Brazilian Journal of Pulmonology

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


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Year 2010 - Volume 36  - Number 4  (July/August)

Original Article

3 - Prevalence and severity of wheezing in the first year of life

Prevalência e gravidade da sibilância no primeiro ano de vida

Ana Caroline Cavalcanti Dela Bianca, Gustavo Falbo Wandalsen, Javier Mallol, Dirceu Solé

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence and severity of wheezing in infants, using the standardized protocol devised for the "Estudio Internacional de Sibilancias en Lactantes" (EISL, International Study of Wheezing in Infants), as well as to determine the relationship between such wheezing and physician-diagnosed asthma, in the first year of life. Methods: Between March of 2005 and August of 2006, the EISL questionnaire was administered to the parents or legal guardians of infants undergoing routine procedures or immunization at public primary health care clinics in the southern part of the city of São Paulo, Brazil. Results: Our sample comprised 1,014 infants (mean age = 5.0 ± 3.0 months), 467 (46.0%) of whom had at least one wheezing episode, 270 (26.6%) having three or more such episodes, in their first year of life. The use of inhaled β2 agonists, inhaled corticosteroids, or antileukotrienes, as well as the occurrence of nocturnal symptoms, difficulty breathing, pneumonia, emergency room visits, and hospitalization due to severe wheezing, was significantly more common among those with recurrent wheezing (p < 0.05). Physician-diagnosed asthma was reported for 35 (7.5%) of the 467 wheezing infants and was found to be associated with the use of inhaled corticosteroids, difficulty breathing during the attacks, and six or more wheezing episodes in the first year of life. However, less than 40% of those infants were treated with inhaled corticosteroids or antileukotrienes. Conclusions: In this study, the prevalence of wheezing episodes among infants in their first year of life was high and had an early onset. The proportion of infants diagnosed with and treated for asthma was low.


Keywords: Asthma/diagnosis; Asthma/epidemiology; Respiratory sounds.


4 - Efficacy and safety of two dry-powder inhalers for the administration of mometasone furoate in asthma patients

Eficácia e segurança de dois inaladores de pó seco usados para a aplicação de furoato de mometasona em pacientes com asma

Carlos Alberto de Castro Pereira, Flávia Fillardo Vianna, Alberto Cukier, Rafael Stelmach, Júlio César Abreu de Oliveira, Erich Vidal Carvalho, Edimar Pedrosa Gomes, Suzete Varela Mayo, Antônio Monteiro da Silva Chibante, Cláudia Patrícia Domingues

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: Mometasone furoate (MF) is a new potent synthetic inhaled corticosteroid. Internationally, MF is administered via a dry-powder inhaler that contains multiple doses. As a preparation that would be more cost-effective, single-dose MF capsules were developed in Brazil. The objective of the present study was to evaluate the efficacy and safety of the two inhalers for MF administration in patients with asthma. Methods: A randomized, multicenter, open-label, parallel-group clinical trial involving 74 adult patients with moderate persistent asthma who were randomized into two groups to receive approximately 400 µg of MF once a day for 60 days, either via the multiple-dose inhaler or via the newly developed single-dose inhaler. Results: No significant differences were observed between the two groups regarding the primary endpoints (FEV1 and rescue medication use) or the secondary endpoints (morning PEF, tolerability, and safety, the last as assessed on the basis of hypothalamic-pituitary-adrenal axis function). Conclusions: The use of the single-dose inhaler developed in Brazil for MF administration is as effective and safe as is that of a standard inhaler in the treatment of patients with asthma. Keywords: Anti-asthmatic agents; Pregnadienediols; Metered dose inhalers.


Keywords: Anti-asthmatic agents; Pregnadienediols; Metered dose inhalers. ( identifier: NCT00975741 [])


5 - Field-test validation of the Brazilian version of the Paediatric Asthma Quality of Life Questionnaire

Versão brasileira do Paediatric Asthma Quality of Life Questionnaire: validação de campo

Edgar Enrique Sarria, Rosana Cardoso Manique Rosa, Gilberto Bueno Fischer, Vânia Naomi Hirakata, Neusa Sica da Rocha, Rita Mattiello

