Brazilian Journal of Pulmonology

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

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Year 2009 - Volume 35  - Number 4  (/April)






Original Article

2 - Prevalence of developmental defects of enamel in children and adolescents with asthma

Prevalência do desenvolvimento de defeitos no esmalte dentário em crianças e adolescentes com asma

Rodrigho Pelisson Guergolette, Cássia Cilene Dezan, Wanda Terezinha Garbelini Frossard, Flaviana Bombarda de Andrade Ferreira, Alcindo Cerci Neto, Karen Barros Parron Fernandes

J Bras Pneumol.2009;35(4):295-300

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to evaluate the prevalence of developmental defects of enamel (DDEs) in relation to asthma severity, symptom onset and pharmacological treatment in pediatric asthma patients. Methods: Children and adolescents (68 asthma patients and 68 controls), 5-15 years of age and residents of the city of Londrina, Brazil, were enrolled in the study. Medical and dental histories were collected through the use of a structured questionnaire. Each participant underwent a dental examination in which the examiner employed the DDE index. Results: Of the 68 asthma group subjects, 61 (89.7%) presented dental enamel defects, compared with only 26 (38.2%) of those in the control group. Using multivariate logistic regression analysis, we estimated the risk of DDEs in permanent dentition to be 11 times higher in pediatric subjects with asthma than in those without (OR = 11.88, p = 0.0001). The occurrence of dental enamel defects correlated with greater asthma severity (p = 0.0001) and earlier symptom onset (p = 0.0001). However, dental enamel defects did not correlate with the initiation of treatment (p = 0.08) or the frequency of medication use (p = 0.93). Conclusions: Pediatric patients with severe, early-onset asthma are at increased risk of dental enamel defects and therefore require priority dental care.

 


Keywords: Asthma/prevention & control; Bronchodilator agents; Adrenal cortex hormones/therapeutic use; Dental enamel; Amelogenesis.

 

3 - Asthma and COPD according to the pulmonologist

A asma e a DPOC na visão do pneumologista

Hisbello da Silva Campos, Antonio Carlos Moreira Lemos

J Bras Pneumol.2009;35(4):301-309

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate how pulmonologists view the impact that asthma and COPD has on their patients, as well as how they treat these diseases. Methods: Survey including 227 pulmonologists participating in the VI Brazilian Congress on Asthma, II Brazilian Congress on COPD and II Brazilian Congress on Smoking, all of which were held in 2007. Results: According to the answers given by the pulmonologists, COPD is a public health problem of equal or greater importance than asthma, and COPD causes various disruptions in the lives of patients and their family members. When prescribing an inhalation device, pulmonologists feel that simplicity of use is more important than is the cost. There was a slight preference for the Aeroliser® and Diskus® systems. The budesonide-formoterol combination was the therapeutic regimen most often cited for the continued treatment of symptomatic asthma, whereas tiotropium bromide was the most often cited medication for the treatment of COPD. Selection of the therapeutic regimen for asthma and COPD is primarily influenced by the results of therapeutic trials published in the literature. Conclusions: The opinions of pulmonologists on the topics under study are in concordance with data in the specialized literature.

 


Keywords: Questionnaires; Asthma; Pulmonary disease, chronic obstructive; Physician's practice patterns; Brazil.

 

4 - 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

Abstract PDF PT PDF EN Portuguese Text

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.

 

5 - Comparative study of two quality of life questionnaires in patients with COPD

Estudo comparativo entre dois questionários de qualidade de vida em pacientes com DPOC

Andréa Sória Buss, Luciano Müller Correa da Silva

J Bras Pneumol.2009;35(4):318-324

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare two quality of life questionnaires-the Saint George's Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36)-in patients with COPD, focusing on the discriminative properties of the questionnaires and correlating their domains with the following variables: Modified Medical Research Council Dyspnea Scale score; Beck Depression Inventory score; visual analog scale general health perception; Mini-Mental State Examination score; and a COPD clinical score developed specifically for the study. Methods: We interviewed 30 COPD patients between May and September of 2006. For the SF-36 and SGRQ, scores (total and domain) were compared and correlated. Results: With the exception of the pain domain, all of the SF-36 domains correlated significantly with the SGRQ total score (r = −0.5 to −0.69; p < 0.01). Of the SGQR domains, only the symptoms domain correlated significantly with all of the variables studied (p < 0.05). Conclusions: The majority of the expected correlations between the SGRQ and the SF-36 were observed, as were those expected between the two questionnaires and the other variables studied. The SGRQ, notably the symptoms domain, presented better discriminative properties than did the generic SF-36 questionnaire. The SF-36 is not an appropriate instrument for determining the affective state of COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Data collection.

