Brazilian Journal of Pulmonology

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

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Profile of patients with tuberculosis: evaluation of the Brazilian national tuberculosis control program in Bagé, Brazil

Perfil dos pacientes com tuberculose e avaliação do programa nacional de controle da tuberculose em Bagé (RS)

Marysabel Pinto Telis Silveira, Raquel Fabiane Roscoff de Adorno, Tiago Fontana

J Bras Pneumol.2007;33(2):199-205

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Objective: To present epidemiological data on patients diagnosed with tuberculosis, as well as on associated factors, and to determine the efficacy of the National Tuberculosis Control Program in Bagé, Brazil. Methods: A retrospective study was carried out at the Pablo Barcellos Center, analyzing cases of tuberculosis reported from January 2001 to December 2004. Data were collected through the review of clinical charts and from the National Case Registry database. Results: During this period, of the 4468 sputum smear microscopies performed, 131 were positive, with higher prevalence among males aged 26 to 35 years old. Prevalence was lower among those aged 65 and above. Over 50% of the patients were Caucasian, had only 1 to 3 years of schooling and worked in low-income jobs (mean salary, 265 Brazilian reals/month). There was no significant difference between smokers and former smokers/nonsmokers, and only one of the 131 cases was HIV positive. Conclusion: The number of sputum smear microscopies performed in Bagé increased in the past four years. In 2003 and 2004, it exceeded the goal of the National Tuberculosis Control Program. However, the number of new cases decreased, demonstrating the efficacy of the active search for tuberculosis cases in the city.

 


Keywords: Tuberculosis; Epidemiology; Communicable disease control.

 


Is a low level of education a limiting factor for asthma control in a population with access to pulmonologists and to treatment?

A baixa escolaridade é um fator limitante para o controle da asma em uma população com acesso a pneumologista e tratamento?

Cassia Caroline Emilio1,a, Cintia Fernanda Bertagni Mingotti1,b, Paula Regina Fiorin1,c, Leydiane Araujo Lima1,d, Raisa Lemos Muniz1,e, Luis Henrique Bigotto1,f, Evaldo Marchi2,g, Eduardo Vieira Ponte1,h

J Bras Pneumol.2019;45(1):e20180052-e20180052

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Objective: To determine whether a low level of education is a risk factor for uncontrolled asthma in a population of patients who have access to pulmonologists and to treatment. Methods: This was a cross-sectional study involving outpatients > 10 years of age diagnosed with asthma who were followed by a pulmonologist for at least 3 months in the city of Jundiai, located in the state of São Paulo, Brazil. The patients completed a questionnaire specifically designed for this study, the 6-item Asthma Control Questionnaire (to assess the control of asthma symptoms), and a questionnaire designed to assess treatment adherence. Patients underwent spirometry, and patient inhaler technique was assessed. Results: 358 patients were enrolled in the study. Level of education was not considered a risk factor for uncontrolled asthma symptoms (OR = 0.99; 95% CI: 0.94-1.05), spirometry findings consistent with obstructive lung disease (OR = 1.00; 95% CI: 0.99-1.01), uncontrolled asthma (OR = 1.03; 95% CI: 0.95-1.10), or the need for moderate/high doses of inhaled medication (OR = 0.99; 95% CI: 0.94-1.06). The number of years of schooling was similar between the patients in whom treatment adherence was good and those in whom it was poor (p = 0.08), as well as between those who demonstrated proper inhaler technique and those who did not (p = 0.41). Conclusions: Among asthma patients with access to pulmonologists and to treatment, a low level of education does not appear to be a limiting factor for adequate asthma control.

 


Keywords: Asthma; Educational status; Spirometry; Treatment adherence and compliance.

 


Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil?

A distância percorrida no teste de caminhada de seis minutos pode predizer a ocorrência de exacerbações agudas da DPOC em pacientes brasileiros?

Fernanda Kazmierski Morakami, Andrea Akemi Morita, Gianna Waldrich Bisca, Josiane Marques Felcar, Marcos Ribeiro, Karina Couto Furlanetto, Nidia Aparecida Hernandes, Fabio Pitta

J Bras Pneumol.2017;43(4):280-284

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Objective: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. Methods: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted.

 


Keywords: Pulmonary disease, chronic obstructive; Risk groups; Exercise.

 


A honra de poder servir à Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)

Thaís Helena Abrahão Thomaz Queluz

J Bras Pneumol.2002;28(5):v-

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Asthma-related hospitalizations and lack of outpatient follow-up treatment

A hospitalização por asma e a carência de acompanhamento ambulatorial

Emanuel Sarinho, Gladys Reis e Silva de Queiroz, Maria Laura Campelo de Melo Dias, Alexandre Jorge Queiroz e Silva

J Bras Pneumol.2007;33(4):365-371

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Objective: To determine whether the children and adolescents with acute asthma attacks admitted to two public hospitals in the city of Recife, Brazil underwent outpatient follow-up treatment for the prevention and control of asthma. Methods: A prospective case series study of hospitalized patients with asthma. The patients were asked to complete a questionnaire at admission in order to determine the frequency of prophylactic outpatient follow-up treatment. Patients presenting two or more attacks of asthma that were responsive to bronchodilators were classified as having asthma. Results: In the intervals between asthma attacks, 67% (112/167 - data regarding 2 patients were not available) of the patients had been treated only in the emergency room. Although 53.3%(89/167 - data regarding 2 patients were not provided) of the patients had been referred to outpatient treatment, only 16% (27/169) had visited an outpatient asthma clinic regularly for preventive treatment, and only 13% (22/169) had used prophylactic medication. Conclusion: Most of the children and adolescents hospitalized with asthma had not undergone preventive outpatient follow-up treatment. Various problems related to the health care system, such as non-referral for outpatient follow-up treatment at hospital discharge, limited access to outpatient clinics, and the cost of prophylactic medication, might have contributed to the low rate of outpatient follow-up treatment in the population studied. Public health care policies that allow asthma control programs to work effectively should be implemented.

 


Keywords: Asthma; Hospitalization; Ambulatory care.

 


Perception of asthma control in asthma patients

A percepção do controle dos sintomas em pacientes asmáticos

Eduardo Vieira Ponte, Jaqueline Petroni, Daniela Campos Borges Ramos, Luciana Pimentel, Daise Naiane Freitas, Álvaro A Cruz

J Bras Pneumol.2007;33(6):635-640

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Objective: To determine the proportion of asthma patients with poor perception of asthma control and to evaluate the characteristics of this subgroup. Methods: A cross-sectional study in which consecutive outpatients (over the age of 12) with mild, moderate, or severe asthma were selected. The patients underwent clinical examination, and pulmonary function tests, as well as being assessed for depression and perception of asthma control. The degree of concordance between patients and physicians regarding the perception of asthma control was determined. Patients with good perception of asthma control were compared, in terms of characteristics, with those presenting poor perception. Results: The degree of concordance between patients and physicians regarding the perception of asthma control was low (kappa index = 0.5). Of the 289 patients included, 66 (23%) presented poor perception of asthma control. The preliminary univariate analysis revealed that the patients with poor perception of asthma control were older, had a lower income, and presented a lower degree of asthma severity. Those factors did not change in the multivariate analysis. There were no differences between the groups in terms of gender, frequency of having literate patients, duration of asthma symptoms, having been diagnosed with rhinitis, frequency of depression, pulmonary function, or treatment compliance. Conclusions: The incidence of poor perception of asthma control in asthma patients is high, especially in elderly patients with lower income and a lower degree of asthma severity.

 


Keywords: Asthma; Signs and symptoms; Asthma/therapy.

 


Brazilian ratification of the Framework Convention on Tobacco Control: a question of public health

A ratificação da Convenção-Quadro para o Controle do Tabaco pelo Brasil: uma questão de saúde pública

Ricardo Henrique Sampaio Meirelles

J Bras Pneumol.2006;32(1):2-3

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Latent tuberculosis and the use of immunomodulatory agents.

A tuberculose latente e o uso de imunomoduladores.

Fábio Silva Aguiar1,a, Fernanda Carvalho de Queiroz Mello1,b.

J Bras Pneumol.2019;45(6):e20190361-e20190361

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The utility of molecular biology in the diagnosis of tuberculosis

A utilidade da biologia molecular no diagnóstico da tuberculose

Fernanda Carvalho de Queiroz Mello, Joseane Fonseca-Costa

J Bras Pneumol.2005;31(3):188-190

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Usefulness of chest CT in the diagnosis of pulmonary sequestration

A utilidade da TC de tórax no diagnóstico do sequestro pulmonar

José Gustavo Pugliese, Thiago Prudente Bártholo, Heron Teixeira Andrade dos Santos, Eduardo Haruo Saito, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2010;36(2):260-264

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Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.

 


Keywords: Hemoptysis; Bronchopulmonary sequestration; Tomography, spiral computed.

 


Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

Hugo Hyung Bok Yoo, Fabiana Guandalini Mendes, Christine Elisabete Rubio Alem, Alexandre Todorovic Fabro, José Eduardo Corrente, Thaís Thomaz Queluz

J Bras Pneumol.2004;30(5):426-432

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Background: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. Objective: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. Method: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. Results: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p<0.0001), diseases of the digestive system (p=0.0001), neoplasia (p=0.024) and trauma (p=0.005) were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%). Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012) and pelvic veins (p=0.015) were associated with fatal PTE. Conclusion: A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.

 


Keywords: Autopsy. Epidemiology. Pulmonary Thromboembolism.

 


Radiological findings in patients with obstructive sleep apnea

Achados radiológicos em pacientes portadores de apneia obstrutiva do sono

Carlos Fernando de Mello Junior, Hélio Antonio Guimarães Filho, Camila Albuquerque de Brito Gomes, Camila Caroline de Amorim Paiva

J Bras Pneumol.2013;39(1):98-101

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Resumo

A apneia obstrutiva do sono (AOS) é caracterizada por obstruções recorrentes das vias aéreas superiores durante o sono que ocorrem no nível da faringe. Apesar de a análise cefalométrica ser um importante método no diagnóstico das deformidades craniofaciais, a TC e a ressonância magnética vêm se destacando como os principais métodos de imagem para a investigação das eventuais causas da AOS que, na maioria das vezes, é multifatorial. Esses métodos permitem uma excelente avaliação nos diversos planos anatômicos do eventual sítio da obstrução, o que permite uma melhor avaliação clínica e abordagem cirúrgica. O presente ensaio pictórico tem como objetivo descrever os aspectos que devem ser avaliados no diagnóstico por imagem dos principais fatores predisponentes para a AOS.

 


Palavras-chave: Síndromes da apneia do sono; Imagem por ressonância magnética; Tomografia computadorizada por raios X.

 


Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients

Acurácia diagnóstica do protocolo de ultrassom pulmonar à beira do leito em situações de emergência para diagnóstico de insuficiência respiratória aguda em pacientes com ventilação espontânea

Felippe Leopoldo Dexheimer Neto, Juliana Mara Stormovski de Andrade, Ana Carolina Tabajara Raupp, Raquel da Silva Townsend, Fabiana Gabe Beltrami, Hélène Brisson, Qin Lu, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2015;41(1):58-64

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Objective: Bedside lung ultrasound (LUS) is a noninvasive, readily available imaging modality that can complement clinical evaluation. The Bedside Lung Ultrasound in Emergency (BLUE) protocol has demonstrated a high diagnostic accuracy in patients with acute respiratory failure (ARF). Recently, bedside LUS has been added to the medical training program of our ICU. The aim of this study was to investigate the accuracy of LUS based on the BLUE protocol, when performed by physicians who are not ultrasound experts, to guide the diagnosis of ARF. Methods: Over a one-year period, all spontaneously breathing adult patients consecutively admitted to the ICU for ARF were prospectively included. After training, 4 non-ultrasound experts performed LUS within 20 minutes of patient admission. They were blinded to patient medical history. LUS diagnosis was compared with the final clinical diagnosis made by the ICU team before patients were discharged from the ICU (gold standard). Results: Thirty-seven patients were included in the analysis (mean age, 73.2  14.7 years; APACHE II, 19.2  7.3). LUS diagnosis had a good agreement with the final diagnosis in 84% of patients (overall kappa, 0.81). The most common etiologies for ARF were pneumonia (n = 17) and hemodynamic lung edema (n = 15). The sensitivity and specificity of LUS as measured against the final diagnosis were, respectively, 88% and 90% for pneumonia and 86% and 87% for hemodynamic lung edema. Conclusions: LUS based on the BLUE protocol was reproducible by physicians who are not ultrasound experts and accurate for the diagnosis of pneumonia and hemodynamic lung edema.

 


Keywords: Ultrasonography, interventional; Respiratory insufficiency; Intensive care units.

 


Adaptation to different noninvasive ventilation masks in critically ill patients

Adaptação a diferentes interfaces de ventilação mecânica não invasiva em pacientes críticos

Renata Matos da Silva, Karina Tavares Timenetski, Renata Cristina Miranda Neves, Liane Hirano Shigemichi, Sandra Sayuri Kanda, Carla Maekawa, Eliezer Silva, Raquel Afonso Caserta Eid

J Bras Pneumol.2013;39(4):-

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Objective: To identify which noninvasive ventilation (NIV) masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. Methods: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. Results: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%). Total face masks were the most commonly used (in 74.7%), followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively). Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. Conclusions: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.

 


Keywords: Intermittent positive-pressure ventilation; Masks; Respiratory insufficiency.

 


Cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review for use in patients with pulmonary hypertension in Colombia

Adaptación transcultural de la escala Cambridge Pulmonary Hypertension Outcome Review en pacientes con hipertensión pulmonar en Colombia

Claudio Villaquirán1,2,a, Socorro Moreno3,b, Rubén Dueñas4,c, Paola Acuña5,d, Juan Ricardo Lutz2,e, Jeanette Wilburn6,f, Alice Heaney6,g

J Bras Pneumol.2019;45(6):e20180332-e20180332

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Objective: To conduct a cross-cultural adaptation of the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) as an instrument to evaluate the perception of symptoms, functional limitation, and health-related quality of life (HRQoL) in subjects diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) in Colombia. Methods: The adaptation process involved 3 phases: translation, cognitive debriefing interviews, and a validation survey. To evaluate the psychometric properties, we recruited individuals ≥ 18 years of age who had been diagnosed with PAH or CTEPH to take part in the latter two stages of the adaptation process. All individuals were being followed on an outpatient basis by the pulmonary hypertension programs at Hospital Universitario San Ignacio, Fundación Clínica Shaio,and Clínicos IPS, all located in the city of Bogotá, Colombia. Results: A Spanish-language version of the CAMPHOR was developed for use in Colombia. The internal consistency was excellent for the symptoms, functioning, and quality of life scales (Cronbach's alpha coefficients of 0.92, 0.87, and 0.93, respectively). Test-retest reliability was above 0.70. The evaluation of the convergent validity and known group validity of the CAMPHOR scales confirmed that there were moderate and strong correlations with the related constructs of the Medical Outcomes Study 36-item Short-Form Health Survey, version 2, as well as showing their capacity to discriminate disease severity. Conclusions: The Spanish-language version of the CAMPHOR developed for use in Colombia was the result of a translation and cultural adaptation process that allows us to consider it equivalent to the original version, having shown good psychometric properties in the study sample. Therefore, its use to assess the impact of interventions on the HRQoL of patients with PAH or CTEPH is recommended, in research and clinical practice.