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the psychometric properties of the official Brazilian Portuguese-language version of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) in a representative group of Brazilian children and adolescents with asthma. Methods: A total of 125 individuals with asthma, aged 8-17 years and being monitored at a pediatric pulmonology outpatient clinic in the city of Porto Alegre, Brazil, completed the PAQLQ. Validity was assessed by means of convergent validity (correlation between PAQLQ domains and those of the Pediatric Quality of Life Inventory (PedsQL) 4.0. Reliability was assessed by determining internal consistency (Cronbach's alpha coefficient), reproducibility (intraclass correlation coefficient), sensitivity to change (effect size), and discriminatory power (floor/ceiling effects). Results: The mean age was 11 years, and 75 (60%) of the participants were male. The mean PAQLQ total score was 5.1, with floor/ceiling effects < 10%. Correlations between PAQLQ domains and the PedsQL 4.0 domains were acceptable (r = 0.37-0.40). The Cronbach's alpha coefficient for the total score was 0.93, ranging from 0.72 to 0.88 for the domains. The overall effect size was 0.60 (range: 0.45-0.60), whereas the overall intraclass correlation coefficient was 0.80 (range: 0.66-0.79). Conclusions: The official Brazilian Portuguese-language version of the PAQLQ showed good psychometric performance, confirming its cultural adequacy for use in Brazil.


Keywords: Keywords: Quality of life; Asthma; Validation studies.


6 - 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.


7 - Occurrence of hepatopulmonary syndrome in patients with cirrhosis who are candidates for liver transplantation

Ocorrência de síndrome hepatopulmonar em pacientes cirróticos candidatos a transplante de fígado

Liana Gonçalves Macêdo, Edmundo Pessoa de Almeida Lopes, Maria de Fátima Pessoa Militão de Albuquerque, Brivaldo Markman-Filho, Flávio Henrique Amaral Pires Véras, Ana Carolina Chiappetta Correia de Araújo, Álvaro Antônio Bandeira Ferraz

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the occurrence of hepatopulmonary syndrome (HPS) in patients with cirrhosis who are candidates for liver transplantation; to compare demographic, clinical, laboratory, and spirometric characteristics, as well as echocardiography results, arterial blood gas analysis, and severity of liver disease between the groups of patients with and without HPS; and to describe the occurrence of HPS in the subgroup of patients with cirrhosis and schistosomiasis mansoni (mixed liver disease). Methods: Between January and November of 2007, we evaluated 44 patients under treatment at the Liver Transplant Outpatient Clinic of the Federal University of Pernambuco Hospital das Clínicas, in the city of Recife, Brazil. The diagnostic criteria for HPS were intrapulmonary vascular dilatation, identified by transthoracic echocardiography, and an alveolar-arterial oxygen tension difference ≥ 15 mmHg or a PaO2 < 80 mmHg. Results: The mean age of the patients was 52 years, and 31 patients (70%) were males. The most common cause of cirrhosis was alcohol use. Schistosomiasis was present in 28 patients (64%). Of the 44 patients, 20 (45.5%) were diagnosed with HPS. No significant differences were found between those patients and the patients without HPS in terms of any of the characteristics studied. Of the 28 patients with cirrhosis and schistosomiasis, 10 (35.7%) were diagnosed with HPS. Conclusions: In the population studied, HPS was highly prevalent and did not correlate with any of the variables analyzed.


Keywords: Hepatopulmonary syndrome; Liver transplantation; Liver cirrhosis; Hypertension, portal; Schistosomiasis mansoni; Echocardiography.


8 - Increased risk of respiratory symptoms and chronic bronchitis in women using biomass fuels in Nigeria

Risco aumentado de sintomas respiratórios e bronquite crônica em mulheres que utilizam biocombustíveis na Nigéria