 

6 - 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.

 

7 - Association of MBL2, TGF-β1 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.

 

8 - 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

Abstract PDF PT PDF EN Portuguese Text

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.

 

9 - Mycobacterium tuberculosis infection among community health workers involved in TB control

Infecção por Mycobacterium tuberculosis entre agentes comunitários de saúde que atuam no controle da TB

Patrícia Marques Rodrigues, Tiago Ricardo Moreira, Andressa Karla Luz de Moraes, Rafael da Cruz Araújo Vieira, Reynaldo Dietze, Rita de Cassia Duarte Lima, Ethel Leonor Noia Maciel

J Bras Pneumol.2009;35(4):351-358

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the incidence of Mycobacterium tuberculosis infection, using tuberculin skin test, among community health agents (CHAs) monitoring TB patients in the city of Cachoeiro de Itapemirim, Brazil. Methods: We included 30 CHAs acting in the Family Health Program and 30 of their family members residing in the same household. The tuberculin skin test results of each CHA were compared with those of the corresponding family member. Results: Of the 30 CHAs, 27 (90.0%) were female, compared with 23 (76.7%) of the 30 family members (p = 0.299). The mean age of the CHA group and of the family member group was, respectively, 36.8 and 39.7 years. No statistically significant difference was found between the groups regarding the level of education. Regarding M. tuberculosis exposure, the same number of participants in the two groups reported having known or had contact with a TB patient (17 individuals; 56.7%). There was a statistically significant difference regarding positive tuberculin skin test results (26.7% in the CHA group and 3.3% in the family member group; p = 0.011). Conclusions: M. tuberculosis infection was significantly higher among CHAs than among their family members, fueling the debate on the occupational risk involved in the activities of these professionals.

 


Keywords: Community health aides; Tuberculosis; Tuberculin test.

 

10 - Juvenile household contacts aged 15 or younger of patients with pulmonary TB in the greater metropolitan area of Vitória, Brazil: a cohort study

Comunicantes domiciliares jovens de pacientes com TB pulmonar na região da grande Vitória (ES): um estudo de coorte

Ethel Leonor Noia Maciel, Luiza Werner Heringer Vieira, Lucília Pereira Dutra Molina, Rosana Alves, Thiago Nascimento do Prado, Reynaldo Dietze

J Bras Pneumol.2009;35(4):359-366

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare clinical, radiological and laboratory aspects of household contacts, aged 15 or younger, of patients presenting a positive culture for Mycobacterium tuberculosis. Methods: This was a cohort study comparing children and adolescents (≤ 15 years of age) who were household contacts of TB cases presenting positive sputum smear and positive culture results (exposed group, n = 100) or negative sputum smear and positive culture results (unexposed group, n = 55). All of the contacts were evaluated via the TB control program of a university hospital in the city of Vitória, Brazil, between July of 2003 and December of 2006. Results: Of the 155 minors evaluated, 87 (56.1%) were female and 68 (43.9%) were male. Of those 155, 28 (18%) were aged 5 or younger, 62 (40%) were aged 5-9, and 65 (42%) were aged 10-15. Symptoms of the disease were found in 17 (17%) of the 100 contacts in the exposed group and in 9 (16%) of the 55 in the unexposed group (p = 0.86). Chest X-rays showed alterations in 20 (21%) and 2 (4%) of the contacts in the exposed and unexposed groups, respectively (RR = 6.9; p = 0.004). In the exposed and unexposed groups, respectively, 35 (38%) and 10 (18%) of the contacts presented positive results on the tuberculin skin test (RR = 2.8; p = 0.01). Of the 100 contacts in the exposed group, 5 (5%) were diagnosed with TB, which was not diagnosed in any of those in the unexposed group (p = 0.08). Conclusions: Although no significant difference was found between the two groups regarding the incidence of TB, it is of note that there is a greater risk of becoming infected with M. tuberculosis if the bacterial load of the index case is high.

 


Keywords: Tuberculosis; Mycobacterium tuberculosis; Tuberculosis, pulmonary; Child; Adolescent.

