Brazilian Journal of Pulmonology

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


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Polymerase chain reaction used to detect Streptococcus pneumoniae resistance to penicillin

A reação em cadeia da polimerase na detecção da resistência à penicilina em Streptococcus pneumoniae

Eduardo Walker Zettler, Rosane M. Scheibe, Cícero A.G. Dias, Patricia Santafé, José da Silva Moreira, Diógenes S. Santos, Carlos Cezar Fritscher

J Bras Pneumol.2004;30(6):521-527

Abstract PDF PT PDF EN

Background: Streptococcus pneumoniae is the most common etiologic agent of community-acquired respiratory infections. In recent years, S. pneumoniae resistance to antimicrobial agents has increased. Minimum inhibitory concentration (MIC) is routinely used to determine resistance. Polymerase chain reaction (PCR) detects the genes responsible for Streptococcus pneumoniae resistance to penicillin within approximately 8 hours. Objective: To compare the PCR and MIC methods in determining Streptococcus pneumoniae resistance to penicillin. Method: A total of 153 Streptococcus pneumoniae samples, isolated from various anatomical sites, were evaluated in order to detect mutations in the genes encoding pbp1a, pbp2a and pbp2x, which are responsible for Streptococcus pneumoniae penicillin resistance. A correlation was found between mutations and penicillin MIP, as determined by the agar diffusion method. Results: Overal Streptococcus pneumoniae resistance to penicillin was 22.8% (16.3% intermediate resistance and 6.5% high resistance). In a statistically significant finding, we observed no mutations in the penicillin-sensitive samples and only one mutation, typically in the gene encoding pbp2x, among the samples with intermediate resistance, whereas mutations in all three genes studied were observed in the high-resistance samples. Conclusion: For determining Streptococcus pneumoniae resistance to penicillin, PCR is a rapid method of detection that could well be used in clinical practice.


Keywords: Streptococcus pneumoniae. Penicillin resistance. Polymerase chain reaction/methods.


Compliance with maintenance treatment of asthma (ADERE study)

Adesão ao tratamento de manutenção em asma (estudo ADERE)

José Miguel Chatkin, Daniela Cavalet-Blanco, Nóris Coimbra Scaglia, Roberto Guidotti Tonietto, Mário B. Wagner, Carlos Cezar Fritscher

J Bras Pneumol.2006;32(4):277-283

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. Methods: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. Results: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. Conclusion: The overall rate of compliance with maintenance treatment of asthma was low.


Keywords: Asthma/drug therapy; Asthma/prevention & control; Patient compliance; Patient education; Physician-patient relations


Evaluation of the efficacy and safety of a fixed-dose, single-capsule budesonide-formoterol combination in uncontrolled asthma: a randomized, double-blind, multicenter, controlled clinical trial

Avaliação da eficácia e segurança da associação de budesonida e formoterol em dose fixa e cápsula única no tratamento de asma não controlada: ensaio clínico randomizado, duplo-cego, multicêntrico e controlado

Roberto Stirbulov, Carlos Cezar Fritscher, Emilio Pizzichini, Márcia Margaret Menezes Pizzichini

J Bras Pneumol.2012;38(4):431-437

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the efficacy and safety of a fixed-dose, single-capsule budesonide-formoterol combination, in comparison with budesonide alone, in patients with uncontrolled asthma. Methods: This was a randomized, double-blind, multicenter, phase III, parallel clinical trial, comparing the short-term efficacy and safety of the combination of budesonide (400 μg) and formoterol (12 μg), with those of budesonide alone (400 μg), both delivered via a dry powder inhaler, in 181 patients with uncontrolled asthma. The age of the patients ranged from 18 to 77 years. After a run-in period of 4 weeks, during which all of the patients received budesonide twice a day, they were randomized into one of the treatment groups. The treatment consisted of the administration of the medications twice a day for 12 weeks. The primary outcome measures were FEV1, FVC, and morning PEF. We performed an intention-to-treat analysis of the data. Results: In comparison with the budesonide-only group patients, those treated with the budesonide-formoterol combination showed a significant improvement in FEV1 (0.12 L vs. 0.02 L; p  =   0.0129) and morning PEF (30.2 L/min vs. 6.3 L/min; p  = 0.0004). These effects were accompanied by good tolerability and safety, as demonstrated by the low frequency of adverse events, only minor adverse events having occurred. Conclusions: The single-capsule combination of budesonide-formoterol appears to be efficacious and safe. Our results indicate that this formulation is a valid therapeutic option for obtaining and maintaining asthma control. ( Identifier: NCT01676987 [])


Keywords: Asthma; Budesonide; Adrenergic beta-2 receptor agonists.


