Objective: To evaluate the relationship between the reduction in the number of asthma-related hospital admissions and the changes occurring after the intervention performed in the health care system of the city of Londrina, Brazil. Methods: In 2003, an intervention was performed in the local health care system (Family Health Clinics). The steps adopted were as follows: development of a protocol based on the III Brazilian Consensus on Asthma Management; access to free inhaled corticosteroids for patients; training of health professionals; and implementation of educational measures, especially for the community. The authorizations for hospital admissions of patients diagnosed with asthma alone between 2002 and 2005 in the city of Londrina were analyzed. Results: The mean age was 14.3 ± 0.5 years, without gender predominance. The number of hospital admissions fell more markedly in 2005 than in the previous years studied. This decline was more pronounced at the Family Health Clinics where professional training occurred earlier. The post-intervention (2004-2005) rate of asthma-related hospital admissions (120/100,000 inhabitants) was significantly lower than the pre-intervention (2002-2003) rate (178/100,000 inhabitants; p < 0.01). Conclusions: The admission curve showed a tendency toward a reduction after 2003, and, aside from the intervention performed, no other factors that would explain the results obtained were identified. The rate at which the number of hospital admissions decreased was in direct proportion to the length of time elapsed since the intervention (greater decreases over time). We conclude that the intervention performed in the local health care system was responsible for the data presented.

Keywords: Asthma; Hospitalization; Public health.

Objective: To estimate the prevalence of human immunodeficiency virus seropositivity among patients with active tuberculosis residing in the city of Londrina, in the state of Paraná, Brazil and treated at the Pulmonology Clinic of the 17th Regional Health Facility of the State of Paraná, and to compare those coinfected with human immunodeficiency virus to those with active tuberculosis only in terms of the clinical form of tuberculosis, sputum smear microscopy, chest X-ray and tuberculosis treatment regimen. Methods: A transversal study involving 188 active tuberculosis patients was conducted. Tuberculosis and human immunodeficiency virus infection were diagnosed based on criteria established by the Brazilian Ministry of Health. In addition to the data obtained through individual tuberculosis investigation files, clinical and epidemiological information were collected by means of questionnaires, which were completed by all participating patients. Results: The prevalence of human immunodeficiency virus seropositivity among patients with tuberculosis was 14.9%. The rate of positive sputum microscopy results was higher in the tuberculosis-only group (p = 0.0275), and the ratio for patients treatment with alternative scheme was significantly higher in the co-infected group (p = 0.042). In 32.1% of the coinfected patients, the serological diagnosis of human immunodeficiency virus infection was made simultaneously to or following that of the tuberculosis. Conclusion: The results underscore the importance of routinely testing for human immunodeficiency virus antibodies in patients diagnosed with tuberculosis.

Keywords: Tuberculosis/complications; Tuberculosis/diagnosis; Soropositivity; HIV/immunology; HIV infections/complications; HIV infections/epidemiology; HIV infections/ drug therapy; Rifampin/therapeutic use; Disease progression

Objective: To determine the prevalence of symptoms of asthma, rhinitis and atopic eczema among students between 6 and 7 years of age in the city of Londrina, Brazil. Methods: A population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaire (asthma, rhinitis and atopic eczema modules), validated for use in Brazil, in public school students between 6 and 7 years of age. Results: Of the 3,963 questionnaires retrieved, 3,600 (90.8%) were appropriately completed and were used in the analysis. The prevalence of symptoms of asthma, rhinitis and atopic eczema in the last 12 months was 22.0%, 27.3% and 9.6%, respectively. The prevalence of physician-diagnosed asthma, rhinitis and atopic eczema was 10.4%, 23.4% and 11.4%, respectively. The prevalence of rhinoconjunctivitis and flexural eczema was 13.6% and 6.6%, respectively. Although symptoms of asthma and rhinitis were more common in males than in females, no gender difference was found regarding atopic eczema symptoms. Conclusions: The prevalence of symptoms of asthma, rhinitis and atopic eczema in our sample was within the range found at the facilities that participated in phases I and III of the ISAAC in Brazil. The low prevalence of physician-diagnosed asthma suggests that asthma continues to be underdiagnosed.

Keywords: Public health; Epidemiology; Asthma.

Objective: To analyze hospitalizations for respiratory diseases among children under 15 years of age in an area with high levels of environmental pollution. Methods: A cross-sectional study of hospitalizations due to respiratory diseases of patients residing in the city of Tangará da Serra, located in the state of Mato Grosso (Brazilian Amazon region), from 2000 to 2005. Data on hospital admissions were obtained from the Brazilian Unified Health Care System and from Brazilian Institute of Geography and Statistics population estimates. Results: In 2005, the rate of hospitalization for respiratory diseases among children under 15 years of age in the microregion of Tangará da Serra was 70.1/1,000 children. Between 2000 and 2005, there were 12,777 such admissions, of which 8,142 (63.7%) were for respiratory diseases. During the dry season (May to October), the rate of admissions for respiratory diseases was 10% higher than during the rainy season (November to April). The principal causes of admission included pneumonia (90.7%) and respiratory insufficiency (8.5%). Admissions of children under 5 years of age for pneumonia were 4 times the expected number for the city. Children under 12 months of age were the most frequently hospitalized, with an average increase of 32.4 admissions per 1,000 children per year. Conclusions: Tangará da Serra presented a high number of pediatric admissions for respiratory diseases. Therefore, it is logical to consider it a priority area for investigation and monitoring of the environmental risk factors for such diseases.