 


Keywords: Quality of life; Hypertension, pulmonary; Pulmonary embolism; Psychometrics.

 


Lung adenocarcinoma, dermatomyositis, and Lambert-Eaton myasthenic syndrome: a rare combination

Adenocarcinoma pulmonar, dermatomiosite e síndrome miastênica de Lambert-Eaton: uma rara associação

Fernanda Manente Milanez, Carlos Alberto de Castro Pereira, Pedro Henrique Duccini Mendes Trindade, Ricardo Milinavicius, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2008;34(5):333-336

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The incidence of lung neoplasms is increasing in Brazil and in the world, probably as a result of the increase in smoking. Due to the greater number of cases, atypical presentations appear. We report the case of a 66-year-old hypertensive male smoker who presented progressive proximal muscular weakness and, in two months, evolved to dysphagia, dysphonia, and V-shaped skin lesions on the chest. A chest X-ray showed a spiculated pulmonary nodule in the right upper lobe. The biochemical analysis revealed elevated creatine kinase levels. After complementary tests and biopsies, the patient underwent right upper lobectomy. Histopathology showed a moderately differentiated adenocarcinoma. The overall analysis of the case and a review of the literature allow us to suggest that the clinical profile of the patient was a result of an overlap of two paraneoplastic syndromes (dermatomyositis and Lambert-Eaton myasthenic syndrome) secondary to lung adenocarcinoma.

 


Keywords: Lung neoplasms; Paraneoplastic syndromes; Dermatomyositis; Lambert-Eaton myasthenic syndrome; Adenocarcinoma.

 


Treatment compliance of patients with paracoccidioidomycosis in Central-West Brazil

Adesão ao tratamento de pacientes com paracoccidioidomicose na Região Centro-Oeste do Brasil

Ursulla Vilella Andrade1,a, Sandra Maria do Valle Leone de Oliveira1,b, Marilene Rodrigues Chang1,c, Edy Firmina Pereira1,d, Ana Paula da Costa Marques1,e, Lidia Raquel de Carvalho2,f, Rinaldo Poncio Mendes2,g, Anamaria Mello Miranda Paniago1,h

J Bras Pneumol.2019;45(2):e20180167-e20180167

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Objective: To evaluate the treatment compliance of patients with paracoccidioidomycosis. Methods: We studied 188 patients with paracoccidioidomycosis admitted to a tertiary referral hospital in the Central-West Region of Brazil from 2000 to 2010, to assess their compliance to treatment. In order to be considered compliant, patients needed to present two established criteria: (1) receive medicines from the pharmacy, and (2) achieve a self-reported utilization of at least 80% of the dispensed antifungal compounds prescribed since their previous appointment. Results: Most patients were male (95.7%), had the chronic form of the disease (94.2%), and were treated with cotrimoxazole (86.2%). Only 44.6% of patients were treatment compliant. The highest loss to follow-up was observed in the first 4 months of treatment (p < 0.02). Treatment compliance was higher for patients with than for those without pulmonary involvement (OR: 2.986; 95%CI 1.351-6.599), and higher for patients with than without tuberculosis as co-morbidity (OR: 2.763; 95%CI 1.004-7.604). Conclusions: Compliance to paracoccidioidomycosis treatment was low, and the period with the highest loss to follow-up corresponds to the first four months. Pulmonary paracoccidioidal involvement or tuberculosis comorbidity predicts a higher compliance to paracoccidioidomycosis therapy.

 


Keywords: Paracoccidioidomycosis; Treatment adherence and compliance; loss to follow-up; mycoses

 


Adherence to treatment in patients with cystic fibrosis

Adesão ao tratamento em pacientes com fibrose cística

Paulo de Tarso Roth Dalcin, Greice Rampon, Lílian Rech Pasin, Gretchem Mesquita Ramon, Claudine Lacerda de Oliveira Abrahão, Viviane Ziebell de Oliveira

J Bras Pneumol.2007;33(6):663-670

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Objectives: To evaluate the self-reported degree of adherence to treatment in patients with cystic fibrosis (CF), investigating associations with characteristics of the disease and with the degree of adherence perceived by health professionals. Methods: This was a prospective, cross-sectional study involving patients with CF monitored at a Program for Adults with CF. The degree of adherence was evaluated using a questionnaire. Patients were divided into two groups: greater degree of adherence and moderate/poor degree of adherence. Clinical data, Shwachman-Kulczycki clinical score, Brasfield radiographic score and spirometry data were obtained for all patients. Results: Out of 38 patients studied, 31 (81.6%) were classified as presenting a greater degree of adherence and 7 (18.4%) as presenting a moderate/poor degree of adherence. The self-reported patient adherence score correlated with the clinical score (r = −0.36, p = 0.028). The self-reported patient adherence score (median = 0.79) was higher than that perceived by health professionals (median = 0.71, p = 0.003). A greater degree of adherence was self-reported for respiratory therapy (by 84.2%), exercise (by 21.1%), prescribed diet (by 65.8%), pancreatic enzymes (by 96.3%), vitamins (by 79.4%), inhaled antibiotic therapy (by 76.7%) and inhaled DNase (by 79.4%). Conclusions: Self-reported adherence of patients attending a Program for Adults with CF was good. The self-reported patient adherence score correlated inversely with the clinical score. Self-reported patient adherence was greater than the adherence perceived by health professionals.

 


Keywords: Cystic fibrosis; Patient compliance; Therapeutics.

 


Adhesiveness and purulence of respiratory secretions: implications for mucociliary transport in patients with bronchiectasis

Adesividade e purulência de secreções respiratórias: implicações no transporte mucociliar em pacientes com bronquiectasias

Joana Tambascio, Roberta Marques Lisboa, Rita de Cássia Vianna Passarelli, José Antonio Baddini Martinez, Ada Clarice Gastaldi

J Bras Pneumol.2010;36(5):545-553

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Objective: To analyze and compare the transport properties of respiratory secretions, classified by selected parameters, in individuals with bronchiectasis unrelated to cystic fibrosis. Methods: We collected mucus samples from 35 individuals with bronchiectasis unrelated to cystic fibrosis. The samples were first classified by their surface properties (adhesive or nonadhesive), as well as by their aspect (mucoid or purulent). We then tested the samples regarding relative transport velocity (RTV), displacement in a simulated cough machine (SCM), and contact angle (CA). For the proposed comparisons, we used ANOVA models, with a level of significance set at 5%. Results: In comparison with nonadhesive samples, adhesive samples showed significantly less displacement in the SCM, as well as a significantly higher CA (6.52 ± 1.88 cm vs. 8.93 ± 2.81 cm and 27.08 ± 6.13° vs. 22.53 ± 5.92°, respectively; p < 0.05 for both). The same was true in the comparison between purulent and mucoid samples (7.57 ± 0.22 cm vs. 9.04 ± 2.48 cm and 25.61 ± 6.12° vs. 21.71 ± 5.89°; p < 0.05 for both). There were no significant differences in RTV among the groups of samples, although the values were low regardless of the surface properties (adhesive: 0.81 ± 0.20; nonadhesive: 0.68 ± 0.24) or the aspect (purulent: 0.74 ± 0.22; mucoid: 0.82 ± 0.22). Conclusions: The respiratory secretions of patients with bronchiectasis showed decreased mucociliary transport. Increased adhesiveness and purulence cause the worsening of transport properties, as demonstrated by the lesser displacement in the SCM and the higher CA.

 


Keywords: Bronchiectasis; Mucus; Mucociliary clearance; Adhesiveness.

 


Admissão do Jornal de Pneumologia na SciELO Brasil: uma vitória com novos desafios

Thaís Helena Abrahão Thomaz Queluz

J Bras Pneumol.2002;28(1):-

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Speeding up the diagnosis of multidrug-resistant tuberculosis in a high-burden region with the use of a commercial line probe assay

Agilizando o diagnóstico da tuberculose multirresistente em uma região endêmica com o uso de um teste comercial de sondas em linha

Angela Pires Brandao1,2,a, Juliana Maira Watanabe Pinhata1,b, Rosangela Siqueira Oliveira1,c, Vera Maria Neder Galesi3,d, Helio Hehl Caiaffa-Filho1,e, Lucilaine Ferrazoli1,f

J Bras Pneumol.2019;45(2):e20180128-e20180128

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Objective: To evaluate the rapid diagnosis of multidrug-resistant tuberculosis, by using a commercial line probe assay for rifampicin and isoniazid detection (LPA-plus), in the routine workflow of a tuberculosis reference laboratory. Methods: The LPA-plus was prospectively evaluated on 341 isolates concurrently submitted to the automated liquid drug susceptibility testing system. Results: Among 303 phenotypically valid results, none was genotypically rifampicin false-susceptible (13/13; 100% sensitivity). Two rifampicin-susceptible isolates harboured rpoB mutations (288/290; 99.3% specificity) which, however, were non-resistance-conferring mutations. LPA-plus missed three isoniazid-resistant isolates (23/26; 88.5% sensitivity) and detected all isoniazid-susceptible isolates (277/277; 100% specificity). Among the 38 (11%) invalid phenotypic results, LPA-plus identified 31 rifampicin- and isoniazid-susceptible isolates, one isoniazid-resistant and six as non-Mycobacterium tuberculosis complex. Conclusions: LPA-plus showed excellent agreement (≥91%) and accuracy (≥99%). Implementing LPA-plus in our setting can speed up the diagnosis of multidrug-resistant tuberculosis, yield a significantly higher number of valid results than phenotypic drug susceptibility testing and provide further information on the drug-resistance level.

 


Keywords: Tuberculosis, multidrug-resistant; Molecular diagnostic techniques; Microbial sensitivity tests; Mycobacterium tuberculosis.

 


Morphological lesions induced by oleic acid in lungs of rats

Alterações morfológicas induzidas pelo ácido oléico em pulmões de ratos

Thais Helena A.T. Queluz, Júlio Defaveri, Silene El-Fakhouri

J Bras Pneumol.1997;23(5):245-251

Abstract PDF PT

Because it has direct and indirect action on lung tissue, oleic acid (OA) has been used experimentally as a model of fat embolism and acute respiratory distress syndrome (ARDS). The aim of this study was to describe acute and chronic pulmonary lesions induced in rats by intravenous injection of OA. Male Wistar rats were injected a 0.05 ml dose of OA. Groups of 5 animals were sacrificed 2, 24, 48 hours, and 5, 10, 30, and 90 days after injection. Diffuse alveolar edema, foci of intra-alveolar hemorrhage, and foci of ischemic necrosis were observed by light microscopic from 2 to 48 hours. At this period of time, severe endothelial injuries and type II alveolar cell lesions were observed on electron microscopy. After the fifth day, no injury was observed and discrete morphological sequelae were found. The lungs of the animals sacrificed at the thirtieth and ninetieth days were identical to those of the control groups. The present model allows animal to survive, being suitable for studies on fat embolism and on ARDS.

 


Keywords: Oleic acid. Fat embolism. Acute respiratory distress syndrome, ARDS. Experimental model.

 


Lung alterations in a rat model of diabetes mellitus: effects of antioxidant therapy

Alterações pulmonares em um modelo de diabetes mellitus em ratos: o efeito da terapia antioxidante

Luiz Alberto Forgiarini Junior, Nélson Alexandre Kretzmann, Juliana Tieppo, Jaqueline Nascimento Picada, Alexandre Simões Dias, Norma Anair Possa Marroni

J Bras Pneumol.2010;36(5):579-587

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate structural alterations of the lung in rats with diabetes mellitus (DM), by quantifying oxidative stress and DNA damage, as well as to determine the effects that exogenous superoxide dismutase (SOD) has on such alterations. Methods: A controlled experimental study involving 40 male Wistar rats, divided into four groups (10 animals each): control; SOD-only (without DM but treated with SOD); IDM-only (with streptozotocin-induced DM but untreated); and IDM+SOD (with streptozotocin-induced DM, treated with SOD). The animals were evaluated over a 60-day period, day 0 being defined as the day on which the streptozotocin-injected animals presented glycemia > 250 mg/dL. The SOD was administered for the last 7 days of that period. At the end of the study period, samples of lung tissue were collected for histopathological analysis, evaluation of tissue oxidative stress, and assessment of DNA damage. Results: There were no significant differences among the groups regarding DNA damage. In the IDM-only group, there was a significant increase in the extracellular matrix and significantly greater hyperplasia of the capillary endothelium than in the SOD-only and control groups. In addition, there were significant changes in type II pneumocytes and macrophages, suggesting an inflammatory process, in the IDM-only group. However, in the IDM+SOD group, there was a reduction in the extracellular matrix, as well as normalization of the capillary endothelium and of the type II pneumocytes. Conclusions: Exogenous SOD can reverse changes in the lungs of animals with induced DM.

 


Keywords: Diabetes mellitus, experimental; Oxidative stress; Lung; DNA damage.

