei da Silva Gomes; Simone Gonçalves Senna; Maria Lucia Rosa Rossetti; Leila de Souza Fonseca

J Bras Pneumol.2004;30(4):455-460

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Background: Knowledge of the rates of drug resistance is one of the pillars of tuberculosis control program evaluation. Data from low-resource countries are scarce and results are delayed due to the techniques employed. There is therefore an urgent need for evaluation of faster and less onerous testing methods. Objective: To compare the performance of rapid colorimetric assays for phenotyping that employ oxidationreduction indicators to determine the susceptibility profile of Mycobacterium tuberculosis with the gold-standard proportion method on Lowenstein-Jensen Medium. Method: We analyzed 166 M. tuberculosis strains of known susceptibility. Minimal inhibition concentrations for isoniazid and rifampicin were determined in microplates, using a liquid medium and Alamar Blue and tetrazolium bromide indicators. To measure agreement the Kappa value was used. Cutoff values between sensitive and resistant strains were defined as 0.2µg/mL and 1.0µg/mL for isoniazid and rifampicin, respectively. Results: There was 100% concordance between Alamar Blue and tetrazolium bromide methods in the determination of minimal inhibition concentrations. Agreement between the colorimetric method and the Lowenstein-Jensen was 95% for isoniazid and rifampicin. Using the colorimetric method, results were obtained within 7 days, in contrast to the 28 days required for the conventional method. Conclusions: Assays to determine minimal inhibition concentrations in liquid medium and employing oxidationreduction indicators proved to be rapid and inexpensive. This method has the potential to become a faster, alternative method for determining susceptibility of M. tuberculosis strains in developing countries.

 


Keywords: Mycobacterium tubercolis. Disease susceptibility. Isoniazid/therapeutic use. Rifampin/therapeutic use.

 


Evaluation of a four-month program of physical training designed for asthmatic children

Avaliação de um programa de treinamento físico por quatro meses para crianças asmáticas

Cristiane Soncino Silva, Lídia Alice Gomes Monteiro Marins Torres, Abel Rahal, João Terra Filho, Elcio Oliveira Vianna

J Bras Pneumol.2005;31(4):279-285

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Objective: The aim of this study was to evaluate physical conditioning and muscle strength before and after a four-month program of physical training. Methods: Two groups of children, ages 8 to 11 years, with moderate asthma were studied. All subjects were tested before and after a program of physical training, which was conducted in 90-min sessions, twice weekly, for four months and also included exercises performed in the water. Children in both groups received general information about asthma, as well as information about the management and treatment of asthma. Results: In the final evaluation, anthropometric parameters (height and weight) were found to have increased. Children in the exercise group presented significant gains in the distance run in nine minutes (initial 1.333 + 0.03 km vs. final 1.440 + 0.03 km; p < 0.05), number of abdominal crunches (initial 24.3 + 1.4 abdominais vs. final 33.2 + 1.1; p < 0.05), maximal inspiratory pressure (initial 73 + 5 cmH2O vs. final 103 + 5 cmH2O; p < 0.05), maximal expiratory pressure (initial 75 + 4 cmH2O vs. final 102 + 4 cmH2O; p < 0.05) and heart rate at rest (initial 84.3 + 1.6 bpm vs. final 77.1 + 2.7 bpm; p < 0.05). The control group presented no significant changes in any of these parameters. Conclusion: An exercise program involving longer sessions, conducted less frequently, facilitates increased participation by children, thereby leading to better physical conditioning and greater muscle strength.

 



Evaluation of a genetic probe (Gen-Probe Accuprobe® system) in comparison to traditional methods for identifying members of the Mycobacterium tuberculosis complex

Avaliação de uma sonda genética (Sistema Accuprobe, Gen Probe®) para identificação de organismos do complexo Mycobacterium tuberculosis, em comparação com métodos tradicionais de caracterização

Delurce Tadeu de Araujo Spada, Manoel Armando Azevedo dos Santos, Elisabete A. Almeida, Marcos Augusto, Maria Idemar Pedrosa Albarral, Fernando Augusto Fiuza de Melo

J Bras Pneumol.2005;31(3):219-224

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Background: The appearance of tuberculosis/human immunodeficiency virus co-infection and the growing number of diseases caused by nontuberculous mycobacteria, as well as the confusion that these can cause in relation to emerging multidrug-resistant strains, require more accurate and rapid laboratory results, not only in the isolation of strains but also in their identification. Objective: A comparative study evaluating a new tool of molecular identification, which uses a genetic probe based on the 16S rDNA sequence of the Mycobacterium tuberculosis gene (Gen-Probe Accuprobe® Gen Probe, Inc.), and the classic methodology. Method: Fifty-five Mycobacterium strains, isolated from the sputum of patients treated at a tuberculosis reference clinic, were selected for study. Subcultures were performed in three tubes: one submitted to genetic identification, one analyzed through classical tests (production and accumulation of niacin; growth in the Lowenstein-Jensen medium with the inhibitor agents p-nitrobenzoic acid and thiophene-2-carboxylic acid hydrazide added), and one held in reserve. Results: The probe identified 51 cases as belonging to the M. tuberculosis complex (one associated with M. kansasii) and the other 4 as nontuberculous mycobacteria, later identified as M. kansasii (3) and M. avium (1). Using traditional methods, 47 samples were identified as belonging to the M. tuberculosis complex, 4 were classified as fitting the profile of nontuberculous mycobacteria (in agreement with the genetic probe results), and 4 were unidentified, 1 of which presented the exact characteristics that 2 mycobacterium species have in common. Conclusion: The benefits of the molecular biology technique justify its implementation and routine use, in combination with classical methods, in a high-traffic clinic where complex cases of tuberculosis are treated.

 


Keywords: Mycobacterium tuberculosis. Molecular probe techniques.

 


Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers

Avaliação do conhecimento sobre o uso de inaladores dosimetrados entre profissionais de saúde de um hospital pediátrico

Fábio Pereira Muchão, Sílvia La Regina Rodrigues Perín, Joaquim Carlos Rodrigues, Cláudio Leone, Luiz Vicente Ribeiro Ferreira Silva Filho

J Bras Pneumol.2008;34(1):4-12

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Objective: To evaluate health professionals working at a tertiary pediatric hospital in terms of their knowledge regarding the practical use of metered-dose inhalers. Methods: Practical and written tests on the use of metered-dose inhalers were applied to physicians, physical therapists, nurses and nursing assistants. A score from 0 to 10 was assigned to each evaluation, and median scores were calculated for each professional category. Questions with higher and lower correct values were identified, and a descriptive comparison was made regarding the performance of the various professional categories. Statistical analysis was performed using the Kruskal-Wallis method for comparison of medians. A sequential logistic multiple regression analysis was also performed. Results: A total of 30 resident physicians or interns in the pediatrics department, 23 attending physicians, 29 physical therapists, 33 nurses and 31 nursing assistants were evaluated. Resident physicians, physical therapists and attending physicians performed significantly better than did nurses and nursing assistants. Only resident physicians had a median score greater than 6. Conclusions: The health professionals evaluated, particularly the nurses and nursing assistants, who are directly involved in the practical use of metered-dose inhalers, possess insufficient knowledge regarding the use of such inhalers.

 


Keywords: Metered dose inhalers; Inhalation spacers; Asthma; Education, public health professional.

 


Assessment of religious coping in patients with COPD

Avaliação do coping religioso em pacientes com DPOC

Francisco Alessandro Braga do Nascimento1,2,a, Guilherme Pinheiro Ferreira da Silva1,3,b, Geisyani Francisca Gomes Prudente1,c, Rafael Mesquita1,d, Eanes Delgado Barros Pereira1,2,e

J Bras Pneumol.2020;46(1):e20180150-e20180150

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Objective: To compare religious coping (RC) in patients with COPD and healthy individuals, as well as to determine whether RC is associated with demographic characteristics, quality of life, depression, and disease severity in the patients with COPD. Methods: This was a cross-sectional study conducted between 2014 and 2016, involving outpatients with moderate to severe COPD seen at one of two hospitals in Fortaleza, Brazil, as well as gender- and age-matched healthy controls. The Brief RCOPE scale assessed RC in all of the participants. We also evaluated the COPD group patients regarding symptoms, quality of life, and depression, as well as submitting them to spirometry and a six-minute walk test. Results: A total of 100 patients were evaluated. The mean age was 67.3 ± 6.8 years, and 54% were men. In the COPD group, the mean positive RC score was significantly higher than was the mean negative RC score (27.17 ± 1.60 vs. 8.21 ± 2.12; p = 0.001). The mean positive RC score was significantly higher in women than in men (27.5 ± 1.1 vs. 26.8 ± 2.8; p = 0.02). Negative RC scores were significantly higher in the COPD group than in the control group (p = 0.01). Negative RC showed an inverse association with six-minute walk distance (6MWD; r = −0.3; p < 0.05) and a direct association with depressive symptoms (r = 0.2; p < 0.03). Positive RC correlated with none of the variables studied. Multiple regression analysis showed that negative RC was associated with 6MWD (coefficient = −0.009; 95% CI: −0.01 to −0.003). 6MWD explained the variance in negative RC in a linear fashion. Conclusions: Patients with COPD employ negative RC more often than do healthy individuals. Exercise capacity and depressive symptoms are associated with negative RC.

 


Keywords: Religion; Spirituality; Adaptation, psychological; Quality of life; Pulmonary disease, chronic obstructive.

 


Detection of cord factor for the presumptive identification of Mycobacterium tuberculosis complex

Avaliação do crescimento em cordas na identificação presuntiva do complexo Mycobacterium tuberculosis

Andrea Gobetti Vieira Coelho, Liliana Aparecida Zamarioli, Clemira Martins Pereira Vidal Reis, Bruno Francisco de Lima Duca

J Bras Pneumol.2007;33(6):707-711

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Objective: Virulent strains of the Mycobacterium tuberculosis complex, under certain appropriate conditions, grow as characteristic ropes, bundles or serpentine cords known as cord factor or growth in cords. The objective of the present study was to evaluate cord factor detection as a method of achieving presumptive identification of the M. tuberculosis complex, comparing it to conventional typing tests. Methods: A total of 743 strains were analyzed from January of 2002 to December of 2005 in the Mycobacteria Sector of the Adolfo Lutz Institute, located in the city of Santos, Brazil. Samples were obtained from clinical specimens collected from patients with respiratory symptoms treated at basic health clinics in the greater metropolitan area of Santos. Ziehl-Neelsen-stained smears were prepared, 301 (40.5%) in MB/BacT broth and 442 (59.5%) on solid media, either Lowenstein-Jensen or Ogawa-Kudoh. Results: The sensitivity, specificity, positive predictive value and negative predictive value obtained during the performance comparison of the two methods (cord factor detection and conventional typing) using both isolation media were, respectively, 98.5, 88, 97 and 93%. The method was more sensitive on solid medium (100%), and the difference in sensitivity between the two media types was only 2.7%. Conclusions: Taking into consideration the results obtained, we conclude that, in laboratories with a high incidence of M. tuberculosis complex isolation and limited economic resources, cord factor detection is a fast and valid criterion for identifying these mycobacteria using liquid or solid medium. It also enables subsequent conclusive identification tests, as well as additional sensitivity tests when necessary.

 


Keywords: Laboratory techniques and procedures; Mycobacterium tuberculosis; Cord factors

 


Evaluation of the diagnostic performance and cut-off value for the rapid shallow breathing index in predicting extubation failure

Avaliação do desempenho diagnóstico e do valor de corte para o índice de respiração rápida e superficial na predição do insucesso da extubação

Aline Roberta Danaga, Ana Lúcia Gut, Letícia Cláudia de Oliveira Antunes, Ana Lúcia dos Anjos Ferreira, Fábio Akio Yamaguti, José Carlos Christovan, Ubirajara Teixeira, Cristina Aparecida Veloso Guedes, Ana Beatriz Sasseron, Luis Cuadrado Martin

J Bras Pneumol.2009;35(6):541-547

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Objective: To evaluate the diagnostic performance of the rapid shallow breathing index (RSBI) in predicting extubation failure among adult patients in the intensive care unit and to determine the appropriateness of the classical RSBI cut-off value. Methods: This was a prospective study conducted in the adult intensive care unit of the Botucatu School of Medicine Hospital das Clínicas. The RSBI was evaluated in 73 consecutive patients considered clinically ready for extubation. Results: The classical RSBI cut-off value (105 breaths/min/L) presented a sensitivity of 20% and a specificity of 95% (sum = 115%). Analysis of the receiver operator characteristic (ROC) curve revealed a better cut-off value (76.5 breaths/min/L), which presented a sensitivity of 66% and a specificity of 74% (sum = 140%). The area under the ROC curve for the RSBI was 0.78. Conclusions: The classical RSBI cut-off value proved inappropriate, predicting only 20% of the cases of extubation failure in our sample. The new cut-off value provided substantial improvement in sensitivity, with an acceptable loss of specificity. The area under the ROC curve indicated that the discriminative power of the RSBI is satisfactory, which justifies the validation of this index for use.

 


Keywords: Adult; Intensive care; ROC curve; Ventilator weaning; Diagnosis; Respiration, artificial.

 


Evaluation of von Willebrand factor in COPD patients

Avaliação do fator de von Willebrand em pacientes com DPOC

Thiago Prudente Bártholo, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2014;40(4):373-379

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Objective: To compare the absolute serum von Willebrand factor (vWF) levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. Methods: The study included 57 subjects, in three groups: COPD (n = 36); smoker (n = 12); and control (n = 9). During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2) was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. Results: Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001) and 1,865 ± 592 pg/mL (p < 0.01). Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05), as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05). In all three groups, there was a negative correlation between FEV1 (% of predicted) and relative serum vWF activity (r2 = −0.13; p = 0.009). Conclusions: Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients.

 


Keywords: von Willebrand factor; Pulmonary disease, chronic obstructive; Endothelial cells.

 


Evaluation of the impact that the changes in tuberculosis treatment implemented in Brazil in 2009 have had on disease control in the country

Avaliação do impacto das mudanças do tratamento da tuberculose implantadas em 2009 no controle da tuberculose pulmonar no Brasil

Marcelo Fouad Rabahi, José Laerte Rodrigues da Silva Júnior, Marcus Barreto Conde

J Bras Pneumol.2017;43(6):437-444

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Objective: To analyze the impact that the 2009 changes in tuberculosis treatment in Brazil had on the rates of cure, tuberculosis recurrence, mortality, treatment abandonment, and multidrug-resistant tuberculosis (MDR-TB). Methods: An ordinary least squares regression model was used in order to perform an interrupted time series analysis of secondary data collected from the Brazilian Tuberculosis Case Registry Database for the period between January of 2003 and December of 2014. Results: The 2009 changes in tuberculosis treatment in Brazil were found to have no association with reductions in the total number of cases (β = 2.17; 95% CI: −3.80 to 8.14; p = 0.47) and in the number of new cases (β = −0.97; 95% CI: −5.89 to 3.94; p = 0.70), as well as having no association with treatment abandonment rates (β = 0.40; 95% CI: −1.12 to 1.93; p = 0.60). The changes in tuberculosis treatment also showed a trend toward an association with decreased cure rates (β = −4.14; 95% CI: −8.63 to 0.34; p = 0.07), as well as an association with increased mortality from pulmonary tuberculosis (β = 0.77; 95% CI: 0.16 to 1.38; p = 0.01). Although there was a significant increase in MDR-TB before and after the changes (p < 0.0001), there was no association between the intervention (i.e., the changes in tuberculosis treatment) and the increase in MDR-TB cases. Conclusions: The changes in tuberculosis treatment were unable to contain the decrease in cure rates, the increase in treatment abandonment rates, and the increase in MDR-TB rates, being associated with increased mortality from pulmonary tuberculosis during the study period.

 


Keywords: Tuberculosis, pulmonary/epidemiology; Tuberculosis, pulmonary/drug therapy; Tuberculosis, pulmonary/mortality; Interrupted time series analysis; Drug resistance, multiple; Drug compounding.

 


Evaluation of the risk of bacterial contamination in the patient submitted to bronchoscopy, after reprocessing the bronchoscope

Avaliação do risco de contaminação por bactérias, no paciente submetido à broncoscopia, após o reprocessamento do broncoscópio

Nancy Spekla Grande, Romilda Aparecida Nakayama, Antonia Maria de Oliveira Machado, Fábio Akio Yamaguti, Cesar Uehara

J Bras Pneumol.2002;28(5):250-260

Abstract PDF PT

Introduction: Bronchoscopic is a diagnostic and therapeutic procedure performed by introducing a flexible tube in the airways that allows for the visualization even of the smallest airways. In order to prevent or reduce the risk of infection, the bronchoscope must be adequately disinfected with at least high level disinfection. Purpose: Check for the risk of bacterial contamination for patients submitted to bronchoscopy at the Hospital São Paulo of Unifesp University, State of São Paulo. Methods: From 1997 to 1998, bronchoscope reprocessing included cleaning, rinsing with sterile or potable water, followed by rinsing with 2% glutaraldehyde for 20 minutes, rinsing again with sterile or potable water, and rinsing with 70% ethyl alcohol, and forced-air drying through the suction channel. Samples of 65 patients were collected for microbiologic tests by instilling sterile saline solution through the suction channel of the bronchoscope. Results: After reprocessing, the following were found in the samples: Staphylococcus epidermidis, Enterobacter sp, Acinetobacter baumanni, Streptococcus viridans, Staphylococcus aureus, Streptococcus beta hemoliticus A, Staphylococcus coagulase negative, and mycobacterial growth was found in the culture of five samples. Conclusions: Bronchoscope disinfection with 2% glutaraldehyde was not sufficient to assured disinfection of the scope and the presence of Staphylococcus epidermidis shows that there was bronchoscope contamination due to handling after disinfection.

 



Evaluation of the nitrate reductase assay for the rapid detection of resistance to first-line medications in Mycobacterium tuberculosis strains isolated from patients in a general hospital

Avaliação do teste de nitrato redutase para a detecção rápida de resistência aos medicamentos de primeira linha em cepas de Mycobacterium tuberculosis isoladas de pacientes em um hospital geral

Maria de Fátima Filardi Oliveira Mansur, Wânia da Silva Carvalho, Raquel Bandeira da Silva, Rodrigo Gonçalves Cata Preta, Lucas Almeida Fernandes Junior, Silvana Spíndola de Miranda

J Bras Pneumol.2012;38(2):210-213

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We compared the nitrate reductase assay with the proportion method, which is considered the gold standard, in 57 Mycobacterium tuberculosis strains isolated from patients treated at the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. For rifampin and isoniazid, the sensitivity, specificity, and accuracy of the nitrate reductase assay were all 100%, whereas they were 100%, 88.9%, and 66.7%, respectively, for streptomycin and 98.0%, 100%, and 98.2%, respectively, for ethambutol. The mean time to results was ten days. In the study sample, the nitrate reductase assay proved highly accurate and showed excellent concordance with the gold standard.

 


Keywords: Mycobacterium tuberculosis; Microbial sensitivity tests; Tuberculosis, multidrug-resistant; Nitrate reductase.

 


Evaluation of diagnostic criteria for severe asthma described in a public health directive regulating the free distribution of medications for the maintenance treatment of asthma

Avaliação dos descritores de asma grave em pacientes incluídos na portaria de saúde pública que regulamenta a distribuição gratuita de medicamentos para o tratamento de manutenção da asma

Maria Amélia Carvalho da Silva Santos, Ana Luisa Godoy Fernandes, Mara Marta Amorim, Patrícia Bueno Lima, Sonia Maria Faresin, Ilka Lopes Santoro

J Bras Pneumol.2009;35(4):310-317

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Objective: To evaluate the capacity of the criteria described in Complementary Directive SAS/MS 12, issued on November 12, 2002, to identify patients with severe asthma, describing and comparing clinical, functional and treatment data of such patients. Methods: This was a nested case-control study using a structured database for adult asthma outpatients. We defined cases as asthma patients who met the inclusion criteria described in the directive, defining controls as those who did not. We collected and compared data related to the following: demographic characteristics; history of asthma; medications in use; comorbidities; history of tobacco use; number of exacerbations within the last 12 months, asthma-related hospitalizations and intensive care unit admissions within the last 12 months; spirometry; and sputum cytology. Results: The case and control groups consisted of 29 and 31 patients, respectively. The number of asthma exacerbations and emergency room visits within the last 12 months, as well as the number of patients that received at least one pulse of oral corticosteroids, was significantly higher in the case group than in the control group. In addition, prebronchodilator FVC was lower among the cases than among the controls. Furthermore, cytology revealed that eosinophil counts were significantly higher in the induced sputum of cases than in that of controls. Conclusions: The criteria described in the directive are suited to stratifying patients with severe asthma.

 


Keywords: Asthma; Budesonide; Combined modality therapy.

 


Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion

Avaliação dos valores sérico e pleural dos marcadores tumorais CEA, CYFRA21-1 e CA 15-3 em portadores de derrame pleural

Isabella Coimbra Wagner, Murilo José de Barros Guimarães, Lilian Karine Neves da Silva,Francisco Montenegro de Melo, Maria Tereza Cartaxo Muniz

J Bras Pneumol.2007;33(2):185-191

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Objective: To determine the levels of the tumor markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and carbohydrate antigen 15-3 (CA 15-3) in the blood and pleural fluid of patients with benign or malignant pleural effusion, evaluating the sensitivity of each marker in these fluids. Methods: We prospectively evaluated 85 patients with pleural effusion. The study of the pleural fluid observed the criteria established in the literature. Levels of the markers were determined using electrochemiluminescence. The sensitivity was determined on the condition that the specificity was ≥ 90%. Results: Of the 85 cases, 36 (42.4%) were malignant, 30 (35.3%) were benign, and the results were inconclusive in 19 (22.3%). In the malignant cases, the CEA and CYFRA21-1 levels were higher in the pleural fluid than in the blood, which was not observed for CA 15-3. In the benign cases, the CYFRA21-1 levels were higher in the pleural fluid than in the blood, whereas the opposite was found for CEA and CA 15-3. There were significant differences between malignant and benign cases for all markers, in pleural fluid and blood. In the pleural fluid, the sensitivity of CEA, CYFRA21-1 and CA 15-3 was 69.4, 69.4 and 66.7%, respectively, and the combined sensitivity was 80.6%. In the blood, the sensitivity was 57.1%, 71.4% and 48.6% for CEA, CYFRA21-1 and CA 15-3, respectively, and the combined sensitivity was 77%. Conclusion: The results suggest that these markers might be useful in the differentiation between malignant and benign pleural effusion.

 


Keywords: Biological tumor marker; Cyfra 21.1; CEA; CA 15.3; Pleural effusion.

 


Spirometry evolution assessment of cystic fibrosis

Avaliação evolutiva da espirometria na fibrose cística

Elenara da Fonseca Andrade, Deisi Letícia Oliveira da Fonseca, Fernando Antônio de Abreu e Silva, Sérgio Saldanha Menna-Barreto

J Bras Pneumol.2001;27(3):130-136

Abstract PDF PT

Objectives: To evaluate the evolution pattern of dynamic pulmonary flow and volume in cystic fibrosis patients and analyze the relation between the severity of ventilatory attacks and age, gender, genotype and pulmonary colonization. Methods: At the Pediatric Pulmonary Unit and Pulmonary Service of Hospital de Clínicas of Porto Alegre, 243 spirometries performed between 1987 and 1999 in 52 cystic fibrosis patients older than four years of age were reviewed. From the patients' medical records the following informations were extracted: age at diagnosis, genetic data, bronchial colonization and absolute as well as percent values of the flows and volumes of the best annual spirometry. Results: The age of the patients ranged from four to 26 years (mean = 13.04 ± 4.82). Out of the 52 patients, 49 (94%) had at least one sputum culture with P. aeruginosa, 45 (86%) with S. aureus and 13 (25%) with B. cepacia. At initial evaluation, that included patients four to six years old (n = 40), mean values for FVC and FEV1 were 114.24% and 112.25%, respectively. Mean FVC remained above baseline until 18 years of age, when it abruptly dropped to 67.2% (p = 0.0002). Mean FEV1 values dropped to less than 80% at ten years and was 50% at 18 years (p < 0.00001). The FEV1/FVC% relationship, the most obstruction sensitive index, was observed to be reduced as early as initial evaluation. It was 85% between four and six years and gradually decreased to 63% at 18 years. The mean values of FEF50, FEF75 and FMEF were initially normal (94%, 80% and 90%, respectively), showed a greater and earlier statistically significant decline, and reached to 37%, 12.5% and 19%, respectively, at 18 years. Although a tendency to lower terminal flow was seen in the girls, the differences were not statistically significant. Significant correlations between pulmonary function and the airway colonizator or genotype were not detected statistic. Conclusion: The evolution pattern of pulmonary function alterations found in these patients is consistent with those reported in the literature, where obstructive ventilatory disorders with early terminal flow reduction and late FVC onset predominate.

 


Keywords: Spirometry. Cystic fibrosis. Pulmonary ventilatory.

 


Pulmonary function tests in asthmatic children and adolescents: Comparison between a microspirometer and a conventional spirometer

Avaliação funcional pulmonar em crianças e adolescentes asmáticos: comparação entre a micro espirometria e a espirometria convencional

Lúcia Bartmann Wild, Alexandre Simões Dias, Gilberto Bueno Fischer, Daniele Ruzzante Rech

J Bras Pneumol.2005;31(2):97-102

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Background: Spirometry is widely used in the diagnosis and quantification of respiratory disorders such as asthma. A microspirometer is a portable and easily used apparatus that can substitute for a regular spirometer, although there is little evidence of its accuracy. Objective: To compare the microspirometer to a regular spirometer for use in asthmatic children and adolescents. Methods: The instruments used were a Micro Spirometer, manufactured by Micro Medical, and a conventional Cosmed Pony Graphic 3.5 spirometer, both with turbinometers (flow sensors). The study sample consisted of 62 children and adolescents, of both genders, clinically diagnosed with asthma and under treatment at a pulmonology clinic. Ages ranged from 5 and 16 years. All spirometric tests were carried out according to the guidelines established by the American Thoracic Society and by the Associacão Brasileira de Normas Técnicas (Brazilian Technical Standards Association). For each patient, microspirometry was performed first, followed by conventional spirometry. The parameters analyzed in both devices were forced vital capacity, forced expiratory volume in one second and peak expiratory flow. Data were analyzed using the Student's t-test and Pearson's correlation test. Results: Strong correlations were found between the two devices in the parameters analyzed: forced expiratory volume in one second: r = 0.97; forced vital capacity: r = 0.97; and peak expiratory flow: r = 0.91. Conclusion: These results demonstrate that the microspirometer is a useful diagnostic tool that can be used when a conventional spirometer is unavailable.

 


Keywords: Key words: Asthma. Spirometry. Micro spirometer. Puomonary ventilation.

 


Mediastinal evaluation in lung cancer staging

Avaliação mediastinal no estadiamento do câncer do pulmão

Angelo Fernandez, Aldo Rodrigues Junqueira Jr., Ricardo H. Bammann, Ricardo Beyruti, Fábio B. Jatene

J Bras Pneumol.1998;24(1):17-22

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The presence of mediastinal lymph node metastasis in lung cancer has a great influence on treatment selection and prognosis, and the diagnosis of lymphatic metastasis must be accurate. CT chest scans and mediastinoscopy are the diagnostic tools available to detect mediastinal lymph node metastases and to establish preoperative staging. Lymph node size evaluated by CT scans is not an acceptable criterion in the patients studied here. The aim of this study was to find out a representative pattern of size to indicate the possibility of neoplastic invasion in the population studied. Fifty consecutive patients were operated on and were submitted to pulmonary resection and mediastinal dissection to treat lung cancer. Seventy-four percent of the lymph nodes with transverse section of more than 3 cm had no neoplastic invasion. CT scans and mediastinoscopy have similar sensitivity (close to 65%), but mediastinoscopy has higher specificity (100%). This means that the authors must have histologic confirmation of any suspected lymph node to achieve a correct staging.

 


Keywords: Carcinoma, non-small cell. Lung neoplasias. Lymph nodes. Lymphatic metastasis. Mediatinoscopy. Neoplasm, staging. CT scanning.

 


Early prognosis of acute asthma in the emergency room

Avaliação prognóstica precoce da asma aguda na sala de emergência

Deise Marcela Piovesan, Diego Milan Menegotto, Suzie Kang, Eduardo Franciscatto, Thaís Millan, Cristine Hoffmann, Lílian Rech Pasin, Josiane Fischer, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2006;32(1):1-9

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Objective: To evaluate clinical and pulmonary function measurements taken in the first fifteen minutes of the assessment of acute asthma in the emergency room and used for prognostic purposes. Methods: A prospective cohort study involving consecutive patients with acute asthma. Only patients who were between the ages of 12 and 55 and presented peak expiratory flow rates < or = 50% of predicted were included. Evaluations were performed upon admission, then again at 15 minutes and 4 hours after the initiation of treatment. Treatment included albuterol and ipratropium delivered by metered-dose inhaler with a spacer, together with 100 mg of intravenous hydrocortisone. Favorable outcomes were defined as peak expiratory flow > or = 50% of predicted after 4 hours of treatment, and unfavorable outcomes were defined as peak expiratory flow < 50% after 4 hours of treatment. Results: Favorable outcomes were seen in 27 patients, and unfavorable outcomes were seen in 24 patients. In the multivariate analysis, peak expiratory flow as percentage of predicted was identified as the variable with the highest predictive value. A peak expiratory flow > or = 40% after 15 minutes of treatment showed significant power in predicting a favorable outcome (sensitivity = 0.74, specificity = 1.00, and positive predictive value = 1.00). A peak expiratory flow < 30% after 15 minutes of treatment was predictive of a poor outcome (sensitivity = 0.54, specificity = 0.93, and positive predictive value = 0.87). Conclusion: Our results suggest that measuring peak expiratory flow after 15 minutes of management in the emergency room is a useful tool for predicting outcomes in cases of acute asthma.

