Elizabeth Clara Barroso, Rosa Maria Salani Mota, Maria Filomena Martiniano Morais, Creusa Lima Campelo, Joana Brasileiro Barroso, Jorge Luis Nobre Rodrigues

J Bras Pneumol.2003;29(6):350-357

Background: Multidrug resistant tuberculosis is a threat to tuberculosis control worldwide. In many studies, it has been suggested that inadequate treatment is a risk factor for the development of multidrug resistent tuberculosis. Objective: To identify the factors associated with inadequate treatment in a group of patients with multidrug resistent tuberculosis. Method: The authors identified all drug sensitivity test for tuberculosis performed at the Central Laboratory of the state of Ceará from 1990 to 1999. Retrospective and prospective analysis was performed, comparing the characteristics of adequately treated patients with those of inadequately treated patients. Multidrug resistance was defined as resistance to 2 drugs (rifampin and isoniazid) or more, using the Cox proportional hazards model. Results: Of the 1,500 sensitivity test performed at the Central Laboratory of Public Health of the state of Ceará, 266 revealed multidrug-resistant strains. Of those 266 patients, the authors were able to identify only 153, of whom 19 were excluded. Thus, our sampling consisted of 134 patients. Univariate analysis demonstrated that the significant factors associated with inadequate treatment were: noncompliance with the treatment, extreme poverty, drug intolerance, mistakes in the management of the patients, lack of medication being supplied by the health service, two or more previous treatments, pronounced lung cavities and bilateral lesions on chest X-rays. They found a further association (p < 0.0010) between alcoholism or smoking and noncompliance with the treatment. In the multivariate analysis, the factors associated with an outcome of inadequate treatment were: two or more previous treatments (p < 0.0001, OR = 5.9; CI 95%: 2.5-13.7), pronounced cavitation (p < 0.0217, OR = 2.7; CI 95%: 1.2-6.1) and bilateral chest X-ray lesions (p < 0.0226, OR = 3.2; CI 95%: 1.4-7.4) Conclusion: In the study, the authors observed that factors related to inadequate treatment are wide-ranging. An attempt at better control of the disease is warranted, especially in those patients with pronounced cavitation or bilateral lesions in chest X-rays. And those with 2 or more previous treatments.

Keywords: Tuberculosis, multidrug-resistant. Risk factors.

7 - Delay in the diagnosis and surgical treatment of lung cancer

Retardo no diagnóstico e no tratamento cirúrgico do câncer de pulmão

Marli Maria Knorst, Rodrigo Dienstmann, Luciane Pankowski Fagundes

J Bras Pneumol.2003;29(6):358-364

8 - Profile and follow-up of patients with Mycobacterium sp. at the Hospital das Clínicas da Universidade Federal de Minas Gerais

Perfil e seguimento dos pacientes portadores de Mycobacterium sp. do Hospital das Clínicas da Universidade Federal de Minas Gerais

Giselle Carvalho Froes, Rosane Luiza Coutinho, Marcelo Nardy de Ávila, Leandra Rocha Cançado, Silvana Spíndola de Miranda

J Bras Pneumol.2003;29(6):365-370

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.

9 - 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

10 - Influence of oral L-carnitine supplementation combined with physical training on exercise tolerance in patients with chronic obstructive pulmonary disease

Efeitos da suplementação oral de L-carnitina associada ao treinamento físico na tolerância ao exercício de pacientes com doença pulmonar obstrutiva crônica

Audrey Borghi Silva, Valéria Amorim Pires Di Lorenzo, Maurício Jamami, Luciana Maria Malosá Sampaio, Aureluce Demonte, Leonardo Cardello, Dirceu Costa

J Bras Pneumol.2003;29(6):379-385

11 - Interference of nail polish colors and time on pulse oximetry in healthy volunteers

Interferência da coloração de esmaltes de unha e do tempo na oximetria de pulso em voluntários sadios

Mara Harumi Miyake, Solange Diccini, Ana Rita de Cássia Bettencourt

J Bras Pneumol.2003;29(6):386-390

Case Report

12 - Idiopathic bronchocentric granulomatosis in a nonasthmatic young woman

Granulomatose broncocêntrica idiopática em jovem não asmática

José Wellington Alves dos Santos, Carlos Renato Mello, Gustavo Trindade Michel, Claudius Wladimir Cornelius de Figueiredo, Jader Miletho, Alessandro Zordan

J Bras Pneumol.2003;29(6):391-394

13 - Interstitial pneumonia in a patient undergoing treatment with leflunomide: drug-induced toxicity?

Pneumonite intersticial em paciente sob tratamento com leflunomide: toxicidade da droga?

Jonatas Reichert, Adriane Reichert, Luci Iolanda Bendhack, Lucia de Noronha, Dante Escuissato, Acir Rachid Filho

J Bras Pneumol.2003;29(6):395-400

14 - Alveolar hemorrhage associated with lupus nephritis

Hemorragia alveolar associada a nefrite lúpica

Ricardo Henrique de Oliveira Braga Teixeira, Marcel Hiratsuka, Flávia Calderini Rosa, Rogério Souza, Carlos Roberto Ribeiro de Carvalho

J Bras Pneumol.2003;29(6):401-404

Review Article

15 - Phosphodiesterase inhibitors: new perspectives on an old therapy for asthma?

Inibidores de fosfodiesterases: novas perspectivas de uma antiga terapia na asma?

Hisbello Campos, Debora Xisto, Walter A. Zin, Patricia R.M. Rocco

J Bras Pneumol.2003;29(6):405-412

16 - Chronic cough in non-smokers: diagnostic approach

Abordagem diagnóstica da tosse crônica em pacientes não-tabagistas

Márcia Jacomelli, Rogério Souza, Wilson Leite Pedreira Júnior

J Bras Pneumol.2003;29(6):413-420

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Year 2003 - Volume 29 - Issue 6 (November/December)

Editorial

1 - O espírito do Jornal de Pneumologia

2 - Prevendo a sobrevida da fibrose pulmonar idiopática: estamos melhorando?

3 - Perfil dos pacientes portadores de Mycobacterium SP

4 - Quem espera nem sempre alcança

Original Article

4 - Lung disease caused by Mycobacterium kansasii

Pneumopatia causada por Mycobacterium kansasii

6 - Factors associated with inadequate treatment in a group of patients with multidrug-resistant tuberculosis

Fatores associados aos tratamentos inadequados em grupo de portadores de tuberculose multirresistente