Brazilian Journal of Pulmonology

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

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Year 2001 - Volume 27  - Number 2  (March/April)






Original Article

1 - Perfil de sensibilidade a antimicrobianos de bactérias isoladas do trato respiratório baixo de pacientes com pneumonia internados em hospitais brasileiros - Resultados do Programa SENTRY, 1997 e 1998

Hélio S. Sader, Rodrigo E. Mendes, Ana C. Gales, Ronald N. Jones, Michael A. Pfaller, Cássia Zoccoli, Jorge Sampaio

J Bras Pneumol.2001;27(2):59-67

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Resumo

Introdução: Pneumonia hospitalar é a mais fatal das infecções hospitalares, com taxas de mortalidade de 30 a 60%. Estima-se que 15% de todas as mortes associadas à hospitalização estejam diretamente relacionadas a pneumonias hospitalares. O SENTRY é um estudo de vigilância de resistência a antimicrobianos envolvendo centros médicos em todo o mundo. Objetivo: Avaliar a sensibilidade a antimicrobianos de bactérias isoladas no trato respiratório baixo de pacientes com pneumonia internados em hospitais brasileiros. Material e métodos: Foram avaliadas 525 amostras bacterianas de 11 hospitais brasileiros, como parte do programa SENTRY. Os isolados foram testados por microdiluição em caldo contra um grande número de antimicrobianos. Resultados: As cinco espécies mais freqüentes foram (n/%): Pseudomonas aeruginosa (158/30,1%), Staphylococcus aureus (103/19,6%), Acinetobacter spp. (68/13,0%), Klebsiella spp. (50/9,5%), e Enterobacter spp. (44/8,4%). Essas cinco espécies representam mais de 80% de toda a amostragem. A P. aeruginosa apresentou altas taxas de resistência à maioria dos antimicrobianos testados. As maiores taxas de sensibilidade foram apresentadas por piperacilina/tazobactam (71,5%) e meropenem (69,0%). Os compostos com maior atividade in vitro contra Acinetobacter spp. foram imipenem e meropenem (80,9% de sensibilidade) seguido pela tetraciclina (63,2%). A sensibilidade das amostras de Klebsiella spp. foi muito baixa. MICs ≥ 2μg/mL para ceftriaxona ou ceftazidima, indicando produção de ESBL, foram encontrados em 36,0% das amostras. Os antimicrobianos mais ativos contra Klebsiella spp. foram os carbapenens (100% de sensibilidade) e as quinolonas (92,0% de sensibilidade). Ceftriaxona foi ativa contra somente 56,8% das amostras de Enterobacter spp. (MIC50, 1μg/mL), enquanto a cefepima foi ativa contra 88,6% destes isolados (MIC50, ≤ 0,12μg/mL). A resistência à oxacilina foi detectada em 43,7% dos isolados de S. aureus. As drogas mais ativas contra essa espécie foram: vancomicina, teicoplanina, quinupristin-dalfopristin e linezolida. Conclusões: Os resultados do presente estudo mostraram alta prevalência de Acinetobacter spp. e altas taxas de resistência entre bacilos gram-negativos quando comparados com resultados de estudos norteamericanos e europeus.

 


2 - Respiratory endoscopy in 89 patients of lung neoplasms

Endoscopia respiratória em 89 pacientes com neoplasia pulmonar

Paulo José Lorenzoni, Maria Ilizabeti Donatti, Paulo de Tarso Muller, Pedro Nango Dobashi

J Bras Pneumol.2001;27(2):