Keywords: Respiratory tract diseases; Pneumonia; Hospitalization; Climate; Air pollution/Brazil.

Background: Surveys of patients diagnosed with mycobacteriosis, taken at the Laboratory of Mycobacteriology of the Hospital das Clínicas da Universidade Federal de Minas Gerais, have shown that lack of information concerning diagnosis prevented 42% from initiating treatment. Objective: To evaluate the profile of patients with mycobacterial infection attending the Hospital das Clínicas da Universidade Federal de Minas Gerais. To describe the follow up of those patients and compare it to the guidelines made by the National Program for the Control of Tuberculosis. Methods: The files of patients diagnosed with mycobacterium infection during 2002 were selected from the archives of the Laboratory of Mycobacteriology of the Hospital das Clínicas da Universidade Federal de Minas Gerais. An active search for these patients was carried out and follow-up exams were then performed. Results: Of the 66 patients selected, 62 (94%) were positive for Mycobacterium tuberculosis and 4 (6%) had nontuberculous mycobacteriosis. Another 4 (6%) had been transferred to other institutions. Of the remaining 58, 37 (63%) had been cured, 1 (2%) had refused treatment, 9 (16%) were not found and 11 (19%) had died. Of the 11 deaths, 7 (64%) had tested positive for HIV. Conclusion: Patients failed to receive treatment not due to lack of diagnosis, but to inadequate structure, low awareness levels of all parties, and lack of tuberculosis control organization at the hospital level. Due to the high number of HIV-positive patients, the number of patients cured was lower than that required by the National Health Ministry. Deaths were attributed to HIV infection and lack of knowledge about the disease. In order to identify and address the problems associated with clinical laboratory practice, laboratory professionals must work in concert with their clinical counterparts when carrying out operational research on tuberculosis.

Keywords: Tuberculosis/diagnosis. Mycobacterium infections/complications.

Objective: Pleurodesis is an effective alternative for the control of malignant pleural effusions. However, there is as yet no consensus regarding the indications for the procedure and the techniques employed therein. The objective of this study was to evaluate how pleurodesis is performed in South and Central America. Methods: Professionals who perform pleurodesis completed a questionnaire regarding the indications for the procedure, the techniques used therein, and the outcomes obtained. Results: Our sample comprised 147 respondents in Brazil, 49 in other South American countries, and 36 in Central America. More than 50% of the respondents reported performing pleurodesis only if pleural malignancy had been confirmed. However, scores on dyspnea and performance status scales were rarely used as indications for the procedure. Nearly 75% of the respondents in Brazil and in Central America preferred to perform pleurodesis only for recurrent effusions and stated that lung expansion should be 90-100%. Talc slurry, instilled via medium-sized chest tubes, was the agent most often employed. Thoracoscopy was performed in less than 25% of cases. Fever and chest pain were the most common side effects, and empyema occurred in ≤ 14% of cases. The mean survival time after the procedure was most often reported to be 6-12 months. Conclusions: There was considerable variation among the countries evaluated in terms of the indications for pleurodesis, techniques used, and outcomes. Talc slurry is the agent most commonly used, and thoracoscopy is the technique of choice in Brazil. Pleurodesis is an effective procedure that has few side effects, as evidenced by the low complication rates and high survival times.

Keywords: Pleural effusion, malignant; Pleura; Pleurodesis.

Objective: To describe the characteristics of patients with influenza A (H1N1)-associated pneumonia treated at two hospitals in the region of Liguria, Italy, as well as to describe their treatment and outcomes. Methods: This was a prospective observational study including all patients older than 16 years of age with a confirmed diagnosis of influenza A (H1N1) who were admitted to Villa Scassi Hospital, in the city of Genoa, Italy, or to the Sestri Levante General Hospital, in the city of Sestri Levante, Italy, between September of 2009 and January of 2010. The primary outcome measure was mortality within 60 days after diagnosis. Secondary outcome measures were the need for mechanical ventilation and the length of hospital stay. Results: Of the 40 patients with a confirmed diagnosis of influenza A (H1N1), 27 presented pneumonia during the study period. The mean age of the 27 patients was 42.8 ± 14.8 years, and the mean length of hospital stay was 11.6 ± 8.2 days. Of the 27 patients, 20 had respiratory failure, 4 underwent invasive mechanical ventilation, and 5 underwent noninvasive ventilation. One patient had comorbidities, developed multiple organ failure, and died. Conclusions: During the influenza A (H1N1) pandemic, the associated mortality rate was lower in Italy than in other countries, and cases reported in the country typically had a milder course than did those reported elsewhere. Nevertheless, 9 of our cases (33%) rapidly evolved to respiratory failure, requiring mechanical ventilation.

Keywords: Pneumonia; Influenza A virus, H1N1 subtype; Respiratory insufficiency.

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.