Olufemi Olumuyiwa Desalu, Adebowale Olayinka Adekoya, Bolawale Adedeji Ampitan

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether respiratory symptoms and chronic bronchitis are associated with the use of biomass fuels (BMFs) among women residing in rural areas of the Ekiti State, in southwestern Nigeria. Methods: From January to June of 2009, we carried out a cross-sectional study including 269 adult women. To collect data on sociodemographic status, type of fuel used for cooking in the household, respiratory symptoms, and smoking history, we used a questionnaire adapted from the European Community Respiratory Health Survey. All of the participants were invited to undergo spirometry. Results: Of the 269 women in the study, 161 (59.9%) used BMFs for cooking. The proportion of women who reported respiratory symptoms was greater among those using BMFs than among those using a non-BMF-cough (13.7% vs. 3.7%); wheezing (8.7% vs. 2.8%); chest pain (7.5% vs. 1.9%); breathlessness (11.8% vs. 6.5%); nasal symptoms (9.3% vs. 4.6%); and chronic bronchitis (10.6% vs. 2.8%). Multivariate logistic regression analysis revealed that the use of BMFs was associated with the following variables: cough (OR = 4.82; p = 0.01); chronic bronchitis (OR = 3.75; p = 0.04); wheezing (OR = 2.22; p = 0.23); chest pain (OR = 3.82; p = 0.09); breathlessness (OR = 1.54; p = 0.35); and nasal symptoms (OR = 2.32; p = 0.20). All of the spirometric parameters evaluated (FEV1, FVC, FEV1/FVC ratio, and PEF) were lower in the women using BMFs than in those using a non-BMF. Conclusions: Our results underscore the need for women using BMFs in their households to replace them with a nontoxic type of fuel, such as electricity or gas.


Keywords: Signs and symptoms, respiratory; Biofuels; Bronchitis, chronic; Air pollution, indoor.


9 - Does the BODE index correlate with quality of life in patients with COPD?

O índice BODE correlaciona-se com a qualidade de vida em pacientes com DPOC?

Zênia Trindade de Souto Araujo, Gardenia Holanda

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index correlates with health-related quality of life in patients with COPD. Methods: We evaluated 42 patients with COPD, quantifying the following: lung function parameters; anthropometric variables; exercise capacity, with the six-minute walk test; dyspnea, with the modified Medical Research Council (MRC) scale; the BODE index; and quality of life, with the modified Saint George's Respiratory Questionnaire (mSGRQ). Patients were divided into two groups by disease severity: FEV1 ≥ 50% and FEV1 < 50%. Results: The mean BODE index was 2.58 ± 1.17 and 4.15 ± 1.81, respectively, for the FEV1 ≥ 50% and FEV1 < 50% groups. There was a significant difference between the groups in terms of FEV1 and the FEV1/FVC ratio. There were moderate to significant correlations between the BODE index scores and all of the mSGRQ domains in the group of patients with FEV1 <50%. Conclusions: The BODE index score correlated with the scores of all of the mSGRQ domains in COPD patients with FEV1 < 50%. Therefore, COPD patients with FEV1 < 50% die sooner and have a poorer quality of life.


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Severity of illness index; Prognosis.


10 - Pulmonary function in children and adolescents with postinfectious bronchiolitis obliterans

Função pulmonar de crianças e adolescentes com bronquiolite obliterante pós-infecciosa

Rita Mattiello, Javier Mallol, Gilberto Bueno Fischer, Helena Teresinha Mocelin, Belkys Rueda, Edgar Enrique Sarria

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the pulmonary function in children and adolescents with postinfectious bronchiolitis oblite­rans (PIBO), as well as to evaluate potential risk factors for severe impairment of pulmonary function. Methods: The pulmonary function of 77 participants, aged 8-18 years, was assessed by spirometry and plethysmography. The following parameters were analyzed: FVC; FEV1; FEF25-75%; FEV1/FVC; RV; TLC; RV/TLC; intrathoracic gas volume; and specific airway resistance (sRaw). We used Poisson regression to investigate the following potential risk factors for severe impairment of pulmonary function: gender; age at first wheeze; age at diagnosis; family history of asthma; tobacco smoke exposure; length of hospital stay; and duration of mechanical ventilation. Results: The mean age was 13.5 years. There were pronounced decreases in FEV1 and FEF25-75%, as well as increases in RV and sRaw. These alterations are characteristic of obstructive airway disease. For the parameters that were the most affected, the mean values (percentage of predicted) were as follows: FEV1 = 45.9%; FEF25-75% = 21.5%; RV = 281.1%; RV/TLC = 236.2%; and sRaw = 665.3%. None of the potential risk factors studied showed a significant association with severely impaired pulmonary function. Conclusions: The patients with PIBO had a common pattern of severe pulmonary function impairment, characterized by marked airway obstruction and pronounced increases in RV and sRaw. The combination of spirometric and plethysmographic measurements can be more useful for assessing functional damage, as well as in the follow-up of these patients, than are either of these techniques used in isolation. Known risk factors for respiratory diseases do not seem to be associated with severely impaired pulmonary function in PIBO.