 


Keywords: Asthma; Acute disease; Respiratory mechanics; Prognosis; Emergency Service, Hospital; Cohort studies

 


Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis

Avaliação quantitativa da intensidade da transpiração palmar e plantar em pacientes portadores de hiperidrose palmoplantar primária

Bruno Yoshihiro Parlato Sakiyama, Thaís Vera Monteiro, Augusto Ishy, José Ribas Milanez de Campos, Paulo Kauffman, Nelson Wolosker

J Bras Pneumol.2012;38(5):573-578

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Objective: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. Methods: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm2. Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24°C). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. Results: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 ± 51.0 g/m2/h and 71.8 ± 40.3 g/m2/h, respectively, compared with 37.9 ± 18.4 g/m2/h and 27.6 ± 14.3 g/m2/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). Conclusions: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

 


Keywords: Hyperhidrosis; Sweat; Dermatology/instrumentation.

 


Quantitative assessment of elastic fibers in chronic obstructive pulmonary disease

Avaliação quantitativa das fibras elásticas na doença pulmonar obstrutiva crônica

Rogerio Rufino, Kalil Madi, Heitor Siffert Pereira de Souza, Cláudia Henrique da Costa, Eduardo Haruo Saito, José Roberto Lapa e Silva

J Bras Pneumol.2007;33(5):502-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). Methods: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. Results: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm2) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r2 = 0.003). Conclusions: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; CD4 Lymphocyte Count; Elastic tissue; Muscle, smooth.

 


Semiquantitative echocardiographic evaluation of intrapulmonary vascular dilatations: correlation with evaluation of shunt levels and pulmonary function parameters

Avaliação semiquantitativa ecocardiográfica de dilatações vasculares intrapulmonares em candidatos a transplante hepático: correlação com avaliação de shunt e parâmetros funcionais pulmonares

Maria Angélica Pires Ferreira, Sérgio Saldanha Menna Barreto, Marli Maria Knorst, Mario Reis Álvares da Silva, Antonio Furlan Pinotti

J Bras Pneumol.2009;35(2):106-113

Abstract PDF PT PDF EN Portuguese Text

Objective: To correlate semiquantitative evaluation of intrapulmonary vascular dilatations (IPVD) with quantitative evaluation of shunt levels, as well as to describe clinical and pulmonary function findings in a sample of liver disease patients with IPVD. Methods: Patients presenting transthoracic echocardiography (TTE) positivity for IPVD underwent clinical evaluation, pulmonary function tests and pulmonary shunt quantification (scintigraphy with technetium-99m-labeled macroaggregated albumin and blood gas analysis after pure oxygen breathing). Results: A total of 28 liver cirrhosis patients were studied (mean age, 47.5 years; 60.7% were Child-Pugh class B). A 4-point, ascending scale was used as a measure of IPVD intensity, which was scored as 1, 2, 3 and 4, respectively, in 13 (46.4%), 9 (32.1%), 2 (7.1%) and 4 (14.3%) of the patients. Patients were divided into a low-intensity group (scores 1 and 2) and a high-intensity group (scores 3 and 4). The mean shunt assessed using scintigraphy was 14.9% in the sample as a whole and was lower in the low-intensity group (11.7% vs. 26.3%; p = 0.01). The mean shunt by blood gas analysis was higher in the high-intensity group (8.3% vs. 16.3%; p < 0.001). Mean PaO2 was lower in the high-intensity group. There was a negative correlation between DLCO and IPVD severity (r = −0.406, p = 0.01). Conclusions: TTE is a safe, useful tool for assessing IPVD severity in liver disease patients. The IPVD intensity assessed using TTE correlated with the intrapulmonary shunt values obtained through the quantitative methods evaluated, as well as with pulmonary gas exchange abnormalities.

 


Keywords: Anoxia; Liver cirrhosis; Hepatopulmonary syndrome; Echocardiography.

 


Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects

Avaliação ultra-sonográfica da mobilidade do diafragma em diferentes posturas em sujeitos saudáveis

Wellington Pereira dos Santos Yamaguti, Elaine Paulin, Simone Shibao, Sérgio Kodaira, Maria Cristina Chammas, Celso Ricardo Fernandes Carvalho

J Bras Pneumol.2007;33(4):407-413

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess, using ultrasound, the effects that changes in body position have on diaphragmatic mobility in healthy subjects during spontaneous breathing. Methods: The study involved seven healthy female volunteers, all of whom were nonsmokers, well nourished, and free of any cardiopulmonary disease. They were submitted to pulmonary function testing and ultrasound evaluation of the mobility of the right diaphragm by the craniocaudal displacement of the left branch of the portal vein using an ultrasound device in mode B. The mobility of the right diaphragm was evaluated in right decubitus and in left decubitus. The order of evaluation was previously determined in a random drawing. Results: The average mobility of the right diaphragm in right decubitus (51.30 ± 9.69 mm) was significantly higher (p = 0.03) than that observed in left decubitus (45.93 ± 10.37 mm). Conclusion: The results suggest that, during spontaneous ventilation, the dependent portion of the diaphragm presents greater mobility than does the nondependent portion, and that the technique used was sufficiently sensitive to detect variations in diaphragmatic mobility related to changes in posture.

 


Keywords: Diaphragm; Ultrasonography; Respiratory function tests; Posture.

 


Evaluating COPD from the perspective of the patient

Avaliando a DPOC pela perspectiva do paciente

Cláudia Adriana Sant'Anna Ferreira, Alberto Cukier

J Bras Pneumol.2006;32(2):7-8

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Low income as a protective factor against asthma in children and adolescents treated via the Brazilian Unified Health System

Baixa renda como fator de proteção contra asma em crianças e adolescentes usuários do Sistema Único de Saúde

Murilo Carlos Amorim de Britto, Emilses Fernandes de Carvalho Freire, Patrícia Gomes de Matos Bezerra, Rita de Cássia Coelho Moraes de Brito, Joakim da Cunha Rego

J Bras Pneumol.2008;34(5):251-255

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the role that low income plays in the development of asthma in children and adolescents. Methods: A case-control study using a questionnaire. Results: A total of 687 participants were studied at a tertiary hospital via the Brazilian Unified Health System. Ages ranged from 5 to 15 years, and 54.7% of the participants were male. Nearly half of the individuals (49.1%) lived in the metropolitan area of the city of Recife, and the remainder lived in the countryside. Most (98.1%) lived in concrete houses or apartments, with a mean of 5.7 rooms and 4.8 occupants per residence. Mean maternal level of education was 6.8 years of schooling. The median monthly per capita income was R$ 103.75 (Brazilian reals). The sample was stratified according to cut-off points related to the national minimum wage (R$ 350.00): <25% of minimum wage = very low income (39% of the sample); <50% of minimum wage = low income (37.3% of the sample); and ≥50% of minimum wage = satisfactory income (23.7% of the sample). There was no association between poverty and development of asthma. Conclusions: Poverty is not protective against asthma in children and adolescents treated via the Brazilian Unified Health System, as we might suppose based on the hygiene hypothesis. However, cohort studies are needed in order to confirm these findings.

 


Keywords: Asthma; Poverty; National health programs/Brazil; Child; Adolescent; Case-control studies.

 


Poor perception of dyspnea following methacholine challenge test in patients with asthma

Baixo grau de percepção da dispneia após teste de broncoprovocação induzida por metacolina em pacientes com asma

Cláudia Loss Reck, Daniel Fiterman-Molinari, Sérgio Saldanha Menna Barreto, Jussara Fiterman

J Bras Pneumol.2010;36(5):539-544

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the proportion of asthma patients with a poor perception of dyspnea, correlating the level of that perception with the severity of acute bronchoconstriction, bronchial hyperresponsiveness, use of maintenance medication, and asthma control. Methods: Uncontrolled clinical trial involving asthma patients treated at the Pulmonology Outpatient Clinic of the São Lucas Hospital, in Porto Alegre, Brazil. Methacholine challenge testing was performed using a five-breath dosimeter protocol. The perception of dyspnea after each breath was determined using the Borg scale. Data concerning asthma control, medication in use, and use of rescue short-acting bronchodilators were recorded. Results: Of the 65 patients included in the study, 53 completed the evaluation. Of those, 32 (60.5%) showed adequate perception of dyspnea after the methacholine challenge test, whereas 21 (39.5%) did not perceive any changes in the degree of dyspnea even after a 20% fall in FEV1. There were no significant differences between the two groups regarding baseline FEV1, percentage fall in FEV1, and the dose of methacholine causing a 20% fall in FEV1. The perception of dyspnea was not significantly associated with age (p = 0.247); gender (p = 0.329); use of maintenance medication (p = 0.152); asthma control (p = 0.562), bronchial hyperresponsiveness (p = 0.082); or severity of acute bronchoconstriction (p = 0.749). Conclusions: A significant proportion of asthma patients have a poor perception of dyspnea. The factors related to the inability of these patients to identify changes in pulmonary function have not yet been well defined. In order to reduce asthma-related morbidity and mortality, it is essential that this group of patients be identified and counseled.

 


Keywords: Asthma; Dyspnea; Airway obstruction.

 


Barriers associated with reduced physical activity in COPD patients

Barreiras associadas à menor atividade física em portadores de DPOC

Priscila Batista Amorim, Rafael Stelmach, Celso Ricardo Fernandes Carvalho, Frederico Leon Arrabal Fernandes, Regina Maria Carvalho-Pinto, Alberto Cukier

J Bras Pneumol.2014;40(5):504-512

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Objective: To evaluate the ability of COPD patients to perform activities of daily living (ADL); to identify barriers that prevent these individuals from performing ADL; and to correlate those barriers with dyspnea severity, six-minute walk test (6MWT), and an ADL limitation score. Methods: In COPD patients and healthy, age-matched controls, the number of steps, the distance walked, and walking time were recorded with a triaxial accelerometer, for seven consecutive days. A questionnaire regarding perceived barriers and the London Chest Activity of Daily Living (LCADL) scale were used in order to identify the factors that prevent the performance of ADL. The severity of dyspnea was assessed with two scales, whereas submaximal exercise capacity was determined on the basis of the 6MWT. Results: We evaluated 40 COPD patients and 40 controls. In comparison with the control values, the mean walk time was significantly shorter for COPD patients (68.5  25.8 min/day vs. 105.2  49.4 min/day; p < 0.001), as was the distance walked (3.9  1.9 km/day vs. 6.4  3.2 km/day; p < 0.001). The COPD patients also walked fewer steps/day. The most common self-reported barriers to performing ADL were lack of infrastructure, social influences, and lack of willpower. The 6MWT distance correlated with the results obtained with the accelerometer but not with the LCADL scale results. Conclusions: Patients with COPD are less active than are healthy adults of a comparable age. Physical inactivity and the barriers to performing ADL have immediate implications for clinical practice, calling for early intervention measures.

 


Keywords: Pulmonary disease, chronic obstructive; Activities of daily living; Exercise tolerance.

 


Cellular and biochemical bases of chronic obstructive pulmonary disease

Bases celulares e bioquímicas da doença pulmonar obstrutiva crônica

Rogério Rufino, José Roberto Lapa e Silva

J Bras Pneumol.2006;32(3):241-248

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is an inflammatory disease. Together with oxidant stimuli, which directly affect lung structures, macrophages, neutrophils and CD8+ lymphocytes actively participate in the pathogenesis of the disease and promote biochemical reactions that result in progressive alteration of the upper airways and irreversible lung remodeling. The release of substances promoted by inflammatory cell recruitment and by oxidative stress lead to a temporary imbalance in the pulmonary defense mechanisms. Understanding the long-term maintenance of this imbalance is key to understanding the current physiopathology of the disease. The present study explores the cellular and molecular alterations seen in chronic obstructive pulmonary disease.

 


Keywords: Pulmonary disease, chronic obstructive/physiopathology; Lung/metabolism; Inflammation; Oxydants; Antioxidants; Oxidative stress

 


Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

Biópsia aspirativa transtorácica por agulha fina guiada por TC de lesões pulmonares: resultados e complicações

Cristiano Dias de Lima, Rodolfo Acatauassu Nunes, Eduardo Haruo Saito, Cláudio Higa, Zanier José Fernando Cardona, Denise Barbosa dos Santos

J Bras Pneumol.2011;37(2):209-216

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. Methods: A retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. Results: The main indication for the procedure was suspicion of advanced-stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. Conclusions: The principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure.

 


Keywords: Biopsy, fine-needle; Tomography, spiral computed; Lung neoplasms; Pneumothorax.

 


CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy

Biópsia percutânea com agulha grossa, guiada por TC, de nódulos pulmonares menores que 2 cm: aspectos técnicos e fatores que influenciam a precisão

Juliano Ribeiro de Andrade1,a, Rafael Dahmer Rocha1,b, Priscila Mina Falsarella1,c, Antonio Rahal Junior1,d, Ricardo Sales dos Santos2,e, Juliana Pereira Franceschini3,f, Hiran Chrishantha Fernando4,g, Rodrigo Gobbo Garcia1,h

J Bras Pneumol.2018;44(4):307-314

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.

 


Keywords: Image-guided biopsy; Neoplasms; Lung.

 


Open lung biopsy in patients on mechanical ventilation and presenting diffuse pulmonary infiltrate

Biópsia pulmonar a céu aberto em pacientes sob ventilação mecânica e com infiltrado pulmonar difuso

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Carlos Alberto de Barros Franco

J Bras Pneumol.2005;31(3):212-218

Abstract PDF PT PDF EN Portuguese Text

Background: Open lung biopsy is regarded as the gold standard for the diagnosis of diffuse pulmonary infiltrates. Objective: To determine the diagnostic yield, therapeutic changes, complications and mortality attributed to open lung biopsy in patients with diffuse pulmonary infiltrates and on mechanical ventilation. Method: We reviewed, retrospectively, the charts of 24 patients, ranging from 26 to 89 years of age, admitted to the intensive care units of two private hospitals and submitted to open lung biopsy. Results: Diagnostic positivity was found in 100% of patients, resulting in an alteration in the treatment regimen in 75%. Postoperative complications occurred in five patients (20.8%). There were no biopsy-related deaths, although global mortality was 45.8%. Conclusion: Open lung biopsy is a safe and high yield procedure for diagnosing diffuse pulmonary infiltrate in patients on mechanical ventilation. Despite the fact that no mortality impact factor has been assigned to such patients, data in the literature regarding prognosis must be taken into consideration.

 


Keywords: Biopsy. Respiratory insufficiency. Respiration artificial.

 


Intrathoracic goiter and invasive thymoma: rare concomitant presentation

Bócio de tireóide intratorácico e timoma invasivo: apresentação simultânea incomum

Rodrigo Silva, Jefferson Gross, Fábio Haddad, Riad Younes

J Bras Pneumol.2006;32(4):371-374

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We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.

 


Keywords: Thymoma/complications; Mediastinal neoplasms/complications; Goite, substernal; Mediastinum/pathology; Case reports [publication type]

 


Aspergillus fumigatus fungus ball in the pleural cavity

Bola fúngica por Aspergillus fumigatus em cavidade pleural

Luciana Silva Guazzelli, Cecília Bittencourt Severo, Leonardo Santos Hoff, Geison Leonardo Fernandes Pinto, José Jesus Camargo, Luiz Carlos Severo

J Bras Pneumol.2012;38(1):125-132

Abstract PDF PT PDF EN Portuguese Text

Objective: To report the cases of 6 patients with fungus ball caused by Aspergillus fumigatus (aspergilloma) in the pleural cavity. Methods: Between 1980 and 2009, 391 patients were diagnosed with aspergilloma at the Santa Casa Hospital Complex in Porto Alegre, Brazil. The diagnosis of aspergilloma in the pleural cavity was made through imaging tests revealing effusion and pleural thickening with air-fluid level; direct mycological examination revealing septate hyphae, consistent with Aspergillus sp.; and positive culture for A. fumigatus in the surgical specimen from the pleural cavity. Results: Of the 391 patients studied, 6 (2%) met the established diagnostic criteria. The mean age of those 6 patients was 48 years (range, 29-66 years), and 5 (83%) were male. The most common complaints were cough, expectoration, and hemoptysis. Four patients (67%) had a history of tuberculosis that had been clinically cured. All of the patients were submitted to surgical removal of the aspergilloma, followed by intrapleural instillation of amphotericin B, in 4; and 2 received systemic antifungal treatment p.o. There was clinical improvement in 5 patients, and 1 died after the surgery. Conclusions: In adult patients with a history of cavitary lung disease or pleural fistula, a careful investigation should be carried out and fungal infection, especially aspergilloma, should be taken into consideration. In such cases, laboratory testing represents the most efficient use of the resources available to elucidate the diagnosis.

 


Keywords: Aspergillus fumigatus; Tuberculosis; Empyema, pleural; Pleural effusion.

 


Aspergillus fumigatus fungus ball in the native lung after single lung transplantation

Bola fúngica por Aspergillus fumigatus no pulmão nativo após transplante unilateral de pulmão

Fernando Ferreira Gazzoni, Bruno Hochhegger, Luiz Carlos Severo, José Jesus Camargo

J Bras Pneumol.2013;39(3):-

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Bronchodilation in COPD: beyond FEV1-the effect of albuterol on resistive and reactive properties of the respiratory system

Broncodilatação na DPOC: muito além do VEF1-efeito do salbutamol nas propriedades resistivas e reativas do sistema respiratório

Gerusa Marítimo da Costa, Alvaro Camilo Dias Faria, Ana Maria Gonçalves Tavares Di Mango, Agnaldo José Lopes, José Manoel Jansen, Pedro Lopes de Melo

J Bras Pneumol.2009;35(4):325-333

Abstract PDF PT PDF EN Portuguese Text

Objective: Current debates on the bronchodilator response in COPD patients and whether the variation in FEV1 can be considered as an indicator of complete reversibility in such patients motivated us to conduct this study. The objective of the study was to determine the effect of albuterol on the resistive and reactive properties of the respiratory system in COPD patients. Methods: We evaluated 70 patients with COPD, divided into two groups based on spirometry findings: bronchodilator (BD)-negative (n = 39); and BD-positive (n = 31). We used the forced oscillation technique (FOT) to evaluate the following parameters: resistance at the intercept (R0), associated with the total resistance of the respiratory system; mean resistance (Rm), associated with central airway resistance; dynamic compliance (Cdyn); and the slope of resistance (S) and mean reactance (Xm), both of which are associated with the homogeneity of the respiratory system. Results: The use of albuterol resulted in significant reductions in R0 (p < 0.00002) and Rm (p < 0.0002). There were also significant increases in S (p < 0.0001), Cdyn (p < 0.0001) and Xm (p < 0.00004). These modifications occurred in both groups, the changes in FOT parameters being greater than those observed for spirometric parameters. Conclusions: The use of albuterol improved the resistive and reactive properties of the respiratory system of the COPD patients under study. These changes occurred regardless of the FEV1-based classification, thereby indicating that the use of this parameter in isolation might not suffice to identify the physiological effects involved.

 


Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Spirometry; Albuterol.

 


Exercise-induced bronchoconstriction in elite long-distance runners in Brazil

Broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite

Renata Nakata Teixeira, Luzimar Raimundo Teixeira, Luiz Augusto Riani Costa, Milton Arruda Martins, Timothy Derick Mickleborough, Celso Ricardo Fernandes Carvalho

J Bras Pneumol.2012;38(3):292-298

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of exercise-induced bronchoconstriction among elite long-distance runners in Brazil and whether there is a difference in the training loads among athletes with and without exercise-induced bronchoconstriction. Methods: This was a cross-sectional study involving elite long-distance runners with neither current asthma symptoms nor a diagnosis of exercise-induced bronchoconstriction. All of the participants underwent eucapnic voluntary hyperpnea challenge and maximal cardiopulmonary exercise tests, as well as completing questionnaires regarding asthma symptoms and physical activity, in order to monitor their weekly training load. Results: Among the 86 male athletes recruited, participation in the study was agreed to by 20, of whom 5 (25%) were subsequently diagnosed with exercise-induced bronchoconstriction. There were no differences between the athletes with and without exercise-induced bronchoconstriction regarding anthropometric characteristics, peak oxygen consumption, baseline pulmonary function values, or reported asthma symptoms. The weekly training load was significantly lower among those with exercise-induced bronchoconstriction than among those without. Conclusions: In this sample of long-distance runners in Brazil, the prevalence of exercise-induced bronchoconstriction was high.

 


Keywords: Athletes; Asthma, exercise-induced; Exercise test.

 


Flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

Ascedio José Rodrigues, Eduardo Quintino Oliveira, Paulo Rogério Scordamaglio, Marcelo Gervilla Gregório, Márcia Jacomelli, Viviane Rossi Figueiredo

J Bras Pneumol.2012;38(3):315-320

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. Methods: This was a retrospective study of all adult patients (over 18 years of age) with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. Results: The study sample comprised 40 adult patients, with a mean age of 52 years (range, 18-88 years). The median time of permanence of the foreign body in the airway was 15 days (range, 12 h to 10 years). All of the patients first underwent diagnostic flexible bronchoscopy. Foreign bodies were successfully removed with flexible bronchoscopy in 33 (82.5%) of the patients. In 1 patient, a metal object lodged in the distal bronchial tree required the use of fluoroscopy. Six patients (15%) required rigid bronchoscopy due to tracheal foreign body-induced dyspnea, in 2, and because the foreign body was too large for the flexible forceps, in 4. Bronchoscopy failed in 1 patient, who therefore required surgical bronchotomy. Conclusions: Although rigid bronchoscopy is considered the gold standard for the removal of foreign bodies from the airways, our experience showed that flexible bronchoscopy can be safely and effectively used in the diagnosis and treatment of stable adult patients.

 


Keywords: Bronchoscopy; Foreign bodies; Airway obstruction; Airway management.

 


Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

Márcia Jacomelli, Priscila Regina Alves Araújo Silva, Ascedio Jose Rodrigues, Sergio Eduardo Demarzo, Márcia Seicento, Viviane Rossi Figueiredo

J Bras Pneumol.2012;38(2):167-173

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Objective: To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. Methods: A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to bronchoscopy-BAL and transbronchial biopsy (TBB). The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. Results: Of the 286 patients studied, 225 (79%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%); nonspecific chronic inflammation, in 51 (18%); pneumocystis, fungal infections, or nocardiosis, in 20 (7%); bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%); lung or metastatic neoplasms, in 7 (2%); and nontuberculous mycobacterium infections, in 6 (2%). For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%), as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%). Minor post-procedure complications occurred in 5.6% of the cases. Conclusions: Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.

 


Keywords: Bronchoscopy; Tuberculosis, pulmonary; Sputum; Bronchoalveolar lavage; Biopsy.

 


Bronchoscopy in the diagnosis of tuberculosis: their role of transbronchial biopsy in HIV-infected and in immunocompetent patients

Broncoscopia no diagnóstico de tuberculose: papel da biópsia transbrônquica em imunocompetentes e em HIV-positivos

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Maria Rita E. Araújo, Kátia R.M. Leite

J Bras Pneumol.1999;25(4):207-212

Abstract PDF PT

Introduction: Bronchoscopy is useful in the diagnosis of tuberculosis suspects with a "negative" sputum smear. The objectives of this study were: to assess yield of bronchoalveolar lavage (BAL) and of transbronchial biopsy (TBB) both in HIV-positive patients (group 1) and immunocompetent individuals (group 2), based on simple and most available laboratory techniques in clinical practice. Patients and methods: The authors performed 319 bronchoscopies in 302 patients. BAL and TBB were sequentially performed in the same lung in all cases. Tuberculosis was diagnosed based on the results of acid-fast stains (AFS) from the lavage (ZN), culture for mycobacteria (LJ), and histological examination of biopsies (HE and ZN). Results: Tuberculosis was the final diagnosis in 28 exams of group 1 (n = 214) and in 35 of group 2 (n = 105). There were abnormal endoscopic findings respectively in 3 and 10 patients. In group 1, AFS were positive in 7 cases, culture of BAL in 14, and TBB in 19. In group 2, AFS were positive in 13 cases, culture in 17, and biopsies in 31. TBB results compared to BAL were in concordance for group 1 (p = 0.823) and different for group 2 (p = 0.022). Immediate results (AFS and TBB) compared to later positive results of culture were similar for group 1 (p = 0.066) but not for group 2 (p = 0.001). There were eight episodes of pneumothorax (2.5%) and one death (0.36%). Conclusions: Both BAL and TBB should be performed whenever possible, aiming towards a higher yield of bronchoscopy in the diagnosis of tuberculosis. Both methods complement each other in immunocompetent patients, whereas TBB establishes a faster diagnosis for HIV-infected patients if associated to AFS.

 


Keywords: Bronchoscopy/methods. Smear-negative tuberculosis/diagnosis. Opportunistic infections related to AIDS/diagnosis.

 


Bronchoscopy for foreign body removal: where is the delay?

Broncoscopia para remoção de corpo estranho: onde está o atraso?

Alexandre Garcia de Lima, Nelson Alves dos Santos, Elen Renate Figueira Rocha, Ivan Felizardo Contrera Toro

J Bras Pneumol.2008;34(11):956-958

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This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (HC-Unicamp versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.

 


Keywords: Airway obstruction; Respiratory aspiration; Bronchoscopy.

 


Localized and multisegmental bronchiectasis: clinical-epidemiological profile and surgical treatment results in 67 cases

Bronquiectasia localizada e multissegmentar: perfil clínico-epidemiológico e resultado do tratamento cirúrgico em 67 casos

Antero Gomes Neto, Marcos Lima de Medeiros, José Mauro Mendes Gifoni

J Bras Pneumol.2001;27(1):1-6

Abstract PDF PT

Bronchiectasis is a disease which is rarely found in developed countries and has a high incidence in developing countries. In Brazil, the most frequent causes are viral or bacterial respiratory infections in childhood, and tuberculosis. Antibiotic therapy considerably reduces morbidity. However, in patients with persistent symptoms, surgical resection offers greater chances of cure or better quality of life. Objectives: Prospectively evaluate the clinical-epidemiological profile of patients with bronchiectasis as well as the results of surgical treatment in patients from two public hospitals in Fortaleza (CE), northeastern Brazil. Patients and method: Sixty-seven patients with bronchiectasis submitted to surgery between August 1989 and March 1999 were evaluated, as well as demographic data, etiology of the disease, complications, and therapeutic success rate. Results: Mean age of patients (39 females e 28 males) was 32.5 ± 14.1 years. The most frequent causes of bronchiectasis were viral or bacterial infection (44.8%) and tuberculosis (31.3%). The disease was localized in 46 patients and multisegmental in 21. In six patients it was bilateral. No surgical death occurred and postoperative complications were more frequent in patients with multisegmental bronchiectasis (9/21 versus 6/46, p = 0.011). From the 62 patients who were followed up, 49 were cured, 10 showed improvement, and 3 did not obtain any benefit. Results were excellent in 39 patients with localized bronchiectasis and in 10 patients with the multisegmental form of the disease (p < 0.001). Conclusion: Results show two distinct groups of patients: those with bronchiectasis, who presented fewer surgical complications and better postoperative results, and those with multisegmental bronchiectasis.

 


Keywords: Bronchiectasis. Epidemiological profiles. Clinical diagnosis. Treatment outcome. Surgical operative procedures.

 


Bronchiectasis caused by common variable immunodeficiency

Bronquiectasia por imunodeficiência comum variável

Paulo Henrique do Amor Divino, José Henrique de Carvalho Basilio, Renato Moraes Alves Fabbri, Igor Polônio Bastos, Wilma Carvalho Neves Forte

J Bras Pneumol.2015;41(5):482-483

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Bronchiectasis caused by common variable immunodeficiency

Bronquiectasia por imunodeficiência comum variável.

Paulo Henrique do Amor Divino1, José Henrique de Carvalho Basilio1, Renato Moraes Alves Fabbri1, Igor Bastos Polonio1, Wilma Carvalho Neves Forte2

J Bras Pneumol.2016;42(1):80-80

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Bronchiectasis associated to Sjögren syndrome: case report

Bronquiectasias associadas à síndrome de Sjögren

Simone Aparecida Câmara Tecchio, José Antônio Baddini Martinez, Adriana Inácio de Pádua, João Terra Filho

J Bras Pneumol.2000;26(4):214-217

Abstract PDF PT

Different kinds of pulmonary impairment have been described in Sjögren syndrome, including rare cases of bronchiectasis. The authors report a female patient with a history of episodes of respiratory infections and progressive breathlessness whose high resolution computerized tomography revealed bronchiectasis. A former open lung biopsy showed bronchiolar inflammatory and fibrotic changes. The diagnosis of Sjögren syndrome was made only late in the evolution, although sicca syndrome symptoms had been present for years. The authors discuss the potential pathogenic mechanisms involved in the development of the bronchiectasis and the need for a high degree of clinical medical skill for the early diagnosis of such conditions.