Phenotypic and genotypic study of macrolide resistance of Streptococcus pneumoniae strains isolated in hospitals in Porto Alegre, in the state of Rio Grande do Sul, Brazil

Estudo fenotípico e genotípico da resistência aos macrolídeos de "Streptococcus pneumoniae" isolados em hospitais de Porto Alegre - RS

Fabiana Rowe Zettler, Eduardo Walker Zettler, Virginia Minghelli Schmitt, Marina Tagliaro Jahns, Cícero Armídio Gomes Dias, Carlos Cezar Fritscher

J Bras Pneumol.2005;31(4):312-317

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to determine the prevalence of macrolide-resistant S. pneumoniae and to identify its phenotypic and genotypic characteristics. Methods: Strains of S. pneumoniae isolated in the city of Porto Alegre between May 2002 and August 2004 from samples collected from different anatomical sites were analyzed. For the agar diffusion test, disks of erythromycin, clarithromycin, azithromycin and clindamycin were used. The minimum inhibitory concentrations of erythromycin were determined for macrolide-resistant isolates by the agar dilution method. Macrolide-resistant isolates were phenotyped by agar diffusion test and genotyped by polymerase chain reaction. Results: A total of 229 pneumococcal strains were evaluated, 12 (5.2%) of which were macrolide-resistant. Among the 12 resistant strains, 9 (75%) presented the MLSB phenotype, and 3 (25%) presented the M phenotype. Polymerase chain reaction testing indicated that 8 MLSB phenotype isolates harbored the ermB gene only, whereas the mefE gene was present in all 3 M phenotype isolates. One MLSB phenotype isolate presented both genes. Conclusion: In Porto Alegre, the S. pneumoniae resistance to macrolides is still low since such resistance is due primarily to the presence of the ermB gene expressing the MLSB phenotype.


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

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.


The role of breastfeeding, diet and nutritional status in the development of asthma and atopy

O papel do aleitamento materno, da dieta e do estado nutricional no desenvolvimento de asma e atopia

Aline Petter Schneider, Renato Tetelbom Stein, Carlos Cezar Fritscher

J Bras Pneumol.2007;33(4):454-462

Abstract PDF PT PDF EN Portuguese Text

In many populations, the prevalence of asthma and atopy has increased in recent years. As a result, both conditions have become major public health problems. The possible influence of nutrition-related factors has been demonstrated in an increasing number of studies. Information regarding the role of breastfeeding, diet, nutritional status (obesity in particular), as well as regarding the immunologic responses triggered, helps to improve our understanding of the correlation between oxidative stress, bronchial inflammation, and the development of atopic and asthma symptoms. The article presents a review of the published literature on the relationships established between and among nutrition, asthma, and atopy over the last two decades.


Keywords: Asthma; Nutritional status; Breast feeding; Diet.


PET/CT imaging in lung cancer: indications and findings

PET/TC em câncer de pulmão: indicações e achados

Bruno Hochhegger1, Giordano Rafael Tronco Alves2, Klaus Loureiro Irion3, Carlos Cezar Fritscher4, Leandro Genehr Fritscher5, Natália Henz Concatto6, Edson Marchiori7

J Bras Pneumol.2015;41(3):264-274

Abstract PDF PT PDF EN Portuguese Text

The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.


Keywords: Carcinoma, non-small-cell lung; Small cell lung carcinoma; Positron-emission tomography; Tomography, X-ray computed; Neoplasm staging.


Recommendations for the pharmacological treatment of COPD: questions and answers

Recomendações para o tratamento farmacológico da DPOC: perguntas e respostas

Frederico Leon Arrabal Fernandes1, Alberto Cukier1, Aquiles Assunção Camelier2,3, Carlos Cezar Fritscher4, Cláudia Henrique da Costa5, Eanes Delgado Barros Pereira6, Irma Godoy7, José Eduardo Delfini Cançado8, José Gustavo Romaldini8, Jose Miguel Chatkin4, José Roberto Jardim9, Marcelo Fouad Rabahi10, Maria Cecília Nieves Maiorano de Nucci11, Maria da Penha Uchoa Sales12, Maria Vera Cruz de Oliveira Castellano13, Miguel Abidon Aidé14, Paulo José Zimermann Teixeira15,16, Renato Maciel17, Ricardo de Amorim Corrêa18, Roberto Stirbulov8, Rodrigo Abensur Athanazio1, Rodrigo Russo19, Suzana Tanni Minamoto7, Fernando Luiz Cavalcanti Lundgren20

J Bras Pneumol.2017;43(4):290-301

Abstract PDF PT PDF EN Portuguese Text

The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.


Keywords: Pulmonary disease, chronic obstructive/drug therapy; pulmonary disease, chronic obstructive/prevention & control; pulmonary disease, chronic obstructive/therapy.


Long-term survival in lung cancer after surgical treatment: is gender a prognostic factor?

Sobrevida de longo prazo em carcinoma brônquico após tratamento cirúrgico: sexo é fator prognóstico?