 


Alterações pulmonares na macroglobulinemia de Waldenström

Renato de Albuquerque Medeiros, Jucineide Araújo, José Kerbauy, Miguel Bogossian

J Bras Pneumol.1997;23(2):110-112

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Respiratory findings in sudden unexpected death in epilepsy: a point of convergence for clinical pulmonologists and neurologists

Alterações respiratórias e morte súbita em epilepsia: um ponto de convergência para pneumologistas clínicos e neurologistas

Fulvio Alexandre Scorza, Vera Cristina Terra, Marly de Albuquerque, Esper Abrão Cavalheiro

J Bras Pneumol.2009;35(6):613-614

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Pulmonary changes on HRCT scans in nonsmoking females with COPD due to wood smokeexposure

Alterações tomográficas pulmonares em mulheres não fumantes com DPOC porexposição à fumaça da combustão de lenha

Maria Auxiliadora Carmo Moreira, Maria Alves Barbosa, Maria Conceição de Castro AntonelliMonteiro de Queiroz, Kim Ir Sen Santos Teixeira, Pedro Paulo Teixeira e Silva Torres,Pedro José de Santana Júnior, Marcelo Eustáquio Montadon Júnior, José Roberto Jardim

J Bras Pneumol.2013;39(2):155-163

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify and characterize alterations seen on HRCT scans in nonsmoking females with COPD due to wood smoke exposure. Methods: We evaluated 42 nonsmoking females diagnosed with wood smoke-related COPD and 31 nonsmoking controls with no history of wood smoke exposure or pulmonary disease. The participants completed a questionnaire regarding demographic data, symptoms, and environmental exposure. All of the participants underwent spirometry and HRCT of the chest. The COPD and control groups were adjusted for age (23 patients each). Results: Most of the patients in the study group were diagnosed with mild to moderate COPD (83.3%). The most common findings on HRCT scans in the COPD group were bronchial wall thickening, bronchiectasis, mosaic perfusion pattern, parenchymal bands, tree-in-bud pattern, and laminar atelectasis (p < 0.001 vs. the control group for all). The alterations were generally mild and not extensive. There was a positive association between bronchial wall thickening and hour-years of wood smoke exposure. Centrilobular emphysema was uncommon, and its occurrence did not differ between the groups (p = 0.232). Conclusions: Wood smoke exposure causes predominantly bronchial changes, which can be detected by HRCT, even in patients with mild COPD.

 


Palavras-chave: Biomassa; Fumaça; Tomografia computadorizada por raios X; Doença pulmonar obstrutiva crônica.

 


Environment and lung

Ambiente e pulmão

Maria João Marques Gomes

J Bras Pneumol.2002;28(5):261-269

Abstract PDF PT

The human body is exposed to different environmental aggressions; accidents, physical, chemical, and microbiological agents are a permanent risk. The respiratory system is particularly exposed to environmental aggressions and is frequently ground of alterations with greater or lesser intensity and danger. The authors review the consequences of air pollution on the respiratory system. They define air pollution, indoor and outdoor pollution, and primary and secondary pollution. They briefly review respiratory system defense mechanisms and describe harmful actions of different air pollutants to airways: SO2, NO2, CO, O3, aerosols and particles. They point to the consequences of tobacco smoking due to its importance to health. They conclude with comments on the intervention that Pneumology and Pneumologists should have in this matter, drawing the attention of the community and authorities to the risks of pollution to health in general and to the respiratory system in particular.

 



Tracheobronchial amyloidosis

Amiloidose traqueobrônquica

Luciano Müller Corrêa da Silva, Jamila Bellicanta, Renata Diniz Marques, Luiz Carlos Corrêa da Silva

J Bras Pneumol.2004;30(6):581-584

Abstract PDF PT PDF EN

Amyloidosis is a disease characterized by extracellular deposition of pathologic fibrillar protein in organs and tissues. Diffuse primary tracheobronchial amyloidosis is rare. Herein, we report a case of a male patient with diffuse tracheobronchial amyloidosis, initially diagnosed as bronchial asthma.

 


Keywords: Asthma/pathology. Amyloidosis/diagnosis. Trachea/pathology.

 


Comparative analysis and reproducibility of the modified shuttle walk test in normal children and in children with cystic fibrosis

Análise comparativa e reprodutibilidade do teste de caminhada com carga progressiva (modificado) em crianças normais e em portadoras de fibrose cística

Cristiane Cenachi Coelho, Evanirso da Silva Aquino, Dorcas Costa de Almeida, Gisele Caroline Oliveira, Roberta de Castro Pinto, Ivana Mara Oliveira Rezende, Cíntia Passos

J Bras Pneumol.2007;33(2):168-174

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the shuttle walk test, and its respective retest, comparing children with cystic fibrosis (CF) to normal children. Methods: The children were divided into two groups: the CF group, composed of children in whom the diagnosis had been confirmed through sweat testing; and the control group, composed of normal children with no history of pulmonary diseases and no alterations in respiratory function. The children were submitted to at least two consecutive tests, 30 min apart. We evaluated distance walked, cardiac overload, peripheral oxygen saturation (SpO2) and subjective perception of exertion (dyspnea at rest scale and Borg dyspnea scale). Results: A total of 28 children were evaluated. Ages ranged from 7 to 15 years (11.57 ± 2.50 and 11.28 ± 1.85 years for the CF and control groups, respectively). The Borg scale scores were significantly higher in the controls (p = 0.007). No differences were found regarding cardiac overload and SpO2. In relation to the intergroup retest, the controls presented significant improvements on the second test, both in the distance walked and in dyspnea at rest (p = 0.014 and p = 0.036, respectively). The CF group presented a significant improvement only in the dyspnea at rest score (p = 0.168 and p = 0.042, respectively). Conclusion: The cardiac overload imposed by the test did not differ between the groups. The greater fatigue at the beginning of the second test suggests that the 30 min rest between the tests was insufficient.

 


Keywords: Cystic fibrosis; Exercise test; Heart rate.

 


Analysis of hospitalizations for respiratory diseases in Tangará da Serra, Brazil

Análise das internações por doenças respiratórias em Tangará da Serra - Amazônia Brasileira

Antonia Maria Rosa, Eliane Ignotti, Sandra de Souza Hacon, Hermano Albuquerque de Castro

J Bras Pneumol.2008;34(8):575-582

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze hospitalizations for respiratory diseases among children under 15 years of age in an area with high levels of environmental pollution. Methods: A cross-sectional study of hospitalizations due to respiratory diseases of patients residing in the city of Tangará da Serra, located in the state of Mato Grosso (Brazilian Amazon region), from 2000 to 2005. Data on hospital admissions were obtained from the Brazilian Unified Health Care System and from Brazilian Institute of Geography and Statistics population estimates. Results: In 2005, the rate of hospitalization for respiratory diseases among children under 15 years of age in the microregion of Tangará da Serra was 70.1/1,000 children. Between 2000 and 2005, there were 12,777 such admissions, of which 8,142 (63.7%) were for respiratory diseases. During the dry season (May to October), the rate of admissions for respiratory diseases was 10% higher than during the rainy season (November to April). The principal causes of admission included pneumonia (90.7%) and respiratory insufficiency (8.5%). Admissions of children under 5 years of age for pneumonia were 4 times the expected number for the city. Children under 12 months of age were the most frequently hospitalized, with an average increase of 32.4 admissions per 1,000 children per year. Conclusions: Tangará da Serra presented a high number of pediatric admissions for respiratory diseases. Therefore, it is logical to consider it a priority area for investigation and monitoring of the environmental risk factors for such diseases.

 


Keywords: Respiratory tract diseases; Pneumonia; Hospitalization; Climate; Air pollution/Brazil.

 


Analysis of 39 cases of idiopathic chronic interstitial pneumonia

Análise de 39 casos de pneumonia intersticial crônica idiopática

Rogério Rufino, Leonardo Rizzo, Cláudia Henrique da Costa, Roberto José de Lima, Kalil Madi

J Bras Pneumol.2006;32(6):505-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. Methods: Samples from 252 open-lung biopsies of patients with interstitial lung disease, all performed between 1977 and 1999, were reviewed, and 39 cases of idiopathic interstitial lung disease were selected and re-evaluated by two pathologists in accordance with the American Thoracic Society/European Respiratory Society classification system. Results: Among those 39 cases, the diagnoses were maintained in 28 (71.8%). A new pathologic entity, nonspecific interstitial pneumonia, was included in the reclassification, and overlapping patterns were observed in 6 cases. Of the 28 cases in which the diagnosis of chronic idiopathic interstitial pneumonia remained unchanged, idiopathic pulmonary fibrosis was accompanied by cryptogenic organizing pneumonia in 4, cryptogenic organizing pneumonia was accompanied by nonspecific interstitial pneumonia in 1, and desquamative interstitial pneumonia was accompanied by nonspecific interstitial pneumonia in 1. All cases of idiopathic pulmonary fibrosis were confirmed, although 3 of those were found to be accompanied by cryptogenic organizing pneumonia. Virtually all prior diagnoses were maintained in the review of the biopsy samples (p > 0,05). Conclusion: The American Thoracic Society/European Respiratory Society system of classifying interstitial lung disease is a useful tool for pathologists who deal with lung biopsies.

 


Keywords: Pulmonary fibrosis; Lung diseases, interstitial

 


Analysis of the Tuberculosis Control Program in the city of Cáceres, Brazil, prior to and after the implementation of a Family Health Program

Análise do Programa de Controle da Tuberculose em Cáceres, Mato Grosso, antes e depois da implantação do Programa de Saúde da Família

Eliane Ignotti, Beatriz Fátima Alves de Oliveira, Shaiana Hartwig, Hellen Caroline de Oliveira, João Henrique Gurtler Scatena

J Bras Pneumol.2007;33(3):287-294

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the effectiveness of the Tuberculosis Control Program, in conjunction with the recently incorporated Family Health Program, in the city of Cáceres, Brazil, between 1999 and 2004. Methods: This was a descriptive epidemiological study, based on the registry of tuberculosis cases diagnosed and treated in Cáceres, according to the characteristics of the cases diagnosed, whether or not the protocol for diagnosis, treatment, and monitoring of patients was followed, as well as the type of health care facility involved. Results: The incidence of tuberculosis was reduced from 99.4 to 49.8 (per 100,000 inhabitants) between 1999 and 2004. The patients presented characteristics similar to those of patients from other regions of Brazil, with a predominance of males during their most economically productive years. Among the patients presenting pulmonary forms and treated via the Family Health Program, there was a reduction in the number of sputum smear microscopies performed at the moment of diagnosis (OR = 0.33; 95%CI: 0.16-0.66) and prior to discharge (OR = 0.32; 95%CI: 0.18‑0.59). The patients monitored via the Family Health Program presented a 16.4% lower cure rate than did those treated at the referral center, as well as being more likely to abandon treatment (OR = 2.93; 95%CI: 1.15-7.46) and to die (OR = 5.71; 95%CI: 1.85‑18.1). Conclusion: The decentralization of the treatment services to the family health clinics did not improve the treatment or monitoring of tuberculosis cases in the city of Cáceres.

 


Keywords: Tuberculosis/epidemiology; Community Health Services; Health care reform/Brazil.

 


Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo

Análise exploratória de solicitações de autorização para dispensação de medicação de alto custo para portadores de DPOC:

Regina Maria Carvalho-Pinto11,a, Ingredy Tavares da Silva1,2,b, Lucas Yoshio Kido Navacchia1,c, Flavia Munhos Granja1,2,d, Gustavo Garcia Marques1,2,e, Telma de Cassia dos Santos Nery1,f, Frederico Leon Arrabal Fernandes1,g, Alberto Cukier1,h, Rafael Stelmach1,i

J Bras Pneumol.2019;45(6):e20180355-e20180355

Abstract PDF PT PDF EN Portuguese Text

Objective: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. Methods: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. Results: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting β2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. Conclusions: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.

 


Keywords: Pulmonary disease, chronic obstructive; Clinical protocols; Drug costs; Tiotropium bromide.

 


Molecular analysis of Mycobacterium tuberculosis strains from an outpatient clinic in Porto Alegre, (RS)

Análise molecular de cepas de Mycobacterium tuberculosis provenientes de um centro de saúde ambulatorial em Porto Alegre, (RS)

Michele Borges; Patrícia Izquierdo Cafrune; Lia Gonçalves Possuelo; Andréia Rosane de Moura Valim; Marta Osório Ribeiro; Maria Lucia Rosa Rossetti

J Bras Pneumol.2004;30(4):448-454

Abstract PDF PT PDF EN

Background: Tuberculosis is an ancient disease, which still remains one of the major ills faced by mankind in the 21st century. In recent decades, new technologies employing the knowledge gained from molecular biology studies have allowed for more accurate detection of tuberculosis and increased investigation of the etiology and epidemiology of the disease. Aim: Evaluating the degree of similarity among strains of Mycobacterium tuberculosis provided by the Phthisiology Sector of Centro de Saúde Navegantes (Navegantes Health Clinic) in Porto Alegre, RS, Brazil. Method: A retrospective study was performed involving RFLP typing of 55 sputum samples from outpatients examined at the Centro de Saúde Navegantes. The results of the genotyping were correlated to the conventional epidemiology data. Results: A single pattern was seen in 39 (70.9%) of the isolates, whereas 16 isolates (29.1%) showed clustering patterns and were grouped into 8 clusters of 2 patients each. An epidemiological link was found for 6 (37.5%) of the 16 patients in the clusters. Conclusion: The appropriate combination of conventional epidemiology and genotyping of M. tuberculosis contributes to a better understanding of the dynamics of tuberculosis transmission even when such a study is performed in a single, isolated health clinic.

 


Keywords: Mycobacterium tuberculosis. Transmission. Polymorphism, Restriction Fragment Length. Epidemiology.

 


Pulmonary artery aneurysms in Behçet's disease: regression after immunosuppressive treatment

Aneurismas das artérias pulmonares na doença de Behçet: regressão após tratamento imunossupressor

Isabela Fernandes de Magalhães, Iugiro R. Kuroki, Agnaldo José Lopes, Elisa M.N. Albuquerque, Evandro Mendes Klumb, Aline Elisa Goulart

J Bras Pneumol.1999;25(3):176-180

Abstract PDF PT

Behçet's disease is a systemic disease with clinical manifestations, whose underlying histopathologic lesion is a non-specific vasculitis. Pulmonary artery aneurysms and, more rarely, pleuropulmonary manifestations may be found. Some reports are available in the literature about the use of immunosuppressive agents in these conditions. The authors describe a case in whom clinical remission and radiologic resolution were observed after corticosteroid and cyclophophamide therapy.

 


Keywords: Behçet's disease. Pulmonary artery aneurysms.

 


Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma

Anticorpos IgE específicos para superantígenos estafilocócicos: grau de sensibilização e associação com a gravidade da asma

José Elabras Filho1,2, Fernanda Carvalho de Queiroz Mello2, Omar Lupi1,3, Blanca Elena Rios Gomes Bica1, José Angelo de Souza Papi1, Alfeu Tavares França1

J Bras Pneumol.2016;42(5):356-361

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. Results: The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Conclusions: Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma.