 


Keywords: Sjögren syndrome; bronchiectasis; bronchiolitis

 


Bronchiectasis: diagnostic and therapeutic features A study of 170 patients

Bronquiectasias: aspectos diagnósticos e terapêuticos Estudo de 170 pacientes

José da Silva Moreira, Nelson da Silva Porto, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso, Ana Luiza Schneider Moreira, Cristiano Feijó Andrade

J Bras Pneumol.2003;29(5):258-263

Abstract PDF PT

Background: Bronchiectasis is a frequently found disease in medical practice in Brazil leading to significant morbidity and decrease in quality of life of the affected individuals. Objectives: To study diagnostic and therapeutic aspects in a series of hospitalized patients with bronchiectasis in a department of pulmonary diseases. Methods: Signs, symptoms, microbiological and radiographic data, and therapeutic results were studied in 170 hospitalized patients between 1978 and 2001 - females 62.4%, males 37.6%, and aged from 12 to 88 years (mean age 36.8 yrs). Previous history of pneumonia in childhood was detected in 52.5% of the patients, tuberculosis in 19.8%; 8.8% had bronchial asthma, and 2 had Kartagener's syndrome. Results: The most common symptoms were cough (100.0%), expectoration (96.0%) and pulmonary rales (66.0%). The pulmonary lesions were unilateral in 46.5% of the cases. Pneumococcus, H. influenzae or mixed flora were found in 85.0% of the examined sputa. All 170 patients received antibiotics and postural drainage, and 88 of them (younger and with a higher functional reserve) were also submitted to pulmonary resections (82 unilateral and 6 bilateral). Two deaths occurred, and repetitive hospitalizations were more frequent among the clinically treated patients. The follow up showed that most of the surgically treated patients had significant symptoms improvement and rarely needed to be re-hospitalized. Conclusions: In the majority of the patients, lung resection surgery improved permanently the prolonged bronchopulmonary symptoms of patients with bronchiectasis, differently from the patients who received only clinical treatment.

 


Keywords: Bronchiectasis/diagnosis. Bronchiectasis/therapy. Bronchiectasis/surgery. Bronchiectasis/complications. Tomography X-ray computed/methods. Inpatients. Retrospective studies.

 


Bronchiolitis associated with exposure to artificial butter flavoring in workers at a cookie factory in Brazil

Bronquiolite associada à exposição a aroma artificial de manteiga em trabalhadores de uma fábrica de biscoitos no Brasil

Zaida do Rego Cavalcanti, Alfredo Pereira Leite de Albuquerque Filho, Carlos Alberto de Castro Pereira, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2012;38(3):395-399

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Objective: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. Methods: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. Results: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. Conclusions: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.

 


Keywords: Diacetyl; Flavoring agents; Bronchiolitis.

 


Bronchiolitis obliterans organizing pneumonia

Bronquiolite obliterante com pneumonia em organização

Gabriela Addor, Andréia Salarini Monteiro, David Henrique Nigri, Wilhermo Torres, Carlos Alberto de Barros Franco

J Bras Pneumol.2004;30(2):154-157

Abstract PDF PT

48 years-old woman, asymptomatic, presented with radiographic findings of patchy airspace consolidation with nodular opacities in the upper right lobe, middle lobe and lingula. The differential diagnoses of neoplasms, sarcoidosis, granulomatous diseases and tuberculosis were considered. Diagnosis of Bronchiolitis obliterans organizing pneumonia was made by means of videothoracoscopy whereupon treatment with corticosteroids was begun. The patient had a positive evolution with resolution of the radiographic finding.

 


Keywords: bronchiolitis obliterans organizing pneumonia, bronchiolitis obliterans

 


Bronchiolitis obliterans with organizing pneumonia (BOOP)

Bronquiolite obliterante com pneumonia em organização (BOOP) aguda

José Eduardo Delfini Cançado, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(5):331-334

Abstract PDF PT

Most interstitial lung diseases (ILD) are indolent in nature, producing subacute or chronic symptoms that progress at various rates and are usually present for months to years before a diagnosis is established. This report describes a case of a fulminating and life-threatening variant of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP). Early suspicion, histologic diagnosis, and prompt initiation of corticosteroid therapy is important to prevent mortality.

 


Keywords: Bronchiolitis obliterans with organizing pneumonia (BOOP). Interstitial lung disease.

 


Bronchiolitis obliterans with organizing pneumonia and aspergilloma in patient with T cell leukemia-lymphoma

Bronquiolite obliterante com pneumonia em organização e aspergiloma em paciente com linfoma-leucemia de células T

Teresa S. Jhayya, Domingo B. Perez, Celia Mallart Llarges, Rimarcs G. Ferreira

J Bras Pneumol.2000;26(1):52-54

Abstract PDF PT

There are few reports in the medical literature about association between bronchiolitis obliterans with organizing pneumonia (BOOP) and aspergilloma. This report shows the presence of both BOOP and pulmonary aspergilloma in a patient with adult T cell leukemia-lymphoma. It is suggested that these findings represent a random association rather than the expression of a nosologic unity.

 


Keywords: bronchiolitis obliterans; aspergillosis; T cell lymphoma; pneumonia

 


Bronchiolitis obliterans organizing migratory pneumonia (BOOP) after unilateral radiotherapy for breast carcinoma treatment

Bronquiolite obliterante com pneumonia organizante (BOOP) migratória após radioterapia unilateral para tratamento de carcinoma de mama

Renata Tristão Rodrigues, Ricardo Togashi, Hugo H Bok Yoo, Júlio Defaveri, Irma de Godoy, Thais Helena A. Thomaz Queluz

J Bras Pneumol.1998;24(1):47-50

Abstract PDF PT

The authors describe a case of a woman submitted to radiation therapy for breast carcinoma who presented, 40 days after the end of the treatment, fever, dry cough, dyspnea on exertion, and weight loss. Chest imaging revealed migratory opacities. The histopathological examination of transbronchial biopsy specimens showed characteristic findings of BOOP. Corticosteroid therapy resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. The authors present a brief review of the literature concerning radiation-induced lung injury, emphasizing the importance of including BOOP in the differential diagnosis in these complications. The present case, as well as the two other reports from the literature, provide further evidence for the role of irradiation injury as a cause of clinicopathological syndrome identical to idiopathic BOOP, i.e., radiation-induced BOOP.

 


Keywords: Bronchiolitis obliterans organizing pneumonia. BOOP. Radiation pneumonitis. Radiotherapy. Breast carcinoma.

 


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-e20180168

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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.

 


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-e20180285

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Lung cancer and schwannoma - the pitfalls of positron emission tomography

Câncer de pulmão e schwannoma - as armadilhas da tomografia por emissão de prótons

Fernando Luiz Westphal, Luiz Carlos de Lima, José Correa Lima-Netto, Michel de Araújo Tavares, Felipe de Siqueira Moreira Gil

J Bras Pneumol.2014;40(3):319-321

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Lung cancer in Brazil

Câncer de pulmão no Brasil

Luiz Henrique Araujo1,2,a, Clarissa Baldotto1,2,b, Gilberto de Castro Jr3,4,c, Artur Katz4,d, Carlos Gil Ferreira5,6,e, Clarissa Mathias7,f, Eldsamira Mascarenhas7,g, Gilberto de Lima Lopes8,9,h, Heloisa Carvalho4,10,i, Jaques Tabacof8, Jeovany Martínez-Mesa11,j, Luciano de Souza Viana12,k, Marcelo de Souza Cruz13,l, Mauro Zukin1,2,m, Pedro De Marchi12,n, Ricardo Mingarini Terra3,o, Ronaldo Albuquerque Ribeiro14, Vladmir Cláudio Cordeiro de Lima15,p, Gustavo Werutsky16,q, Carlos Henrique Barrios17,r; Grupo Brasileiro de Oncologia Torácica

J Bras Pneumol.2018;44(1):55-64

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Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

 


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil.

 


Lung cancer: histology, staging, treatment and survival

Câncer de pulmão: histologia, estádio, tratamento e sobrevida

Fabiola Trocoli Novaes, Daniele Cristina Cataneo, Raul Lopes Ruiz Junior, Júlio Defaveri, Odair Carlito Michelin, Antonio José Maria Cataneo

J Bras Pneumol.2008;34(8):595-600

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Objective: To analyze principal histological types of lung cancer, as well as the staging, treatment and survival of lung cancer patients. Methods: This was a retrospective study based on the analysis of medical charts of patients treated at the Botucatu School of Medicine Hospital das Clínicas over a six-year period. Results: From January of 2000 to January of 2006, 240 patients with lung cancer, most (64%) of whom were male, were treated. The most common histological type was squamous cell carcinoma (37.5%), followed by adenocarcinoma (30%), neuroendocrine carcinoma (19.6%) and large cell carcinoma (6.6%). Only 131 patients (54.6%) were treated. Of those, 52 patients (39.7%) received only chemotherapy, 32 (24.4%) were treated with chemotherapy combined with radiotherapy, and 47 (35.9%) were submitted to surgery alone or surgery accompanied by chemotherapy, with or without radiotherapy. Only 27 patients (20.6%) were submitted to surgery alone. Concerning staging, 34.4% presented stage IV at the time of diagnosis, 20.6% presented stage IIIB, 16.8% presented stage IIIA, and the remaining 28.2% were classified as stage I or II. Five-year survival was 65% for those in stage I and 25% for those in the remaining stages. Conclusions: Of the various histological types, the most common was squamous cell carcinoma and the least common was large cell carcinoma. Most cases presented advanced stages at the moment of diagnosis, and less than 30% of the cases presented early stages. This accounts for the low survival rate and the small number of patients submitted to surgical treatment alone, the majority being submitted to chemotherapy alone.

 


Keywords: Carcinoma, bronchogenic; Lung neoplasms/histology; Lung neoplasms/drug therapy; Lung neoplasms/radiotherapy; Surgery; Survival.

 


Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil

Câncer de pulmão: mudanças na histologia, sexo e idade nos últimos 30 anos no Brasil

Maria Teresa Ruiz Tsukazan1,2, Álvaro Vigo2, Vinícius Duval da Silva3, Carlos Henrique Barrios4, Jayme de Oliveira Rios1, José Antônio de Figueiredo Pinto1

J Bras Pneumol.2017;43(5):363-367

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Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women.

 


Keywords: Lung neoplasms; Epidemiology; Histology; Adenocarcinoma; Carcinoma, non-small-cell lung; Carcinoma, squamous cell.

 


Inspiratory capacity, exercise limitation, markers of severity, and prognostic factors in chronic obstructive pulmonary disease

Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica

Clarice Guimarães de Freitas, Carlos Alberto de Castro Pereira, Carlos Alberto de Assis Viegas

J Bras Pneumol.2007;33(4):389-396

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Objective: To correlate the postbronchodilator (post-BD) inspiratory capacity (IC), % of predicted, with other markers of severity and prognostic factors in chronic obstructive pulmonary disease (COPD). Methods: Eighty stable patients with COPD performed forced vital capacity and slow vital capacity maneuvers, as well as the 6-min walk test, prior to and after receiving albuterol spray (400 μg). Patients were divided into four groups, based on post-BD forced expiratory volume in one second. Several variables were tested to establish correlations with the post-BD distance walked, using univariate and multivariate analysis. Post-BD IC was found to correlated with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and with the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Results: Multivariate regression analysis revealed that the distance walked, % predicted, correlated significantly with the IC post-BD, % predicted (p = 0.001), long-term oxygen use (p = 0.014), and number of medications used in the treatment (p = 0.044). IC ≤ 70% was observed in 56% patients in GOLD stages 3 or 4 vs. 20% in GOLD 1 or 2 (p < 0.001). IC ≤ 70% was observed in (60%) patients with BODE score 3 or 4 vs. (33%) BODE score 1 or 2 (p = 0.02). Conclusion: Post-BD IC% predicted is the best functional predictor of distance walked and is significantly associated with GOLD staging and BODE index. Therefore, We propose that the inspiratory capacity should be added to the routine evaluation of the COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; Walking; Respiratory function tests; Inspiratory capacity.

 


Submaximal exercise capacity in adolescent and adult patients with cystic fibrosis

Capacidade submáxima de exercício em pacientes adolescentes e adultos com fibrose cística

Bruna Ziegler, Paula Maria Eidt Rovedder, Janice Luisa Lukrafka, Claudine Lacerda Oliveira, Sérgio Saldanha Menna-Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2007;33(3):263-269

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Objective: To determine the submaximal exercise capacity of patients with cystic fibrosis (CF) by means of the 6-minute walk test (6MWT), correlating the results with clinical score, nutritional status, radiographic score, and pulmonary function tests. Methods: This was a prospective, cross-sectional study involving patients aged 16 or older enrolled in a program for adults with CF. The patients were submitted to clinical evaluation, determination of maximal respiratory pressures, 6MWT, spirometry, and chest X-ray. Results: The study comprised 41 patients. The mean age was 23.7 ± 6.5 years, and the mean forced expiratory volume in one second (FEV1) was 55.1 ± 27.8%. On the 6MWT, 30 (73.2%) of the patients covered a distance (mean, 556.7 ± 76.5 m) that was less than the predicted normal value. The distance walked did not correlate significantly with body mass index, clinical score, radiographic score, maximal respiratory pressures, peripheral oxygen saturation at rest, desaturation during the 6MWT, sensation of dyspnea, or fatigue, although it did so with age at diagnosis, FEV1 in liters, and forced vital capacity in liters. Worsening of pulmonary function was associated with greater desaturation during the 6MWT. Conclusion: This study showed that most patients attending an adult CF program had reduced submaximal exercise capacity. The 6MWT can be valuable for identifying patients who might experience oxygen desaturation and physical impairment in daily activities.

 


Keywords: Cystic fibrosis; Respiratory function tests; Exercise tolerance.

 


Chapter 1 - Laboratory diagnosis of pulmonary mycoses

Capítulo 1 - Diagnóstico laboratorial das micoses pulmonares

Melissa Orzechowski Xavier, Flávio de Mattos Oliveira, Luiz Carlos Severo

J Bras Pneumol.2009;35(9):907-919

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In this era of immunosuppression and transplantation, it is imperative that laboratory scientists remain in close communication with physicians. In patients receiving immunosuppressive therapy, the diagnosis of mycoses must be rapid, which is complicated, requiring the cooperation and collaboration of a number of professionals from various fields of expertise. In this paper, the laboratory diagnosis of pulmonary fungal infection is reviewed. The following topics are included: host factors such as immunological response and predisposing anatomical features; collection, transport and storage of specimens; laboratory processing of samples; direct microscopy; staining techniques, culture and identification of fungi; laboratory biosafety; tissue tropism and reactions; serology; and antigen detection.

 


Keywords: Mycology; Laboratories, hospital; Diagnostic techniques and procedures; Lung diseases, fungal.

 


Chapter 2 - Coccidioidomycosis

Capítulo 2 - Coccidioidomicose

Antônio de Deus Filho

J Bras Pneumol.2009;35(9):920-930

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Coccidioidomycosis is a systemic mycosis caused by the dimorphic fungi Coccidioides immitis and Coccidioides posadasii. Infection is acquired by inhalation of infective arthroconidia that live in the soil. In 60% of cases, the infection is benign and resolves spontaneously. In the northern hemisphere, coccidioidomycosis is endemic to arid and semi-arid regions at latitudes between 40°N and 40°S, particularly in the southwestern United States and in northern Mexico. In the semi-arid northeastern region of Brazil, cases of coccidioidomycosis have recently been reported in four states: Piauí (100 cases); Ceará (20 cases); Maranhão (6 cases); and Bahia (2 cases). The illness manifests in one of three clinical forms: the primary pulmonary form; the progressive pulmonary form; or the disseminated form. On average, the symptoms of respiratory infection appear 10 days after exposure. The diagnosis is made by the isolation of Coccidioides sp. in culture or by positive results from smear microscopy (10% potassium hydroxide test), periodic acid-Schiff staining or silver staining of any suspect material (sputum, cerebrospinal fluid, skin exudate, lymph node aspirate, etc.) Agar gel immunodiffusion is the diagnostic test most widely used. The most common finding on X-rays and CT scans is diffuse distribution of multiple pulmonary nodules, most of which are cavitated. The recommended treatment is fluconazole or itraconazole, the mean dose ranging from 200 to 400 mg/day, although as much as 1,200 mg/day is used in certain cases. In severe cases, amphotericin B can be the drug of choice. In cases of neurological involvement, the recommended treatment is administration of fluconazole, at a minimum dose of 400 mg/day.

 


Keywords: Mycoses/immunology; Coccidioidomycosis; Lung diseases, fungal.

 


Chapter 3 - Pulmonary cryptococcosis

Capítulo 3 - Criptococose pulmonar

Cecília Bittencourt Severo, Alexandra Flávia Gazzoni, Luiz Carlos Severo

J Bras Pneumol.2009;35(11):1136-1144

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Cryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.

 


Keywords: Cryptococcus neoformans; Pneumonia; Acquired immunodeficiency syndrome; Amphotericin B; Fluconazole.

 


Chapter 8 - Fungal infections in immunocompromised patients

Capítulo 8 - Infecções fúngicas em imunocomprometidos

Rodney Frare e Silva

J Bras Pneumol.2010;36(1):142-147

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Pulmonary complications are the most common cause of morbidity and mortality in immunocompromised patients, who lack of the basic mechanisms of cellular defense. Regardless of the cause of the immunodeficiency, the most common complications are infections (bacterial, viral or fungal). Among the fungal infections, aspergillosis is the most common (incidence, 1-9%; mortality, 55-92%) following organ transplant. Although pulmonary involvement is the most common form of aspergillosis, central nervous system involvement and sinusitis are not uncommon. On CT scans, the halo sign represents an area of low attenuation around the nodule, revealing edema or hemorrhage. The gold standard for the diagnosis is the culture identification of the fungus in sputum, BAL fluid or biopsy samples. Failing this identification, the detection of galactomannan, which is one of the fungal wall components, has shown sensitivity and specificity of 89% and 98%, respectively. Amphotericin B, liposomal amphotericin B, caspofungin and, especially, voriconazole are effective against the fungus. Although Pneumocystis jirovecii pneumonia can be fatal, the incidence of this disease has decreased due to the prophylactic use of trimethoprim-sulfamethoxazole. In immunocompromised patients presenting with dyspnea and hypoxemia, screening for fungi is indicated. A 14- to 21-day course of trimethoprim-sulfamethoxazole in combination with corticosteroids is usually efficacious. Another rare fungal infection is disseminated candidiasis, which is caused by Candida spp.

 


Keywords: Pneumonia; Immunosuppression; Lung diseases, fungal.

 


Characteristics associated with complete surgical resection of primary malignant mediastinal tumors

Características associadas à ressecção cirúrgica completa de tumores malignos primários do mediastino

Jefferson Luiz Gross, Ulisses Augusto Correia Rosalino, Riad Naim Younes, Fábio José Haddad, Rodrigo Afonso da Silva, Antonio Bomfim Marçal Avertano Rocha

J Bras Pneumol.2009;35(9):832-838

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Objective: To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. Methods: Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. Results: The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the tumor had invaded organs other than the lung (as identified through imaging studies) than in those in which it was restricted to the lung (47.6% vs. 14.3%; p = 0.04). None of the other preoperative characteristics analyzed were found to be associated with complete resection. Conclusions: Preoperative radiological evidence of invasion of organs other than the lung is associated with the incomplete surgical resection of primary malignant mediastinal tumors.

 


Keywords: Thoracic surgery; Survival rate; Mediastinal neoplasms; Diagnostic imaging.

 


Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

Características clínicas de crianças e adolescentes brasileiros com asma grave resistente a terapia

Andrea Mendonça Rodrigues1, Cristian Roncada1, Giovana Santos2, João Paulo Heinzmann-Filho1, Rodrigo Godinho de Souza2, Mauro Henrique Moraes Vargas1, Leonardo Araújo Pinto3, Marcus Herbert Jones3, Renato Tetelbom Stein3, Paulo Márcio Pitrez3

J Bras Pneumol.2015;41(4):343-350

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Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

 


Keywords: Arthritis, rheumatoid; Lung diseases, interstitial; Spirometry; Radiography, thoracic; Airway ob-struction.

 


Clinical and epidemiological characteristics of contagious adult of tuberculosis in children

Características clínicas e epidemiológicas do adulto contagiante da criança com tuberculose

João Ab Lima, Edgar Enrique Sarria Icaza, Beatriz G. Menegotto, Gilberto Bueno Fischer, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2004;30(3):243-252

Abstract PDF PT

Background: Tuberculosis in children generally occurs as a direct result of cohabitation with a contagious adult. Objective: To create a profile of a typical adult with contagious tuberculosis (as identified through the public health system) living with a child who has been diagnosed with tuberculosis. Method: Case study. Children younger than 14 years of age who were diagnosed with tuberculosis were included. Parents were interviewed using structured questionnaires. Means and standard deviations were analyzed using the Student's t-test. Fisher's exact test or the Dz test was used for comparisons. Results: Fifty children, representing 96% of those diagnosed with tuberculosis in the Porto Alegre health care system between July 20, 2001 and August 10, 2002, were included. The mean age was 76 months, and 60% were girls. The classic forms of pulmonary presentation (consolidation or cavitation) were seen in 38%. The majority of the children were diagnosed in the hospital and came from homes in which there were (a mean of) 6 cohabitants and a total family income less than 2 times the local minimum wage. Using ELISA, HIV co-infection was identified in 25% (although not all were tested). The children regularly visited places other than their homes. In 78% of cases, the contagious adult was identified. These contagious adults were mostly males (56%), and the mean age was 32. In most cases (79%), the contagious adult was a relative, usually a parent. Within this group of adults with contagious tuberculosis, HIV co-infection was identified in 43% of those tested. Conclusions: Adults with contagious tuberculosis living in the home continue to be the most likely source of tuberculosis infection in children. Co-infection with HIV in these pediatric patients, as well as in the cohabiting adults with contagious tuberculosis, is a significant finding. It must be emphasized that the possibility of contact with contagious individuals in the home should be explored in every diagnosed case of pediatric tuberculosis.

 


Keywords: Tuberculosis/epidemiology. Children. Communicable diseases/etiology.

 


Clinical characteristics and evolution of non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Denise Rossato Silva, Diego Millán Menegotto, Luis Fernando Schulz, Marcelo Basso Gazzana, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2010;36(4):-

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Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients.

 


Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host.

 


Clinical characteristics and prognosis in near-fatal asthma patients in Salvador, Brazil

Características clínicas e prognóstico em pacientes com asma quase fatal em Salvador, Bahia

Eduardo Vieira Ponte, Adelmir Souza-Machado, Carolina Souza-Machado, Rosana Franco, Álvaro Augusto Cruz

J Bras Pneumol.2011;37(4):431-437

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Objective: To determine the frequency of near-fatal asthma in a group of severe asthma patients, as well as the clinical characteristics and prognosis of these patients within a one-year follow-up period. Methods: A prospective study involving 731 low-income patients with severe asthma treated at a referral outpatient clinic located in the city of Salvador, Brazil. The patients were submitted to spirometry at admission, received medications for asthma, and were monitored regarding the frequency of asthma exacerbations during the follow-up period. A subsample of 511 patients also completed questionnaires regarding asthma symptoms and asthma-related quality of life. Results: Of the 731 patients studied, 563 (77%) were female. The median age was 47 years, and 12% were illiterate. Most of the patients had rhinitis, and 70 patients (10%) reported near-fatal asthma prior to admission. Of these 70 patients, 41 (59%) reported having been intubated previously. The patients reporting a history of near-fatal asthma at admission were more likely to have asthma exacerbations during the follow-up period and to respond poorly to therapy than were those not reporting such a history. At the end of the follow-up period, the scores on the two questionnaires were similar between the two groups of patients. Conclusions: The frequency of near-fatal asthma was high in this group of low-income patients with severe asthma. The patients with a history of near-fatal asthma had a worse prognosis than did those without such a history, although both groups had received the same kind of treatment. Curiously, the intensity of symptoms and the quality of life at the end of the study were similar between the two groups.

 


Keywords: Asthma/prevention and control; Asthma/complications; Quality of life; Prognosis.

 


Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brasil between 1994 and 2004

Características clínico-demográficas de pacientes hospitalizados com tuberculose no Brasil, no período de 1994 a 2004

Norma Pinheiro Franco Severo, Clarice Queico Fujimura Leite, Marisa Veiga Capela, Maria Jacira da Silva Simões

J Bras Pneumol.2007;33(5):565-571

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Objective: To describe the demographic and clinical characteristics of patients with tuberculosis hospitalized in the Nestor Goulart Reis Hospital, located in the city of Américo Brasiliense, Brazil. Methods: Epidemiological investigation by means of an observational, retrospective, descriptive study based on the medical charts of patients diagnosed with tuberculosis and hospitalized between 1994 and 2004. Results: There were 1787 patients diagnosed with tuberculosis during the period evaluated. Of those, 117 (7%) were females, 1670 (93%) were males; 1215 (68%) were single, separated or widowed. Most of the patients (74%) had not completed middle school, and most (63%) were between 30 and 50 years of age. In addition, 61% suffered from alcoholism. The most common occupation was farm worker (25% of the patients), and 70% of the patients were unemployed. The most common clinical form of the disease was the pulmonary form (in 92%). The rate of medical discharge was 60%. The treatment regimen differed from the standard (rifampin, isoniazid and pyrazinamide) in 34% of the cases. Conclusions: The profile of the patients with tuberculosis hospitalized in the hospital studied showed that they had special requirements: they were unable to take care of themselves (social cases) and required alternative treatment regimens, which justified their hospitalization. This hospital played an important social role in the treatment and guidance of these patients.

 


Keywords: Hospitalization; Tuberculosis; Demography.

 


Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program

Características da tuberculose em idosos no Recife (PE): contribuição para o programa de controle

Zilda do Rego Cavalcanti, Maria de Fátima Pessoa Militão de Albuquerque, Antônio Roberto Leite Campelo, Ricardo Ximenes, Ulisses Montarroyos, Marianne Karel Amaral Verçosa

J Bras Pneumol.2006;32(6):535-543

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Objective: To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. Methods: A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. Results: The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. Conclusion: In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.

 


Keywords: Tuberculosis; Elderly; Case-control; Brazil

 


Characteristics of patients with lung cancer in the city of Manaus, Brazil

Características de pacientes com câncer de pulmão na cidade de Manaus

Fernando Luiz Westphal, Luis Carlos de Lima, Edson Oliveira Andrade, José Corrêa Lima Netto, Andrei Salvioni da Silva, Bruna Cecília Neves de Carvalho

J Bras Pneumol.2009;35(2):157-163

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Objective: To analyze the characteristics of patients with lung cancer. Methods: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. Results: Of the 352 patients selected, 262 (74.4%) were male and 90 (25.6%) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8%; adenocarcinoma, 24.7%; small cell carcinoma, 9.1%; and large cell carcinoma, 3.4%. The most common stages were stages IIIB and IV, in 45% and 21.5%, respectively. Of the total sample, 73.4% were submitted to treatment. Of these, 51.4% underwent radiotherapy; 16.6%, surgery; 15.8%, chemotherapy; and 16.2%, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5%, and five-year survival was 3.5%. Conclusions: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.

 


Keywords: Lung neoplasms; Neoplasm staging; Survival.

 


Characteristics of COPD patients admitted to the ICU of a referral hospital for respiratory diseases in Brazil

Características de pacientes com DPOC internados em UTI de um hospital de referência para doenças respiratórias no Brasil

Mariângela Pimentel Pincelli, Ana Cristina Burigo Grumann, Camilo Fernandes, André G C Cavalheiro, Daiane A P Haussen, Israel Silva Maia

J Bras Pneumol.2011;37(2):217-222

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Objective: To report data regarding COPD patients admitted to the ICU of a referral hospital for respiratory diseases, including outcomes and treatment evaluation. Methods: Study of a series of patients with respiratory failure and COPD admitted to the ICU of Nereu Ramos Hospital, located in the city of Florianópolis, Brazil, between October of 2006 and October of 2007. Data related to demographics, causes of hospitalization, pharmacological treatment, ventilatory support, length of hospital stay, in-hospital complications, ICU mortality, and 28-day mortality were obtained from the medical charts of the patients. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. Mortality at 18 months was assessed by subsequent telephone calls. Results: During the study period, 192 patients were admitted to the ICU, 24 (12.5%) of whom were diagnosed with respiratory failure and COPD. The mean length of ICU stay was 12.0 ± 11.1 days. Noninvasive ventilation was used in 10 of the 24 patients (41.66%) and failed in 5 of those 10. Invasive mechanical ventilation (IMV) was used in a total of 15 patients (62.5%). Overall ICU mortality and 28-day mortality were 20.83% and 33.33%, respectively. However, 18-month mortality was 62.5%. Conclusions: Respiratory failure associated with COPD was responsible for 12.5% of the ICU admissions. Orotracheal intubation and IMV were necessary in 62.5% of the cases. The ICU mortality rate was in accordance with that predicted by the APACHE II scores. However, late mortality was high.