Abstract PDF PT Portuguese Text

Objectives: Lung neoplasms are one of the most common causes of mortality in Brazil. The objective of this survey is to evaluate the diagnosis of these neoplasms using fiberoptics bronchoscopy. Methods: 89 patients were analyzed retrospectively in a period of five years. They were divided into two groups: Group 1 (n = 53) - the presence of visible lesion on endoscopy, Group 2 (n = 36) - the absence of visible lesion on endoscopy. Epidemiological elements, endoscopic discoveries, cytopathologic and anatomopathologic examination were performed in the review, as well the examination that provided the final diagnosis. Results: The findings of indirect endoscopies of neoplasms corresponded to 59.5% and the presence of tumor inside bronchi was 48.8%. The most frequent histologic type was the epidermoid carcinoma (59.5%), followed by adenocarcinoma (15.7%), small-cell carcinoma (10.1%), and others (14.7%). In endoscopically visible or not visible tumors, the anatomopathologic study of bronchial biopsy and/preor the cytopathologic examination of the bronchial washing and brushing showed a sensitivity of 83.1% in the diagnosis of lung neoplasms. When the lesion was visible on endoscopy, the sensitivity was 96.2%: positive biopsy was 94.2%, and cytology was 43.75%. When the lesion in the bronchi is not observed, its addition was significantly small (63.8%), namely: biopsy registered 72.7% and cytopathology 38.4%. Not significant complications resulting from the endoscopic examination occurred in 11.2% of patients and there were no serious complications. Conclusion: The fiberoptics bronchoscopy was an excellent method to investigate patients with suspicion of lung neoplasms, with 83.1% of sensitivity. This sensitivity was higher in visible lesions and in non-visible lesions when endobronchial biopsy was used.

 


Keywords: Lung neoplasms. Bronchoscopy. Bronchogenic carcinoma. Diagnostic techniques and procedures.

 

3 - Change in asthma mortality trends in children and adolescents in Rio Grande do Sul: 1970-1998

Mudança da tendência da mortalidade por asma em crianças e adolescentes no Rio Grande do Sul: 1970-1998

José Miguel Chatkin, Jussara Fiterman, Nivalvo Almeida Fonseca, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(2):89-93

Abstract PDF PT Portuguese Text

Introduction: During the period from 1970 to 1992, mortality from asthma in children and young adults increased in Rio Grande do Sul. The present study aimed at assessing this phenomenon in patients of the same age group, now extending the time period to 1998. Methods: The death certificates of 157 patients aged between 5 and 19 years in which asthma was reported to be the cause of death during 1970-80 were reviewed. Testing for trends was conducted using the log-linear, S-curve, and quadratic models. Results: Asthma mortality rate ranged from 0.04 to 0.399/100,000. Among the tested models, S curve trend model showed the best accuracy for the adjusted time series: r2=0.59; mean absolute percentage error (MAPE) = 23.48; mean absolute deviation (MAD) = 0.035; mean square deviation (MSD) = 0.0021. These results suggest that a plateau has probably been reached. The quadratic model also showed good accuracy values suggesting that a decrease in the coefficients probably started to occur. In this model, the estimated maximal point value was found in the 25th year (1994). Conclusions: Stabilization of asthma death rates is starting to occur in Rio Grande do Sul and it is likely that a decrease will take place.

 


Keywords: Asthma. Mortality. Brazil.

 

Review Article

4 - Sleepiness and motor vehicle accidents

Sonolência e acidentes automobilísticos

Simone Fagondes Canani, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2001;27(2):94-96

Abstract PDF PT Portuguese Text

Objective: The purpose of this article is to present a brief review of the effects of excessive sleepiness on driving performance, and to emphasize the importance of the subject. Methods: Bibliographic review of national and international literature, including original articles and official publications from the American Thoracic Society and the American Sleep Apnea Association. Results: There is growing evidence that excessive sleepiness may be an important factor related to the occurrence of motor vehicle accidents. Difficulties regarding the identification of sleepiness as a preceding factor related to motor vehicle crashes are discussed on the text. There are many causes for excessive sleepiness. Fortunately most of them are easy to recognize and have specific treatment. Conclusions: A better understanding of the problem is fundamental to promote a better approach for patients with excessive sleepiness and perhaps encourage the discussion about the current motor vehicle legislation and the physicians' legal obligations.