 


Keywords: Asthma; Immunoglobulin E; Superantigens; Bacterial toxins; Staphylococcus aureus.

 


Applicability of the 12-Item Short-Form Health Survey in patients with progressive systemic sclerosis

Aplicabilidade do questionário de qualidade de vida relacionada à saúde - the 12-Item Short-Form Health Survey - em pacientes portadores de esclerose sistêmica progressiva

Thamine Lessa Andrade, Aquiles Assunção Camelier, Fernanda Warken Rosa, Marcia Pina Santos, Sérgio Jezler, Jorge Luiz Pereira e Silva

J Bras Pneumol.2007;33(4):414-422

Abstract PDF PT PDF EN Portuguese Text

To evaluate the applicability of the 12-Item Short-Form Health Survey (SF-12) as an instrument to measure health-related quality of life in a sample of patients with progressive systemic sclerosis (PSS) through the analysis of its reproducibility and its correlation with functional and clinical parameters. Methods: A test-retest reproducibility study for the comparative analysis of the intraclass correlation coefficients (ICCs) of the SF-12 and the SF-36. A total of 46 patients diagnosed with PSS were studied, regardless of the presence of respiratory symptoms. Results: The physical component summary 12 (PCS-12) score had an ICC of 0.47 (95%CI: 0.05-0.71; p < 0.02), whereas the mental component summary (MCS-12) score had an ICC of 0.72 (95%CI: 0.49-0.84; p < 0.001). The PCS-36 score had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001), and the MCS-36 score also had an ICC of 0.88 (95%CI: 0.78-0.93; p < 0.001). Conclusion: The SF-12 is a reliable instrument for measuring health-related quality of life in patients with PSS, since it has been proven to be reproducible. However, this version of the SF-12 should only be used in clinical research settings.

 


Keywords: Quality of life; Questionnaires; Statistics; Scleroderma, systemic.

 


Therapeutic application of collateral ventilation with pulmonary drainage in the treatment of diffuse emphysema: report of the first three cases

Aplicação terapêutica da ventilação colateral com drenagem pulmonar no tratamento do enfisema pulmonar difuso: relato dos três primeiros casos

Roberto Saad Junior, Vicente Dorgan Neto, Marcio Botter, Roberto Stirbulov, Jorge Henrique Rivaben, Roberto Gonçalves

J Bras Pneumol.2009;35(1):14-19

Abstract PDF PT PDF EN Portuguese Text

Objective: To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. Methods: Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the post-operative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means. Results: When the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied. Conclusions: The results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.

 


Keywords: Pulmonary emphysema; Lung diseases, obstructive; Lung, hyperlucent.

 


Obstructive sleep apnea and quality of life in elderly patients with a pacemaker

Apneia obstrutiva do sono e qualidade de vida em idosos portadores de marca-passo

Tatiana Albuquerque Gonçalves de Lima1,a, Evandro Cabral de Brito2,b, Robson Martins2,c, Sandro Gonçalves de Lima3,d, Rodrigo Pinto Pedrosa2,e

J Bras Pneumol.2019;45(1):e20170333-e20170333

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate quality of life in elderly patients with obstructive sleep apnea (OSA) who have a pacemaker. Methods: This was a cross-sectional study involving elderly patients (≥ 60 years of age) with a pacemaker. The dependent variable was quality of life, as evaluated with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Sociodemographic and clinical parameters, including anxiety and depression (Hospital Anxiety and Depression Scale score), as well as the presence of OSA (defined as an apnea-hypopnea index ≥ 15 events/h), were analyzed as independent variables. Patients with cognitive/neurological deficits or decompensated heart failure were excluded. Results: We evaluated 72 patients, 17 (23.6%) of whom presented OSA. Of those 17 patients, 9 (52.9%) were male. The mean age was 72.3 ± 9.3 years. A diagnosis of OSA was not associated with gender (p = 0.132), age (p = 0.294), or body mass index (p = 0.790). There were no differences between the patients with OSA and those without, in terms of the SF-36 domain scores. Fourteen patients (19.4%) presented moderate or severe anxiety. Of those 14 patients, only 3 (21.4%) had OSA (p = 0.89 vs. no OSA). Twelve patients (16.6%) had moderate or severe depression. Of those 12 patients, only 2 (16.6%) had OSA (p = 0.73 vs. no OSA). Conclusions: In elderly patients with a pacemaker, OSA was not found to be associated with quality of life or with symptoms of anxiety or depression.

 


Keywords: Quality of life; Aged; Sleep apnea, obstructive.

 


Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.

 


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.

 


Asthma and pregnancy: repercussions for neonates

Asma e gravidez: repercussões no recém-nascido

Maria Luiza Doria Almeida, Priscila Andrade Santana, Alzira Maria d'Ávila Nery Guimarães, Ricardo Queiroz Gurgel, Elcio Oliveira Vianna

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe socioeconomic and behavioral aspects of pregnant women with asthma and to analyze the effects of maternal asthma on certain perinatal parameters in a birth cohort. Methods: An observational cross-sectional analytical study using data regarding the mothers of a birth cohort at maternity hospitals in the greater metropolitan area of Aracaju, Brazil, between the 8th of March and the 15th of July of 2005. In the pregnant women, asthma was self-reported, based on previous medical diagnosis. Epidemiological, obstetric and perinatal variables were studied. Results: Of the 4,757 mothers included in the study, 299 (6.3%) had asthma. The mothers with asthma had lower family incomes and more frequently made use of the public health care system (for prenatal care and delivery) than did those without asthma. Although only 9.4% of the mothers with asthma smoked and only 27.6% consumed alcoholic beverages, these proportions were higher than were those observed for the control group. Asthma was not found to be associated with obstetric problems or with problems involving the neonates. Nor did we find asthma to be associated with cesarean delivery, prematurity or small-for-gestational-age neonates. Conclusions: Low socioeconomic level seems to be a risk factor for asthma.

 


Keywords: Asthma; Pregnancy; Socioeconomic factors; Infant, newborn.

 


Clinicopathological aspects of and survival in patients with clinical stage I bronchioloalveolar carcinoma

Aspectos clínico-patológicos do carcinoma bronquioloalveolar e sobrevida em pacientes no estágio clínico I

Daniel Sammartino Brandão, Rui Haddad, Giovanni Antonio Marsico, Carlos Henrique Ribeiro Boasquevisque

J Bras Pneumol.2010;36(2):167-174

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Objective: To analyze the clinicopathological aspects of bronchioloalveolar carcinoma (BAC) and the survival in a sample of patients at clinical stage I. Methods: A retrospective study involving 26 patients diagnosed with clinical stage I BAC and undergoing surgery at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, in the city of Rio de Janeiro, Brazil, between 1987 and 2007. We analyzed clinicopathological and radiological aspects, as well as mortality and survival. The data, which were collected from the medical charts of the patients, were statistically analyzed. Results: Females predominated (n = 16). The mean age at diagnosis was 68.5 years. Most patients were active smokers (69.2%). The most common forms of presentation of BAC were the asymptomatic form (84.6%) and the nodular form (88.5%). Involvement of the upper lobes predominated (57.7%). Stage IB was the most common pathological stage, followed by stages IA and IIB (46.2%, 38.4% and 15.4%, respectively). There was no in-hospital mortality. Four patients died during the postoperative follow-up, with a mean disease-free survival time of 21.3 months. The overall five-year survival rate was 83%. The probability of survival for the patients diagnosed after 1999 showed a trend toward an increase when compared with that for those diagnosed up through 1999 (three-year survival rate: 92% vs. 68%; p = 0.07). Conclusions: The clinicopathological aspects of this study sample were similar to those of patients with BAC evaluated in previous studies.

 


Keywords: Adenocarcinoma, bronchiolo-alveolar; Carcinoma, non-small-cell lung; Lung; Smoking.

 


Aspects of bronchioloalveolar carcinoma and of adenocarcinoma with a bronchioloalveolar component: CT findings

Aspectos tomográficos do carcinoma bronquíolo-alveolar e dos adenocarcinomas mistos com componente bronquíolo-alveolar

Pedro Paulo Teixeira e Silva Torres, Julia Capobianco, Marcelo Eustáquio Montandon Júnior, Gustavo Souza Portes Meirelles

J Bras Pneumol.2012;38(2):218-225

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Bronchioloalveolar carcinoma has various presentations and a wide spectrum of imaging patterns, as does adenocarcinoma with a bronchioloalveolar component. The objective of this essay was to describe and illustrate the CT findings that are most characteristic of these tumors. Three presentations are described: solitary pulmonary nodule, consolidation, and diffuse pattern. The last two should be included in the differential diagnosis, together with infectious diseases. Knowledge of the various presentations and the use of proper diagnostic procedures are crucial to early diagnosis and to improving survival.

 


Keywords: Lung neoplasms; Adenocarcinoma, bronchiolo-alveolar; Tomography, X-ray computed.

 


Foreign body aspiration in children and adolescents: experience of a Brazilian referral center

Aspiração de corpo estranho por menores de 15 anos: experiência de um centro de referência do Brasil

Sílvia Teresa Evangelista Vidotto de Sousa, Valdinar Sousa Ribeiro, José Mário de Menezes Filho, Alcione Miranda dos Santos, Marco Antonio Barbieri, José Albuquerque de Figueiredo Neto

J Bras Pneumol.2009;35(7):653-659

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Objective: To describe the clinical, radiological and endoscopic characteristics of foreign body aspiration among individuals under the age of 15 treated at a referral center in the city of São Luís, Brazil. Methods: This was a descriptive study using data from the medical charts of patients treated for foreign body aspiration at the Hospital Universitário Materno Infantil between 1995 and 2005. We investigated 72 confirmed cases of foreign body aspiration, evaluating the place of residence, as well as biological, clinical, radiological and endoscopic variables. We used the chi-square test to identify statistically significant differences in frequency among the variables studied. Results: The majority of the patients were from outlying areas (55.6%). The following variables presented the highest frequencies: 0-3 year age bracket (81.9%); male gender (63.9%); evolution > 24 h (66.7%); hypotransparency on chest X-ray (57.7%); foreign body in the right lung (41.2%) or in the larynx (20.5%); organic nature of the foreign body (83.3%); complication in the form of localized inflammation (59.4%); glottal edema as an endoscopic complication (47.6%); and seeds (46.6%), fish bone (28.3%) or plastics (25.5%) as the type of foreign body. There were no deaths. Conclusions: Preventive care should be a priority for male children under the age of 3 living in outlying areas. Such children should not be given access to substances that can be aspirated, including certain foodstuffs. Simple and easily accessible radiological tests have been underused, which jeopardizes the quality of the initial treatment.

 


Keywords: Foreign bodies; Inhalation; Bronchoscopy.

 


Association between nutritional status measurements and pulmonary function in children and adolescents with cystic fibrosis

Associação entre medidas do estado nutricional e a função pulmonar de crianças e adolescentes com fibrose cística

Célia Regina Moutinho de Miranda Chaves, José Augusto Alves de Britto, Cristiano Queiroz de Oliveira, Miriam Martins Gomes, Ana Lúcia Pereira da Cunha

J Bras Pneumol.2009;35(5):409-414

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Objective: To evaluate the association between nutritional status measurements and pulmonary function in children and adolescents with cystic fibrosis. Methods: We evaluated the nutritional status of 48 children and adolescents (aged 6-18 years) with cystic fibrosis based on body mass index (BMI) and body composition measurements-mid-arm muscle circumference (MAMC) and triceps skinfold thickness (TST)-at a referral center in the city of Rio de Janeiro, Brazil. Pulmonary function was assessed by means of spirometry, using FEV1 to classify the severity of airway obstruction. We used Student's t-tests for comparisons between proportions and linear regression analysis for associations between continuous variables. The level of significance was set at p < 0.05. Results: The evaluation of nutritional status based on BMI identified a smaller number of malnourished patients than did that based on MAMC (14 vs. 25 patients, respectively). Most of the patients presented mild pulmonary disease. Mean FEV1 was 82.5% of predicted. Pulmonary function was found to correlate significantly with BMI, MAMC and TST (p = 0.001, p = 0.001 and p = 0.03, respectively). All subjects with moderate or severe pulmonary involvement were considered malnourished based on BMI and body composition parameters. Of the 25 patients considered malnourished based on body composition (MAMC), 19 were considered well-nourished based on their BMI. Conclusions: In the present study, all nutritional status measurements correlated directly with the pulmonary function of children and adolescents with cystic fibrosis. However, body composition measurements allowed earlier detection of nutritional deficiencies.

 


Keywords: Cystic fibrosis; Body composition; Spirometry; Nutrition assessment.

 


Association between paracoccidioidomycosis and tuberculosis: reality and misdiagnosis

Associação entre paracoccidioidomicose e tuberculose: realidade e erro diagnóstico

Reynaldo Quagliato Júnior, Tiago de Araújo Guerra Grangeia, Reinaldo Alexandre de Carvalho Massucio, Eduardo Mello De Capitani, Sílvio de Moraes Rezende, Alípio Barbosa Balthazar

J Bras Pneumol.2007;33(3):295-300

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Objective: To evaluate the frequency of the real association between paracoccidioidomycosis (PCM) and tuberculosis (TB) as well as the rate of previous TB misdiagnosis in individuals with PCM among the patients treated in the Pulmonology Division of the State University of Campinas Hospital das Clínicas, Campinas, Brazil. Methods: A retrospective study of 227 adult patients with PCM (chronic form) treated between 1980 and 2005. Results: Of the 227 patients studied, 36 (15.8%) had been previously treated for TB. However, only 18 (7.9%) presented positive sputum smear microscopy results. The remaining 18 (7.9%) neither presented positive sputum smear microscopy nor showed improvement after receiving specific anti-TB treatment. Conclusion: Although the existence of an association between PCM and TB has been documented in the literature, misdiagnosis is common due to the superimposition of and the similarity between their clinical and radiographic presentations, thereby warranting the need for bacteriological diagnosis before initiating specific treatment.

 


Keywords: Paracoccidioidomycosis; Tuberculosis, pulmonary; Diagnosis, differential.