 


Keywords: Epidemiology; Respiration, artificial; Respiratory insufficiency; Pulmonary disease, chronic obstructive; Intensive care units; Mortality.

 


Epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil

Características epidemiológicas de pacientes com sarcoidose na cidade do Rio de Janeiro

Vinicius Lemos-Silva, Paula Barroso Araújo, Christiane Lopes, Rogério Rufino, Cláudia Henrique da Costa

J Bras Pneumol.2011;37(4):438-445

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Objective: To analyze the epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. Methods: A descriptive, case-control study involving 100 sarcoidosis patients under outpatient treatment between 2008 and 2010 at the Pedro Ernesto University Hospital, located in the city of Rio de Janeiro, Brazil. The diagnosis of sarcoidosis was based on clinical, radiological, biochemical, and histopathological criteria. Results: There was a predominance of females in the 35-40 year age bracket (range, 7-69 years), who accounted for 65% of the sample, although there was a second peak at approximately 55 years of age. The most common symptom was dyspnea (in 47%), and the most common radiological findings were pulmonary and lymph node involvement (stage II; in 43%), followed by stage III (in 20%), stage I (in 19%), stage 0 (in 15%), and stage IV (in 3%). No pleural effusion or digital clubbing was observed at diagnosis. The tuberculin skin test was negative in 94 patients. Spirometric findings at diagnosis were normal in 61 patients; indicative of obstructive lung disease in 21; and indicative of restrictive lung disease in 18. The most common biopsy sites were the lungs (principally by bronchoscopy) and the skin, the diagnosis being confirmed by biopsy in 56% and 29% of the cases, respectively. Treatment with prednisone was initiated in 75% of the patients and maintained for more than 2 years in 19.7%. Conclusions: This study corroborates the findings of previous studies regarding the epidemiological characteristics of sarcoidosis patients.

 


Keywords: Sarcoidosis/epidemiology; Sarcoidosis/diagnosis; Sarcoidosis/therapy.

 


Pulmonary function parameters and use of bronchodilators in patients with cystic fibrosis

Características funcionais pulmonares e uso de broncodilatador em pacientes com fibrose cística

Lucia Harumi Muramatu, Roberto Stirbulov, Wilma Carvalho Neves Forte

J Bras Pneumol.2013;39(1):48-55

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Resumo

Objetivo: Analisar as características funcionais pulmonares, a resposta farmacodinâmica a um broncodilatador e sua prescrição em pacientes com diagnóstico de fibrose cística (FC). Métodos: Estudo de coorte retrospectivo de pacientes (6-18 anos) com diagnóstico de FC acompanhados em um centro de referência, capazes de realizar testes de função pulmonar (TFP) entre 2008 e 2010. Foram analisados CVF, VEF1 e FEF25-75%, em percentual do previsto, antes e após prova broncodilatadora (pré-BD e pós-BD, respectivamente) de 312 TFP. Foram realizadas ANOVA para medidas repetidas e comparações múltiplas. Resultados: Foram incluídos no estudo 56 pacientes. Desses, 37 e 19, respectivamente, tinham resultados de TFP entre 2008 e 2010 e apenas em 2009-2010, formando dois grupos. No grupo com TFP nos três anos estudados, houve redução significativa em VEF1 pós-BD em 2008-2010 (p = 0,028) e 2009-2010 (p = 0,036) e em FEF25-75% pré-BD e pós-BD em todas as comparações múltiplas (2008 vs. 2009; 2008 vs. 2010; e 2009 vs. 2010). No grupo com TFP apenas em 2009-2010, não houve diferenças significativas em nenhuma das comparações das variáveis estudadas. Dos 312 TFP, somente 24 (7,7%) apresentaram resposta significativa ao broncodilatador e pertenciam a pacientes sem prescrição de broncodilatador durante o período estudado. Conclusões: Houve perda funcional, com indicação de doença pulmonar progressiva, nos pacientes com FC estudados. Houve maiores alterações no FEF25-75%, sugerindo o comprometimento inicial de vias aéreas menores.

 


Palavras-chave: Fibrose cística; Testes de função respiratória; Broncodilatadores.

 


Genetic and phenotypic traits of children and adolescents with cystic fibrosis in Southern Brazil

Características genéticas e fenotípicas de crianças e adolescentes com fibrose cística no Sul do Brasil

Katiana Murieli da Rosa1,a, Eliandra da Silveira de Lima2,b, Camila Correia Machado3,c, Thaiane Rispoli4,d, Victória d'Azevedo Silveira3,e, Renata Ongaratto2,f, Talitha Comaru2,g, Leonardo Araújo Pinto5,h

J Bras Pneumol.2018;44(6):498-504

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Objectives: To characterize the main identified mutations on cystic fibrosis transmembrane conductance regulator (CFTR) in a group of children and adolescents at a cystic fibrosis center and its association with the clinical and laboratorial characteristics. Method: Descriptive cross-sectional study including patients with cystic fibrosis who had two alleles identified with CFTR mutation. Clinical, anthropometrical, laboratorial and pulmonary function (spirometry) data were collected from patients' records in charts and described with the results of the sample genotyping. Results: 42 patients with cystic fibrosis were included in the study. The most frequent mutation was F508del, covering 60 alleles (71.4%). The second most common mutation was G542X (six alleles, 7.1%), followed by N1303K and R1162X mutations (both with four alleles each). Three patients (7.14%) presented type III and IV mutations, and 22 patients (52.38%) presented homozygous mutation for F508del. Thirty three patients (78.6%) suffered of pancreatic insufficiency, 26.2% presented meconium ileus, and 16.7%, nutritional deficit. Of the patients in the study, 59.52% would be potential candidates for the use of CFTR-modulating drugs. Conclusions: The mutations of CFTR identified more frequently were F508del and G542X. These are type II and I mutations, respectively. Along with type III, they present a more severe cystic fibrosis phenotype. More than half of the sample (52.38%) presented homozygous mutation for F508del, that is, patients who could be treated with Lumacaftor/Ivacaftor. Approximately 7% of the patients (7.14%) presented type III and IV mutations, therefore becoming candidates for the treatment with Ivacaftor.

 


Keywords: Cystic fibrosis; Mutations; Genetics; Phenotype; Child

 


Phenotypic characterization of lymphocyte subsets in bronchoalveolar lavage of patients with silicosis

Caracterização imunofenotípica das subpopulações de linfócitos do lavado broncoalveolar de pacientes com silicose

Ângela Ferreira, Jose da Silva Moreira, Regina Caetano, José Manoel Gabetto, Thereza Quirico-Santos

J Bras Pneumol.2000;26(3):107-112

Abstract PDF PT

Bronchoalveolar lavage is a safe and simple technique to evaluate lung disease related to exposure to mineral dusts. The aim of this study was to characterize the lymphocyte subsets in bronchoalveolar lavage of patients with silicosis. Bronchoalveolar lavage was carried out in 26 workers with different forms of silicosis: simple form (n = 12), complicated (n = 13) and 1 patient with acute form of the disease. As a control group, 7 healthy individuals were included. Compared to the control group, silicotic patients showed intense pleocytosis constituted mainly by alveolar macrophages with slight lymphocytosis. Lymphocyte subsets present in the bronchoalveolar fluid (BAL) of normal individuals were mature lymphocytes with phenotype CD2+TCRab (87.3%) and only 2.9% were CD2+TCRgd. CD4/CD8 ratio was 1.8 with few (16%) immature double negative T cells subsets (CD4-CD8-). In contrast, silicotic patients showed reduction of the more mature lymphocyte subset CD2+CD4+, CD2+CD8+ and a great increase (47%) of immature (CD4-CD8-) T cell subsets. No increase in the NK (CD56+) cell population was observed. Biochemical analysis of protein contents and determination of the Ig/albumin ratio characterized local immunoglobulin production within the pulmonary microenvironment. Furthermore, lack of increase of plasma cells, as well as the maintenance of the percentage of B lymphocyte population (CD19+) in the BAL of silicotic patients, favors the hypothesis that the cells responsible for Ig production are possibly located in the interstitial space. Altogether the results suggest development of lymphopoiesis and tertiary lymphoid tissue within the pulmonary microenvironment during the clinical course of silicosis.

 


Keywords: bronchoalveolar lavage, lymphocyte subsets, silicosis, immunophenotyping

 


Adenoid cystic carcinoma of the trachea: treatment by removing the larynx, trachea, and esophagus, and mediastinal tracheostomy

Carcinoma adenóide cístico de traquéia: tratamento pela laringotráqueo-esofagectomia e traqueostomia mediastinal

Manoel Ximenes Netto, Gutemberg F. Rego, André L.a. Carvalho, Hélcio L. Miziara

J Bras Pneumol.1999;25(6):343-346

Abstract PDF PT

The authors describe the case of a 54 year-old female with adenoid cystic carcinoma of the trachea at the cricoid level upon whom extensive surgical resection was performed, including the larynx, part of the trachea and esophagus. Reconstruction of the digestive tract was done by means of a gastric tube and the airway with a mediastinal tracheostomy. Five years after the original procedure there was a local cutaneous recurrence which was removed. Seven years later the disease recurred in the mediastinum, which responded to irradiation. The patient is alive and well eight years and five months after the operation.

 


Keywords: Trachea. Neoplasm. Carcinoma, adenoid cystic. Tracheostomy.

 


Small cell carcinoma in Pancoast syndrome

Carcinoma de pequenas células na síndrome de Pancoast

Jefferson Fontinele e Silva, Melânio de Paula Barbosa, Cláudio Luiz Viegas

J Bras Pneumol.2009;35(2):190-193

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Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

 


Keywords: Pancoast syndrome; Small cell lung carcinoma; Lung neoplasms.

 


Mucoepidermoid carcinoma

Carcinoma mucoepidermóide

Cristiano Feijó Andrade, Spencer Marcantônio Camargo, Paulo Francisco Guerreiro Cardoso, José Carlos Felicetti

J Bras Pneumol.2002;28(6):342-344

Abstract PDF PT

Mucoepidermoid carcinoma is an uncommon neoplasm of the tracheobronchial tree, of unknown etiology. Its preferred endobronchial location often results in respiratory symptoms such as obstruction of the airways and lung diseases of slow recovery. They usually are slow growing tumors although they may present an aggressive behavior with local invasion and lymph node metastases depending on their histopathologic characteristics. The mainstay therapy is complete surgical resection either by means of lobectomy or by lung sparing procedures such as bronchotomy and bronchoplasty. Prognosis depends upon the degree of cellular differentiation of the tumors. The authors report a case of this rare neoplasia and describe the clinical and radiographic characteristics, and the surgical treatment.

 



Mucoepidermoid carcinoma of the trachea mimicking asthma

Carcinoma mucoepidermoide da traqueia mimetizando asma brônquica

Ricardo Kalaf Mussi, Ivan Felizardo Contrera Toro, Mônica Corso Pereira

J Bras Pneumol.2009;35(3):280-284

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In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.

 


Keywords: Bronchial hyperreactivity; Carcinoma, mucoepidermoid; Trachea; Asthma; Lung diseases, obstructive.

 


Sarcomatoid carcinoma of the lung with brain metastases

Carcinoma sarcomatoide de pulmão com metástases cerebrais

Matheus Fernandes de Oliveira, Sílvia Conde Watanabe, Mara Patrícia Guilhermina de Andrade, José Marcus Rotta, Fernando Campos Gomes Pinto

J Bras Pneumol.2013;39(6):753-756

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Takotsubo cardiomyopathy triggered by &#61538;2 adrenergic agonist

Cardiomiopatia de takotsubo desencadeada pelo uso de agonista β2-adrenérgico

Vera Maria Cury Salemi, Edmar Atik, Ronaldo Adib Kairalla, Eduardo Lira Queiroz, Leonardo Vieira da Rosa, Roberto Kalil Filho

J Bras Pneumol.2011;37(4):560-562

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Tuberculosis load: reflections on a theme

Carga da tuberculose: reflexões sobre o tema

Antonio Ruffino Netto

J Bras Pneumol.2004;30(4):398-400

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A rare case of co-infection with pulmonary tuberculosis and oronasal actinomycosis

Caso raro de coinfecção tuberculose pulmonar e actinomicose oronasal

Vitor Alexandre Oliveira Fonseca, Gustavo Reis, Carlos Alves, Maria José Simões, Elvira Camacho, António Pinto Saraiva

J Bras Pneumol.2009;35(11):1152-1155

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Oronasal actinomycosis is an infection seldom described in the literature, especially in the form of a co-infection with pulmonary tuberculosis. We report the case of a 48-year-old male admitted to the isolation ward due to active pulmonary tuberculosis, with a history of diabetes and alcohol abuse. While hospitalized, the patient complained of dysphagia and nasal regurgitation of food. The examination of the oral cavity revealed an oronasal fistula. The infecting agent was identified, and the treatment was successful. We also present a brief review of the literature, as well as a full description and discussion of the process of investigating this rare clinical case.

 


Keywords: Actinomycosis, cervicofacial; Tuberculosis, pulmonary; Oral fistula.

 


An unusual cause of pleural effusion in a patient with heart failure

Causa incomum de derrame pleural em paciente com insuficiência cardíaca

Daniel Bruno Takizawa1,a, Philippe de Figueiredo Braga Colares1,b, Olívia Meira Dias1,c

J Bras Pneumol.2019;45(5):e20180343-e20180343

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Causes of death in asthma patients enrolled in the Bahia State Program for the Control of Asthma and Allergic Rhinitis

Causas de óbitos entre asmáticos graves admitidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia

Adelmir Souza-Machado, Carolina Souza-Machado, Daisy Freitas Silva, Eduardo Vieira Ponte, Alvaro A. Cruz

J Bras Pneumol.2007;33(4):372-379

Abstract PDF PT PDF EN Portuguese Text

Objective: To report demographic and clinical characteristics of patients with asthma who evolved to death, as well as to describe the conditions related to this outcome in a subgroup of patients admitted to the Program for the Control of Asthma and Rhinitis in Bahia (ProAR). Methods: A descriptive, retrospective, observational study. Data from clinical charts and death certificates of 16 patients of 930 subjects with severe asthma monitored at the ProAR Central Reference Center from December 2003 to June 2006 were reviewed. Results: Of the 930 patients participating in the program, 16 (1.72%) died. Of these, there were 10 males and 6 females, ranging in age from 39 to 74 years (median, 55 years); 12 (75%) of the patients were black. Time since diagnosis ranged from 1 to 68 years (median, 30 years). In 43.8 and 53.8%, respectively, there was a personal or family history of atopy. Ex-smokers (<10 pack-years) accounted for 37.5% of the cases. Causes of death listed on the death certificates were as follows: asthma or asthma exacerbations in 8 (50%); respiratory failure in 3 (18.75%); acute heart infarction in 2 (12.5%); hepatitis in 1 (6.25%); hypovolemic shock in 1 (6.25%); and cardiorespiratory arrest in 1 (6.25%). Of the 16 deaths, 13 (81.25%) occurred inside hospitals. Conclusion: Asphyxia and cardiovascular diseases were the most common atributed causes of mortality in this subgroup of patients with severe asthma. Hospital-based mortality, male gender, advanced age, long-term disease and fixed airflow obstruction were the aspects most frequently observed in the cases studied.

 


Keywords: Mortality; Rhinitis/treatment; Asthma/treatment; Cardiovascular diseases.

 


Cell profile of BAL fluid in children and adolescents with and without lung disease

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Isabela Furtado de Mendonça Picinin, Paulo Augusto Moreira Camargos, Christophe Marguet

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.

 


Keywords: Bronchoalveolar lavage; Bronchoalveolar lavage fluid/cytology; Child; Adolescent.

 


Smoking cessation among patients at a university hospital in Curitiba, Brazil

Cessação de tabagismo em pacientes de um hospital universitário em Curitiba

Rodney Luiz Frare e Silva, Eliane Ribeiro Carmes, Alain Felipe Schwartz, Denise de Souza Blaszkowski, Raphael Henrique Déa Cirino, Renata Dal-Prá Ducci

J Bras Pneumol.2011;37(4):480-487

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Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. Methods: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. Results: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. Conclusions: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.

 


Keywords: Smoking/prevention & control; Smoking cessation; Hospitalization/statistics & numerical data.

 


The electronic cigarette: the new cigarette of the 21st century?

Cigarro eletrônico: o novo cigarro do século 21?

Marli Maria Knorst, Igor Gorski Benedetto, Mariana Costa Hoffmeister, Marcelo Basso Gazzana

J Bras Pneumol.2014;40(5):564-573

Abstract PDF PT PDF EN Portuguese Text

The electronic nicotine delivery system, also known as the electronic cigarette, is generating considerable controversy, not only in the general population but also among health professionals. Smokers the world over have been increasingly using electronic cigarettes as an aid to smoking cessation and as a substitute for conventional cigarettes. There are few available data regarding the safety of electronic cigarettes. There is as yet no evidence that electronic cigarettes are effective in treating nicotine addiction. Some smokers have reported using electronic cigarettes for over a year, often combined with conventional cigarettes, thus prolonging nicotine addiction. In addition, the increasing use of electronic cigarettes by adolescents is a cause for concern. The objective of this study was to describe electronic cigarettes and their components, as well as to review the literature regarding their safety; their impact on smoking initiation and smoking cessation; and regulatory issues related to their use.

 


Keywords: Smoking; Tobacco Products; Nicotine.

 


Lung volume reduction surgery in an experimental rat model of emphysema

Cirurgia de redução do volume pulmonar em modelo experimental de enfisema em ratos

Laerte Brasiliense Fusco, Marcelo Heleno Fonseca, Paulo Manuel Pêgo-Fernandes, Rogério Pazetti, Vera Capelozzi, Fabio Biscegli Jatene, Sergio Almeida Oliveira

J Bras Pneumol.2005;31(1):-

Abstract PDF PT PDF EN Portuguese Text

Background: Lung volume reduction surgery may be a viable treatment alternative for emphysema patients suffering from severe respiratory insufficiency. Objectives: To evaluate functional and morphological aspects of emphysematous rat lungs, prior to and following lung volume reduction surgery. Method: Wistar rats were divided into two experimental groups (papain without surgery and papain with surgery) and three control groups (saline without surgery, saline with surgery and papain without mechanical ventilation). After approximately 40 days of endotracheal instillation of papain or saline solution, animals in the papain with surgery and saline with surgery groups were submitted to bilobectomy of the middle lobes by right thoracotomy along the posterior border of the superior vena cava. After 1 week, the same animals were submitted to a mechanical ventilation study, which involved measurement of lung elasticity and airway resistance. For all of the animals studied, lung tissue was analyzed in order to determine alveolar diameter and the elastic fiber quantity. Results: Morphometric analysis revealed higher mean alveolar diameter in the lungs of all animals exposed to papain as compared to those exposed to saline. Elastic fiber counts in the alveolar septa of animals treated with papain were lower than those of animals receiving saline. In the animals submitted to bilobectomy and papain, lung elasticity was greater than in those receiving papain without surgery and was statistically equal to that seen in animals receiving saline (with or without surgery). Conclusion: In the respiratory systems of animals with pulmonary emphysema submitted to lung volume reduction by bilobectomy, the capacity for elastic recoil returned to values equivalent to those of the control group animals.

 


Keywords: Key words: Pulmonary emphysema. Papain/drugs efects. Case-control studies. Disease models, animal. Respiratory mechanics/drugs efects. Lung/sugery. Lung/anatomy & histology.

 


Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil

Cirurgia torácica robótica no tratamento do câncer de pulmão de células não pequenas: experiência inicial no Brasil

Ricardo Mingarini Terra1,2,3,4,a, Benoit Jacques Bibas1,3,4,b, Rui Haddad5,6,c, José Ribas Milanez-de-Campos1,3,d, Pedro Henrique Xavier Nabuco-de-Araujo1,2,4,e, Carlos Eduardo Teixeira-Lima5,6,f, Felipe Braga dos Santos5,6,g, Leticia Leone Lauricella1,2,4,h, Paulo Manuel Pêgo-Fernandes1,2,3,i

J Bras Pneumol.2020;46(1):e20190003-e20190003

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

 


Keywords: Lung neoplasms/surgery; Lung neoplasms/mortality; Robotic surgical procedures.

 


Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

Cirurgia torácica robótica para ressecção de timoma e tumores tímicos: desenvolvimento técnico e experiência inicial

Ricardo Mingarini Terra1,a, José Ribas Milanez-de-Campos1,b, Rui Haddad2,c, Juliana Rocha Mol Trindade3,d, Leticia Leone Lauricella3,e, Benoit Jacques Bibas3,f, Paulo Manuel Pêgo-Fernandes1,g

J Bras Pneumol.2020;46(1):e20180315-e20180315

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperativeymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; R outcomes comparable to those of other techniques.

 


Keywords: Thymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; Robotic surgical procedures.

 


Bronchogenic cyst with videothoracoscopic approach

Cisto broncogênico com abordagem videotoracoscópica

Nelson Perelman Rosenberg, Celso Schuler, Fernando Delgiovo, José Augusto Ferreira Bittencourt

J Bras Pneumol.2002;28(6):339-341

Abstract PDF PT

Bronchogenic cysts are the most common cause of mediastinal cystic mass and surgical resection is the treatment of choice. The authors report a case of bronchogenic cyst with successful treatment by video-assisted thoracic surgery (VATS). They emphasize the benefits of VATS in the management of this pathology and compare this technique to conventional thoracotomy.

 



Mediastinal cyst as a cause of severe airway compression and dysphonia

Cisto mediastinal como causa de grave compressão da via aérea central e disfonia

Vanessa Costa Menezes, Paulo Francisco Guerreiro Cardoso, Hélio Minamoto, Márcia Jacomelli, Paulo Sampaio Gutierrez, Fabio Biscegli Jatene

J Bras Pneumol.2013;39(5):636-640

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Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation

Citocinas no líquido pleural após transplante pulmonar como marcadores de rejeição aguda

Priscila Cilene León Bueno de Camargo, José Eduardo Afonso Jr, Marcos Naoyuki Samano, Milena Marques Pagliarelli Acencio, Leila Antonangelo, Ricardo Henrique de Oliveira Braga Teixeira

J Bras Pneumol.2014;40(4):425-428

Abstract PDF PT PDF EN Portuguese Text

Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.

 


Keywords: Lung transplantation; Pleural effusion; Cytokines; Graft rejection.

 


Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil

Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará

Ricardo Hideo Togashi, Fernando Moreira Batista Aguiar, Dalton Barros Ferreira, Camille Matos de Moura, Monique Teixeira Montezuma Sales, Nikaelle Ximenes Rios

J Bras Pneumol.2009;35(3):275-279

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Coccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment.

 


Keywords: Coccidioidomycosis; Lung diseases, fungal; Coccidioides.

 


Pulmonary coccidioidomycosis in a armadillo hunter

Coccidioidomicose pulmonar em caçador de tatus

Fabrício André Martins da Costa, Ricardo Coelho Reis, Fábio Benevides, Geraldo de Sousa Tomé, Marcelo Alcântara Holanda

J Bras Pneumol.2001;27(5):275-278

Abstract PDF PT

Coccidioidomycosis is a disease caused by inhalation of arthrospores of the fungus Coccidioides immitis. It has been recognized as a clinical entity since 1892. It is related to activities that involves dust exposure. It is found in many regions of the western hemisphere with dry and alkaline soil. In Brazil it has been described almost exclusively in the Northeast region where drought periods may favor its growth in its soil. We report a case of fatal coccidioidomycosis, in an immunocompetent host, associated to the activity of armadillo hunting (Dasypus novemcynctus) in a rural area of Ceará state.

 


Keywords: Coccidioidomycosis. Occupational exposure. Armadillos.

 


Coccidioidomycosis: an unusual cause of acute respiratory distress syndrome

Coccidioidomicose: causa rara de síndrome do desconforto respiratório agudo

Kelson Nobre Veras, Bruno C. de Souza Figueirêdo, Liline Maria Soares Martins, Jayro T. Paiva Vasconcelos, Bodo Wanke

J Bras Pneumol.2003;29(1):45-48

Abstract PDF PT

A male farmer, 20 years old, from the countryside of the State of Piauí, developed acute respiratory infection. Despite adequate antimicrobial therapy, there was worsening respiratory manifestations demanding mechanical ventilation. Radiographs showed diffuse pulmonary infiltrates. PaO2/FiO2 was 58. Direct microscopy and culture from tracheal aspirates disclosed Coccidioides immitis. Autochthonous cases of coccidioidomycosis have only recently been described in Brazil, most of them from the State of Piauí. C. immitis has been isolated from humans, dogs and armadillos (Dasypus novemcinctus), and also from soil samples of armadillo's burrows. Therapeutic failure to antimicrobials and patient's origin from recognized endemic areas should alert for the possibility of acute pulmonary coccidioidomycosis.

 



Sleep disordered breathing concomitant with fibromyalgia syndrome

Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica

Dienaro Germanowicz, Magali Santos Lumertz, Denis Martinez, Ane Freitas Margaretes

J Bras Pneumol.2006;32(4):333-338

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify fibromyalgia syndrome in patients with sleep disordered breathing. Method: We studied 50 patients seeking treatment at a sleep disorder clinic for snoring, apnea and excessive daytime sleepiness. Sleep disordered breathing was diagnosed through the use of polysomnography. To diagnose fibromyalgia syndrome, patients were evaluated in accordance with the criteria established by the American College of Rheumatology. Results: Of the 50 patients, 32 were male. The mean (± standard deviation) age of the group was 50 ± 12 years. The mean body mass index was 29.7 ± 5.6 kg/m2. The mean apnea-hypopnea index was 36 ± 29 attacks of apnea or hypopnea per hour of sleep. Of the 18 women and 32 men evaluated, 9 and 2, respectively, met the American College of Rheumatology criteria for fibromyalgia syndrome. Conclusion: Considering the fact that the prevalence of fibromyalgia syndrome in the general population is 0.5% for men and 3.4% for women, the more than ten-fold higher proportion of fibromyalgia cases seen in this sample supports the hypothesis that there is an association between sleep disordered breathing and fibromyalgia syndrome.

 


Keywords: Respiration disorders/complications; Fibromyalgia/complications; Sleep apnea, obstructive; Polysomnography

 


Pseudomonas aeruginosa colonization in the upper and lower airways of a child with cystic fibrosis: a father's meticulous approach to successful eradication

Colonização por Pseudomonas aeruginosa nas vias aéreas superiores e inferiores de uma criança com fibrose cística: abordagem meticulosa do pai para a erradicação bem-sucedida

Jochen Georg Mainz1,2,a, Michael Baier3,b, Anke Jaudszus1,2,c, Harold Tabori2,d, José Dirceu Ribeiro4,e, Michael Lorenz1,f

J Bras Pneumol.2019;45(6):e20190191-e20190191

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Fighting respiratory diseases: divided efforts lead to weakness

Combate a doenças respiratórias: esforços divididos levam ao enfraquecimento

Rogelio Pérez-Padilla, Rafael Stelmach, Manuel Soto-Quiroz, Álvaro Augusto Cruz

J Bras Pneumol.2014;40(3):207-210

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Como administrar drogas por via inalatória na asma

Luiz Fernando F. Pereira

J Bras Pneumol.1998;24(3):133-144

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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-e20190020

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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-e20190167

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Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia

Comparação da acurácia de preditores de mortalidade na pneumonia associada à ventilação mecânica

Renato Seligman, Beatriz Graeff Santos Seligman, Paulo José Zimermann Teixeira

J Bras Pneumol.2011;37(4):495-503

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Objective: Levels of procalcitonin, midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal provasopressin (copeptin), and C-reactive protein (CRP), as well as Sequential Organ Failure Assessment (SOFA) scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP). This study sought to compare the predictive value of these biomarkers for mortality in VAP. Methods: An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0), and on day 4 of treatment (D4). Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors. Results: Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8%) received appropriate antimicrobial therapy, compared with 18 (69.2%) of the 26 nonsurvivors (p = 0.57). On D0 and D4, the levels of all biomarkers (except CRP), as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71) and positive predictive value (0.60), but procalcitonin had the highest negative predictive value (0.87). On D4, procalcitonin had the highest positive likelihood ratio (3.46), the highest positive predictive value (0.66), and the highest negative predictive value (0.93). Conclusions: The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.

 


Keywords: Pneumonia, ventilator-associated/mortality; Biological markers/analysis; Health Status Indicators.