 


Keywords: sleepiness; motor vehicle accidents

 

Original Article

4 - Prevalence of mycobacterium tuberculosis infection among medical students of Federal University of Rio de Janeiro

Prevalência de infecção pelo "Mycobacterium tuberculosis" entre alunos da Faculdade de Medicina da Universidade Federal do Rio de Janeiro

Vania Maria Carneiro da Silva, Jaqueline R. Oliveira, Flávia Matos Silva dos Santos, Clarisse Moreira de Araújo, Afrânio Lineu Kritski

J Bras Pneumol.2001;27(2):77-82

Abstract PDF PT Portuguese Text

Introduction: The teaching hospital, HUCFF, Southeastern Brazil, annually receives three hundred tuberculosis cases. Medical students have their practice at that hospital. Objective: To determine the prevalence of Mycobacterium tuberculosis (Mtb) infection among the students of the UFRJ School of Medicine. Design: Cross-sectional study of medical students at different levels of their training programs. Information about social and demographic characteristics, BCG vaccination history, and potential exposures to tuberculosis were obtained with a standardized questionnaire. Tuberculin skin testing was used to determine the prevalence of tuberculosis infection. Results: The prevalence of tuberculin skin testing positivity among medical students increased as they advanced to higher training levels (4.6%, 7.8%, 16.2%, respectively; P = 0.002). The risks were greatest during the years of clinical training, when medical students had more contact with patients. Conclusions: Medical students in the HUCFF/UFRJ may be at an increased risk of M. tuberculosis infection. A program of routine tuberculin skin testing, combined with interventions to confirm TST conversion and to reduce the risk of nosocomial transmission in the workplace is needed.

 


Keywords: Nosocomial infection. Medical students. Risk factors. Cross-sectional studies.

 

Review Article

5 - Risk factors and prophylaxis of community-acquired pneumonias

Fatores de risco e medidas profiláticas nas pneumonias adquiridas na comunidade

Lucy Gomes

J Bras Pneumol.2001;27(2):97-114

Abstract PDF PT Portuguese Text

This article reviews the effects of aging, tobacco-smoking, chronic bronchitis and emphysema, heart failure, oropharyngeal colonization, aspiration (micro and macro), alcoholism, hepatic cirrhosis, nutritional deficiency, immunosuppression, and environmental factors on the risk of community-acquired pneumonia and its severity. In the second part, the authors review the prophylactic action of anti-influenza and anti-pneumococcus vaccines as well as the role of prevention and treatment of antiviral agents in community-acquired pneumonia.

 


Keywords: Pneumococcal pneumonia. Influenza. Influenza vaccine. Viral vaccines. Risk factors.

 

Case Report

7 - Job's syndrome or hyperimmunoglobulinemia E

Síndrome de Jó ou hiperimunoglobulinemia E

Ricardo Coelho Reis, Marcelo Alcântara Holanda, Juvêncio Paiva Câmara, José Humberto Araújo, Micheline Paiva Aquinos, Laryssa Braga Cavalcante Santana

J Bras Pneumol.2001;27(2):115-118

Abstract PDF PT Portuguese Text

Job's syndrome, or hyperimmunoglobulinemia E, is a rare immunodeficiency condition with no established etiology, characterized by recurrent lower and upper respiratory tract and skin infections associated with high levels of immunoglobulin E, eosinophilia, and a characteristic facial alteration. The authors report on a 22-year-old man who carried this disease complicated by pleural empyema and lung cysts, showing a good evolution.

 


Keywords: Job's syndrome. Respiratory tract infections. Recurrence.

 

8 - Tracheoesophageal fistula as a late complication of tracheostomy

Fístula traqueoesofágica como complicação tardia de traqueostomia

Marlos de Souza Coelho, José Antônio Zampier, Sérgio Augusto Zanin, Elisângela de Mattos e Silva, Paulo de Souza Fonseca Guimarães

J Bras Pneumol.2001;27(2):119-122

Abstract PDF PT Portuguese Text

Tracheoesophageal fistula as a late complication of tracheostomy is rare and its incidence is less than 1%. Nonetheless, it should be known, diagnosed, and promptly treated in order to prevent an unfavorable evolution. The authors report on a 41-year-old female who had had tracheostomy a long time before, due to a cerebrovascular accident. Following hospital discharge, the patient presented acute respiratory insufficiency and it was observed that some material was secreted through the tracheostomy nasogastric probe. Tracheoesophageal fistula was endoscopically diagnosed, the patient was submitted to a tracheoplasty and showed good evolution.

 


Keywords: Tracheostomy. Tracheal tubes. Intubation. Tracheoesophageal fistula. Intensive care units.

 

Letters to the Editor

9 - Hérnia diafragmática traumática transpericárdica

Antonio Sebastião Porto

J Bras Pneumol.2001;27(2):19-21

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