Keywords: Respiratory function tests; Airway obstruction; Bronchiolitis obliterans


11 - Predicting reduced TLC in patients with low FVC and a normal or elevated FEV1/FVC ratio

Predizendo redução da CPT em pacientes com CVF reduzida e relação VEF1/CVF normal ou elevada

Luiz Carlos D'Aquino, Sílvia Carla Sousa Rodrigues, João Adriano de Barros, Adalberto Sperb Rubin, Nelson Augusto Rosário Filho, Carlos Alberto de Castro Pereira

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To use clinical and spirometry findings in order to distinguish between the restrictive and nonspecific patterns of pulmonary function test results in patients with low FVC and a normal or elevated FEV1/FVC ratio. Methods: We analyzed the pulmonary function test results of 211 adult patients submitted to spirometry and lung volume measurements. We used the clinical diagnosis at the time spirometry was ordered, together with various functional data, in order to distinguish between patients presenting with a "true" restrictive pattern (reduced TLC) and those presenting with a nonspecific pattern (normal TLC). Results: In the study sample, TLC was reduced in 144 cases and was within the normal range in 67. The most common causes of a nonspecific pattern were obstructive disorders, congestive heart failure, obesity, bronchiolitis, interstitial diseases, and neuromuscular disorders. In patients given a working diagnosis of pulmonary fibrosis, pleural disease, or chest wall disease, the positive predictive value (PPV) for restriction was ≥ 90%. In males, an FVC ≤ 60% of predicted had a PPV for restriction of 98.8%. In females, the restrictive pattern was found in 84.4% of those with an FVC ≤ 50% of predicted. A difference of ≥ 0% between the FEV1% and the FVC% had a PPV for restriction of 89.5%. After performing logistic regression, we developed a point scale for predicting the restrictive pattern. Conclusions: In many patients with reduced FEV1, reduced FVC, and a normal FEV1/FVC ratio, the restrictive pattern can be identified with confidence through the use of an algorithm that takes the clinical diagnosis and certain spirometry measurements into account.


Keywords: Spirometry; Airway resistance; Respiratory function tests; Vital capacity.


12 - Determination of total proteins and lactate dehydrogenase for the diagnosis of pleural transudates and exudates: redefining the classical criterion with a new statistical approach

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

Bernardo Henrique Ferraz Maranhão, Cyro Teixeira da Silva Junior, Antonio Monteiro da Silva Chibante, Gilberto Perez Cardoso

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Objective: To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. Methods: This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. Results: Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8%, 68.6%, and 94.5%, whereas the corresponding values for the diagnosis of pleural transudates were 76.1%, 90.1%, and 87.6%. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4%, 72.6%, and 99.2%, whereas the corresponding values for the diagnosis of transudates were 98.5%, 83.4%, and 90.0%. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). Conclusions: The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.


Keywords: Pleural effusion/diagnosis; Pleural effusion/classification; Exudates and transudates.


13 - 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):

Abstract PDF PT PDF EN Portuguese Text

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.


Brief Communication

14 - 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):

Abstract PDF PT PDF EN Portuguese Text

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.


15 - Experimental model of isolated lung perfusion in rats: technique and application in lung preservation studies

Modelo experimental de perfusão pulmonar isolada em ratos: técnica e aplicações em estudos de preservação pulmonar

Paulo Manuel Pêgo-Fernandes, Eduardo de Campos Werebe, Paulo Francisco Guerreiro Cardoso, Rogério Pazetti, Karina Andrighetti de Oliveira, Paula Roberta Otaviano Soares, Fabio Biscegli Jatene

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.


Keywords: Lung transplantation; Reperfusion injury; Rats; Models, animal.


16 - Heterogeneidade de resposta por IFN-γ a cepas clínicas de Mycobacterium tuberculosis em humanos

Heterogeneidade de resposta por IFN-γ a cepas clínicas de Mycobacterium tuberculosis em humanos

Vinícius Ribeiro Cabral, Cláudia Ferreira de Souza, Fernanda Luiza Pedrosa Guimarães, Maria Helena Feres Saad

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Mycobacterium tuberculosis is one of the most successful human pathogens. Highly virulent strains, which are more easily transmitted than are less virulent strains, elicit variable immune responses. We evaluated the Th1 responses (IFN-γ production) in healthy volunteers after stimulation with various strains. Our results show that the individuals with negative tuberculin skin test (TST) results were not necessarily naive to all of the strains tested, whereas individuals with positive TST results did not respond to all of the strains tested. Drug-resistant strains induced a lower mean level of IFN-γ production than did drug-sensitive strains. One possible practical application of this finding would be for the prediction of responses to treatment, in which it might be advantageous to have knowledge of the estimated IFN-γ production elicited by a specific isolated strain.