 


Comparison of two experimental models of pulmonary hypertension

Comparação de dois modelos experimentais de hipertensão pulmonar

Igor Bastos Polônio, Milena Marques Pagliarelli Acencio, Rogério Pazetti, Francine Maria de Almeida, Mauro Canzian, Bárbara Soares da Silva, Karina Aparecida Bonifácio Pereira, Rogério de Souza

J Bras Pneumol.2012;38(4):452-460

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare two models of pulmonary hypertension (monocrotaline and monocrotaline+pneumonectomy) regarding hemodynamic severity, structure of pulmonary arteries, inflammatory markers (IL-1 and PDGF), and 45-day survival. Methods: We used 80 Sprague-Dawley rats in two study protocols: structural analysis; and survival analysis. The rats were divided into four groups: control; monocrotaline (M), pneumonectomy (P), and monocrotaline+pneumonectomy (M+P). In the structural analysis protocol, 40 rats (10/group) were catheterized for the determination of hemodynamic variables, followed by euthanasia for the removal of heart and lung tissue. The right ventricle (RV) was dissected from the interventricular septum (IS), and the ratio between RV weight and the weight of the left ventricle (LV) plus IS (RV/LV+IS) was taken as the index of RV hypertrophy. In lung tissues, we performed histological analyses, as well as using ELISA to determine IL-1 and PDGF levels. In the survival protocol, 40 animals (10/group) were followed for 45 days. Results: The M and M+P rats developed pulmonary hypertension, whereas the control and P rats did not. The RV/LV+IS ratio was significantly higher in M+P rats than in M rats, as well as being significantly higher in M and M+P rats than in control and P rats. There were no significant differences between the M and M+P rats regarding the area of the medial layer of the pulmonary arteries; IL-1 and PDGF levels; or survival. Conclusions: On the basis of our results, we cannot conclude that the monocrotaline+pneumonectomy model is superior to the monocrotaline model.

 


Keywords: Monocrotaline; Hypertension, pulmonary; Pneumonectomy; Interleukin-1; Receptor, platelet-derived growth factor beta.

 


Comparison of two smoking cessation interventions for inpatients

Comparação de duas intervenções de cessação do tabagismo em pacientes internados

Antonio Carlos Ferreira Campos1,a, Angela Santos Ferreira Nani2,b, Vilma Aparecida da Silva Fonseca3,c, Eduardo Nani Silva1,2,d, Marcos César Santos de Castro2,4,e, Wolney de Andrade Martins1,2,f

J Bras Pneumol.2018;44(3):195-201

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Objective: This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge. Methods: This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO). Results: Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001). Conclusions: The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.

 


Keywords: Smoking cessation; Tobacco use disorder; Inpatients; Hospitalization.

 


Performance comparison between the mycobacteria growth indicator tube system and Löwenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial

Comparação do desempenho do sistema mycobacteria growth indicator tube e meio Löwenstein-Jensen na detecção de rotina de Mycobacterium tuberculosis em unidades do sistema único de saúde no Rio de Janeiro: resultados preliminares de um ensaio clínico pragmático

Adriana da Silva Rezende Moreira, Gisele Huf, Maria Armanda Vieira, Leila Fonseca, Monica Ricks, Afrânio Lineu Kritski

J Bras Pneumol.2013;39(3):365-367

Abstract PDF PT PDF EN Portuguese Text

In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/])

 


Keywords: Controlled clinical trial; Tuberculosis; Diagnostic tests, routine.

 


Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease

Comparação entre a azitromicina e a amoxicilina no tratamento da exacerbação infecciosa da doença pulmonar obstrutiva crônica

Mara Rúbia Andre-Alves, José Roberto Jardim, Rodney Frare e Silva, Elie Fiss, Denison Noronha Freire, Paulo José Zimermann Teixeira

J Bras Pneumol.2007;33(1):43-50

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Objective: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. Methods: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. Results: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85% vs. 78% (p = 0.368) on day ten; and 83% vs. 78% (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. Conclusion: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.

 


Keywords: Amoxicillin/therapeutic use; Azithromycin/therapeutic use; Bronchitis, chronic/drug therapy;

 


Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function

Comparação entre duas técnicas de fechamento de toracotomia: dor pós-operatória e função pulmonar

Juliana Duarte Leandro, Olavo Ribeiro Rodrigues, Annie France Frere Slaets, Aurelino F. Schmidt Jr, Milton L. Yaekashi

J Bras Pneumol.2014;40(4):389-396

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Objective: To compare two thoracotomy closure techniques (pericostal and transcostal suture) in terms of postoperative pain and pulmonary function. Methods: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age) undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16) and transcostal suture (TS; n = 14). Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF) were determined in the preoperative period and on postoperative days 21 and 60. Results: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. Conclusions: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice.

 


Keywords: Thoracic surgery; Suture techniques; Acute pain.

 


Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth?

Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?

Rafael Stelmach, Frederico Leon Arrabal Fernandes, Regina Maria Carvalho-Pinto, Rodrigo Abensur Athanazio, Samia Zahi Rached, Gustavo Faibischew Prado, Alberto Cukier

J Bras Pneumol.2015;41(2):124-132

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Objective: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. Methods: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. Results: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. Conclusions: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.

 


Keywords: Asthma; Pulmonary disease, chronic obstructive; Cotinine; Carbon monoxide; Smoking.

 


Comparison among pulmonary function test results, the Shwachman-Kulczycki score and the Brasfield score in patients with cystic fibrosis

Comparação entre provas de função pulmonar, escore de Shwachman‑Kulczycki e escore de Brasfield em pacientes com fibrose cística

Ivanice Duarte Freire, Fernando Antônio de Abreu e Silva, Manuel Ângelo de Araújo

J Bras Pneumol.2008;34(5):280-287

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Objective: To study correlations among pulmonary function, chest radiology and clinical status in cystic fibrosis. Methods: A retrospective cross-sectional study was performed to evaluate chest X-rays and clinical charts of patients treated at the Hospital de Clínicas de Porto Alegre. Spirometry findings, Shwachman-Kulczycki (S-K) scores and Brasfield scores were analyzed. Results: The final sample consisted of 40 patients (mean age 9.72 ± 3.27). The following mean S-K scores were obtained: total, 80.87 ± 10.24; general activity, 24.75 ± 1.1; physical examination, 18.87 ± 4.59; nutrition, 21.87 ± 4.18; radiology, 15.37 ± 5.23. The mean Brasfield score was 18.2 ± 4. The pulmonary function test results, in percentage of predicted, were as follows: forced vital capacity (FVC), 82.99 ± 14.36%; forced expiratory volume in one second (FEV1), 83.62 ± 18.26%; and forced expiratory flow between 25 and 75% of FVC (FEF25-75), 74.63 ± 2.53%. The S-K score correlated moderately with FVC, whereas it correlated strongly with FEV1 and FEF25-75. The Brasfield score correlated strongly with the S-K total and radiology score, whereas it correlated moderately with pulmonary function. Physical examination correlated moderately with FVC, FEV1 and FEF25-75; as did nutrition with FEF25-75; and radiology with FEV1 and FEF25-75. General activity was the domain that had the greatest influence on the total S-K score. Conclusions: These two scoring systems are complementary, correlating with each other, as well as with pulmonary function tests. The radiology domain of the S-K scoring system is a good alternative to the Brasfield score.

 


Keywords: Cystic fibrosis; Spirometry; Lung/radiography.

 


Comparison of three sets of reference equations for spirometry in children and adolescents with distinct body mass indices

Comparação entre três equações de referência para a espirometria em crianças e adolescentes com diferentes índices de massa corpórea

Sarah Costa Drumond, Maria Jussara Fernandes Fontes, Irmgard de Assis, Marco Antônio Duarte, Joel Alves Lamounier, Luciana de Carvalho Lopes Orlandi, Maria da Glória Rodrigues Machado

J Bras Pneumol.2009;35(5):415-422

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Objective: To compare FEV1 and FVC, calculated using three sets of reference equations (devised by Polgar & Promadhat, Hsu et al. and Mallozi in 1971, 1979 and 1995, respectively), and to determine whether the three are similar in predicting lung function in children and adolescents with distinct body mass indices (BMIs). Methods: The individuals were separated into four groups in accordance with the reference standards of the National Center for Health Statistics: underweight (UW), normal weight (NW), overweight (OW), and obese (OB). All were then submitted to spirometry. Results: We evaluated 122 healthy children and adolescents, aged 7-14 years. The FVC values predicted for NW females and UW males through the use of the Hsu et al. equation were significantly higher than the measured values, as were the FEV1 values for UW females and males predicted via the Polgar & Promadhat and Hsu et al. equations. In NW females, the FEV1 values predicted via the Polgar & Promadhat equation were significantly higher than were the measured values. Conclusions: In individuals with distinct BMIs, the measured FVC and FEV1 values were not equivalent to those predicted via the Polgar & Promadhat and Hsu et al. equations. The same was not true for the Mallozi equations. The BMI was not a relevant factor for the predictive index of these equations; therefore, the Mallozi equations can be used without alteration for children and adolescents with distinct BMIs.

 


Keywords: Spirometry; Reference values; Body mass index; Child; Adolescent.

 


Prevalences of asthma and rhinitis among adolescents in the city of Fortaleza, Brazil: temporal changes

Comparação temporal das prevalências de asma e rinite em adolescentes em Fortaleza, Brasil

Maria de Fátima Gomes de Luna, Gilberto Bueno Fischer, João Rafael Gomes de Luna, Marcelo Gurgel Carlos da Silva, Paulo César de Almeida, Daniela Chiesa

J Bras Pneumol.2013;39(2):128-137

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Objective: To describe the prevalences of asthma and rhinitis in adolescents (13-14 years of age) in the city of Fortaleza, Brazil, in 2010, comparing the results with those obtained in a prevalence survey conducted in 2006-2007. Methods: This was a cross-sectional study involving probabilistic samples of 3,015 and 3,020 adolescents in surveys conducted in 2006-2007 and 2010, respectively. The International Study of Asthma and Allergies in Childhood protocol was used on both occasions. Results: Comparing the two periods, there were no significant differences regarding cumulative wheezing, active asthma, four or more wheezing attacks within the last year, sleep disturbed by wheezing more than one night per week, and speech-limiting wheezing. The prevalences of exercise-induced wheezing, dry cough at night, and physician-diagnosed asthma were significantly higher in 2010 than in the 2006-2007 period (p < 0.01 for all). The prevalence of physician-diagnosed rhinitis was significantly lower in 2010 (p = 0.01), whereas there were no significant differences between the two periods regarding cumulative rhinitis, current rhinitis, and rhinoconjunctivitis. In both periods, dry cough at night, current rhinitis, and rhinoconjunctivitis were significantly more prevalent in females than in males (p < 0.01 for all). Also in both periods, active asthma, current rhinitis, and rhinoconjunctivitis were more prevalent in private school students than in public school students (p < 0.01 for all). Conclusions: Our data show that the prevalences of asthma and rhinitis symptoms remain high among 13- and 14-year-olds in Fortaleza, predominantly among females and private school students.

 


Keywords: Asthma/epidemiology; Rhinitis/epidemiology; Adolescent.

 


Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease

Completude das fichas de notificações de tuberculose em cinco capitais do Brasil com elevada incidência da doença

Normeide Pedreira dos Santos, Monique Lírio, Louran Andrade Reis Passos, Juarez Pereira Dias, Afrânio Lineu Kritski, Bernardo Galvão-Castro, Maria Fernanda Rios Grassi

J Bras Pneumol.2013;39(2):221-225

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The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010-Salvador, Rio de Janeiro, Cuiabß, Porto Alegre, and BelÚm-using tabulations obtained from the Sistema Nacional de InformaþÒo de Agravos de NotificaþÒo (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabß, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes.

 


Keywords: Tuberculosis; Public health surveillance; Disease notification.

 


Complexity of autonomic nervous system function in individuals with COPD

Complexidade do sistema nervoso autônomo em indivíduos com DPOC

Laís Manata Vanzella1,f, Aline Fernanda Barbosa Bernardo1,d, Tatiana Dias de Carvalho3,e, Franciele Marques Vanderlei2,a, Anne Kastelianne França da Silva1,c, Luiz Carlos Marques Vanderlei2,b

J Bras Pneumol.2018;44(1):24-30

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Objective: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. Methods: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. Results: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. Conclusions: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.

 


Keywords: Pulmonary disease, chronic obstructive; Autonomic nervous system; Nonlinear dynamics; Recurrence; Heart rate; Sympathetic nervous system.

 


Complicações cardiovasculares da síndrome da apnéia do sono obstrutiva

Lia Rita Azeredo Bittencourt, Odair Marson, Luiz E. Nery, Sérgio Tufik

J Bras Pneumol.1998;24(5):311-316

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Pleuropulmonary complications related to pulmonary instillation of activated charcoal

Complicações pleuropulmonares relacionadas à instilação pulmonar de carvão ativado

Luiz Felipe Nobre, Edson Marchiori, Daniel Yared Forte, Gláucia Zanetti

J Bras Pneumol.2013;39(3):-

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Complications related to lobectomy in living lobar lung transplant donors

Complicações relacionadas à lobectomia em doadores de transplante pulmonar intervivos

Spencer Marcantônio Camargo, José de Jesus Peixoto Camargo, Sadi Marcelo Schio, Leticia Beatriz Sánchez, José Carlos Felicetti, José da Silva Moreira, Cristiano Feijó Andrade

J Bras Pneumol.2008;34(5):256-263

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Objective: To evaluate post-operative complications in living lobar lung transplant donors. Methods: Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of post-operative complications and alterations in pulmonary function after lobectomy. Results: Twenty-two donors (68.75%) presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6% of the sample). Red blood cell transfusion was necessary in 3 donors (9.3%), and 2 donors underwent a second surgical procedure due to hemothorax. One donor presented pneumothorax after chest tube removal, and one developed respiratory infection. There were two intra-operative complications (6.25%): one donor required bronchoplasty of the middle lobe; and another required lingular resection. No intra-operative mortality was observed. Post-operative pulmonary function tests demonstrated an average reduction of 20% in forced expiratory volume in one second (p < 000.1) compared to pre-operative values. Conclusions: Lobectomy in living lung transplant donors presents high risk of post-operative complications and irreversible impairment of pulmonary function. Careful pre-operative evaluation is necessary in order to reduce the incidence of complications in living lobar lung transplant donors.

 


Keywords: Lung transplantation; Living donors; Pneumonectomy; Postoperative complications.

 


Postoperative respiratory complications from elective and urgent/emergency surgery performed at a university hospital

Complicações respiratórias no pós-operatório de cirurgias eletivas e de urgência e emergência em um Hospital Universitário

Luiz Joia Neto, João Carlos Thomson, Jefferson Rosa Cardoso

J Bras Pneumol.2005;31(1):-

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Background: Respiratory complications have been the focus of studies aiming to identify methods of reducing postoperative morbidity/mortality and controlling the cost of treatment. Objectives: To estimate the incidence of the respiratory complications in patients submitted to elective or urgent/emergency surgical procedures and determine any correlations between respiratory complications and potential risk factors. Method: A retrospective cohort study of patients submitted to elective or urgent/emergency surgery at a university hospital during 2001. The sample was restricted to patients hospitalized for at least 24 hours following surgery. Data were collected from patient charts and according to protocol. Results: Of the 5075 patients submitted to elective or urgent/emergency surgery during the year 2001, 1345 (25.5%) were included in the study. There was no statistically significant difference between elective surgery and urgent/emergency surgery in terms of respiratory complications. The incidence of respiratory complications was 11.7%. The most frequent complication (at 52.5%) was pneumonia. Overall mortality was 7.2% and 27.8% of deaths were related to respiratory complications. Conclusion: The incidence of postoperative respiratory complications was 11.7% (11.3% in elective surgery and 12.3% in urgent/emergency surgery). Pneumonia was the most frequent complication. The risk factors that correlated with respiratory complications were previous lung disease, use of a nasogastric tube, admission to the intensive care unit, endotracheal intubation and tracheostomy.

 


Keywords: Key words: Postoperative complications. Lung diseases/complications. Risk factors. Cohort studies 

 


Dynamic hyperinflation during treadmill exercise testing in patients with moderate to severe COPD

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

Priscila Kessar Cordoni, Danilo Cortozi Berton, Selma Denis Squassoni, Maria Enedina Aquino Scuarcialupi, José Alberto Neder, Elie Fiss

J Bras Pneumol.2012;38(1):13-23

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Objective: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. Methods: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1= 43 ± 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. Results: Of the 30 patients studied, 19 (63.3%) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH− group). None of the variables studied correlated with exercise tolerance in the DH− group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔICTlim,2min = −0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). Conclusions: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.

 


Keywords: Pulmonary disease, chronic obstructive; Exercise; Exercise test; Inspiratory capacity.

 


Left main coronary artery compression in a patient with portopulmonary hypertension

Compressão de tronco de artéria coronária esquerda em paciente com hipertensão portopulmonar

Iara Teixeira de Araújo1,a, Pammela Jacomeli Lembi1,b, Eduardo Belisario Falchetto2,c, Ricardo de Amorim Corrêa3,4,d

J Bras Pneumol.2018;44(4):337-338

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Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation

Compressão torácica com incremento da pressão em ventilação com pressão de suporte: efeitos na remoção de secreções, hemodinâmica e mecânica pulmonar em pacientes em ventilação mecânica

Wagner da Silva Naue, Luiz Alberto Forgiarini Junior, Alexandre Simões Dias, Silvia Regina Rios Vieira

J Bras Pneumol.2014;40(1):55-60

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Objective: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. Methods: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. Results: We included 34 patients. The mean age was 64.2  14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16  69 mL vs. 56  69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1  4.9 cmH2O vs. 2.8  4.5 cmH2O; p = 0.005). Conclusions: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/])

 


Keywords: Physical therapy modalities; Respiration, Artificial; Intensive care units; Respiratory therapy.

 


Interstitial lung disease in patients with progressive systemic sclerosis. A study of 58 cases

Comprometimento do interstício pulmonar em portadores de esclerose sistêmica progressiva. Estudo de uma série de 58 casos

Sergio Fernandes de Oliveira Jezler, Mittermayer Barreto Santiago, Thamine Lessa Andrade, César Araujo Neto, Helio Braga, Álvaro Augusto Cruz

J Bras Pneumol.2005;31(4):300-306

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Objective: To estimate the frequency of interstitial lung disease in a group of patients with progressive systemic sclerosis, and to describe the clinical, functional and radiological characteristics of the patients studied. Methods: Fifty-eight patients diagnosed with progressive systemic sclerosis were submitted to high-resolution computed tomography of the chest, pulmonary function tests and a blood test for anti-Scl 70 antibodies. Comparisons were drawn between patients with interstitial lung disease and those without. Logistic regression with multivariate analysis was used to identify factors predictive of interstitial lung disease. Results: Of the 58 patients evaluated, 51.7% presented interstitial lung disease on high-resolution computerized tomography scans. Dyspnea and cough were the most common symptoms (seen in 65.5% and 39.7%, respectively). Bronchiolectasis and honeycombing were the most common tomographic abnormalities (observed in 83.3% and 80%, respectively). When compared to individuals without interstitial lung disease, patients with the condition had a comparable frequency of pulmonary and extrapulmonary symptoms but presented progressive systemic sclerosis of longer duration, a higher frequency of crackling rales, higher rates of anti-Scl 70 positivity, lower vital capacity and reduced total lung capacity. Only forced vital capacity < 80% was found to be a predictor of interstitial lung disease. Conclusion: Interstitial lung disease was common in this group of patients with progressive systemic sclerosis. No correlation with symptoms was found, although interstitial lung disease was found to correlate with crackling rales and with anti-Scl 70 positivity. Nevertheless, only reduced forced vital capacity was found to be predictive of interstitial lung disease.

 



Pulmonary involvement in Crohn's disease

Comprometimento pulmonar na doença de Crohn

Rodolfo Augusto Bacelar de Athayde1,a, Felipe Marques da Costa1,b, Ellen Caroline Toledo do Nascimento2,c, Roberta Karla Barbosa de Sales1,d, Andre Nathan Costa1,e

J Bras Pneumol.2018;44(6):519-521

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Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans

Concordância entre observadores no diagnóstico das doenças pulmonares intersticiais por imagens de TCAR

Viviane Baptista Antunes, Gustavo de Souza Portes Meirelles, Dany Jasinowodolinski, Carlos Alberto de Castro Pereira, Carlos Gustavo Yuji Verrastro, Fabíola Goda Torlai, Giuseppe D'Ippolito

J Bras Pneumol.2010;36(1):29-36

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Objective: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. Methods: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. Results: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3% (κ = 0.42) and 62.1% (κ = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (κ = 0.32) and 36.2% (κ = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. Conclusions: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

 


Keywords: Lung diseases, interstitial; Tomography, X-ray computed; Observer variation.

 


Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment

Concordância entre os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células, estádios I e II, submetidos a tratamento cirúrgico

Pedro Augusto Reck dos Santos, Rodrigo Sponchiado da Rocha, Maurício Pipkin, Marner Lopes da Silveira, Marcelo Cypel, Jayme Oliveira Rios, José Antonio Lopes de Figueiredo Pinto

J Bras Pneumol.2007;33(6):647-654

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Objective: To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. Methods: Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. Results: Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. Conclusions: The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.

 


Keywords: Neoplasm staging; Lung neoplasms/diagnosis; Lung neoplasms/surgery; Prognosis.

 


Isolated pulmonary chondroma: a case of incomplete Carney triad?

Condroma pulmonar isolado: caso incompleto da tríade de Carney?

Raul Lopes Ruiz Júnior, Júlio Defaveri, Antonio José Maria Cataneo, Rogério Cardoso da Silva, Sérgio Marrone Ribeiro, Cristiano Ventorim de Barros

J Bras Pneumol.2005;31(4):356-359

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A 45-year-old man presented with recurrent pulmonary infection for four years, cough, bloody sputum, yellowish excretion and nonpleuritic chest pain. Tomography of the chest revealed a calcified nodule occluding the right lower lobe bronchus. A right lower and middle lobectomy was performed, and the histopathological examination of the bronchi revealed chondroma, a rare pulmonary tumor usually associated with the Carney triad (pulmonary chondroma, gastric leiomyosarcoma and extra-adrenal paraganglioma), being the less common of the three components. In the present case, the other two components of the triad were not observed. Since these components may appear years later, long-term follow-up care is necessary.

 


Keywords: Chondroma; Lung neoplasms/radiography; Lung neoplasms/surgery; Leiomyosarcoma;

 


Sternal chondrosarcoma

Condrossarcoma de esterno

Nelson Perelman Rosenberg, Ivo Leuck Jr., Celso Schuler, Fernando Delgiovo, Eduardo Spadari de Araújo, Paula Vasconcelos Martini

J Bras Pneumol.2003;29(1):43-44

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Sternal neoplasms are very uncommon. The lack of consistent reports in the literature renders it difficult to make prospective evaluations. The authors report the case of a seventy-year old woman who presented with a chondrosarcoma of the sternum, treated at their service.

 



Reliability of a rapid hematology stain for sputum cytology

Confiabilidade da coloração hematológica rápida para citologia de escarro

Jéssica Gonçalves, Emilio Pizzichini, Marcia Margaret Menezes Pizzichini, Leila John Marques Steidle, Cristiane Cinara Rocha, Samira Cardoso Ferreira, Célia Tânia Zimmermann

J Bras Pneumol.2014;40(3):250-258

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Objective: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. Methods: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. Results: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). Conclusions: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples.

 


Keywords: Sputum\analysis; Sputum\cytology; Azure stains.

 


Getting to know our pneumococcus

Conhecimento do nosso pneumococo

Fernando Luiz Cavalcanti Lundgren1,2,a

J Bras Pneumol.2018;44(5):343-344

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Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

Conhecimento e percepção de médicos e enfermeiros em três capitais brasileiras com alta incidência de tuberculose a respeito da transmissão e prevenção da doença

Jonas Ramos1,a, Maria F Wakoff-Pereira1,b, Marcelo Cordeiro-Santos2,3,c, Maria de Fátima Militão de Albuquerque4,d, Philip C Hill5,e, Dick Menzies6,f, Anete Trajman,6,7,g

J Bras Pneumol.2018;44(2):168-170

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Knowledge of and practices related to smoking cessation among physicians in Nigeria

Conhecimento e práticas para a cessação do tabagismo entre médicos nigerianos

Olufemi Olumuyiwa Desalu, Adebowale Olayinka Adekoya, Adetokunbo Olujimi Elegbede, Adeolu Dosunmu, Tolutope Fasanmi Kolawole, Kelechukwu Chukwudi Nwogu

J Bras Pneumol.2009;35(12):-

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Objective: To evaluate the knowledge and practices of smoking cessation among physicians in Nigeria. Methods: We conducted a cross-sectional survey in Lagos and three geopolitical zones of Nigeria. A self-administered structured questionnaire was used to obtain information on tobacco use and its health effects, as well as on the knowledge and practices of smoking cessation, from 436 physicians. Results: Of the 436 physicians, 292 (67.0%) were aware of smoking cessation, but only 132 (30.3%) showed good knowledge on this topic. The prevalence of smoking among the physicians was 17.7%. In addition, 308 physicians (70.6%) reported that tobacco education in the medical school curriculum was inadequate. Of the 436 physicians, 372 (86.2%) asked their patients whether they smoked, and 172 (39.4%) asked their patients the reasons for using tobacco. As a means of smoking cessation intervention, 268 (61.5%) used brief advice/counseling (2-5 min), 12 (3.7%) prescribed antidepressants, 16 (2.8%) prescribed nicotine replacement therapy (NRT), and 76 (17.4%) arranged follow-up visits. When the physicians were questioned regarding the obstacles to smoking cessation interventions, 289 (66.3%) cited poor knowledge of the issue, 55 (12.6%) cited a lack of time, and 20 (4.6%) cited unavailability of NRT. Conclusions: The results of this study highlight the lack of knowledge among physicians in Nigeria in terms of smoking cessation, as well as their failure to apply appropriate practices. The results of this study can further the evaluation and formulation of guidelines on smoking cessation and smoking education programs for physicians. Our findings also underscore the need to offer smoking cessation programs in all treatment facilities.

 


Keywords: Smoking cessation; Tobacco; Physicians; Nigeria; Health knowledge, attitudes, practice.

 


Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil

Conhecimento e uso do cigarro eletrônico entre estudantes da Universidade Federal de Mato Grosso

Wemerson José Corrêa de Oliveira1,a, Alexandre Figueiredo Zobiole1,b, Claudia Bonadiman de Lima1,c, Rebeca Melo Zurita1,d, Pedro Eduarto Muniz Flores1,e, Luís Guilherme Val Rodrigues1,f, Raissa Carolina de Assis Pinheiro1,g, Victor Francisco Figueiredo Rocha Soares e Silva1,h

J Bras Pneumol.2018;44(5):367-369

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Objective: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. Methods: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. Results: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. Conclusions: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use.

 


Keywords: Electronic Nicotine Delivery Systems; Young adult; Smoking.

 


Brazilian Consensus on Terminology Used to Describe Computed Tomography of the Chest

Consenso Brasileiro sobre a Terminologia dos Descritores de Tomografia Computadorizada do Tórax

Brazilian Society Of Pulmonology and Phthisiology, Department of Diagnostic Imaging 2002-2004 Biennium

J Bras Pneumol.2005;31(2):149-156

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Brazilian consensus on non-cystic fibrosis bronchiectasis

Consenso brasileiro sobre bronquiectasias não fibrocísticas

Mônica Corso Pereira1,a, Rodrigo Abensur Athanazio2,b, Paulo de Tarso Roth Dalcin3,4,c, Mara Rúbia Fernandes de Figueiredo5,d, Mauro Gomes6,7,e, Clarice Guimarães de Freitas8,f, Fernando Ludgren9,g, Ilma Aparecida Paschoal1,h, Samia Zahi Rached2,i, Rosemeri Maurici10,j

J Bras Pneumol.2019;45(4):e20190122-e20190122

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Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.

 


Keywords: Bronchiectasis; Tomography, X-ray; Radiography, thoracic.

 


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-e20170351

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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.

 


Role of the open lung biopsy in the evaluation of undiagnosed acute lung disease in a pediatric intensive care unit

Contribuição da biópsia pulmonar a céu aberto na avaliação de pneumopatias difusas e agudas em unidade de terapia intensiva pediátrica

Albert Bousso, Evandro Roberto Baldacci, José Carlos Fernandes, Iracema de Cássia Oliveira Fernandes, Andréa Maria Gomes Cordeiro, José Pinhata Otoch, Bernardo Ejzenberg, Yassuhiko Okay

J Bras Pneumol.2002;28(1):30-40

Abstract PDF PT

Introduction: The diagnosis of diffuse lung disease is still a challenge for the pediatric intensive care physician. Routine clinical examinations and laboratory tests are frequently negative. The objective of this study was to evaluate the diagnostic potential, the impact on therapy and the rate of complications of open lung biopsy in children with undiagnosed diffuse lung disease, respiratory failure and inappropriate response to initial therapy. Methods: From January 1987 to January 1997, 29 children with diffuse pulmonary disease of unknown etiology, respiratory failure (PaO2 /FiO2 < 300) and no response to previous treatments were considered for open lung biopsy. Newborns, children with known chronic pulmonary disease and children with untreatable shock or coagulopathy were excluded. All biopsies were performed by a thoracic surgeon by a microthoracotomy in the lung shown to be the most affected by X-ray examination. Tissue samples were analyzed in terms of cultures, light microscopy, electron microscopy and immunofluorescence microscopy, according to the pathologist's decision. Results: All biopsies (100%) resulted in at least one histological diagnosis and in 20 patients (68.9%) it was obtained a specific diagnosis. The most frequent histological patterns found were: non-specific interstitial pneumonitis with variable degrees of fibrosis in 18 cases; bronchiolitis in eight cases and pulmonary hypertension in three cases. Regarding the most frequent specific diagnosis, six children were found with cytomegalovirus infection, three with Pneumocystis carinii, three with adenovirus and three with respiratory syncytial virus infection. These data induced a change in therapy in 20 children (68.9%). The most frequent changes in therapy were the use of corticosteroids in 14 children and a review of the antibiotic regimen in six patients. Seven patients (24.1%) presented with complications that were easily resolved. There were 13 deaths, probably due to the critical conditions of these patients, all unrelated to the procedure. Conclusions: Open lung biopsy, though an invasive procedure, should be considered in the evaluation of selected children with undiagnosed diffuse lung disease, respiratory failure and with no satisfactory response to previous therapies.