 


Association between serum selenium level and conversion of bacteriological tests during antitu-berculosis treatment

Associações entre níveis de selênio sérico e conversão de testes bacteriológicos durante o tratamento antituberculose

Milena Lima de Moraes, Daniela Maria de Paula Ramalho, Karina Neves Delogo, Pryscila Fernandes Campino Miranda, Eliene Denites Duarte Mesquita, Hedi Marinho de Melo Guedes de Oliveira, Antônio Ruffino-Netto, Paulo César de Almeida, Rachel Ann Hauser-Davis, Reinaldo Calixto Campos, Afrânio Lineu Kritski, Martha Maria de Oliveira

J Bras Pneumol.2014;40(3):269-278

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Objective: To determine whether serum selenium levels are associated with the conversion of bacteriological tests in patients diagnosed with active pulmonary tuberculosis after eight weeks of standard treatment. Methods: We evaluated 35 healthy male controls and 35 male patients with pulmonary tuberculosis, the latter being evaluated at baseline, as well as at 30 and 60 days of antituberculosis treatment. For all participants, we measured anthropometric indices, as well as determining serum levels of albumin, C-reactive protein (CRP) and selenium. Because there are no reference values for the Brazilian population, we used the median of the serum selenium level of the controls as the cut-off point. At 30 and 60 days of antituberculosis treatment, we repeated the biochemical tests, as well as collecting sputum for smear microscopy and culture from the patients. Results: The mean age of the patients was 38.4  11.4 years. Of the 35 patients, 25 (71%) described themselves as alcoholic; 20 (57.0%) were smokers; and 21 (60.0%) and 32 (91.4%) presented with muscle mass depletion as determined by measuring the triceps skinfold thickness and arm muscle area, respectively. Of 24 patients, 12 (39.2%) were classified as moderately or severely emaciated, and 15 (62.5%) had lost > 10% of their body weight by six months before diagnosis. At baseline, the tuberculosis group had lower serum selenium levels than did the control group. The conversion of bacteriological tests was associated with the CRP/albumin ratio and serum selenium levels 60 days after treatment initiation. Conclusions: Higher serum selenium levels after 60 days of treatment were associated with the conversion of bacteriological tests in pulmonary tuberculosis patients.

 


Keywords: Selenium; Nutritional status; Tuberculosis; Immunity.

 


Update on the approach to smoking in patients with respiratory diseases

Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

Maria Penha Uchoa Sales1,a, Alberto José de Araújo2,b, José Miguel Chatkin3,c, Irma de Godoy4,d, Luiz Fernando Ferreira Pereira5,e, Maria Vera Cruz de Oliveira Castellano6,f, Suzana Erico Tanni4,g, Adriana Ávila de Almeida7,h, Gustavo Chatkin3,i, Luiz Carlos Côrrea da Silva8,j, Cristina Maria Cantarino Gonçalves9,k, Clóvis Botelho12,13,l, Ubiratan Paula Santos14,m, Carlos Alberto de Assis Viegas15,n, Maristela Rodrigues Sestelo16,o, Ricardo Henrique Sampaio Meireles10,11,p, Paulo César Rodrigues Pinto Correa17,q, Maria Eunice Moraes de Oliveira18,r, Jonatas Reichert19,s, Mariana Silva Lima6,t, Celso Antonio Rodrigues da Silva20,u

J Bras Pneumol.2019;45(3):e20180314-e20180314

Abstract PDF PT PDF EN Portuguese Text

Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

 


Keywords: Respiratory tract diseases/therapy; Respiratory tract diseases/drug therapy; Tobacco use disorder/epidemiology; Smoking cessation; Counseling; Lung neoplasms.

 


Control measures to trace &#8804; 15-year-old contacts of index cases of active pulmonary tuberculosis

Atualização no diagnóstico e tratamento da fibrose pulmonar idiopática

José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6

J Bras Pneumol.2015;41(5):454-466

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Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.

 


Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Idiopathic pulmonary fibrosis/rehabilitation.

 


Evaluating physical capacity in patients with chronic obstructive pulmonary disease: comparing the shuttle walk test with the encouraged 6-minute walk test

Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento

Fernanda Warken Rosa, Aquiles Camelier, Anamaria Mayer, José Roberto Jardim

J Bras Pneumol.2006;32(2):106-113

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Objective: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. Methods: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. Results: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). Conclusion: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise test; Motor activity; Reproducibility of results;

 


Evaluation of pulmonary function and respiratory symptoms in pyrochlore mine workers

Avaliação da função pulmonar e sintomas respiratórios em trabalhadores da mineração de pirocloro

Ritta de Cássia Canedo Oliveira Borges, José Cerqueira Barros Júnior, Fabrício Borges Oliveira, Marisa Andrade Brunherotti, Paulo Roberto Veiga Quemelo

J Bras Pneumol.2016;42(4):279-285

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Objective: To identify respiratory symptoms and evaluate lung function in mine workers. Methods: This was a cross-sectional observational study involving production sector workers of a pyrochlore mining company. The subjects completed the British Medical Research Council questionnaire, which is designed to evaluate respiratory symptoms, occupational exposure factors, and smoking status. In addition, they underwent pulmonary function tests with a portable spirometer. Results: The study involved 147 workers (all male). The mean age was 41.37 ± 8.71 years, and the mean duration of occupational exposure was 12.26 ± 7.09 years. We found that 33 (22.44%) of the workers had respiratory symptoms and that 26 (17.69%) showed abnormalities in the spirometry results. However, we found that the spirometry results did not correlate significantly with the presence of respiratory symptoms or with the duration of occupational exposure. Conclusions: The frequencies of respiratory symptoms and spirometric changes were low when compared with those reported in other studies involving occupational exposure to dust. No significant associations were observed between respiratory symptoms and spirometry results.

 


Keywords: Spirometry; Mining; Niobium; Occupational exposure.

 


Evaluation of the limited participation by university students in a smoking cessation program

Avaliação da participação de pequeno número de estudantes universitários em um programa de tratamento do tabagismo

Wilson Paloschi Spiandorello, Liliana Zugno Filippini, Angélica Dal Pizzol, Fernanda Kreische, Diogo Sandri Soligo, Tiago Spiandorello, Raquel Boff, Mauricio Michele

J Bras Pneumol.2007;33(1):69-75

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Objective: To evaluate the limited participation by university students in a smoking cessation program. Methods: A cross-sectional, comparative study was conducted at the University of Caxias do Sul, located in Caxias do Sul, Brazil, involving students who enrolled in a smoking cessation program, together with those who did not. Results: Of the 108 student who did not enroll in the program, 102 (94.4%) stated that they had no intention to quit smoking (95% confidence interval: 88.29-97.93%. Comparisons between the enrolled and nonenrolled students revealed the following statistical differences: in mean age (35 vs. 23 years, p < 0.01); mean duration of the smoking habit (19.42 vs. 7.36 years, p < 0.01); considering oneself addicted (100% vs. 58.5%, p = 0.047); believing oneself able to stop smoking at any time (7.1% vs. 22.6%, p = 0.02); having no knowledge of any reasons to quit smoking (37.5% vs. 12%, p = 0.03); having suffered discrimination (42.9% vs. 9.3%, p < 0.01). Conclusion: Among the university students evaluated, there was a phase, classified as precontemplative or contemplative, during which they were refractory to smoking cessation. Although all of the students were aware of the diseases caused by smoking, 41.5% did not consider themselves addicted. The concept of substance dependence does not apply to these students. It would seem more appropriate to define nicotine dependence as resulting from the lifetime consumption of at least 100 cigarettes. These students do not perceive that they are passing through the initial phase of the natural history of tobacco use disorder and do not realize that they are increasing their risk of presenting smoking-related diseases in the future.

 


Keywords: Smoking; Students; Smoking cessation

 


Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel

Avaliação da qualidade de vida de pacientes com carcinoma pulmonar de células não pequenas em estágio avançado, tratados com carboplatina associada a paclitaxel

Camila Uanne Resende Avelino, Rafael Marques Cardoso, Suzana Sales de Aguiar, Mário Jorge Sobreira da Silva

J Bras Pneumol.2015;41(2):133-142

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Objective: Non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Most patients are diagnosed at an advanced stage, palliative chemotherapy therefore being the only treatment option. This study was aimed at evaluating the health-related quality of life (HRQoL) of advanced-stage NSCLC patients receiving palliative chemotherapy with carboplatin and paclitaxel. Methods: This was a multiple case study of advanced-stage NSCLC outpatients receiving chemotherapy at a public hospital in Rio de Janeiro, Brazil. The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire was used in conjunction with its supplemental lung cancer-specific module in order to assess HRQoL. Results: Physical and cognitive functioning scale scores differed significantly among chemotherapy cycles, indicating improved and worsened HRQoL, respectively. The differences regarding the scores for pain, loss of appetite, chest pain, and arm/shoulder pain indicated improved HRQoL. Conclusions: Chemotherapy was found to improve certain aspects of HRQoL in patients with advanced-stage NSCLC.

 


Keywords: Carcinoma, non-small-cell lung; Quality of life; Palliative care; Carboplatin; Paclitaxel.

 


Using the Saint George's Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil

Avaliação da qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória em portadores de doença pulmonar obstrutiva crônica: validação de uma nova versão para o Brasil

Aquiles Camelier, Fernanda Warken Rosa, Christine Salim, Oliver Augusto Nascimento, Fábio Cardoso, José Roberto Jardim

J Bras Pneumol.2006;32(2):114-122

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Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months. Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart. Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001). Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Reproducibility of results; Cross-cultural comparison; Questionnaires

 


Lung ultrasound assessment of response to antibiotic therapy in cystic fibrosis exacerbations: a study of two cases

Avaliação da resposta à antibioticoterapia durante exacerbação na fibrose cística por ultrassom pulmonar: estudo de dois casos

Andressa Oliveira Peixoto1,2,3,a, Fernando Augusto Lima Marson1,2,4,5,b, Tiago Henrique Souza1,6,c, Andrea de Melo Alexandre Fraga1,3,d, José Dirceu Ribeiro1,3,e

J Bras Pneumol.2019;45(6):e20190128-e20190128

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Evaluating bronchodilator response in pediatric patients with post-infectious bronchiolitis obliterans: use of different criteria for identifying airway reversibility

Avaliação da resposta ao broncodilatador em pacientes pediátricos com bronquiolite obliterante pós-infecciosa: uso de diferentes critérios de identificação de reversibilidade das vias aéreas

Rita Mattiello1, Paula Cristina Vidal2, Edgar Enrique Sarria3, Paulo Márcio Pitrez1, Renato Tetelbom Stein1, Helena Teresinha Mocelin4, Gilberto Bueno Fischer4, Marcus Herbert Jones1, Leonardo Araújo Pinto1

J Bras Pneumol.2016;42(3):174-178

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Objective: Post-infectious bronchiolitis obliterans (PIBO) is a clinical entity that has been classified as constrictive, fixed obstruction of the lumen by fibrotic tissue. However, recent studies using impulse oscillometry have reported bronchodilator responses in PIBO patients. The objective of this study was to evaluate bronchodilator responses in pediatric PIBO patients, comparing different criteria to define the response. Methods: We evaluated pediatric patients diagnosed with PIBO and treated at one of two pediatric pulmonology outpatient clinics in the city of Porto Alegre, Brazil. Spirometric parameters were measured in accordance with international recommendations. Results: We included a total of 72 pediatric PIBO patients. The mean pre- and post-bronchodilator values were clearly lower than the reference values for all parameters, especially FEF25‑75%. There were post-bronchodilator improvements. When measured as mean percent increases, FEV1 and FEF25-75%, improved by 11% and 20%, respectively. However, when the absolute values were calculated, the mean FEV1 and FEF25-75% both increased by only 0.1 L. We found that age at viral aggression, a family history of asthma, and allergy had no significant effects on bronchodilator responses. Conclusions: Pediatric patients with PIBO have peripheral airway obstruction that is responsive to treatment but is not completely reversible with a bronchodilator. The concept of PIBO as fixed, irreversible obstruction does not seem to apply to this population. Our data suggest that airway obstruction is variable in PIBO patients, a finding that could have major clinical implications.

 


Keywords: Bronchiolitis obliterans; Infection/complications; Airway obstruction; Bronchodilator agents.

 


Evaluation of acute bacterial rhinosinusitis in asthma patients based on clinical parameters and imaging studies, together with ear, nose and throat examination

Avaliação da rinussinusite bacteriana aguda em pacientes asmáticos com base em parâmetros clínicos, exame otorrinolaringológico e estudo de imagem

Alecsandra Calil Moises Faure, Ilka Lopes Santoro, Luc Louis Maurice Weckx, Henrique Manoel Lederman, Artur da Rocha Correa Fernandes, Ana Luisa Godoy Fernandes

J Bras Pneumol.2008;34(6):340-346

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Objective: To evaluate paranasal sinuses in patients with stable or acute asthma in order to determine the prevalence of acute bacterial rhinosinusitis. Methods: A cross-sectional study including 30 patients with acute asthma (73% females) treated in the emergency room and 30 patients with stable asthma (80% females) regularly monitored as outpatients. All patients completed a questionnaire on respiratory signs and symptoms and were submitted to ear, nose and throat (ENT) examination, as well as to X-ray and computed tomography (CT) imaging of the sinuses. Results: Based on the clinical diagnosis, the prevalence of acute bacterial rhinosinusitis was 40% in the patients with acute asthma and 3% in those with stable asthma. The ENT examination findings and the imaging findings in isolation were not useful to confirm the diagnosis. Conclusions: In themselves, ENT examination findings, X-ray findings and CT findings were not useful for the diagnosis of acute bacterial rhinosinusitis. Our results provide further evidence that a clinical diagnosis of bacterial rhinosinusitis should be made with caution.

 


Keywords: Asthma; Sinusitis; Radiography; Tomography, X-ray computed; Endoscopy.

 


Evaluation of the use of transbronchial biopsy in patients with clinical suspicion of interstitial lung disease

Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

Cristiano Claudino Oliveira, Alexandre Todorovic Fabro, Sérgio Marrone Ribeiro, Julio Defaveri, Vera Luiza Capelozzi, Thais Helena Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2011;37(2):168-175

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Objective: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital. Methods: We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil. Results: The study included 56 patients. Of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01). Conclusions: For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions.

 


Keywords: Lung diseases, interstitial; Diagnosis, differential; Bronchoscopy.