Keywords: Tuberculosis; Polymorphism, restriction fragment length; Mycobacterium tuberculosis; Immunity, cellular; Interferon-gamma.


Review Article

17 - Portable monitoring devices in the diagnosis of obstructive sleep apnea: current status, advantages, and limitations

Monitorização portátil no diagnóstico da apneia obstrutiva do sono: situação atual, vantagens e limitações

Jéssica Fábia Polese, Rogério Santos-Silva, Rafael Freire Kobayashi, Indira Nunes de Paula Pinto, Sérgio Tufik, Lia Rita Azeredo Bittencourt

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Recent years have seen a growing interest in the use of portable monitoring devices for the diagnosis of obstructive sleep apnea syndrome. These have the potential to be used in lieu of the more complicated and uncomfortable alternative, polysomnography, which has long been considered to be the gold standard for the diagnosis of this relatively prevalent condition. Following their approval in 2008 by the Center of Medicare and Medicaid Services, the federal agency which administers Medicare and Medicaid in the United States, there has been extensive discussion about the utility and validity of these devices for use in the diagnosis of obstructive sleep apnea syndrome. Although there are various models of portable monitoring devices, the literature contains little information regarding how each device should be used in specific age groups, patients presenting comorbidities, and asymptomatic patients. Additionally, studies about the cost-effectiveness of this diagnostic method are scarce and conflicting. Therefore, this objective of this study was to review what has been learned about portable monitoring devices over time, as well as to examine the recent progress, advantages, limitations, and applications of these devices in the diagnosis of obstructive sleep apnea syndrome in different groups of patients.


Keywords: Sleep apnea, obstructive/diagnosis; Polysomnography; Diagnostic equipment; Monitoring, ambulatory.


18 - Bronchial thermoplasty in asthma

Termoplastia brônquica em asma

Adalberto Sperb Rubin, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Currently available treatments for asthma provide satisfactory control of the disease in most cases. However, a significant number of patients do not respond to such treatments (i.e., do not achieve effective symptom relief). One novel approach to treating asthma is bronchial thermoplasty, in which the airway smooth muscle is specifically and directly treated. This procedure delivers radiofrequency energy to the airways in order to reduce smooth muscle-mediated bronchoconstriction. In this article, we present the thermoplasty technique, summarizing the results of the major randomized clinical trials of the procedure, as well as discussing its mechanisms of action and potential adverse effects. We also propose strategies for the future clinical use of this new treatment.


Keywords: Asthma/prevention & control; Asthma/therapy; Bronchoscopy.


Case Report

19 - Severe paraquat poisoning: clinical and radiological findings in a survivor

Intoxicação grave por paraquat: achados clínicos e radiológicos em um sobrevivente

Fábio Fernandes Neves, Romualdo Barroso Sousa, Antônio Pazin-Filho, Palmira Cupo, Jorge Elias Júnior, Marcello Henrique Nogueira-Barbosa

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning.


Keywords: Paraquat/poisoning; Pulmonary fibrosis; Pneumothorax.


20 - Giant cell tumor of the sternum

Tumor de células gigantes do esterno

Ricardo Alexandre Faria, Carlos Maciel da Silva, José Elias Abrão Miziara, Fernando Yaeda de Melo, Sandra Regina Morini da Silva, Cristiano Ribeiro Viana

J Bras Pneumol.2010;36(4):

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 74-year-old female patient diagnosed with a giant cell tumor of the sternum. The clinical and radiological presentation was indicative of a primary tumor of the sternum. The patient underwent complementary tests and surgery. The pathological examination confirmed the diagnosis. Commonly observed in the long bones of the appendicular skeleton, this type of tumor is characterized by its local aggressiveness and metastatic potential. We also review the literature on the topic.


Keywords: Sternum; Giant cell tumors; Thorax.



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