 



Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma

Controle da asma, função pulmonar, estado nutricional e qualidade de vida relacionada à saúde: diferenças entre homens e mulheres adultos com asma

Gabriele Carra Forte1,a, Maria Luiza Hennemann2,b, Paulo de Tarso Roth Dalcin1,3,c

J Bras Pneumol.2018;44(4):273-278

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Objective: To evaluate health-related quality of life in asthma patients treated at a referral center in southern Brazil, identifying differences between male and female patients, as well as to evaluate differences between the males and females in terms of asthma control, lung function, and nutritional status. Methods: This was a cross-sectional study involving patients ≥ 18 years of age treated at an asthma outpatient clinic. We evaluated clinical parameters, lung function, nutritional status, and quality of life. Results: A total of 198 patients completed the study. The mean age was 56.2 ± 14.8 years, and 81.8% were female. The proportion of patients with uncontrolled asthma was higher among females than among males (63.0% vs. 44.4%; p = 0.041). The body mass index (BMI) and percentage of body fat were higher in females than in males (30.2 ± 5.8 kg/m2 vs. 26.9 ± 4.5 kg/m2 and 37.4 ± 6.4% vs. 26.5 ± 7.4%; p = 0.002 and p < 0.001, respectively). Quality of life was lower in females than in males in the following domains: symptoms (3.8 ± 1.5 vs. 4.6 ± 1.7; p = 0.006); activity limitation (3.6 ± 1.3 vs. 4.4 ± 1.5; p = 0.001); emotional function (3.6 ± 1.9 vs. 4.5 ± 1.7; p = 0.014); and environmental stimuli (3.2 ± 1.6 vs. 4.3 ± 1.9; p = 0.001). Conclusions: Male asthma patients appear to fare better than do female asthma patients in terms of health-related quality of life, asthma control, BMI, percentage of body fat, and comorbidities.

 


Keywords: Asthma; Nutritional status; Quality of life; Adult.

 


Clinical and functional correlations of the difference between slow vital capacity and FVC

Correlação clínica e funcional da diferença entre capacidade vital lenta e CVF

Jonathan Jerias Fernandez1,2, Maria Vera Cruz de Oliveira Castellano3, Flavia de Almeida Filardo Vianna3, Sérgio Roberto Nacif1, Roberto Rodrigues Junior4, Sílvia Carla Sousa Rodrigues1,5

J Bras Pneumol.2020;46(1):e20180328-e20180328

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Objective: To evaluate the relationship that the difference between slow vital capacity (SVC) and FVC (ΔSVC-FVC) has with demographic, clinical, and pulmonary function data. Methods: This was an analytical cross-sectional study in which participants completed a respiratory health questionnaire, as well as undergoing spirometry and plethysmography. The sample was divided into two groups: ΔSVC-FVC ≥ 200 mL and ΔSVC-FVC < 200 mL. The intergroup correlations were analyzed, and binomial logistic regression analysis was performed. Results: The sample comprised 187 individuals. In the sample as a whole, the mean ΔSVC-FVC was 0.17 ± 0.14 L, and 61 individuals (32.62%) had a ΔSVC-FVC ≥ 200 mL. The use of an SVC maneuver reduced the prevalence of nonspecific lung disease and of normal spirometry results by revealing obstructive lung disease (OLD). In the final logistic regression model (adjusted for weight and body mass index > 30 kg/m2), OLD and findings of air trapping (high functional residual capacity and a low inspiratory capacity/TLC ratio) were predictors of a ΔSVC-FVC ≥ 200 mL. The chance of a bronchodilator response was found to be greater in the ΔSVC-FVC ≥ 200 mL group: for FEV1 (OR = 4.38; 95% CI: 1.45-13.26); and for FVC (OR = 3.83; 95% CI: 1.26-11.71). Conclusions: The use of an SVC maneuver appears to decrease the prevalence of nonspecific lung disease and of normal spirometry results. Individuals with a ΔSVC-FVC ≥ 200 mL, which is probably the result of OLD and air trapping, are apparently more likely to respond to bronchodilator administration.

 


Keywords: Vital capacity; Plethysmography; Airway obstruction.

 


Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

Correlação entre a gravidade de pacientes críticos e preditores clínicos de risco para a broncoaspiração

Gisele Chagas de Medeiros1, Fernanda Chiarion Sassi2, Lucas Santos Zambom3, Claudia Regina Furquim de Andrade2

J Bras Pneumol.2016;42(2):114-120

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Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

 


Keywords: Deglutition; Deglutition disorders; Intubation, intratracheal; Pneumonia, aspiration; Intensive care units.

 


Correlation between resistance to pyrazinamide and resistance to other antituberculosis drugs in Mycobacterium tuberculosis strains isolated at a referral hospital

Correlação entre a resistência a pirazinamida e a resistência a outros fármacos antituberculose em cepas de Mycobacterium tuberculosis isoladas em um hospital de referência

Leila de Souza Fonseca, Anna Grazia Marsico, Gisele Betzler de Oliveira Vieira, Rafael da Silva Duarte, Maria Helena Féres Saad, Fernanda de Carvalho Queiroz Mello

J Bras Pneumol.2012;38(5):630-633

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The correlation between resistance to pyrazinamide (PZA) and resistance to other first-line antituberculosis drugs was investigated in 395 Mycobacterium tuberculosis strains isolated from clinical specimens, representing 14% of the overall number of M. tuberculosis isolates obtained between 2003 and 2008 at the laboratory of a referral university hospital for tuberculosis. A high correlation was found between resistance to PZA and multidrug resistance, as well as between PZA resistance and resistance to rifampin, isoniazid, and ethambutol (p < 0.01 for all). These results highlight the importance of performing PZA susceptibility testing prior to the prescription of this drug in order to treat drug-resistant and multidrug-resistant tuberculosis.

 


Keywords: Tuberculosis/drug therapy; Tuberculosis/microbiology; Antibiotics, antitubercular.

 


Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity

Correlação entre mediadores inflamatórios na secreção nasofaríngea e no soro de crianças com infecção do trato respiratório inferior por vírus sincicial respiratórioe a gravidade da doença

Renata Amato Vieira, Edna Maria de Albuquerque Diniz,Maria Esther Jurfest Rivero Ceccon

J Bras Pneumol.2010;36(1):59-66

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Objective: To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-α, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. Methods: Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. Results: The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. Conclusions: At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.

 


Keywords: Respiratory syncytial virus, human; Chemokine CCL5; Intercellular adhesion molecule-1; Interleukin-6; Interleukin-10; Tumor necrosis factor-alpha.

 


Correlates of experimentation with smoking and current cigarette consumption among adolescents

Correlatos de experimentação e consumo atual de cigarros entre adolescentes

Amanda Gimenes Bonilha, Antonio Ruffino-Netto, Mayara Piani Sicchieri, Jorge Alberto Achcar, Antonio Luiz Rodrigues-Júnior, José Baddini-Martinez

J Bras Pneumol.2014;40(6):634-642

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Objective: The aim of this study was to analyze social characteristics and stress as correlates of cigarette smoking in adolescence. The main intent was to identify elements that distinguish adolescents who had experimented with smoking and did not progress to regular smoking from those who became current smokers. Methods: Students at 10 high schools in the city of Ribeirão Preto, Brazil, completed a questionnaire based on an instrument employed in a similar large-scale study. The students were classified as never-smokers or experimenters. The experimenters were subcategorized as having become current smokers or nonprogressors. Analyses were performed using adjusted logistic models. Results: A total of 2,014 students (mean age, 16.2  1.1 years; females, 53%) completed the questionnaire. We categorized 1,283 students (63.7%) as never-smokers, 244 (12.1%) as current smokers, and 487 (24.2%) as nonprogressors. We found that experimentation with smoking was associated with being held back a grade in school (OR = 1.80), alcohol intake (low/occasional, OR = 8.92; high/regular, OR = 2.64), illicit drug use (OR = 9.32), having a sibling or cousin who smokes (OR = 1.39), having a friend who smokes (OR = 2.08), and high levels of stress (in females only, OR = 1.32). Factors associated with an increased risk of transitioning from experimenter to current smoker were alcohol intake (low/occasional, OR = 3.28; high/regular, OR = 2.16), illicit drug use (OR = 3.61), and having a friend who smokes (OR = 7.20). Conclusions: Current smoking was associated with a profile of socioeconomic correlates different from that associated with experimentation only. Our data (showing that current smoking was associated with having a friend who smokes, alcohol intake, and illicit drug use) suggest the need for comprehensive approaches to discourage substance use during adolescence.

 


Keywords: Smoking; Tobacco use; Adolescent behavior; Stress, psychological.

 


Correspondence about the article - Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

Correspondência sobre o artigo - Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas

Juliana Guarize1, Stefano Donghi1, Maurício Guidi Saueressig1,2,3

J Bras Pneumol.2017;43(1):76-76

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Inhaled corticosteroids: effects on growth and adrenal suppression

Corticóide inalatório: efeitos no crescimento e na supressão adrenal

Elisete E. Arend, Gilberto Bueno Fischer, Helena Mocelin, Lídia Medeiros

J Bras Pneumol.2005;31(4):341-349

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This is a review of the medical literature regarding inhaled corticosteroids and their effects on growth and adrenal suppression in children and adolescents. A review of the literature, principally that published over the last five years, was conducted using Medline and searching indexes of articles published in national and international scientific journals. There is considerable controversy regarding the side effects of inhaled corticosteroids. In 21 studies evaluating the effect that inhaled corticosteroids have on growth, a statistically significant reduction (growth retarded by 1-1.5 cm) was observed within the first year of treatment with Beclomethasone or Budesonide inhalers. However, in studies of longer duration, no significant difference was found between final adult height and adult height of the parents. However, in ten studies of the use of inhaled corticosteroids and their effect on adrenal suppression, hypoglycemia and arrested development (no height or weight gains), as well as changes in morning serum levels and 24-h urinary levels of cortisol, were reported, especially when high doses of inhaled corticosteroids were used. Inhaled corticosteroids can reduce growth during the first year of use but do not affect adult height. However, further long-term studies are needed in order to determine the full impact of inhaled corticosteroids on final adult height. Height measures are a means of evaluating the safety and efficacy of the use of inhaled corticosteroids in children. Tests that evaluate the hypothalamic-pituitary-adrenal axis and adrenal insufficiency should be correlated with clinical symptoms and side effects.

 



Growth, lung function, and physical activity in schoolchildren who were very-low-birth-weight preterm infants

Crescimento, função pulmonar e atividade física em escolares nascidos prematuros e com muito baixo peso

Aline Dill Winck1,2, João Paulo Heinzmann-Filho3, Deise Schumann4, Helen Zatti4, Rita Mattiello3,5, Marcus Herbert Jones3,5, Renato Tetelbom Stein3,

J Bras Pneumol.2016;42(4):254-260

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare somatic growth, lung function, and level of physical activity in schoolchildren who had been very-low-birth-weight preterm infants (VLBWPIs) or normal-birth-weight full-term infants. Methods: We recruited two groups of schoolchildren between 8 and 11 years of age residing in the study catchment area: those who had been VLBWPIs (birth weight < 1,500 g); and those who had been normal-birth-weight full-term infants (controls, birth weight ≥ 2,500 g). Anthropometric and spirometric data were collected from the schoolchildren, who also completed a questionnaire regarding their physical activity. In addition, data regarding the perinatal and neonatal period were collected from the medical records of the VLBWPIs. Results: Of the 93 schoolchildren screened, 48 and 45 were in the VLBWPI and control groups, respectively. No significant differences were found between the groups regarding anthropometric characteristics, nutritional status, or pulmonary function. No associations were found between perinatal/neonatal variables and lung function parameters in the VLBWPI group. Although the difference was not significant, the level of physical activity was slightly higher in the VLBWPI group than in the control group. Conclusions: Among the schoolchildren evaluated here, neither growth nor lung function appear to have been affected by prematurity birth weight, or level of physical activity.

 


Keywords: Premature birth; Birth weight; Respiratory function tests; Motor activity; Pediatrics.

 


Modified crichothyroidotomy: an alternative for tracheobronchial secretions removal

Cricotireoidotomia modificada: opção para remoção das secreções traqueobrônquicas

Wilson Paloschi Spiandorello, Darcy Ribeiro Pinto Filho, Gisele Bassani, Franca Stedile Angeli Spiandorello

J Bras Pneumol.2002;28(2):61-64

Abstract PDF PT

Introduction: Inhalations, postural drainage and respiratory physiotherapy are not always effective in removing tracheobronchial secretions. Objectives: To evaluate an alternative surgical technique, modified crichothyroidotomy, to aspirate tracheobronchial secretions. Method: Modified crichothyroidotomy is the introduction of a catheter number 8, 10 or 12 into the crichothyroid membrane in order to stimulate coughing and the aspiration of secretions. This is a descriptive study of the benefits as well as immediate and late complications caused by the use of this technique in 45 patients with excessive tracheobronchial secretions inadequately removed by usual methods. Results: Immediate surgical complications were bleeding (10 patients), oropharynx deviation (3), subcutaneous emphysema (1) and difficult introduction (1). Mean catheter permanence was 14 ± 16 days and, in all cases, the catheter provoked coughing and allowed the easy aspiration of secretions. The most frequent occurrence (17 patients) was the expulsion of the catheter by coughing, inadequate catheter handling during aspiration and moving of the patients. Conclusion: This is a simple technique with a low morbidity rate and represents constitutes an effective alternative to be used in the aspiration of tracheobronchial secretions.

 


Keywords: Postural drainage. Aspiration.

 


Isolated pulmonary cryptococcosis in an immunocompetent patient

Criptococose pulmonar isolada em paciente imunocompetente

Ana Teresa Fernandes Barbosa, Fernando Antônio Colares, Edson da Silva Gusmão, Amanda Araújo Barros, Cristiane Gonçalves Cordeiro, Maria Cecília Tolentino Andrade

J Bras Pneumol.2006;32(5):476-480

Abstract PDF PT PDF EN Portuguese Text

In this study, we report a case of pulmonary cryptococcosis in a patient presenting respiratory symptoms and a lung mass on the chest X-ray. The patient had no concomitant diseases, was seronegative for human immunodeficiency virus and was not receiving immunosuppressive therapy of any kind. The diagnosis was confirmed through transbronchial biopsy and bronchoalveolar lavage. The patient was treated as an outpatient with fluconazole (300 mg/day for six months), evolving to clinical improvement and partial regression of the lung mass, as seen on a second chest X-ray. The current case illustrates an unusual presentation of pulmonary cryptococcosis and raises questions regarding the therapeutic approaches proposed in the literature.

 


Keywords: Cryptococcosis; Lung diseases, fungal; Lung/radiography; Immunocompetence

 


Pulmonary cryptosporidiosis in AIDS patients, an underdiagnosed disease

Criptosporidiose pulmonar em pacientes com AIDS, uma doença subdiagnosticada

Yvana Maria Maia de Albuquerque, Márcia Cristina Fraga Silva, Ana Luiza Magalhães de Andrade Lima, Vera Magalhães

J Bras Pneumol.2012;38(4):530-532

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Inclusion and exclusion criteria in research studies: definitions and why they matter

Critérios de inclusão e exclusão em estudos de pesquisa: definições e por que eles importam

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

J Bras Pneumol.2018;44(2):84-84

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Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series

Critérios diagnósticos e seguimento em hiperplasia de células neuroendócrinas do lactente: uma série de casos

Vivianne Calheiros Chaves Gomes, Mara Cristina Coelho Silva, José Holanda Maia Filho, Pedro Daltro, Simone Gusmão Ramos, Alan S. Brody, Edson Marchiori

J Bras Pneumol.2013;39(5):569-578

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Objective: Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. Methods: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. Results: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. Conclusions: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment.

 


Keywords: Lung diseases, interstitial/diagnosis; Lung diseases, interstitial/treatment; Tomography, X-ray computed.

 


Psychological criteria for contraindication in lung transplant candidates: a five-year study

Critérios psicológicos para contraindicação em candidatos a transplante pulmonar: um estudo de cinco anos

Elaine Marques Hojaij1, Bellkiss Wilma Romano1, André Nathan Costa2, Jose Eduardo Afonso Junior3, Priscila Cilene Leon Bueno de Camargo3, Rafael Medeiros Carraro3, Silvia Vidal Campos4, Marcos Naoyuki Samano5, Ricardo Henrique de Oliveira Braga Teixeira6

J Bras Pneumol.2015;41(3):246-249

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Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

 


Keywords: Lung transplantation; Interview, psychological; Psychological tests; Preoperative care.

 


Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial

Cultura quantitativa de amostras de aspirado endotraqueal e lavado broncoalveolar no manejo de pacientes com pneumonia associada à ventilação mecânica: um ensaio clínico randomizado

Ricardo de Amorim Corrêa, Carlos Michel Luna, José Carlos Fernandez Versiani dos Anjos, Eurípedes Alvarenga Barbosa, Cláudia Juliana de Rezende, Adriano Pereira Rezende, Fernando Henrique Pereira, Manoel Otávio da Costa Rocha

J Bras Pneumol.2014;40(6):643-651

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Objective: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. Methods: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. Results: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). Conclusions: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-86DCDX [http://www.ensaiosclinicos.gov.br])

 


Keywords: Bronchoalveolar lavage fluid/diagnosis; Respiratory aspiration; Pneumonia, ventilator-associated.

 


Cost-effectiveness of an education program for asthmatic adults of a public university hospital

Custo-efetividade de programa de educação para adultos asmáticos atendidos em hospital-escola de instituição pública

Maria Alenita de Oliveira, Maria Tereza Muniz, Lucia Ande Santos, Sônia Maria Faresin, Ana Luisa Godoy Fernandes

J Bras Pneumol.2002;28(2):71-76

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The direct costs incurred in managing patients with poorly controlled asthma are high and educational programs could decrease these costs. Aim: The objectives of this study were to compare the direct cost of the implementation of an educational program for adult asthmatic patients with the cost of the usual care delivered to asthmatics by specialists. Methods: Five years ago, a six-month study demonstrated that an educational program improved clinical outcomes (22 in educational program-E and 20 patients in control group-C). Throughout the educational intervention period all cases of hospitalization, emergency and regular calls involving patients from both groups were recorded. The basis for the values utilized in the calculation of costs was the healthcare database of the Brazilian government (DATASUS). The overall medication cost/patient in both groups was based on the amount of medication taken during the month preceding the last call. The final values were converted into US dollars. Results: The mean direct cost/patient in the educational (E) and control (C) groups and the difference (Δ) between groups were: hospitalizations (C = US$ 183, E = 0, Δ = US$ 183); emergency calls (C = US$ 14, E = US$ 5, Δ = US$ 9); regular calls (C = US$ 10, E = US$ 24, Δ = -US$ 14); medication (C = US$ 124,3, E = US$ 195,6, Δ = -US$ 71,3). The total cost was US$ 33/patient in group C and US$ 224/patient in group E with an average cost saving of US$ 107/patient. Conclusion: The expenses with medication is higher in E group because the regular use of maintenance drugs, however the study suggested that the application of the asthma education program reduced the total direct costs of asthma.

 


Keywords: Asthma. Cost-benefit. Patient education.

 


Oxidative damage induced by cigarette smoke exposure in mice: impact on lung tissue and dia-phragm muscle

Dano oxidativo induzido por exposição a fumaça de cigarro em camundongos: impacto sobre o pulmão e o músculo diafragma

Samanta Portão de Carlos, Alexandre Simões Dias, Luiz Alberto Forgiarini Júnior, Patrícia Damiani Patricio, Thaise Graciano, Renata Tiscoski Nesi, Samuel Valença, Adriana Meira Guntzel Chiappa, Gerson Cipriano Jr, Claudio Teodoro de Souza, Gaspar Rogério da Silva Chiappa

J Bras Pneumol.2014;40(4):411-420

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Objetivo: Avaliar o dano oxidativo (oxidação lipídica, oxidação proteica, thiobarbituric acid-reactive substances [TBARS, substâncias reativas ao ácido tiobarbitúrico], e carbonilação) e inflamação (expressão de phosphorylated AMP-activated protein kinase e de phosphorylated mammalian target of rapamycin (p-AMPK e p-mTOR, respectivamente) em tecido pulmonar e músculos do diafragma em camundongos C57BL/6 machos expostos à fumaça de cigarro (FC) por 7, 15, 30, 45 ou 60 dias. Métodos: Trinta e seis camundongos machos da espécie C57BL/6 foram divididos em seis grupos (n = 6/grupo): grupo controle e 5 grupos expostos a FC por 7, 15, 30, 45 e 60 dias, respectivamente. Resultados: Comparados aos camundongos controle, os camundongos expostos à FC apresentaram menor peso corporal em 30 dias. Nos camundongos expostos à FC (comparados aos controle) as maiores diferenças (aumentos) nos níveis de TBARS foram observados no dia 7 no músculo diafragma, comparado ao dia 45 em tecido pulmonar; as maiores diferenças (aumentos) nos níveis de carbonilas foram observados no dia 7 em ambos os tipos de tecido; e os níveis de sulfidrilas foram menores, nos dois tipos de tecidos, em todos os tempos. No tecido pulmonar e no músculo diafragma, a expressão de p-AMPK exibiu um comportamento semelhante ao dos níveis de TBARS. A expressão de p-mTOR foi maior que o valor controle nos dias 7 e 15 no tecido pulmonar, assim como no dia 45 no músculo diafragma. Conclusões: Nossos dados demonstram que a exposição à FC produz dano oxidativo tanto no tecido pulmonar quanto (primariamente) no tecido muscular, tendo um efeito adicional no músculo respiratório, como é frequentemente observado em fumantes com DPOC.

 


Keywords: Oxidative stress; Mice; Respiratory system; Smoking; Inflammation.

 


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-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.

 


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-e20170355

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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.

 


Delmiro, o "coçado" que curou a tuberculose (ou) A supervisão de boteco às vezes funciona

Fernando Augusto Fiuza de Melo

J Bras Pneumol.2002;28(2):113-114

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Pulmonary deposition of inhaled tobramycin prior to and after respiratory therapy and use of inhaled albuterol in cystic fibrosis patients colonized with Pseudomonas aeruginosa

Deposição pulmonar de tobramicina inalatória antes e após fisioterapia respiratória e uso de salbutamol inalatório em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa

Milena Baptistella Grotta, Elba Cristina de Sá Camargo Etchebere, Antonio Fernando Ribeiro, Juliana Romanato, Maria Ângela Gonçalves de Oliveira Ribeiro, José Dirceu Ribeiro

J Bras Pneumol.2009;35(1):35-43

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Objective: To evaluate whether respiratory therapy followed by the use of inhaled albuterol modifies the pulmonary deposition of inhaled tobramycin in patients with cystic fibrosis (CF) and whether pulmonary deposition correlates with disease severity or genotype. Methods: A prospective study was carried out including patients with CF older than 6 years of age and colonized with Pseudomonas aeruginosa. Exclusion criteria were pulmonary exacerbation, changes in therapy between the study phases and FEV1 < 25%. All patients were submitted to pulmonary scintigraphy by means of a scintillation camera equipped with a low-energy all-purpose collimator in order to evaluate drug penetration following the administration of inhaled 99mTc-tobramycin, as well as to pulmonary perfusion with 99mTc-macroaggregated albumin (phase 1). One month later, the same procedure was performed following respiratory therapy and administration of inhaled albuterol (phase 2). Results: We included 24 patients (12 males) aged 5-27 years (mean ± SD: 12.85 ± 6.64 years). The Shwachman score (SS) was excellent/good in 8 patients, moderate/fair in 16 and poor in 0. Genotyping revealed that 7 patients were ΔF508 homozygotes, 13 were ΔF508 heterozygotes; and 4 presented other mutations. In all patients, lung deposition of tobramycin decreased in phase 2, especially in those with moderate/fair SS (p = 0.017) and in heterozygotes (p = 0.043). Conclusions: The use of a respiratory therapy technique and the administration of inhaled albuterol immediately prior to the use of inhaled tobramycin decreased the pulmonary deposition of the latter in CF patients, and this reduction correlates with disease severity and genotype.

 


Keywords: Cystic fibrosis; Tobramycin; Respiratory therapy; Albuterol; Radionuclide imaging.

 


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-e20170426

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Derrame pleural com elevado teor de amilase

Célia Mallart Llarges, Jaqueline Maria Lima, Luís Felipe F. da Silva, Carlos Eduardo P. Barreto

J Bras Pneumol.1998;24(5):342-344

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Uncommon pleural effusion: pleuropulmonary metastasis from primitive neuroectodermal tumor

Derrame pleural incomum: metástase pleuropulmonar de tumor neuroectodérmico primitivo

Leila Antonangelo, Adriana Gonçalves Rosa, Aline Pivetta Corá, Milena Marques Pagliarelli Acencio, Luís César Moreira, Francisco Vargas Suso

J Bras Pneumol.2009;35(6):606-609

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Primitive neuroectodermal tumor is an invasive neoplasm with neuronal differentiation, which frequently results in metastasis in various organs. We report the case of a patient with primitive neuroectodermal tumor whose primary site was the axilla. The patient presented with metastases in the lung, pleura, bone, iliac muscle and bone marrow. We highlight the uncommon finding in the pleural fluid cytology.

 


Keywords: Neuroectodermal tumors, primitive; Neoplasm metastasis; Cytology; Pleural effusion.

 


Pleural effusion following ovarian hyperstimulation

Derrame pleural secundário à hiperestimulação ovariana

Jader Joel Machado Junqueira, Ricardo Helbert Bammann, Ricardo Mingarini Terra, Ana Cristina Pugliesi de Castro, Augusto Ishy, Angelo Fernandez

J Bras Pneumol.2012;38(3):400-403

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Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

 


Keywords: Fertilization in vitro; Ovarian hyperstimulation syndrome; Pleural effusion.

 


Pleural effusion: an extraintestinal complication of Crohn's disease

Derrame pleural: uma complicação extra-intestinal da doença de Crohn

Elie Fiss, Flavio Steinwaurz, Andrea Barranjard Vannucci, Camila de Menezes Succi

J Bras Pneumol.2002;28(5):285-287

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A 34-year-old patient had had Crohn's disease (CD) for eight years; she was seen for complaints of thoracic pain and fever, without gastrointestinal manifestations. Initial laboratory exams were compatible with the presence of inflammatory activity (VHS = 45 mm for normal value of 20 mm and PCR+). The physical exam revealed signs of pleural effusion in the left hemithorax base, which was confirmed by thoracic RX. The pleural liquid analysis showed that the cells were 100% of lymphocytes, with negative BAAR research. The pleural biopsy evidenced non caseous granuloma. Despite the tuberculosis treatment, the patient only got better when corticotherapy was introduced in high doses, suggesting the activity of CD as the cause of the pleural effusion. This case establishes a connection between activity of CD and manifestations of lung disease.

 



Challenges in lung transplantation

Desafios do transplante pulmonar

Fábio Biscegli Jatene, Paulo Manuel Pêgo-Fernandes

J Bras Pneumol.2008;34(5):249-250

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Performance of nested PCR in the specific detection of Mycobacterium tuberculosis complex in blood samples of pediatric patients

Desempenho da técnica nested PCR na detecção específica do complexo Mycobacterium tuberculosis em amostras sanguíneas de pacientes pediátricos

Juliana Figueirêdo da Costa Lima, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Marta Maciel Lyra Cabral, Andrea Santos Lima, Frederico Guilherme Coutinho Abath (in memoriam), Haiana Charifker Schindler

J Bras Pneumol.2009;35(7):690-697

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Objective: To evaluate the performance of nested PCR (nPCR) in detecting the Mycobacterium tuberculosis complex in blood samples of patients suspected of having TB, in order to determine its potential for use as an auxiliary tool in the laboratory diagnosis of TB in children. Methods: Detection of the M. tuberculosis complex in blood samples using as a target the insertion sequence IS6110 of the genomic DNA of the bacillus. Blood samples of 120 patients were evaluated. All of the patients were under 15 years of age at the time of their treatment at public hospitals in the city of Recife, Brazil (between January of 2003 and August of 2005). Attending physicians at the hospitals diagnosed TB based on the criteria recommended by the American Thoracic Society. The nPCR amplified a 123-bp fragment with outer oligonucleotides (IS1/IS2) and, in the subsequent reaction, using inner oligonucleotides (IS3/IS4), generating an 81-bp amplicon. Results: Active or latent TB was found in 65 patients, TB was ruled out in 28 suspected cases, and 27 patients were TB-free (controls). The sensitivity of nPCR was 26.15% and was significantly higher for the extrapulmonary form of the disease (55.56%) than for the pulmonary form (18.18%). The specificity was 92.73%. Conclusions: Despite the difficulties in diagnosing TB in children and the low number of cases evaluated in the present study, nPCR in blood samples proved to be a rapid and specific technique, albeit one with low sensitivity. In order to establish its true usefulness in the diagnosis of paucibacillary forms, especially extrapulmonary TB, further studies need to be carried out with a larger sample of children and analyzing biological specimens other than blood.