Carolina Mariante de Abreu, José Miguel Chatkin, Carlos Cezar Fritscher, Mário Bernardes Wagner, José A. L. Figueiredo Pinto

J Bras Pneumol.2004;30(1):2-8

Abstract PDF PT

BACKGROUND: In agreement with other reported studies, wehad previously found a possible association between gender and prognosis in stage I non-small cell lung cancer (NSCLC), showing a higher survival rate among females. OBJECTIVES: The purpose of this study was to further clarify the role of gender as a possible prognostic factor in NSCLC. METHOD: In a retrospective cohort study, we examined the survival of 163 NSCLC patients who underwent curative surgical treatment at the Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Hospital between 1990 and 1997. Data was analyzed using Kaplan-Meier plots. Additionally, we used the Mann-Whitney test for comparing group survival rates and the Cox regression model to adjust for potential confounding factors. RESULTS: Were included 124 (76.07%) males and 39 (23.93%) females, whose median survival was of 32.3 and 60.6 months, respectively. The 5-year survival was 38.0% for men and 55.4% for women (P=0.030). Considering only stage I patients, survival rates were 44.4% and 81.8% for men and women, respectively (P=0.009). Effect of gender continued after adjustment for several factors (age, hemoglobin, histology, tumor size, type of surgery and postoperative complications). CONCLUSION: This study confirms our previous findings that women live longer after NSCLC surgery when compared to men. This result is only observed at an early stage and persists after adjustment of several factorsP


Keywords: Carcinoma, bronchogenic [surgery]; Carcinoma, bronchogenic [epidemiolgy]; Prognosis; Sex distribution; Disease - free survival.


Smoking cessation with bupropion and nicotine replacement

Tratamento do tabagismo com bupropiona e reposição nicotínica

Fábio Maraschin Haggsträm, José Miguel Chatkin, Daniela Cavalet-Blanco, Vanessa Rodin, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):255-261


Introduction: Around one third of the world adult population smoke. Due to the recent researches on the smoking addiction and to the use of new drugs, the possibilities to succeed on the attempts to quit smoking have increased remarkably. Purposes: To study the tobacco abstinence in patients under treatment at the Ambulatório de Auxílio ao Abandono do Tabagismo da Pontifícia Universidade Católica do Rio Grande do Sul (AAAT-PUCRS) and to evaluate the role of some variables as risk factors to the chosen outcomes. Patients and methods: In a prospective open clinical trial not randomized we studied all the smokers who attended the AAAT-PUCRS within July 1999 and October 2000. All of them were submitted to the same standard program; the results were analyzed by central tendency measures for quantifying variables, relative risk with a IC95% for the associated factors and the Kaplan Meier's curve for the analyses of the time trend. Results: The study included 169 patients (67.5% women), average age 46 (± 10.4) years old; the most of them smoked 20 cigarettes/day for around 30 years. Even for a very young cohort like this one, it was possible to show that in relation to the outcome success/failure, 49% of the patients quit smoking, 14% remarkably diminished the number of smoked cigarettes and 37% failed completely. For the studied variables, severe dependency to nicotine was the only one associated with an increased risk to failure quitting smoking. Conclusions: It was possible to achieve a reasonable quitting smoking percentage adopting standard procedures described, but adapted for each patient. Pharmacological therapy was associated to a higher percentage of success.


Keywords: Smoking. Treatment. Tobacco use cessation. Ambulatory care.


Asthma and atopy prevalence in a group of students from Porto Alegre, Rio Grande do Sul

Variação na prevalência de asma e atopia em um grupo de escolares de Porto Alegre, Rio Grande do Sul

Renata Wagner Fiore, Adriana Barbieri Comparsi, Cláudia Loss Reck, Jéferson Krawcyk de Oliveira, Karina Brasco Pampanelli, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):237-242


Introduction: A considerable increase in asthma and atopy prevalence has been noticed worldwide through the last decades, however, in our country, epidemiological data are still insufficient. Objective: This study was carried out to determine the prevalence of asthma and atopy in a group of students, and compare these data with those found in two previous studies undertaken in Porto Alegre, Rio Grande do Sul. Methods: Asthma prevalence was identified through a questionnaire applied to 855 students from five schools of Porto Alegre. The students submitted to skin tests who presented, at least, one positive reaction were considered atopic. The signature of an informed consent from one of the parents was required for the skin test performance. Results: Prevalence was found to be 42.5% and 22% of cumulative and active asthma, respectively, with predominance in females. Atopy was identified in 50.1% of the sample. These results were significantly higher than the 6.7% (1980) and 16% (1989) of cumulative asthma, 10.9% (1989) of active asthma and 15.8% (1980) of atopy found in the two previous studies. Conclusion: A high prevalence of asthma and atopy was identified in our students. Future studies should be performed to elucidate the phenomenon herein demonstrated.


Keywords: Asthma. Epidemiology. Atopy.




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