 

11 - Intrahospital transport of patients on invasive ventilation: cardiorespiratory repercussions and adverse events

Transporte intra-hospitalar de pacientes sob ventilação invasiva: repercussões cardiorrespiratórias e eventos adversos

Lea Tami Suzuki Zuchelo, Paulo Antônio Chiavone

J Bras Pneumol.2009;35(4):367-374

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the occurrence of cardiorespiratory alterations and to identify adverse events during the intrahospital transport of patients on invasive ventilation. Methods: A prospective observational non-randomized study was conducted at two tertiary hospitals between April of 2005 and December of 2006. We included patients on invasive ventilation who required intrahospital transport during the study period. Exclusion criteria were as follows: being under suspicion of brain death; being submitted to alternate periods of mechanical ventilation/nebulization via a T-piece; and being transported to the operating room. Prior to and after transport, we evaluated blood gas analysis results, vital signs, use of medications by means of a continuous infusion pump, parameters regarding the mechanical ventilator, duration of transport, transport distance and number of professionals involved. Results: We included 48 patients in a total of 58 intrahospital transports. Relevant cardiorespiratory alterations were identified in 39 transports, totaling 86 episodes, as well as 16 adverse events related to equipment or personnel failure, such as problems related to batteries and to miscommunication. Conclusions: During the intrahospital transport of patients on invasive ventilation, cardiorespiratory alterations were common (67.2%), and adverse events occurred in 75.7% of the transports.

 


Keywords: Patient transfer; Intensive care; Respiration, artificial; Ventilators, mechanical.

 

Review Article

12 - Role of immunohistochemistry in the diagnosis of lung cancer

Papel da imuno-histoquímica no diagnóstico do câncer de pulmão

Vera Luiza Capelozzi

J Bras Pneumol.2009;35(4):375-382

Abstract PDF PT PDF EN Portuguese Text

The role of immunohistochemistry is to recognize antigens and, consequently, to identify and classify specific cells within a cell population whose morphology is heterogenous or apparently homogenous. The visualization of the antigen-antibody complex is made possible through the addition of either a fluorochrome conjugate or an enzyme to the antibody, which is then viewed under microscopy. Immunohistochemistry can be used in the routine diagnosis of lung cancer, in order to identify biological markers (diagnostic and prognostic). The essential immunohistochemistry panels will be discussed in this review.

 


Keywords: Immunohistochemistry; Tumor markers, biological; Lung neoplasms.

 

Case Report

13 - Ectopic thyroid in the anterior mediastinum

Tireoide ectópica no mediastino anterior

Maria José Araújo da Cunha Guimarães, Carla Manuela Silva Valente, Lèlita Santos, Manuel Fontes Baganha

J Bras Pneumol.2009;35(4):383-387

Abstract PDF PT PDF EN Portuguese Text

Ectopic thyroid is a rare condition, and its location in the anterior mediastinum is even rarer, there having been only 5 reported cases in the past 30 years. Here, we describe 2 clinical cases and present a review of the literature regarding the etiology, embryology and clinical manifestations of ectopic thyroid.

 


Keywords: Thyroid dysgenesis; Mediastinum; Goiter.

 

14 - Chylothorax after surgical treatment of right-sided thoracic outlet syndrome

Fístula linfática após tratamento cirúrgico de síndrome do desfiladeiro torácico à direita

Luiz Felipe Lopes Araujo, Alexandre Heitor Moreschi, Guilherme Baroni de Macedo, Laura Moschetti, Eduardo Lopes Machado, Maurício Guidi Saueressig

J Bras Pneumol.2009;35(4):388-391

Abstract PDF PT PDF EN Portuguese Text

Chylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.

 


Keywords: Chylothorax; Thoracic outlet syndrome; Cervical rib syndrome; Postoperative complications.

 

15 - Lung pseudotumor as the initial presentation of Wegener's granulomatosis

Pseudotumor pulmonar como apresentação inicial de granulomatose de Wegener

Marcelo Fouad Rabahi, Ludmila Bertti Coelho, Eliza de Oliveira Borges, Marcella Stival Lemes, Weniskley Mendes de Castro, Siderley de Souza Carneiro

J Bras Pneumol.2009;35(4):392-395

Abstract PDF PT PDF EN Portuguese Text

Wegener's granulomatosis is a multisystemic inflammatory illness of unknown etiology, characterized by vasculitis of small and medium caliber vessels. The most common clinical manifestations involve the upper respiratory tract, lungs and kidneys. Common alterations in imaging studies include pulmonary opacities and bilateral multiple nodules, cavitations occurring in 50% of the cases. Treatment includes corticosteroids and immunosuppressants. We describe an atypical case of a 61-year-old man initially investigated due to suspicion of a unilateral lung tumor, which proved to be, in fact, a case of Wegener's granulomatosis.

 


Keywords: Wegener's Granulomatosis; Vasculitis; Diagnosis, differential; Lung neoplasms.

 

Author's reply

17 - Author's reply

Resposta dos autores

Carlos Alberto de Assis Viegas

J Bras Pneumol.2009;35(4):397-398

PDF PT PDF EN Portuguese Text


 


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