 


Keywords: Tuberculosis; Diagnosis; Blood; Polymerase chain reaction.

 


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-e20180185

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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.

 


Performance of a word labeled visual analog scale in determining the degree of dyspnea during exercise-induced bronchoconstriction in children and adolescents with asthma

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

Patrícia Bueno Lima, Ilka Lopes Santoro, Lilian Ballini Caetano, Anna Lúcia de Barros Cabral, Ana Luisa Godoy Fernandes

J Bras Pneumol.2010;36(5):532-538

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Objective: There is an indirect relationship between airway obstruction in asthma and the intensity of breathlessness (dyspnea). A word labeled visual analog dyspnea scale with a 0-3 score has been widely used for the assessment of the degree of bronchoconstriction, although the perception of such obstruction varies considerably. The objective of this study was to determine whether children and adolescents are able to perceive acute exercise-induced bronchoconstriction (EIB), as well as to measure the discriminatory power of a word labeled visual analog dyspnea scale in relation to the intensity of the EIB. Methods: A cross-sectional study involving 134 children and adolescents with asthma and submitted to a six-minute steady-state exercise test on a cycle ergometer. The intensity of dyspnea was determined using a word labeled visual analog dyspnea scale prior to each determination of FEV1. The scale is scored from 0 to 3, with a logical sequence of pictures, ranging from "no symptoms" to "severe dyspnea". Variables were determined at baseline, as well as at 5, 10, and 20 min after the exercise test. The accuracy of the dyspnea scale in identifying the degree of EIB was determined by means of ROC curves for the post-exercise fall in FEV1, using cut-off points of 10%, 20%, 30%, and 40%. Results: Of the patients selected, 111 finished the study, and 52 (46.8%) presented with EIB. The area under the ROC curve increased in direct proportion to increases in the degree of bronchoconstriction. Conclusions: Among children and adolescents with asthma, the accuracy of this dyspnea scale improves as the post-exercise percentage fall in FEV1 increases. However, the predictive value of the scale is suboptimal when the percentage fall in FEV1 is lower.

 


Keywords: Asthma; Asthma, exercise-induced; Dyspnea.

 


Functional performance on the six-minute walk test in patients with cystic fibrosis

Desempenho funcional de pacientes com fibrose cística e indivíduos saudáveis no teste de caminhada de seis minutos

Fabíola Meister Pereira, Maria Ângela Gonçalves de Oliveira Ribeiro, Antônio Fernando Ribeiro, Adyléia Aparecida Dalbo Contrera Toro, Gabriel Hessel, José Dirceu Ribeiro

J Bras Pneumol.2011;37(6):735-744

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Objective: To compare patients with cystic fibrosis and healthy individuals in terms of their functional performance on the six-minute walk test (6MWT). Methods: A prospective, cross-sectional study involving healthy individuals and patients with cystic fibrosis treated at a referral university hospital in the city of Campinas, Brazil. The 6MWT was administered in accordance with the American Thoracic Society guidelines, and it was repeated after a 30-min rest period. For all of the participants, RR, HR, SpO2, and Borg scale scores were obtained. For the cystic fibrosis patients, nutritional status and spirometric values were determined. Patients with pulmonary exacerbation were excluded. Spearman's correlation coefficient and repeated measures ANOVA were used. Results: The cystic fibrosis group comprised 55 patients, and the control group comprised 185 healthy individuals. The mean ages were 12.2 ± 4.3 and 11.3 ± 4.3 years, respectively. The six-minute walk distance (6MWD) was significantly shorter in the cystic fibrosis group than in the control group for both tests (547.2 ± 80.6 m vs. 610.3 ± 53.4 m for the first and 552.2 ± 82.1 m vs. 616.2 ± 58.0 m for the second; p < 0.0001 for both). The 6MWD correlated with age, weight, and height only in the cystic fibrosis group. During the tests, SpO2 remained stable, whereas HR and RR increased. Conclusions: In our sample, functional performance on the 6MWT was poorer among the cystic fibrosis patients than among the healthy controls in the same age bracket, and we found immediate repetition of the test to be unadvisable.

 


Keywords: Cystic fibrosis; Exercise tolerance; Dyspnea.

 


Developing research questions that make a difference

Desenvolvendo perguntas do estudo que fazem a diferença

Cecilia Maria Patino1,2, Juliana Carvalho Ferreira2,3

J Bras Pneumol.2016;42(6):403-403

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Development of a modified Dumon stent for tracheal applications: an experimental study in dogs

Desenvolvimento de uma órtese de Dumon modificada para aplicações traqueais: um estudo experimental em cães

Rogério Gastal Xavier, Paulo Roberto Stefani Sanches, Amarilio Viera de Macedo Neto, Gabriel Kuhl, Samanta Bianchi Vearick, Marcelo Dall'Onder Michelon

J Bras Pneumol.2008;34(1):21-26

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the development of a silicone stent and perform in vivo testing for biocompatibility/applicability in the normal canine trachea. Methods: Four different densities were tested in order to obtain the silicone prototypes. The pressure required for compression considering a contact area of 1 cm2, and a 30% reduction in diameter was calculated for each density. The best density was 70-75 Shore A hardness. Powdered barium sulfate was added to the silicone to make the stent radiopaque and easily identifiable in radiological imaging. This novel stent presents a corrugated external surface with discontinuous and protruding arcs resembling the tracheobronchial rings (for intercalation and fixation in the lumen of the lower airways), a highly polished inner surface and smooth extremities (to prevent friction-related damage). The prototype considered most appropriate in terms of rigidity and flexibility was bronchoscopically implanted in normal canine tracheas. After eight weeks, the animals were euthanized, and the tracheas were removed for anatomopathological analysis. Results: There were no postimplantation complications, and none had to be removed. After eight weeks, the devices were found to be well-positioned. Histopathology revealed a well-preserved epithelial basal membrane, foci of denuded epithelium, mild submucosal inflammatory infiltrate with scattered granulation tissue, vascular neoformation, and no microorganisms. Conclusions: The stent developed proved resistant to mechanical stress, biocompatible in the canine trachea and well-preserved at the study endpoint.

 


Keywords: Implants, experimental; Silicones; Biocompatible materials.

 


Development and assessment of a multimedia computer program to teach pleural drainage techniques

Desenvolvimento e avaliação de um programa multimídia de computador para ensino de drenagem pleural

João Aléssio Juliano Perfeito, Vicente Forte, Roseli Giudici, José Ernesto Succi, Jae Min Lee, Daniel Sigulem

J Bras Pneumol.2008;34(7):437-444

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Objective: To develop a multimedia educational computer program designed to teach pleural drainage techniques to health professionals, as well as to evaluate its efficacy. Methods: We planned and developed a program, which was evaluated by 35 medical students, randomized into two groups. Group 1 comprised 18 students who studied using the program, and group 2 comprised 17 students who attended a traditional theoretical class given by an experienced teacher. Group 1 students were submitted to two subjective evaluations using questionnaires, and both groups took an objective theoretical test with multiple-choice questions and descriptive questions. The results of the theoretical test were compared using the Mann-Whitney test. Results: The subjective evaluation of the technological aspects and content of the program ranged from excellent to very good and good. The software was considered highly instructive by 16 students (88.9%), and 17 students (94.4%) thought it might partially substitute for traditional classes. Between the two groups, there was no significant difference in the multiple-choice test results, although there was such a difference in the descriptive question results (p < 0.001), group 1 students scoring higher than did those in group 2. Conclusions: The computer program developed at the Federal University of São Paulo Paulista School of Medicine proved to be a feasible means of teaching pleural drainage techniques. The subjective evaluation of this new teaching method revealed a high level of student satisfaction, and the objective evaluation showed that the program was as efficacious as is traditional instruction.

 


Keywords: Teaching; Thoracic surgery; Multimedia; Drainage; Pleural diseases.

 


Validation and development of an immunonephelometric assay for the determination of alpha-1 antitrypsin levels in dried blood spots from patients with COPD

Desenvolvimento e validação de um método de imunonefelometria em amostras de sangue em papel-filtro para a dosagem da alfa-1 antitripsina em pacientes com DPOC

Laura Russo Zillmer, Rodrigo Russo, Beatriz Martins Manzano, Ivan Ivanaga, Oliver Augusto Nascimento, Altay Alves Lino de Souza, Gildo Santos Júnior, Francisco Rodriguez, Marc Miravitlles, José Roberto Jardim

J Bras Pneumol.2013;39(5):547-554

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Objective: To validate and develop an immunonephelometric assay for the determination of alpha-1 antitrypsin (AAT) levels in dried blood spots from COPD patients in Brazil. Methods: We determined AAT levels in serum samples and dried blood spots from 192 COPD patients. For the preparation of dried blood spots, a disk (diameter, 6 mm) was placed into a tube, eluted with 200 µL of PBS, and stored overnight at 4°C. All of the samples were analyzed by immunonephelometry in duplicate. We used the bootstrap resampling method in order to determine a cut-off point for AAT levels in dried blood spots. Results: The correlation coefficient between the AAT levels in serum samples and those in dried blood spots was r = 0.45. For dried blood spots, the cut-off value was 2.02 mg/dL (97% CI: 1.45-2.64 mg/dL), with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 95.7%, 27.2%, and 100%, respectively. Conclusions: This method for the determination of AAT levels in dried blood spots appears to be a reliable screening tool for patients with AAT deficiency.

 



Development and validation of an asthma knowledge questionnaire for use in Brazil

Desenvolvimento e validação de um questionário de conhecimento em asma para uso no Brasil

Marcos Carvalho Borges, Érica Ferraz, Sílvia Maria Romão Pontes, Andrea de Cássia Vernier Antunes Cetlin, Roseane Durães Caldeira, Cristiane Soncino da Silva, Ana Carla Sousa Araújo, Elcio Oliveira Vianna

J Bras Pneumol.2010;36(1):-

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To develop and validate an asthma knowledge questionnaire for use in adult asthma patients in Brazil. Methods: A 34-item self-report questionnaire was constructed and administered to adult asthma patients and adult controls. The maximum total score was 34. Results: The questionnaire was shown to be discriminatory, with good reliability and reproducibility. The mean score for asthma patients and controls was, respectively, 21.47 ± 4.11 (range: 9-31) and 17.27 ± 5.11 (range: 7-28; p < 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.53, and the Bartlett's test of sphericity demonstrated a satisfactory suitability of the data to factor analysis (p < 0.001). There was no significant difference between the total scores obtained in the first and in the second application of the questionnaire within a two-week interval (p = 0.43). The internal consistency reliability (KR-20 coefficient) was 0.69. Conclusions: This study has validated an asthma knowledge questionnaire for use in Brazil.

 


Keywords: Asthma; Questionnaires; Validation studies; Reproducibility of results.

 


Clinical treatment outcomes of tuberculosis treated with the basic regimen recommended by the Brazilian National Ministry of Health using fixed-dose combination tablets in the greater metropolitan area of Goiânia, Brazil

Desfechos clínicos do tratamento de tuberculose utilizando o esquema básico recomendado pelo Ministério da Saúde do Brasil com comprimidos em dose fixa combinada na região metropolitana de Goiânia

Anna Carolina Galvão Ferreira, José Laerte Rodrigues da Silva Júnior, Marcus Barreto Conde, Marcelo Fouad Rabahi

J Bras Pneumol.2013;39(1):76-83

Abstract PDF PT PDF EN Portuguese Text

Resumo

Objetivo: Descrever as taxas de cura, falência e abandono do tratamento da tuberculose com o esquema básico preconizado pelo Ministério da Saúde (tratamento com rifampicina, isoniazida, pirazinamida e etambutol por dois meses seguido de isoniazida e rifampicina por quatro meses) utilizando comprimidos em dose fixa combinada em regime autoadministrado e descrever os eventos adversos e seus possíveis impactos nos desfechos do tratamento. Métodos: Estudo descritivo utilizando dados coletados prospectivamente dos prontuários médicos de pacientes com tuberculose (idade ≥ 18 anos) tratados com o esquema básico em duas unidades básicas de saúde da região metropolitana de Goiânia, GO. Resultados: A amostra foi composta por 40 pacientes com tuberculose. A taxa de cura foi de 67,5%, a taxa de abandono foi de 17,5%, e não ocorreram casos de falência. Nessa amostra, 19 pacientes (47%) relataram reações adversas aos medicamentos. Essas foram leves e moderadas, respectivamente, em 87% e 13% dos casos. Em nenhum caso houve necessidade de mudança do esquema ou suspensão do tratamento. Conclusões: A taxa de cura do esquema básico com o uso de comprimidos em dose fixa combinada sob regime autoadministrado foi semelhante às taxas históricas do esquema anterior. A taxa de abandono, na amostra estudada, foi muito acima da taxa preconizada como adequada (até 5%).

 


Palavras-chave: Tuberculose; Resultado de tratamento; Combinação de medicamentos.

 


Retreatment of tuberculosis patients in the city of Porto Alegre, Brazil: outcomes

Desfechos do retratamento de pacientes com tuberculose com o uso do esquema 3 em Porto Alegre, Brasil

Pedro Dornelles Picon, Carlos Fernando Carvalho Rizzon, Sergio Luiz Bassanesi, Luiz Carlos Correa da Silva, Maria de Lourdes Della Giustina

J Bras Pneumol.2011;37(4):504-511

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Objective: To describe the outcomes of retreatment in tuberculosis patients receiving the regimen known, in Brazil, as regimen 3 (streptomycin, ethambutol, ethionamide, and pyrazinamide for 3 months + ethambutol and ethionamide for 9 months) after treatment failure with the basic regimen (rifampin, isoniazid, and pyrazinamide for 2 months + rifampin and isoniazid for 4 months). Methods: A descriptive, uncontrolled, historical cohort study involving adult tuberculosis patients treated with regimen 3. We evaluated adverse drug effects, recurrence, treatment outcomes, and associated factors. Results: The study included 229 patients. The overall cure rate was 62%. For the patients who used the medications regularly and those who did not, the cure rate was 88% and 31%, respectively. Adverse events occurred in 95 patients (41.5%), and most of those events were related to the gastrointestinal tract. In the five-year follow-up period, relapse occurred in 17 cases (12.0%). Conclusions: Overall, the outcomes of treatment with regimen 3 were unsatisfactory, in part because this regimen was administered to a selected population of patients at high risk for noncompliance with treatment, as well as because it presents high rates of adverse effects, especially those related to the gastrointestinal tract, which might be caused by ethionamide. However, for those who took the medications regularly, the cure rate was satisfactory. The recurrence rate was higher than that recommended in international consensus guidelines, which might be attributable to the short (12-month) treatment period. We believe that regimen 3, extended to 18 months, represents an option for patients with proven treatment compliance.

 


Keywords: Tuberculosis, pulmonary/therapy; Treatment outcome; Retreatment.

 


Maternal malnutrition during lactation in Wistar rats: effects on elastic fibers of the extracellular matrix in the trachea of offspring

Desnutrição materna durante a lactação em ratos Wistar: efeitos sobre as fibras elásticas da matriz extracelular na traqueia dos filhotes

Filipe Moreira de Andrade, Luiz Felippe Judice, Gilberto Perez Cardoso, Rafael Cisne, Cristiane da Fonte Ramos, Marcio Antonio Babinski

J Bras Pneumol.2012;38(5):588-594

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Objective: To investigate the effects of maternal protein malnutrition during lactation on the elastic fibers in the tracheas of Wistar rat pups. Methods: At delivery, 12 male pups of two Wistar rat dams were equally divided into two groups: control, in which the dam received water and standard rat chow ad libitum during lactation; and protein-restricted (PR), in which the dam received water ad libitum and an isoenergetic PR diet (8% protein). At 21 days of age, the pups were killed and their tracheas were excised. The elastic fibers were stained with Weigert's resorcin-fuchsin (after oxidation) and evaluated under light microscopy. Morphometric determinations were performed by stereology, with the point-counting method, and expressed as volumetric densities. Results: Elastic fibers, most having a longitudinal distribution, were identified beneath the tracheal mucosa. In addition, well-defined circular layers of elastic fibers were found around the inner and outer surfaces of the cartilaginous ring. There were no differences between the groups regarding the organization and distribution of the elastic fibers. The volumetric density of the elastic fibers of the pups in the control and PR groups was 2.46 ± 0.99% and 3.25 ± 1.13%, respectively (p < 0.01). Conclusions: The volumetric density of elastic fibers appears to be greater in rat pups breastfed by dams receiving a PR diet than in those breastfed by dams receiving a normal diet.

 


Keywords: Trachea/growth and development; Trachea/anatomy and histology; Extracellular matrix; Airway remodeling; Malnutrition.

 


Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases

Destaques das Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

Bruno Guedes Baldi, Carlos Alberto de Castro Pereira, Adalberto Sperb Rubin, Alfredo Nicodemos da Cruz Santana, André Nathan Costa, Carlos Roberto Ribeiro Carvalho, Eduardo Algranti, Eduardo Mello de Capitani, Eduardo Pamplona Bethlem, Ester Nei Aparecida Martins Coletta, Jaquelina Sonoe Ota Arakaki, José Antônio Baddini Martinez, Jozélio Freire de Carvalho, Leila John Marques Steidle, Marcelo Jorge Jacó Rocha, Mariana Silva Lima, Maria Raquel Soares, Marlova Luzzi Caramori, Miguel Abidon Aidé, Rimarcs Gomes Ferreira, Ronaldo Adib Kairalla, Rudolf Krawczenko Feitoza de Oliveira, Sérgio Jezler, Sílvia Carla Sousa Rodrigues, Suzana Pinheiro Pimenta

J Bras Pneumol.2012;38(3):282-291

Abstract PDF PT PDF EN Portuguese Text

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.

 


Keywords: Lung diseases, interstitial; Guidelines as topic; Brazil.

 


Detection of micrometastases in pN0 non-small cell lung cancer: an alternative method combining tissue microarray and immunohistochemistry

Detecção de micrometástases em câncer de pulmão não-pequenas células estádio pN0: um método alternativo combinando imunohistoquímica e análise em microsséries

Maíra Rovigatti Franco, Edwin Roger Parra, Teresa Yae Takagaki, Fernando Augusto Soares, Vera Luiza Capelozzi

J Bras Pneumol.2008;34(3):129-135

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Objective: To present an alternative method of detecting micrometastases in lymph nodes previously testing negative for non-small cell lung cancer (NSCLC) by routine hematoxylin-eosin staining. Methods: A total of 77 hilar and mediastinal lymph nodes resected from 18 patients with NSCLC were investigated for the presence of micrometastases using a combination of microarray analysis and immunohistochemistry. Results: Micrometastases were detected by identifying cytokeratin- and chromogranin-positive cells in lymph node microarrays. Of the 18 patients initially staged as pN0 through routine hematoxylin-eosin staining, 9 (50%) were restaged as N1, and the prognoses were re-evaluated in terms of histological and clinical parameters. The comparison of the survival curves revealed that survival was higher in the patients without micrometastases than in those with micrometastases. In addition, in the multivariate analysis adjusted for age, gender, histological type, and restaging, the presence of micrometastases proved to be an independent predictor of survival. Among patients who had been previously staged as pN0, the risk of death was found to be 7-times greater for those later diagnosed with micrometastases than for those in whom no micrometastases were identified. Conclusion: The combination of microarray analysis and immunohistochemistry might represent a low-cost and less time-consuming alternative for identifying occult micrometastases and predicting prognoses in surgically resected patients with pN0 NSCLC. Larger randomized, prospective studies are needed in order to determine the accuracy of this method.

 


Keywords: Lung neoplasms; Microarray analysis; Chromogranin A; Survival analysis.

 


Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens

Detecção do complexo Mycobacterium tuberculosis por nested polymerase chain reaction em espécimes pulmonares e extrapulmonares

Adriana Antônia da Cruz Furini, Heloisa da Silveira Paro Pedro, Jean Francisco Rodrigues, Lilian Maria Lapa Montenegro, Ricardo Luiz Dantas Machado, Célia Franco, Haiana Charifker Schindler, Ida Maria Foschiani Dias Batista, Andrea Regina Baptista Rossit

J Bras Pneumol.2013;39(6):711-718

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Objective: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. Methods: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. Results: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). Conclusions: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis.

 


Keywords: Tuberculosis/diagnosis; Tuberculosis/microbiology; Mycobacterium tuberculosis; Polymerase chain reaction.

 


Cord factor detection and macroscopic evaluation of mycobacterial colonies: an efficient combined screening test for the presumptive identification of Mycobacterium tuberculosis complex on solid media

Detecção do fator corda e avaliação do aspecto macroscópico das colônias de micobactérias: um eficiente teste de triagem combinado para a identificação presuntiva do complexo Mycobacterium tuberculosis em meios sólidos

Fernanda Cristina dos Santos Simeão, Erica Chimara, Rosângela Siqueira Oliveira, Jonas Umeoka Yamauchi, Fábio Oliveira Latrilha, Maria Alice da Silva Telles

J Bras Pneumol.2009;35(12):-

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Objective: The rapid differentiation between Mycobacterium tuberculosis and nontuberculous mycobacteria is fundamental for patients co-infected with tuberculosis and HIV. To that end, we use two methods in our laboratory: detection of cord factor and PCR-restriction enzyme analysis (PRA). The objective of this study was to evaluate the accuracy of a screening test on solid medium as a rapid method for the presumptive identification of M. tuberculosis complex, considering costs and turnover time. Methods: A total of 152 strains were submitted to a combined screening test, consisting of the detection of cord factor under microscopy (Ziehl-Neelsen staining) and evaluation of the macroscopic aspect of colonies, as well as to PRA, which was used as the gold standard. Costs were estimated by calculating the price of all of the materials needed for each test. Results: The overall accuracy of cord factor detection alone was 95.4% (95% CI: 90.7-98.1%), and that of the combined screening test was 99.3% (95% CI: 96.4-100%). Cord factor detection costs US$ 0.25, whereas the PRA costs US$ 7.00. Results from cord factor detection are ready in 2 days, whereas PRA requires 4 days to yield results. Conclusions: The presumptive identification of M. tuberculosis using the macroscopic evaluation of colonies combined with cord factor detection under microscopy is a simple, rapid and inexpensive test. We recommend the combined screening test to rapidly identify M. tuberculosis in resource-poor settings and in less well-equipped laboratories while awaiting a definite identification by molecular or biochemical methods.

 


Keywords: Tuberculosis; Mycobacterium/classification; Polymerase chain reaction; Diagnostic tests, routine.

 


Determination of the efficacy of FEV6 as a surrogate for FVC in the diagnostic screening for chronic obstructive pulmonary disease through the comparison of FEV1/FVC and FEV1/FEV6 ratios

Determinação da eficiência do VEF6 como substituto da CVF na triagem diagnóstica da doença pulmonar obstrutiva crônica através da comparação entre as relações VEF1/CVF e VEF1/VEF6

Fernando Luiz Cavalcanti Lundgren, Marília Montenegro Cabral, Danielle Cristina Silva Clímaco, Liana Gonçalves de Macedo, Marta de Andrade Lima Coelho, Ana Lúcia Pereira Lima Alves Dias

J Bras Pneumol.2007;33(2):148-151

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Objective: To determine the efficacy of using forced expiratory volume in six seconds (FEV6) as a surrogate for forced vital capacity (FVC) in the diagnostic screening for chronic obstructive pulmonary disease (COPD) by comparing FEV1/FVC ratios with FEV1/FEV6 ratios. Methods: In November of 2003, on World COPD Day, we conducted a campaign of diagnostic screening for COPD. The participants completed the clinical questionnaire of the Global Initiative for Obstructive Lung Disease, and those who responded affirmatively to at least three questions underwent spirometry. Results: A total of 134 individuals responded to three questions affirmatively and underwent spirometry. Of those, 59 were excluded: 45 for being non-smokers and 14 due to the fact that their tests did not meet the American Thoracic Society criteria for satisfactory spirometry. The number of tests in which the FEV1/FEV6 ratio was below 70% was similar to that found for the FEV1/FVC ratio. The sensitivity of FEV1/FEV6 in diagnosing airway obstruction (defined as FEV1/FVC below 70%) was 92%, and its specificity was 99%. The positive predictive value was 100%, and the negative predictive value was 98%. The Kendall correlation test revealed r = 0.99 (p < 0.0001). The t-test for paired samples revealed a negative correlation: t = −5.93 (p < 0.0001). Conclusion: The FEV1/FEV6 proved efficient for use in the diagnostic screening for COPD. There is a strong correlation between FEV1/FVC and FEV1/FEV6.

 


Keywords: Pulmonary disease, Chronic obstructive; Diagnosis; Spirometry; Forced expiratory volume; Vital capacity.

 


Determining the score and cut-off point that would identify asthmatic adults in epidemiological studies using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire

Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos

Elayne de Fátima Maçãira, Eduardo Algranti, Rafael Stelmach, Marcos Ribeiro, Maria do Patrocínio Tenório Nunes, Elizabete Medina Coeli Mendonça, Marco Antônio Bussacos

J Bras Pneumol.2005;31(6):477-485

Abstract PDF PT PDF EN Portuguese Text

Objective: To validate, for use in asthma prevalence studies, the asthma module of the standardized written questionnaire developed for use in the International Study of Asthma and Allergies in Childhood, establishing the score and cut-off point that would identify asthmatic adults. Methods: We interviewed 78 adult outpatients (40 adult asthmatics and 38 age-matched and gender-matched controls) using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire, which is composed of questions related to eight dichotomous features of asthma. We determined the score and cut-off point required to accurately identify asthmatic adults, calculating sensitivity, specificity and Youden index. The method was validated against the clinical and functional diagnosis of asthma. The reproducibility of individual questions was evaluated by conducting second interviews with half of the patients some weeks later. Results: The score ranged from 0 to 14 points. A score = 5 allowed patients with asthma to be distinguished from those without (sensitivity = 93%; specificity = 100%; Youden index = 0.93). Most questions presented satisfactory reproducibility in the second interviews conducted after 48.2 ± 11.1 days (kappa and weighted kappa ranging from 0.43 to 1.00 for individual questions). Conclusion: For studies of adult asthma prevalence, the determination/validation of a cut-off point allows an alternative interpretation of the information gathered through the application of the asthma module of the International Study of Asthma and Allergies in Childhood, taking into account the totality of the data rather than responses to individual questions.

 


Keywords: Asthma/diagnosis; Asthma/epidemiology; International cooperation; Questionnaires

 


Determination of the inflammatory component of airway diseases by induced sputum cell counts: use in clinical practice

Determinação do componente inflamatório das doenças das vias aéreas através do escarro induzido: utilização na prática clínica

Pablo Moritz, Leila John Marques Steidle, Manuela Brisot Felisbino, Túlia Kleveston, Marcia Margaret Menezes Pizzichini, Emilio Pizzichini

J Bras Pneumol.2008;34(11):913-921

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Objective: To evaluate the usefulness of determining the inflammatory component of airway diseases (inflammometry) by induced sputum cell counts, as well as its influence on treatment decisions in a tertiary facility for the treatment of respiratory diseases. Methods: We analyzed 151 sputum samples from 132 consecutive patients referred for clinical sputum induction by five pulmonologists between July of 2006 and February of 2007. A structured questionnaire related to the reasons for requesting the test and to the therapeutic decision making based on test results was completed by each attending physician upon receiving the test results. Induced sputum was obtained and processed according to a technique previously described. Results: The principal motives for ordering the test were inhaled corticosteroid dose titration in patients with moderate-to-severe asthma (in 54.3%), investigation of chronic cough (in 30.5%), and monitoring airway inflammation in patients with bronchiectasis (in 7.3%) or chronic obstructive pulmonary disease (in 6%). Of the 82 patients with asthma, 47 (57%) presented eosinophilic bronchitis (>3% eosinophils). Nonasthmatic eosinophilic bronchitis was diagnosed in 9 (19%) of the 46 patients with chronic cough. Neutrophilic bronchitis (>65% neutrophils) was found in 13 patients, of which 5 had asthma, 2 had chronic cough, and 6 had chronic obstructive pulmonary disease/bronchiectasis. Based on the induced sputum results, the corticosteroid dose was modified in 48 asthma patients (64.7%). Conclusions: The systematic application of inflammometry using induced sputum cell counts can be beneficial for patients with airway diseases, particularly those with asthma or chronic cough.

 


Keywords: Sputum; Asthma; Bronchitis.