 


Evaluation of surveillance of contacts of new tuberculosis cases in the state of Mato Grosso - Brazil

Avaliação da vigilância de contatos de casos novos de tuberculose no Estado de Mato Grosso - Brasil

Shaiana Vilella Hartwig, Eliane Ignotti, Beatriz Fátima Alves de Oliveira, Hellen Caroline de Oliveira Pereira, João Henrique Scatena

J Bras Pneumol.2008;34(5):298-303

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Objective: To evaluate surveillance of contacts of new tuberculosis cases in the state of Mato Grosso from 1999 to 2004. Methods: This was a descriptive epidemiological study based on data from the Tuberculosis Case Registry Database. The number of new tuberculosis cases, the number of contacts (estimated, investigated, and uninvestigated), and the tuberculosis incidence rate were analyzed by age bracket. The mean rate of contacts investigated for each case of tuberculosis by age bracket was calculated per year of study. The cases of pulmonary tuberculosis with and without contacts investigated were analyzed by sputum smear microscopy results. Results: In 2004, there were 41.3 cases of tuberculosis per 100,000 inhabitants in the state of Mato Grosso. The south-central region presented the highest incidence rate (57 cases/100,000 inhabitants) and a 15% rate of contacts investigated. Among those younger than 15 years, 63 contacts (60.5%) were investigated, whereas among those aged 15 or older, 389 (8.9%) were investigated. In 1999, the mean rate of contacts investigated statewide was 0.02 (0.5%), and, in 2004, it reached 0.42 (10.5%). The percentage of contacts investigated was 40% higher among the contacts of contagious cases (OR = 1.4; 95% CI: 1.08-1.83). Conclusions: The percentage of contacts investigated is very low, principally among adults. The adoption of the standards for investigation of tuberculosis contacts proposed by the Brazilian National Ministry of Health Department of Health Surveillance has not ensured that this group at highest risk of developing active tuberculosis be given priority at health care facilities in the state of Mato Grosso.

 


Keywords: Contact tracing; Epidemiologic surveillance; Tuberculosis/prevention & control.

 


Using the forced oscillation technique to evaluate respiratory resistance in individuals with silicosis

Avaliação das características resistivas do sistema respiratório de indivíduos portadores de silicose pela técnica de oscilações forçadas

Jayme Alves de Mesquita Júnior, Agnaldo José Lopes, José Manoel Jansen, Pedro Lopes de Melo

J Bras Pneumol.2006;32(3):213-220

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Objective: To evaluate the resistance values obtained through the use of the forced oscillation technique in patients with varying degrees of airway obstruction resulting from silicosis. Methods: A total of 40 never-smoking volunteers were analyzed: 10 were healthy subjects with no history of pulmonary disease or silica exposure, and 30 had silicosis. The forced oscillation technique was used to examine the subjects, and spirometry was used as a reference in order to classify the obstruction by degree. This classification resulted in five groups: control (n = 10); normal exam, composed of individuals diagnosed clinically and radiologically with silicosis but presenting normal spirometry results (n = 7); mild obstruction (n = 10); moderate obstruction (n = 8); and severe obstruction (n = 5). Results: The reduction observed in the spirometric values corresponded to a significant increase in the total respiratory resistance (p < 0.001), as well as in airway resistance (p < 0.003). A significant reduction in ventilation homogeneity was also observed (p < 0.004). Conclusion: In individuals with silicosis, the additional respiratory resistance-related data obtained through the use of the forced oscillation technique can complement spirometric data. Therefore, the forced oscillation technique presents great potential for the analysis of such patients.

 


Keywords: Pneumoconiosis; Silicosis; Forced expiratory volume; Oscillometry; Respiratory function tests

 


Evaluation of atopy in patients with COPD

Avaliação de atopia em portadores de DPOC

Margarida Célia Lima Costa Neves, Yuri Costa Sarno Neves, Carlos Mauricio Cardeal Mendes, Monalisa Nobre Bastos, Aquiles Assunção Camelier, Cleriston Farias Queiroz, Bernardo Fonseca Mendoza, Antônio Carlos Moreira Lemos, Argemiro D'Oliveira Junior

J Bras Pneumol.2013;39(3):296-305

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. Methods: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. Results: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. Conclusions: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood.

 


Keywords: Pulmonary disease, chronic obstructive; Allergy and immunology; Nasal lavage fluid; Asthma; Rhinitis, allergic, perennial.

 


Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers

Avaliação do conhecimento sobre o uso de inaladores dosimetrados entre profissionais de saúde de um hospital pediátrico

Fábio Pereira Muchão, Sílvia La Regina Rodrigues Perín, Joaquim Carlos Rodrigues, Cláudio Leone, Luiz Vicente Ribeiro Ferreira Silva Filho

J Bras Pneumol.2008;34(1):4-12

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Objective: To evaluate health professionals working at a tertiary pediatric hospital in terms of their knowledge regarding the practical use of metered-dose inhalers. Methods: Practical and written tests on the use of metered-dose inhalers were applied to physicians, physical therapists, nurses and nursing assistants. A score from 0 to 10 was assigned to each evaluation, and median scores were calculated for each professional category. Questions with higher and lower correct values were identified, and a descriptive comparison was made regarding the performance of the various professional categories. Statistical analysis was performed using the Kruskal-Wallis method for comparison of medians. A sequential logistic multiple regression analysis was also performed. Results: A total of 30 resident physicians or interns in the pediatrics department, 23 attending physicians, 29 physical therapists, 33 nurses and 31 nursing assistants were evaluated. Resident physicians, physical therapists and attending physicians performed significantly better than did nurses and nursing assistants. Only resident physicians had a median score greater than 6. Conclusions: The health professionals evaluated, particularly the nurses and nursing assistants, who are directly involved in the practical use of metered-dose inhalers, possess insufficient knowledge regarding the use of such inhalers.

 


Keywords: Metered dose inhalers; Inhalation spacers; Asthma; Education, public health professional.

 


Assessment of religious coping in patients with COPD

Avaliação do coping religioso em pacientes com DPOC

Francisco Alessandro Braga do Nascimento1,2,a, Guilherme Pinheiro Ferreira da Silva1,3,b, Geisyani Francisca Gomes Prudente1,c, Rafael Mesquita1,d, Eanes Delgado Barros Pereira1,2,e

J Bras Pneumol.2020;46(1):e20180150-e20180150

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Objective: To compare religious coping (RC) in patients with COPD and healthy individuals, as well as to determine whether RC is associated with demographic characteristics, quality of life, depression, and disease severity in the patients with COPD. Methods: This was a cross-sectional study conducted between 2014 and 2016, involving outpatients with moderate to severe COPD seen at one of two hospitals in Fortaleza, Brazil, as well as gender- and age-matched healthy controls. The Brief RCOPE scale assessed RC in all of the participants. We also evaluated the COPD group patients regarding symptoms, quality of life, and depression, as well as submitting them to spirometry and a six-minute walk test. Results: A total of 100 patients were evaluated. The mean age was 67.3 ± 6.8 years, and 54% were men. In the COPD group, the mean positive RC score was significantly higher than was the mean negative RC score (27.17 ± 1.60 vs. 8.21 ± 2.12; p = 0.001). The mean positive RC score was significantly higher in women than in men (27.5 ± 1.1 vs. 26.8 ± 2.8; p = 0.02). Negative RC scores were significantly higher in the COPD group than in the control group (p = 0.01). Negative RC showed an inverse association with six-minute walk distance (6MWD; r = −0.3; p < 0.05) and a direct association with depressive symptoms (r = 0.2; p < 0.03). Positive RC correlated with none of the variables studied. Multiple regression analysis showed that negative RC was associated with 6MWD (coefficient = −0.009; 95% CI: −0.01 to −0.003). 6MWD explained the variance in negative RC in a linear fashion. Conclusions: Patients with COPD employ negative RC more often than do healthy individuals. Exercise capacity and depressive symptoms are associated with negative RC.

 


Keywords: Religion; Spirituality; Adaptation, psychological; Quality of life; Pulmonary disease, chronic obstructive.

 


Evaluation of von Willebrand factor in COPD patients

Avaliação do fator de von Willebrand em pacientes com DPOC

Thiago Prudente Bártholo, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2014;40(4):373-379

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare the absolute serum von Willebrand factor (vWF) levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. Methods: The study included 57 subjects, in three groups: COPD (n = 36); smoker (n = 12); and control (n = 9). During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2) was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. Results: Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001) and 1,865 ± 592 pg/mL (p < 0.01). Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05), as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05). In all three groups, there was a negative correlation between FEV1 (% of predicted) and relative serum vWF activity (r2 = −0.13; p = 0.009). Conclusions: Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients.

 


Keywords: von Willebrand factor; Pulmonary disease, chronic obstructive; Endothelial cells.

 


Evaluation of the Asthma Control Questionnaire validated for use in Brazil

Avaliação do Questionário de Controle da Asma validado para uso no Brasil

Mylene Leite, Eduardo Vieira Ponte, Jaqueline Petroni, Argemiro D`Oliveira Júnior, Emílio Pizzichini, Álvaro Augusto Cruz

J Bras Pneumol.2008;34(10):756-763

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate whether the Portuguese version of the Asthma Control Questionnaire (ACQ) is a valid instrument to measure asthma control in adult outpatients in Brazil. Methods: We selected 278 outpatients diagnosed with asthma. All of the patients completed the questionnaire, underwent spirometry and were clinically evaluated by a physician in order to characterize the control of the disease in the first visit. The questionnaire was evaluated in three versions, with 5, 6 and 7 questions, respectively, and scores of 0.75 and 1.50 were used as cut-off points. Results: Of the 278 patients, 77 (27.7%) had intermittent asthma, 39 (14.0%) had mild persistent asthma, 40 (14.4%) had moderate persistent asthma and 122 (43.9%) had severe persistent asthma. The sensitivity of ACQ to identify uncontrolled asthma ranged from 77% to 99%, and the specificity ranged from 36% to 84%. The positive predictive value ranged from 73% to 90%, and the negative predictive value ranged from 67% to 95%. The positive likelihood ratio ranged from 1.55 to 4.81, and the negative likelihood ratio ranged from 0.03 to 0.27. In the 5- and 6-question versions of the ACQ, the intraclass correlation coefficient was 0.92. These two versions were both responsive to clinical changes in the patients. Conclusions: All three versions of the ACQ satisfactorily discriminated between patients with uncontrolled asthma and those with controlled asthma. The 5- and 6-question versions also presented good reliability and responsiveness. Therefore, the ACQ is a valid tool for evaluating asthma control in adult outpatients in Brazil.

 


Keywords: Asthma; Therapeutics; Diagnosis; Questionnaires; Reproducibility of results.

 


Evaluation of the nitrate reductase assay for the rapid detection of resistance to first-line medications in Mycobacterium tuberculosis strains isolated from patients in a general hospital

Avaliação do teste de nitrato redutase para a detecção rápida de resistência aos medicamentos de primeira linha em cepas de Mycobacterium tuberculosis isoladas de pacientes em um hospital geral

Maria de Fátima Filardi Oliveira Mansur, Wânia da Silva Carvalho, Raquel Bandeira da Silva, Rodrigo Gonçalves Cata Preta, Lucas Almeida Fernandes Junior, Silvana Spíndola de Miranda

J Bras Pneumol.2012;38(2):210-213

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We compared the nitrate reductase assay with the proportion method, which is considered the gold standard, in 57 Mycobacterium tuberculosis strains isolated from patients treated at the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. For rifampin and isoniazid, the sensitivity, specificity, and accuracy of the nitrate reductase assay were all 100%, whereas they were 100%, 88.9%, and 66.7%, respectively, for streptomycin and 98.0%, 100%, and 98.2%, respectively, for ethambutol. The mean time to results was ten days. In the study sample, the nitrate reductase assay proved highly accurate and showed excellent concordance with the gold standard.

 


Keywords: Mycobacterium tuberculosis; Microbial sensitivity tests; Tuberculosis, multidrug-resistant; Nitrate reductase.

 


Mediastinal evaluation in lung cancer staging

Avaliação mediastinal no estadiamento do câncer do pulmão

Angelo Fernandez, Aldo Rodrigues Junqueira Jr., Ricardo H. Bammann, Ricardo Beyruti, Fábio B. Jatene

J Bras Pneumol.1998;24(1):17-22

Abstract PDF PT

The presence of mediastinal lymph node metastasis in lung cancer has a great influence on treatment selection and prognosis, and the diagnosis of lymphatic metastasis must be accurate. CT chest scans and mediastinoscopy are the diagnostic tools available to detect mediastinal lymph node metastases and to establish preoperative staging. Lymph node size evaluated by CT scans is not an acceptable criterion in the patients studied here. The aim of this study was to find out a representative pattern of size to indicate the possibility of neoplastic invasion in the population studied. Fifty consecutive patients were operated on and were submitted to pulmonary resection and mediastinal dissection to treat lung cancer. Seventy-four percent of the lymph nodes with transverse section of more than 3 cm had no neoplastic invasion. CT scans and mediastinoscopy have similar sensitivity (close to 65%), but mediastinoscopy has higher specificity (100%). This means that the authors must have histologic confirmation of any suspected lymph node to achieve a correct staging.

 


Keywords: Carcinoma, non-small cell. Lung neoplasias. Lymph nodes. Lymphatic metastasis. Mediatinoscopy. Neoplasm, staging. CT scanning.

 


Pre-operative evaluation in obstructive sleep apnea patients undergoing bariatric surgery: sleep laboratory limitations

Avaliação pré-operatória de apneia obstrutiva do sono em doentes a serem submetidos à cirurgia bariátrica: limitações do laboratório do sono

João Pedro Abreu Cravo1, Antonio Matias Esquinas2

J Bras Pneumol.2016;42(2):158-158

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Quantitative assessment of elastic fibers in chronic obstructive pulmonary disease

Avaliação quantitativa das fibras elásticas na doença pulmonar obstrutiva crônica

Rogerio Rufino, Kalil Madi, Heitor Siffert Pereira de Souza, Cláudia Henrique da Costa, Eduardo Haruo Saito, José Roberto Lapa e Silva

J Bras Pneumol.2007;33(5):502-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). Methods: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. Results: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm2) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r2 = 0.003). Conclusions: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.

 


Keywords: Pulmonary disease, chronic obstructive; CD4 Lymphocyte Count; Elastic tissue; Muscle, smooth.