 


Determinants of smoking experimentation and initiation among adolescent students in the city of Salvador, Brazil

Determinantes da experimentação do cigarro e do início precoce do tabagismo entre adolescentes escolares em Salvador (BA)

Adelmo de Souza Machado Neto, Tarcisio Matos Andrade, Carlos Napoli, Lilian Carine Souza de Lima Abdon, Mônica Rocha Garcia, Francisco Inácio Bastos

J Bras Pneumol.2010;36(6):674-682

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To identify the factors associated with smoking experimentation and initiation among adolescent students (11-14 years of age). Methods: A cross-sectional, population-based study involving adolescent (middle and high school) students at public and private schools in the city of Salvador, Brazil. A multiple-stage sampling protocol was used. The participants completed an anonymous, voluntary, self-report questionnaire. The dependent variables were age at smoking experimentation and smoking initiation. Sociodemographic and educational variables, as well as those related to media influence and alcohol consumption, were considered independent variables. Multivariate logistic regression analysis was performed, followed by analysis of the fit of the final logistic regression model. Results: The prevalence of smoking experimentation was 16.1% (95% CI: 15.1-17.2). Of the 5,347 students evaluated, 757 had experimented with cigarettes, and 462 (61.2%) of those 757 had done so before the age of 15 (mean age at smoking experimentation, 13.9 ± 1.8 years). Smoking initiation was associated with paternal smoking (OR = 1.53; 83% CI = 1.07-2.19) and with media influence (OR = 2.43; 83% CI: 1.46‑4.04). Smoking experimentation was associated with alcohol consumption (OR = 6.04; 83% CI: 4.62-7.88), having friends who smoke (OR = 3.18; 83% CI: 2.54-3.99), having a boyfriend/girlfriend who smokes (OR = 3.42; 83% CI: 1.78-6.56), and coercive/aggressive educational interventions by the parents (OR = 1.60; 83% CI: 1.26‑2.04). Conclusions: Alcohol consumption and the influence of peers and relatives who smoke showed a strong association with smoking experimentation. Paternal smoking and media influence were found to increase the chances of adolescent smoking.

 


Keywords: Smoking; Adolescence; Health education; Cross-sectional studies; Epidemiologic factors; Brazil.

 


Morphological prognostic factors in nosocomial pneumonia:an autopsy study

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Luiz Mário Baptista Martinelli, Paulo José Fortes Villas Boas, Thais Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2010;36(1):51-58

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Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco‑associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

 


Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality.

 


Should the bronchiectasis treatment given to cystic fibrosis patients be extrapolated to those with bronchiectasis from other causes?

Deve-se extrapolar o tratamento de bronquiectasias em pacientes com fibrose cística para aqueles com bronquiectasias de outras etiologias?

Rodrigo Abensur Athanazio, Samia Zahi Rached, Ciro Rohde, Regina Carvalho Pinto, Frederico Leon Arrabal Fernandes, Rafael Stelmach

J Bras Pneumol.2010;36(4):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To profile the characteristics of adult patients with bronchiectasis, drawing comparisons between cystic fibrosis (CF) patients and those with bronchiectasis from other causes in order to determine whether it is rational to extrapolate the bronchiectasis treatment given to CF patients to those with bronchiectasis from other causes. Methods: A retrospective analysis of the medical charts of 87 patients diagnosed with bronchiectasis and under follow-up treatment at our outpatient clinic. Patients who had tuberculosis (current or previous) were excluded. We evaluated the clinical, functional, and treatment data of the patients. Results: Of the 87 patients with bronchiectasis, 38 (43.7%) had been diagnosed with CF, through determination of sweat sodium and chloride concentrations or through genetic analysis, whereas the disease was due to another etiology in 49 (56.3%), of whom 34 (39.0%) had been diagnosed with idiopathic bronchiectasis. The mean age at diagnosis was lower in the patients with CF than in those without (14.2 vs. 24.2 years; p < 0.05). The prevalence of symptoms (cough, expectoration, hemoptysis, and wheezing) was similar between the groups. Colonization by Pseudomonas aeruginosa or Staphylococcus aureus was more common in the CF patients (82.4 vs. 29.7% and 64.7 vs. 5.4%, respectively). Conclusions: The causes and clinical manifestations of bronchiectasis are heterogeneous, and it is important to identify the differences. It is crucial that these differences be recognized so that new strategies for the management of patients with bronchiectasis can be developed.

 


Keywords: Cystic fibrosis; Bronchiectasis/diagnosis; Bronchiectasis/therapy; Respiratory function tests.

 


Detection of pulmonary nodules by computer-aided diagnosis in multidetector computed tomography: preliminary study of 24 cases

Diagnóstico auxiliado por computador na detecção de nódulos pulmonares pela tomografia computadorizada com múltiplos detectores: estudo preliminar de 24 casos

Julia Capobianco, Dany Jasinowodolinski, Gilberto Szarf

J Bras Pneumol.2008;34(1):27-33

Abstract PDF PT PDF EN Portuguese Text

Objectives: To evaluate the performance of a computer program designed to facilitate the detection of pulmonary nodules using multidetector computed tomography (MDCT) scans of the chest. Methods: We evaluated 24 consecutive MDCT scans of the chest at the Fleury Diagnostic Imaging Center during the period from October 7 to October 19 of 2006, using a 64-channel CT scanner. The study comprised 12 females and 12 males, ranging from 35 to 77 years of age (mean, 57.9 years). Double reading and a computer-aided diagnosis (CAD) system were used in order to perform two independent analyses of the data. The nodules found using both methods were recorded, and the data were compared. Results: The total sensitivity of CAD for the detection of nodules was 16.5%, increasing to 55% when nodules <4 mm in diameter were excluded. Sensitivity by diameter was 6.5% for nodules <4 mm, 45% for nodules of 4-6 mm, 100% for nodules of 6 mm-1 cm, and 0% for nodules >1 cm. More than 99% of true nodules detected by CAD were registered in the image double-reading process. Conclusions: In this preliminary 24-case study, the sensitivity of computer program tested was not significantly greater than that of the double-reading process that is routinely performed in this facility.

 


Keywords: Image interpretation, computer-assisted; Coin lesion, pulmonary; Tomography, X-ray computed.

 


Diagnóstico diferencial de lesão cavitária em HIV positivo

Maria Inês Bueno de André Valery, Lino Alexandre de Barros, Rimarcs Ferreira

J Bras Pneumol.1997;23(3):143-147

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Diagnosis of circadian rhythm sleep disorders

Diagnóstico dos transtornos do sono relacionados ao ritmo circadiano

Denis Martinez, Maria do Carmo Sfreddo Lenz, Luiz Menna-Barreto

J Bras Pneumol.2008;34(3):173-180

Abstract PDF PT PDF EN Portuguese Text

Insomnia and excessive sleepiness are common in the investigation of sleep-disordered breathing. Circadian rhythm sleep disorders are perhaps the most often overlooked conditions in the differential diagnosis of these symptoms. Circadian rhythm sleep disorders manifest as misalignment between the sleep period and the physical/social 24-h environmental cycle. The two most prevalent circadian rhythm sleep disorders are delayed sleep phase (common in adolescents) and advanced sleep phase (common in the elderly), situations in which the sleep period is displaced to a later or earlier time, respectively. It is important to keep these two disorders in mind, since they can be confused with insomnia and excessive sleepiness. However, there are nine possible diagnoses, and all nine are of clinical interest. Since light is the principal cue used in synchronizing the biological clock, blind individuals and night-shift/swing-shift workers are more prone to develop circadian rhythm sleep disorders. In this article, the new international classification of circadian rhythm sleep disorders is reviewed.

 


Keywords: Circadian rhythm; Sleep disorders; Sleep initiation and maintenance disorders; Sleep stages; Sleep apnea syndromes.

 


Diagnosis and staging of lung cancer

Diagnóstico e estadiamento do câncer de pulmão

Angelo Fernandez, Fabio B. Jatene, Mauro Zamboni

J Bras Pneumol.2002;28(4):219-228

Abstract PDF PT

Carcinoma of the lung can present in a number of guises and a number of possible and often complementary diagnostic approaches are available. The choice of procedure should reflect the presentation of the tumor, local expertise, intended management and patient preference. There are different methods of investigation: sputum cytology, fiberbronchoscopy, transbronchial biopsy, transbronchial needle aspiration, transthoracic fine needle aspiration, etc. The association of all of these methods increases the power of diagnosis. Staging is the measurement of the anatomical extent of a tumor in any given patient. The staging of cancer began with Denoix's TNM classification system, and, although several modifications were developed, it remains the basis of lung cancer staging systems up to now. Assigning patients to a particular TNM stage allows choosing the most appropriate therapy and provides prognostic information. Also, the impact of new therapeutic methods can be evaluated for efficacy and a comparison of the expected survival rates can be predicted.

 



Using electron microscopy and multivariate cluster analysis to determine diagnosis and prognosis in cases of neuroendocrine lung carcinoma

Diagnóstico e prognóstico dos tumores pulmonares neuroendócrinos mediante microscopia eletrônica e análise multivariavel de agrupamento

Cecília Aparecida Vaiano Farhat, Edwin Roger Parra, Andrew V. Rogers, Silvia Nagib Elian, Mary N. Sheppard, Vera Luiza Capelozzi

J Bras Pneumol.2008;34(10):804-811

Abstract PDF PT PDF EN Portuguese Text

Objective: To establish reproducible electron microscopic criteria for identifying the four major types of neuroendocrine tumors of the lung: carcinoid; atypical carcinoid; large cell neuroendocrine carcinoma; and small cell carcinoma. Methods: Measurements were made on electron micrographs using a digital image analyzer. Sixteen morphometric variables related to tumor cell differentiation were assessed in 27 tumors. The examination under electron microscopy revealed that all of the tumors could be classified as belonging to one of the four categories listed above. Cluster analysis of the morphometry variables was used to group the tumors into three clusters, and Kaplan-Meier survival function curves were employed in order to draw correlations between each cluster and survival. Results: All three clusters of neuroendocrine carcinomas were found to be associated with survival curves, demonstrating the prognostic significance of electron microscopic features. The tumors fell into three well-defined clusters, which represent the spectrum of neuroendocrine differentiation: typical carcinoid (cluster 1); atypical carcinoid and large cell neuroendocrine carcinoma (cluster 2); and small cell carcinoma (cluster 3). Cluster 2 represents an intermediate step in neuroendocrine carcinogenesis, between typical carcinoid tumors and small cell carcinomas. Conclusions: Our findings confirm that electron microscopy is useful in making the diagnosis and prognosis in cases of lung tumor.

 


Keywords: Neuroendocrine tumors/lung; Microscopy, electron; Cluster analysis; Survival analysis.

 


Diagnosis and treatment of latent tuberculosis in patients with chronic inflammatory diseases: use of TNF-alpha-targeting biological products

Diagnóstico e tratamento da tuberculose latente em pacientes com doenças inflamatórias crônicas e uso de imunobiológicos inibidores do TNF-α

Diana Maria de Almeida Lopes, Valéria Goes Ferreira Pinheiro, Helena Serra Azul Monteiro, José Ajax Nogueira Queiroz, Lucivaldo dos Santos Madeira, Mônica Maria de Almeida Lopes

J Bras Pneumol.2011;37(3):308-316

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Objective: To determine the clinical and epidemiological profile of patients who are candidates for TNF-α inhibitor use and are classified as having latent tuberculosis (LTB), as well as to evaluate the outcomes of prophylactic treatment with isoniazid. Methods: A prospective descriptive analysis followed by an analytical, observational, cross-sectional study of the outcomes of prophylactic treatment in a group of 45 candidates for TNF-α inhibitor use. We evaluated the patients through anamnesis, clinical examination, chest X-ray, and tuberculin skin test (TST) using the Mantoux method. Results: The mean age was 45 years, and 56.0% of the patients were female. Chronic rheumatic diseases, chronic dermatological diseases, and Crohn's disease were present in 46.7%, 40.0%, and 13.3% of the patients, respectively. The mean TST induration was 14.6 mm (range: 5-30 mm). The majority (n = 30) of the 45 patients (66.7%) had an induration > 10 mm. In the 16 patients with BCG vaccination scars, the mean induration was 15.7 mm, and 14 of those patients had an induration > 10 mm. Chest X-ray results were considered normal, with minimal alterations, in 64.4% and 35.6% of the patients, respectively. The treatment with isoniazid was abandoned by 1 patient (2.2%) and completed by 41 (91.2%), whereas it was interrupted because of drug-induced hepatitis in 2 (4.4%), and 1 patient (2.2%) was transferred to another hospital. Of those who completed the treatment, 5 experienced mild side effects. Conclusions: Determining the profile of candidates for TNF-α inhibitor use is important for the management of LTB treatment and for the establishment of clinical protocols for the use and monitoring of the use of these medications.

 


Keywords: Tuberculosis; Latent tuberculosis; Tuberculin test; Isoniazid; Tumor necrosis factor-alpha.

 


Diagnosis and treatment of mediastinal tumors by thoracoscopy

Diagnóstico e tratamento dos tumores mediastinais por toracoscopia

José Ribas Milanez de Campos, Luís Marcelo Inaco Cirino, Angelo Fernandez, Marcos Naoyuki Samano, Paulo Pego Fernandez, Luiz Tarcísio Britto Filomeno, Fábio Biscegli Jatene

J Bras Pneumol.2000;26(4):169-174

Abstract PDF PT

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventy-three patients were submitted to thoracoscopy for the treatment of mediastinal masses and were analyzed retrospectively, in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from two to 81 years (mean 43.8) with a slight predominance of females over males (41 versus 32). All underwent general anesthesia using simple (22) or double lumen (51) intubation. Results: The histological type of tumor was identified in all patients. For therapeutic purposes, conversion to thoracotomy was necessary in nine patients. The reasons were tumor size and invasion of nearby structures, difficulty to continue dissection, to perform an upper lobectomy, and to suture the iatrogenic diaphragm lesion. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusions: Thoracoscopy was confirmed to be an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.

 


Keywords: Thoracoscopy, thoracic surgery, mediastinal neoplasms, mediastinal cysts.

 


Early diagnosis of lung cancer: the great challenge. Epidemiological variables, clinical variables, staging and treatment

Diagnóstico precoce do câncer de pulmão: o grande desafio. Variáveis epidemiológicas e clínicas, estadiamento e tratamento

João Adriano Barros, Geraldo Valladares, Adriane Reichert Faria, Erika Megumi Fugita, Ana Paula Ruiz, André Gustavo Daher Vianna, Guilherme Luís Trevisan, Fabrício Augusto Martinelli de Oliveira

J Bras Pneumol.2006;32(3):221-227

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Objective: To evaluate confirmed cases of lung cancer, reviewing epidemiological variables, clinical variables, staging and treatment. Methods: The cases of 263 patients were studied. All of the patients had been treated at the Universidade Federal do Paraná (Federal University of Paraná) Hospital de Clínicas or at the Hospital Erasto Gaertner, two institutions that, together, serve a significant portion of the patients seeking treatment in the city of Curitiba, located in the state of Paraná. This was a retrospective study, involving the administration of questionnaires. The descriptive analysis of the data obtained was performed using the Epi-Info program. Results: There was a predominance of male patients (76%). At the time of diagnosis, the majority of patients (90%) were smokers or former smokers. In 87% of the cases, there was no history of lung disease. The most common initial symptoms were cough (142 cases) and chest pain (92 cases). Non-small cell lung cancer was found in 87% of the patients, and the most common histological type was spinocellular carcinoma, which was found in 49% of all of the patients. Smoking was found to be the most significant predisposing factor. Conclusion: The characteristics of lung cancer progression, such as the nonspecificity of the initial symptoms, the duration of tumor growth and the course of the tumor, together with the lack of tracking programs, are the principal factors that hinder the early detection of lung cancer, making it difficult to treat lung cancer patients and to increase their survival.

 


Keywords: Lung neoplasms/diagnosis; Lung neoplasms/epidemiology; Lung neoplasms/surgery; Early diagnosis; Neoplasms staging

 


Synchronous diagnosis of primitive papillary adenocarcinomas: beyond the realm of probability

Diagnóstico simultâneo de adenocarcinomas papilares primitivos: além da probabilidade

Pedro Gonçalo de Silva Ferreira, Paulo Matos, António Jorge Gouveia Ferreira

J Bras Pneumol.2013;39(6):747-749

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Delayed diagnosis of sarcoidosis is common in Brazil

Diagnóstico tardio da sarcoidose é comum no Brasil

Mauri Monteiro Rodrigues, Ester Nei Aparecida Martins Coletta, Rimarcs Gomes Ferreira, Carlos Alberto de Castro Pereira

J Bras Pneumol.2013;39(5):539-546

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Objective: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. Methods: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed ( 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). Results: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis ( 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). Conclusions: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.

 


Keywords: Sarcoidosis; Sarcoidosis, pulmonary/diagnosis; Tuberculosis.

 


Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

Diagnósticos alternativos corroborados por angiotomografia computadorizada de tórax em pacientes com suspeita de tromboembolia pulmonar

Eleci Vaz Ferreira1,2, Marcelo Basso Gazzana2,3, Muriel Bossle Sarmento4, Pedro Arends Guazzelli4, Mariana Costa Hoffmeister4, Vinicius André Guerra2, Renato Seligman4,5, Marli Maria Knorst2,3,4

J Bras Pneumol.2016;42(1):35-41

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Objective: To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods: This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results: On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions: Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients.

 


Keywords: Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Angiography.

 


Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities

Diferenças entre os sexos na percepção de asma e sintomas respiratórios em uma amostra populacional em quatro cidades brasileiras

Laura Russo Zillmer, Mariana Rodrigues Gazzotti, Oliver Augusto Nascimento, Federico Montealegre, James Fish, José Roberto Jardim

J Bras Pneumol.2014;40(6):591-598

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Objective: To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil. Methods: We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication. Results: Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men. Conclusions: Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.

 


Keywords: Asthma/diagnosis; Asthma/prevention & control; Quality of life.

 


Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV

Pedro Dornelles Picon, Maria Luiza Avancini Caramori, Sérgio Luiz Bassanesi, Sandra Jungblut, Marcelo Folgierini, Nelson da Silva Porto, Carlos Fernando Carvalho Rizzon, Roberto Luiz Targa Ferreira, Tânia Mariza de Freitas, Carla Adriane Jarczewski

J Bras Pneumol.2007;33(4):429-436

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Objective: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. Methods: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. Results: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm3; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm3; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm3; p < 0.01). Conclusion: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.

 


Keywords: Tuberculosis, pulmonary; HIV infections; Radiography, thoracic.

 


Intensity of physical exercise and its effect on functional capacity in COPD: systematic review and meta-analysis

Diferentes intensidades de exercício físico e capacidade funcional na DPOC: revisão sistemática e meta-análise

Juliano Rodrigues Adolfo1,a, William Dhein1,b, Graciele Sbruzzi1,2,3,c

J Bras Pneumol.2019;45(6):e20180011-e20180011

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Objective: To evaluate the effects of high-intensity interval training (HIIT), in comparison with those of continuous exercise, on functional capacity and cardiovascular variables in patients with COPD, through a systematic review and meta-analysis of randomized controlled trials. Methods: We searched PubMed, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, and EMBASE, as well as performing hand searches, for articles published up through January of 2017. We included studies comparing exercise regimens of different intensities, in terms of their effects on functional capacity and cardiovascular variables in patients with COPD. Results: Of the 78 articles identified, 6 were included in the systematic review and meta-analysis. Maximal oxygen consumption (VO2max) did not differ significantly between HIIT and control interventions. That was true for relative VO2max (0.03 mL/kg/min; 95% CI: −3.05 to 3.10) and absolute VO2max (0.03 L/min, 95% CI: −0.02 to 0.08). Conclusions: The effects of HIIT appear to be comparable to those of continuous exercise in relation to functional and cardiovascular responses. However, our findings should be interpreted with caution because the studies evaluated present a high risk of bias, which could have a direct influence on the results.

 


Keywords: Pulmonary disease, chronic obstructive; Exercise; Oxygen consumption.

 


Dimensions of sleepiness and their correlations with sleep-disordered breathing in mild sleep apnea

Dimensões da sonolência e suas correlações com os transtornos respiratórios do sono na apneia do sono leve

Denis Martinez, Magali Santos Lumertz, Maria do Carmo Sfreddo Lenz

J Bras Pneumol.2009;35(6):507-514

Abstract PDF PT PDF EN Portuguese Text

Objective: There are many ways of assessing sleepiness, which has many dimensions. In patients presenting a borderline apnea-hypopnea index (AHI, expressed as events/hour of sleep), the mechanisms of excessive daytime sleepiness (EDS) remain only partially understood. In the initial stages of sleep-disordered breathing, the AHI might be related to as-yet-unexplored EDS dimensions. Methods: We reviewed the polysomnography results of 331 patients (52% males). The mean age was 40 ± 13 years, and the mean AHI was 4 ± 2 (range, 0-9). We assessed ten potential dimensions of sleepiness based on polysomnography results and medical histories. Results: The AHI in non-rapid eye movement (NREM) stage 1 sleep (AHI-N1), in NREM stage 2 sleep (AHI-N2), and in REM sleep (AHI-REM) were, respectively, 6 ± 7, 3 ± 3 and 10 ± 4. The AHI-N2 correlated significantly with the greatest number of EDS dimensions (5/10), including the Epworth sleepiness scale score (r = 0.216, p < 0.001). Factor analysis, using Cronbach's alpha, reduced the variables to three relevant factors: QUESTIONNAIRE (α = 0.7); POLYSOMNOGRAPHY (α = 0.68); and COMPLAINTS (α = 0.55). We used these factors as dependent variables in a stepwise multiple regression analysis, adjusting for age, gender, and body mass index. The AHI-N1 correlated significantly with POLYSOMNOGRAPHY (β = −0.173, p = 0.003), and the AHI-N2 correlated significantly with COMPLAINTS (β = −0.152, p = 0.017). The AHI-REM did not correlate with any factor. Conclusions: Our results underscore the multidimensionality of EDS in mild sleep apnea.

 


Keywords: Disorders of excessive somnolence; Sleep apnea syndromes; Sleep, REM; Polysomnography.

 


Brazilian guidelines for the diagnosis and treatment of cystic fibrosis

Diretrizes brasileiras de diagnóstico e tratamento da fibrose cística

Rodrigo Abensur Athanazio1*, Luiz Vicente Ribeiro Ferreira da Silva Filho2,3*, Alberto Andrade Vergara4, Antônio Fernando Ribeiro5, Carlos Antônio Riedi6, Elenara da Fonseca Andrade Procianoy7, Fabíola Villac Adde2, Francisco José Caldeira Reis4, José Dirceu Ribeiro5, Lídia Alice Torres8, Marcelo Bicalho de Fuccio9, Matias Epifanio10, Mônica de Cássia Firmida11, Neiva Damaceno12, Norberto Ludwig-Neto13,14, Paulo José Cauduro Maróstica7,15, Samia Zahi Rached1, Suzana Fonseca de Oliveira Melo4; Grupo de Trabalho das Diretrizes Brasileiras de Diagnóstico e Tratamento da Fibrose Cística.

J Bras Pneumol.2017;43(3):219-245

Abstract PDF PT PDF EN Portuguese Text Appendix

Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions.

 


Keywords: Cystic fibrosis/diagnosis; Cystic fibrosis/therapy; Cystic fibrosis/complications; Practice guideline.

 


Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

Ricardo de Amorim Corrêa, Fernando Luiz Cavalcanti Lundgren, Jorge Luiz Pereira-Silva, Rodney Luiz Frare e Silva (editores); Grupo de Trabalho da Diretriz

J Bras Pneumol.2009;35(6):574-601

Abstract PDF PT PDF EN Portuguese Text

Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.

 


Keywords: Pneumonia; Diagnosis; Epidemiology; Practice guideline; Primary prevention.

 


Clinical practice guidelines: how do they help clinicians and patients make important decisions about health?

Diretrizes de prática clínica: como elas ajudam médicos e pacientes a tomar decisões importantes sobre saúde?

Juliana Carvalho Ferreira1,2, Cecilia Maria Patino1,3

J Bras Pneumol.2019;45(5):e20190321-e20190321

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Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória

Roberto de Menezes Lyra, José Ribas Milanez de Campos, Davi Wen Wei Kang, Marcelo de Paula Loureiro, Marcos Bessa Furian, Mário Gesteira Costa, Marlos de Souza Coelho

J Bras Pneumol.2008;34(11):967-977

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With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of compensatory hyperhidrosis, as well as on a review of the medical literature, the participants prepared a preliminary text, whose recommendations were revised and subsequently approved by all of the participants. The consensus text was posted on the Internet, becoming the object of further corrections and revisions prior to taking on its present form.

 


Keywords: Hyperhidrosis/therapy; Hyperhidrosis/surgery; Sympathectomy/methods; Postoperative complications; Thoracic surgery, video‑assisted.

 


Primary ciliary dyskinesia

Discinesia ciliar primária

José Wellington Alves dos Santos, Aland Waldow, Claudius Wladimir Cornelius de Figueiredo, Diego Rossi Kleinubing, Severo Salles de Barros

J Bras Pneumol.2001;27(5):262-268

Abstract PDF PT

Primary ciliary dyskinesia is an autosomal recessive disorder characterized by a history of recurrent upper and lower respiratory tract infections with chronic otitis media, bronchitis and rhinosinusitis, associated with situs inversus in 50% of cases. The diagnosis is established by ciliary ultrastructural analysis of respiratory specimens, after ruling out some disorders as cystic fibrosis, a-1 anti-trypsin deficiency, immune deficiencies (IgG, neutrophils and complement) and Young's syndrome. The purpose of this paper is to review the clinical features, diagnosis and management of primary ciliary dyskinesia, including a diagnostic algorithm.

 


Keywords: Ciliary dyskinesia. Situs inversus. Diagnosis.

 


Design and evaluation of a device for collecting exhaled breath condensate

Diseño y evaluación de un equipo para obtener aire espirado condensado

Oscar Florencio Araneda Valenzuela, Maria Paulina Salazar Encina

J Bras Pneumol.2009;35(1):69-72

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In recent years, the analysis of exhaled breath condensate samples has been given great weight as a noninvasive methodology of studying physiology and lung diseases. The present study describes a device for measuring exhaled breath condensate that is affordable, easily constructed, portable and suitable for use in the field, as well as allowing the collection of simultaneous samples. The results obtained with this device in terms of the concentrations of pH, hydrogen peroxide and nitrite, metabolites related to inflammatory and oxidative damage, in exhaled breath condensate samples are comparable to those obtained with other devices previously described.

 


Keywords: Exhalation; Lung diseases; Equipment design.

 


Diaphragmatic dysfunction and mortality in patients with COPD

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

Wellington Pereira dos Santos Yamaguti, Elaine Paulin, João Marcos Salge, Maria Cristina Chammas, Alberto Cukier, Celso Ricardo Fernandes de Carvalho

J Bras Pneumol.2009;35(12):-

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Objective: To determine whether COPD patients with diaphragmatic dysfunction present higher risk of mortality than do those without such dysfunction. Methods: We evaluated pulmonary function, diaphragm mobility and quality of life, as well as determining the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, in 42 COPD patients. The patients were allocated to two groups according to the degree to which diaphragm mobility was impaired: low mobility (LM; mobility ≤ 33.99 mm); and high mobility (HM; mobility ≥ 34.00 mm). The BODE index and the quality of life were quantified in both groups. All patients were followed up prospectively for up to 48 months in order to determine the number of deaths resulting from respiratory complications due to COPD. Results: Of the 42 patients evaluated, 20 were allocated to the LM group, and 22 were allocated to the HM group. There were no significant differences between the groups regarding age, lung hyperinflation or quality of life. However, BODE index values were higher in the LM group than in the HM group (p = 0.01). During the 48-month follow-up period, there were four deaths within the population studied, and all of those deaths occurred in the LM group (15.79%; p = 0.02). Conclusions: These findings suggest that COPD patients with diaphragmatic dysfunction, characterized by low diaphragm mobility, have a higher risk of death than do those without such dysfunction.

 


Keywords: Pulmonary disease, chronic obstructive/mortality; Diaphragm; Exercise tolerance; Quality of life.

 


Peripheral muscle dysfunction in COPD: lower limbs versus upper limbs

Disfunção muscular periférica em DPOC: membros inferiores versus membros superiores

Eduardo Foschini Miranda, Carla Malaguti, Simone Dal Corso

J Bras Pneumol.2011;37(3):380-388

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O prejuízo funcional parece diferir entre membros superiores e membros inferiores de pacientes com DPOC. Dois possíveis mecanismos explicam os sintomas importantes de dispneia e fadiga relatados pelos pacientes ao executar tarefas com membros superiores não sustentados: a disfunção neuromecânica dos músculos respiratórios e a alteração dos volumes pulmonares durante as atividades realizadas com membros superiores. A disfunção neuromecânica está relacionada à alteração do padrão respiratório e à simultaneidade de estímulos aferentes e eferentes musculares, o que causaria a dissincronia na ação dos músculos respiratórios em pacientes com DPOC durante esse tipo de exercício. Adicionalmente, o aumento da ventilação durante os exercícios com membros superiores em pacientes com DPOC induz à hiperinsuflação dinâmica em diferentes cargas de trabalho. Nos membros inferiores, há redução da força e da endurance muscular do quadríceps femoral nos pacientes com DPOC comparados a indivíduos saudáveis. Uma explicação para essas reduções é a anormalidade no metabolismo muscular (diminuição da capac