 


BCGitis: A rare complication after intravesical BCG therapy

BCGite: Uma complicação rara da terapia intravesical com BCG

Maria João Oliveira, Daniel Vaz, Aurora Carvalho, Rosário Braga, Raquel Duarte

J Bras Pneumol.2015;41(5):480-481

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Open lung biopsy in patients on mechanical ventilation and presenting diffuse pulmonary infiltrate

Biópsia pulmonar a céu aberto em pacientes sob ventilação mecânica e com infiltrado pulmonar difuso

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Carlos Alberto de Barros Franco

J Bras Pneumol.2005;31(3):212-218

Abstract PDF PT PDF EN Portuguese Text

Background: Open lung biopsy is regarded as the gold standard for the diagnosis of diffuse pulmonary infiltrates. Objective: To determine the diagnostic yield, therapeutic changes, complications and mortality attributed to open lung biopsy in patients with diffuse pulmonary infiltrates and on mechanical ventilation. Method: We reviewed, retrospectively, the charts of 24 patients, ranging from 26 to 89 years of age, admitted to the intensive care units of two private hospitals and submitted to open lung biopsy. Results: Diagnostic positivity was found in 100% of patients, resulting in an alteration in the treatment regimen in 75%. Postoperative complications occurred in five patients (20.8%). There were no biopsy-related deaths, although global mortality was 45.8%. Conclusion: Open lung biopsy is a safe and high yield procedure for diagnosing diffuse pulmonary infiltrate in patients on mechanical ventilation. Despite the fact that no mortality impact factor has been assigned to such patients, data in the literature regarding prognosis must be taken into consideration.

 


Keywords: Biopsy. Respiratory insufficiency. Respiration artificial.

 


Activated charcoal bronchial aspiration

Broncoaspiração de carvão ativado

Bruna Quaranta Lobão Bairral, Makoto Saito, Nelson Morrone

J Bras Pneumol.2012;38(4):533-534

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Flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos

Ascedio José Rodrigues, Eduardo Quintino Oliveira, Paulo Rogério Scordamaglio, Marcelo Gervilla Gregório, Márcia Jacomelli, Viviane Rossi Figueiredo

J Bras Pneumol.2012;38(3):315-320

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. Methods: This was a retrospective study of all adult patients (over 18 years of age) with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. Results: The study sample comprised 40 adult patients, with a mean age of 52 years (range, 18-88 years). The median time of permanence of the foreign body in the airway was 15 days (range, 12 h to 10 years). All of the patients first underwent diagnostic flexible bronchoscopy. Foreign bodies were successfully removed with flexible bronchoscopy in 33 (82.5%) of the patients. In 1 patient, a metal object lodged in the distal bronchial tree required the use of fluoroscopy. Six patients (15%) required rigid bronchoscopy due to tracheal foreign body-induced dyspnea, in 2, and because the foreign body was too large for the flexible forceps, in 4. Bronchoscopy failed in 1 patient, who therefore required surgical bronchotomy. Conclusions: Although rigid bronchoscopy is considered the gold standard for the removal of foreign bodies from the airways, our experience showed that flexible bronchoscopy can be safely and effectively used in the diagnosis and treatment of stable adult patients.

 


Keywords: Bronchoscopy; Foreign bodies; Airway obstruction; Airway management.

 


Bronchoscopy in the diagnosis of tuberculosis: their role of transbronchial biopsy in HIV-infected and in immunocompetent patients

Broncoscopia no diagnóstico de tuberculose: papel da biópsia transbrônquica em imunocompetentes e em HIV-positivos

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Maria Rita E. Araújo, Kátia R.M. Leite

J Bras Pneumol.1999;25(4):207-212

Abstract PDF PT

Introduction: Bronchoscopy is useful in the diagnosis of tuberculosis suspects with a "negative" sputum smear. The objectives of this study were: to assess yield of bronchoalveolar lavage (BAL) and of transbronchial biopsy (TBB) both in HIV-positive patients (group 1) and immunocompetent individuals (group 2), based on simple and most available laboratory techniques in clinical practice. Patients and methods: The authors performed 319 bronchoscopies in 302 patients. BAL and TBB were sequentially performed in the same lung in all cases. Tuberculosis was diagnosed based on the results of acid-fast stains (AFS) from the lavage (ZN), culture for mycobacteria (LJ), and histological examination of biopsies (HE and ZN). Results: Tuberculosis was the final diagnosis in 28 exams of group 1 (n = 214) and in 35 of group 2 (n = 105). There were abnormal endoscopic findings respectively in 3 and 10 patients. In group 1, AFS were positive in 7 cases, culture of BAL in 14, and TBB in 19. In group 2, AFS were positive in 13 cases, culture in 17, and biopsies in 31. TBB results compared to BAL were in concordance for group 1 (p = 0.823) and different for group 2 (p = 0.022). Immediate results (AFS and TBB) compared to later positive results of culture were similar for group 1 (p = 0.066) but not for group 2 (p = 0.001). There were eight episodes of pneumothorax (2.5%) and one death (0.36%). Conclusions: Both BAL and TBB should be performed whenever possible, aiming towards a higher yield of bronchoscopy in the diagnosis of tuberculosis. Both methods complement each other in immunocompetent patients, whereas TBB establishes a faster diagnosis for HIV-infected patients if associated to AFS.

 


Keywords: Bronchoscopy/methods. Smear-negative tuberculosis/diagnosis. Opportunistic infections related to AIDS/diagnosis.

 


Bronchiectasis caused by common variable immunodeficiency

Bronquiectasia por imunodeficiência comum variável

Paulo Henrique do Amor Divino, José Henrique de Carvalho Basilio, Renato Moraes Alves Fabbri, Igor Polônio Bastos, Wilma Carvalho Neves Forte

J Bras Pneumol.2015;41(5):482-483

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Bronchiectasis caused by common variable immunodeficiency

Bronquiectasia por imunodeficiência comum variável.

Paulo Henrique do Amor Divino1, José Henrique de Carvalho Basilio1, Renato Moraes Alves Fabbri1, Igor Bastos Polonio1, Wilma Carvalho Neves Forte2

J Bras Pneumol.2016;42(1):80-80

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Bronchiolitis associated with exposure to artificial butter flavoring in workers at a cookie factory in Brazil

Bronquiolite associada à exposição a aroma artificial de manteiga em trabalhadores de uma fábrica de biscoitos no Brasil

Zaida do Rego Cavalcanti, Alfredo Pereira Leite de Albuquerque Filho, Carlos Alberto de Castro Pereira, Ester Nei Aparecida Martins Coletta

J Bras Pneumol.2012;38(3):395-399

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Objective: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. Methods: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. Results: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. Conclusions: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.

 


Keywords: Diacetyl; Flavoring agents; Bronchiolitis.

 


Bronchiolitis obliterans organizing pneumonia

Bronquiolite obliterante com pneumonia em organização

Gabriela Addor, Andréia Salarini Monteiro, David Henrique Nigri, Wilhermo Torres, Carlos Alberto de Barros Franco

J Bras Pneumol.2004;30(2):154-157

Abstract PDF PT

48 years-old woman, asymptomatic, presented with radiographic findings of patchy airspace consolidation with nodular opacities in the upper right lobe, middle lobe and lingula. The differential diagnoses of neoplasms, sarcoidosis, granulomatous diseases and tuberculosis were considered. Diagnosis of Bronchiolitis obliterans organizing pneumonia was made by means of videothoracoscopy whereupon treatment with corticosteroids was begun. The patient had a positive evolution with resolution of the radiographic finding.

 


Keywords: bronchiolitis obliterans organizing pneumonia, bronchiolitis obliterans

 


Bronchiolitis obliterans organizing migratory pneumonia (BOOP) after unilateral radiotherapy for breast carcinoma treatment

Bronquiolite obliterante com pneumonia organizante (BOOP) migratória após radioterapia unilateral para tratamento de carcinoma de mama

Renata Tristão Rodrigues, Ricardo Togashi, Hugo H Bok Yoo, Júlio Defaveri, Irma de Godoy, Thais Helena A. Thomaz Queluz

J Bras Pneumol.1998;24(1):47-50

Abstract PDF PT

The authors describe a case of a woman submitted to radiation therapy for breast carcinoma who presented, 40 days after the end of the treatment, fever, dry cough, dyspnea on exertion, and weight loss. Chest imaging revealed migratory opacities. The histopathological examination of transbronchial biopsy specimens showed characteristic findings of BOOP. Corticosteroid therapy resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. The authors present a brief review of the literature concerning radiation-induced lung injury, emphasizing the importance of including BOOP in the differential diagnosis in these complications. The present case, as well as the two other reports from the literature, provide further evidence for the role of irradiation injury as a cause of clinicopathological syndrome identical to idiopathic BOOP, i.e., radiation-induced BOOP.

 


Keywords: Bronchiolitis obliterans organizing pneumonia. BOOP. Radiation pneumonitis. Radiotherapy. Breast carcinoma.

 


Bronchiolitis obliterans in nodular form

Bronquiolite obliterante na forma nodular

Paulo de Almeida, Murilo J.B. Guimarães, Mario Gesteira Costa, Vital Lyra, Isabella Coimbra, Luiz Adriano de Albuquerque Oliveira

J Bras Pneumol.2002;28(6):335-338

Abstract PDF PT

A 54 year old female patient, public servant, ex-smoker, after two weeks of a common cold complained of cough with yellow sputum, nasal obstruction and facial pain. A chest X-ray showed a solitary nodular lesion in the upper left lobe. The patient was submitted to a left thoracotomy, which established the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP).

 



Lung cancer and schwannoma - the pitfalls of positron emission tomography

Câncer de pulmão e schwannoma - as armadilhas da tomografia por emissão de prótons

Fernando Luiz Westphal, Luiz Carlos de Lima, José Correa Lima-Netto, Michel de Araújo Tavares, Felipe de Siqueira Moreira Gil

J Bras Pneumol.2014;40(3):319-321

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Lung cancer in Brazil

Câncer de pulmão no Brasil

Luiz Henrique Araujo1,2,a, Clarissa Baldotto1,2,b, Gilberto de Castro Jr3,4,c, Artur Katz4,d, Carlos Gil Ferreira5,6,e, Clarissa Mathias7,f, Eldsamira Mascarenhas7,g, Gilberto de Lima Lopes8,9,h, Heloisa Carvalho4,10,i, Jaques Tabacof8, Jeovany Martínez-Mesa11,j, Luciano de Souza Viana12,k, Marcelo de Souza Cruz13,l, Mauro Zukin1,2,m, Pedro De Marchi12,n, Ricardo Mingarini Terra3,o, Ronaldo Albuquerque Ribeiro14, Vladmir Cláudio Cordeiro de Lima15,p, Gustavo Werutsky16,q, Carlos Henrique Barrios17,r; Grupo Brasileiro de Oncologia Torácica

J Bras Pneumol.2018;44(1):55-64

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Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

 


Keywords: Lung neoplasms/epidemiology; Lung neoplasms/therapy; Lung neoplasms/diagnosis; Biomarkers; Brazil.

 


Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil

Câncer de pulmão: mudanças na histologia, sexo e idade nos últimos 30 anos no Brasil

Maria Teresa Ruiz Tsukazan1,2, Álvaro Vigo2, Vinícius Duval da Silva3, Carlos Henrique Barrios4, Jayme de Oliveira Rios1, José Antônio de Figueiredo Pinto1

J Bras Pneumol.2017;43(5):363-367

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Objective: To describe the trends in tumor histology, gender and age among patients with non-small cell lung cancer (NSCLC) treated with lung resection. The histology of lung cancer has changed in developed countries, and there is still little information available on the topic for developing countries. Methods: This was a retrospective study of 1,030 patients with NSCLC treated with lung resection between 1986 and 2015 at a university hospital in southern Brazil. Differences in histology, stage, and type of surgery were analyzed by gender and for three periods (1986-1995, 1996-2005, and 2006-2015). Results: Most (64.5%) of the patients were males, and the main histological types were squamous cell carcinoma (in 40.6%) and adenocarcinoma (in 44.5%). The mean age at surgery during the first period was 56.4 years for women and 58.9 years for men, compared with 62.2 for women and 64.6 for men in the third period (p < 0.001). The proportion of females increased from 26.6% in the first period to 44.1% in the third. From the first to the third period, the proportion of patients with squamous cell carcinoma decreased from 49.6% to 34.8% overall (p < 0.001), decreasing to an even greater degree (from 38.9% to 23.2%) among men. Among the NSCLC patients in our sample, females with adenocarcinoma accounted for 11.9% in the first period and 24.0% in the third period (p < 0.001). Conclusions: As has been seen in developed countries, the rates of lung cancer in females in southern Brazil have been rising over the last three decades, although they have yet to surpass those observed for males in the region. The incidence of squamous cell carcinoma has decreased in males, approaching adenocarcinoma rates, whereas adenocarcinoma has significantly increased among women.

 


Keywords: Lung neoplasms; Epidemiology; Histology; Adenocarcinoma; Carcinoma, non-small-cell lung; Carcinoma, squamous cell.

 


Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

Características clínicas de crianças e adolescentes brasileiros com asma grave resistente a terapia

Andrea Mendonça Rodrigues1, Cristian Roncada1, Giovana Santos2, João Paulo Heinzmann-Filho1, Rodrigo Godinho de Souza2, Mauro Henrique Moraes Vargas1, Leonardo Araújo Pinto3, Marcus Herbert Jones3, Renato Tetelbom Stein3, Paulo Márcio Pitrez3

J Bras Pneumol.2015;41(4):343-350

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA). Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry. Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure. Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

 


Keywords: Arthritis, rheumatoid; Lung diseases, interstitial; Spirometry; Radiography, thoracic; Airway ob-struction.

 


Clinical and epidemiological characteristics of contagious adult of tuberculosis in children

Características clínicas e epidemiológicas do adulto contagiante da criança com tuberculose

João Ab Lima, Edgar Enrique Sarria Icaza, Beatriz G. Menegotto, Gilberto Bueno Fischer, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2004;30(3):243-252

Abstract PDF PT

Background: Tuberculosis in children generally occurs as a direct result of cohabitation with a contagious adult. Objective: To create a profile of a typical adult with contagious tuberculosis (as identified through the public health system) living with a child who has been diagnosed with tuberculosis. Method: Case study. Children younger than 14 years of age who were diagnosed with tuberculosis were included. Parents were interviewed using structured questionnaires. Means and standard deviations were analyzed using the Student's t-test. Fisher's exact test or the Dz test was used for comparisons. Results: Fifty children, representing 96% of those diagnosed with tuberculosis in the Porto Alegre health care system between July 20, 2001 and August 10, 2002, were included. The mean age was 76 months, and 60% were girls. The classic forms of pulmonary presentation (consolidation or cavitation) were seen in 38%. The majority of the children were diagnosed in the hospital and came from homes in which there were (a mean of) 6 cohabitants and a total family income less than 2 times the local minimum wage. Using ELISA, HIV co-infection was identified in 25% (although not all were tested). The children regularly visited places other than their homes. In 78% of cases, the contagious adult was identified. These contagious adults were mostly males (56%), and the mean age was 32. In most cases (79%), the contagious adult was a relative, usually a parent. Within this group of adults with contagious tuberculosis, HIV co-infection was identified in 43% of those tested. Conclusions: Adults with contagious tuberculosis living in the home continue to be the most likely source of tuberculosis infection in children. Co-infection with HIV in these pediatric patients, as well as in the cohabiting adults with contagious tuberculosis, is a significant finding. It must be emphasized that the possibility of contact with contagious individuals in the home should be explored in every diagnosed case of pediatric tuberculosis.

 


Keywords: Tuberculosis/epidemiology. Children. Communicable diseases/etiology.

 


Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brasil between 1994 and 2004

Características clínico-demográficas de pacientes hospitalizados com tuberculose no Brasil, no período de 1994 a 2004

Norma Pinheiro Franco Severo, Clarice Queico Fujimura Leite, Marisa Veiga Capela, Maria Jacira da Silva Simões

J Bras Pneumol.2007;33(5):565-571

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Objective: To describe the demographic and clinical characteristics of patients with tuberculosis hospitalized in the Nestor Goulart Reis Hospital, located in the city of Américo Brasiliense, Brazil. Methods: Epidemiological investigation by means of an observational, retrospective, descriptive study based on the medical charts of patients diagnosed with tuberculosis and hospitalized between 1994 and 2004. Results: There were 1787 patients diagnosed with tuberculosis during the period evaluated. Of those, 117 (7%) were females, 1670 (93%) were males; 1215 (68%) were single, separated or widowed. Most of the patients (74%) had not completed middle school, and most (63%) were between 30 and 50 years of age. In addition, 61% suffered from alcoholism. The most common occupation was farm worker (25% of the patients), and 70% of the patients were unemployed. The most common clinical form of the disease was the pulmonary form (in 92%). The rate of medical discharge was 60%. The treatment regimen differed from the standard (rifampin, isoniazid and pyrazinamide) in 34% of the cases. Conclusions: The profile of the patients with tuberculosis hospitalized in the hospital studied showed that they had special requirements: they were unable to take care of themselves (social cases) and required alternative treatment regimens, which justified their hospitalization. This hospital played an important social role in the treatment and guidance of these patients.

 


Keywords: Hospitalization; Tuberculosis; Demography.

 


Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program

Características da tuberculose em idosos no Recife (PE): contribuição para o programa de controle

Zilda do Rego Cavalcanti, Maria de Fátima Pessoa Militão de Albuquerque, Antônio Roberto Leite Campelo, Ricardo Ximenes, Ulisses Montarroyos, Marianne Karel Amaral Verçosa

J Bras Pneumol.2006;32(6):535-543

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Objective: To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. Methods: A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. Results: The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. Conclusion: In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.

 


Keywords: Tuberculosis; Elderly; Case-control; Brazil

 


Epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil

Características epidemiológicas de pacientes com sarcoidose na cidade do Rio de Janeiro

Vinicius Lemos-Silva, Paula Barroso Araújo, Christiane Lopes, Rogério Rufino, Cláudia Henrique da Costa

J Bras Pneumol.2011;37(4):438-445

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Objective: To analyze the epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. Methods: A descriptive, case-control study involving 100 sarcoidosis patients under outpatient treatment between 2008 and 2010 at the Pedro Ernesto University Hospital, located in the city of Rio de Janeiro, Brazil. The diagnosis of sarcoidosis was based on clinical, radiological, biochemical, and histopathological criteria. Results: There was a predominance of females in the 35-40 year age bracket (range, 7-69 years), who accounted for 65% of the sample, although there was a second peak at approximately 55 years of age. The most common symptom was dyspnea (in 47%), and the most common radiological findings were pulmonary and lymph node involvement (stage II; in 43%), followed by stage III (in 20%), stage I (in 19%), stage 0 (in 15%), and stage IV (in 3%). No pleural effusion or digital clubbing was observed at diagnosis. The tuberculin skin test was negative in 94 patients. Spirometric findings at diagnosis were normal in 61 patients; indicative of obstructive lung disease in 21; and indicative of restrictive lung disease in 18. The most common biopsy sites were the lungs (principally by bronchoscopy) and the skin, the diagnosis being confirmed by biopsy in 56% and 29% of the cases, respectively. Treatment with prednisone was initiated in 75% of the patients and maintained for more than 2 years in 19.7%. Conclusions: This study corroborates the findings of previous studies regarding the epidemiological characteristics of sarcoidosis patients.

 


Keywords: Sarcoidosis/epidemiology; Sarcoidosis/diagnosis; Sarcoidosis/therapy.

 


Phenotypic characterization of lymphocyte subsets in bronchoalveolar lavage of patients with silicosis

Caracterização imunofenotípica das subpopulações de linfócitos do lavado broncoalveolar de pacientes com silicose

Ângela Ferreira, Jose da Silva Moreira, Regina Caetano, José Manoel Gabetto, Thereza Quirico-Santos

J Bras Pneumol.2000;26(3):107-112

Abstract PDF PT

Bronchoalveolar lavage is a safe and simple technique to evaluate lung disease related to exposure to mineral dusts. The aim of this study was to characterize the lymphocyte subsets in bronchoalveolar lavage of patients with silicosis. Bronchoalveolar lavage was carried out in 26 workers with different forms of silicosis: simple form (n = 12), complicated (n = 13) and 1 patient with acute form of the disease. As a control group, 7 healthy individuals were included. Compared to the control group, silicotic patients showed intense pleocytosis constituted mainly by alveolar macrophages with slight lymphocytosis. Lymphocyte subsets present in the bronchoalveolar fluid (BAL) of normal individuals were mature lymphocytes with phenotype CD2+TCRab (87.3%) and only 2.9% were CD2+TCRgd. CD4/CD8 ratio was 1.8 with few (16%) immature double negative T cells subsets (CD4-CD8-). In contrast, silicotic patients showed reduction of the more mature lymphocyte subset CD2+CD4+, CD2+CD8+ and a great increase (47%) of immature (CD4-CD8-) T cell subsets. No increase in the NK (CD56+) cell population was observed. Biochemical analysis of protein contents and determination of the Ig/albumin ratio characterized local immunoglobulin production within the pulmonary microenvironment. Furthermore, lack of increase of plasma cells, as well as the maintenance of the percentage of B lymphocyte population (CD19+) in the BAL of silicotic patients, favors the hypothesis that the cells responsible for Ig production are possibly located in the interstitial space. Altogether the results suggest development of lymphopoiesis and tertiary lymphoid tissue within the pulmonary microenvironment during the clinical course of silicosis.

 


Keywords: bronchoalveolar lavage, lymphocyte subsets, silicosis, immunophenotyping

 


Takotsubo cardiomyopathy triggered by &#61538;2 adrenergic agonist

Cardiomiopatia de takotsubo desencadeada pelo uso de agonista β2-adrenérgico

Vera Maria Cury Salemi, Edmar Atik, Ronaldo Adib Kairalla, Eduardo Lira Queiroz, Leonardo Vieira da Rosa, Roberto Kalil Filho

J Bras Pneumol.2011;37(4):560-562

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Smoking cessation among patients at a university hospital in Curitiba, Brazil

Cessação de tabagismo em pacientes de um hospital universitário em Curitiba

Rodney Luiz Frare e Silva, Eliane Ribeiro Carmes, Alain Felipe Schwartz, Denise de Souza Blaszkowski, Raphael Henrique Déa Cirino, Renata Dal-Prá Ducci

J Bras Pneumol.2011;37(4):480-487

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Objective: To determine the prevalence of smoking and the frequency of smoking cessation counseling among patients at a university hospital, as well as to compare smokers and former smokers in terms of smoking history. Methods: A cross-sectional study involving 629 patients at the Federal University of Paraná Hospital de Clínicas, located in the city of Curitiba, Brazil. Results: Of the 629 patients, 206 (32.7%) were male, 76 (12.1%) were smokers, 179 (28.5%) were former smokers, and 374 (59.5%) were nonsmokers. The mean age of the patients was 49.9 ± 15.0 years (range, 18-84 years). Of the 76 smokers and 179 former smokers, 72 (94.7%) and 166 (92.7%), respectively, were questioned about tobacco use. Smoking history and degree of nicotine dependence were higher among the former smokers (p = 0.0292 and p = 0.0125, respectively). Gender, age at smoking initiation, physician inquiry about tobacco use, and smoking cessation counseling were comparable between the two groups. The smoking cessation rate was 0.70. The prevalence of heavy smoking varied by gender and by age bracket, being higher in males and in the 41-70 year age bracket. Conclusions: The smoking prevalence in this group of patients was lower than that reported for patients at another university hospital, for adults in Curitiba, and for adults in Brazil. The smoking cessation rate was higher in these patients than in the general population of Curitiba. Smokers and former smokers differed regarding age, smoking history, and degree of nicotine dependence. Heavy smoking and a moderate or high degree of nicotine dependence were not obstacles to smoking cessation.

 


Keywords: Smoking/prevention & control; Smoking cessation; Hospitalization/statistics & numerical data.

 


Robotic thoracic surgery for non-small cell lung cancer: initial experience in Brazil

Cirurgia torácica robótica no tratamento do câncer de pulmão de células não pequenas: experiência inicial no Brasil

Ricardo Mingarini Terra1,2,3,4,a, Benoit Jacques Bibas1,3,4,b, Rui Haddad5,6,c, José Ribas Milanez-de-Campos1,3,d, Pedro Henrique Xavier Nabuco-de-Araujo1,2,4,e, Carlos Eduardo Teixeira-Lima5,6,f, Felipe Braga dos Santos5,6,g, Leticia Leone Lauricella1,2,4,h, Paulo Manuel Pêgo-Fernandes1,2,3,i

J Bras Pneumol.2020;46(1):e20190003-e20190003

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Objective: To describe the morbidity, mortality, and rate of complete resection associated with robotic surgery for the treatment of non-small cell lung cancer in Brazil, as well as to report the rates of overall survival and disease-free survival in patients so treated. Methods: This was a retrospective study of patients diagnosed with non-small cell lung carcinoma and undergoing resection by robotic surgery at one of six hospitals in Brazil between February of 2015 and July of 2018. Data were collected retrospectively from the electronic medical records. Results: A total of 154 patients were included. The mean age was 65 ± 9.5 years (range, 30-85 years). The main histological diagnosis was adenocarcinoma, which was identified in 128 patients (81.5%), followed by epidermoid carcinoma, identified in 14 (9.0%). Lobectomy was performed in 133 patients (86.3%), and segmentectomy was performed in 21 (13.7%). The mean operative time was 209 ± 80 min. Postoperative complications occurred in 32 patients (20.4%). The main complication was air leak, which occurred in 15 patients (9.5%). The median (interquartile range) values for hospital stay and drainage time were 4 days (3-6 days) and 2 days (2-4 days), respectively. There was one death in the immediate postoperative period (30-day mortality rate, 0.5%). The mean follow-up period was 326 ± 274 days (range, 3-1,110 days). Complete resection was achieved in 97.4% of the cases. Overall mortality was 1.5% (3 deaths), and overall survival was 97.5%. Conclusions: Robotic pulmonary resection proved to be a safe treatment for lung cancer. Longer follow-up periods are required in order to assess long-term survival.

 


Keywords: Lung neoplasms/surgery; Lung neoplasms/mortality; Robotic surgical procedures.

 


Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

Cirurgia torácica robótica para ressecção de timoma e tumores tímicos: desenvolvimento técnico e experiência inicial

Ricardo Mingarini Terra1,a, José Ribas Milanez-de-Campos1,b, Rui Haddad2,c, Juliana Rocha Mol Trindade3,d, Leticia Leone Lauricella3,e, Benoit Jacques Bibas3,f, Paulo Manuel Pêgo-Fernandes1,g

J Bras Pneumol.2020;46(1):e20180315-e20180315

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Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperativeymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; R outcomes comparable to those of other techniques.

 


Keywords: Thymoma; Thymus neoplasms; Thymectomy; Thoracic surgery; Robotic surgical procedures.

 


Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation

Citocinas no líquido pleural após transplante pulmonar como marcadores de rejeição aguda

Priscila Cilene León Bueno de Camargo, José Eduardo Afonso Jr, Marcos Naoyuki Samano, Milena Marques Pagliarelli Acencio, Leila Antonangelo, Ricardo Henrique de Oliveira Braga Teixeira

J Bras Pneumol.2014;40(4):425-428

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Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.

 


Keywords: Lung transplantation; Pleural effusion; Cytokines; Graft rejection.

 


Pulmonary and extrapulmonary coccidioidomycosis: three cases in an endemic area in the state of Ceará, Brazil

Coccidioidomicose pulmonar e extrapulmonar: três casos em zona endêmica no interior do Ceará

Ricardo Hideo Togashi, Fernando Moreira Batista Aguiar, Dalton Barros Ferreira, Camille Matos de Moura, Monique Teixeira Montezuma Sales, Nikaelle Ximenes Rios

J Bras Pneumol.2009;35(3):275-279

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Coccidioidomycosis, a fungal illness acquired by the inhalation of arthroconidia of Coccidioides sp., was first described in 1894. Coccidioidomycosis is mainly restricted to areas with arid climate, alkaline soil and low rainfall. Consequently, most of the reported cases in Brazil have occurred in the northeastern region. We report three cases of pulmonary coccidioidomycosis occurring between 2005 and 2006 in an endemic area in the state of Ceará, Brazil. The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. All three patients presented pulmonary involvement, and one also presented cutaneous lesions. Chest X-rays and CT scans of the patients revealed characteristic coccidioidomycosis lesions. The diagnosis was confirmed by serological testing. All of the patients evolved to cure after antifungal treatment.

 


Keywords: Coccidioidomycosis; Lung diseases, fungal; Coccidioides.

 


Fighting respiratory diseases: divided efforts lead to weakness

Combate a doenças respiratórias: esforços divididos levam ao enfraquecimento

Rogelio Pérez-Padilla, Rafael Stelmach, Manuel Soto-Quiroz, Álvaro Augusto Cruz

J Bras Pneumol.2014;40(3):207-210

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Comparison of two experimental models of pulmonary hypertension

Comparação de dois modelos experimentais de hipertensão pulmonar

Igor Bastos Polônio, Milena Marques Pagliarelli Acencio, Rogério Pazetti, Francine Maria de Almeida, Mauro Canzian, Bárbara Soares da Silva, Karina Aparecida Bonifácio Pereira, Rogério de Souza

J Bras Pneumol.2012;38(4):452-460

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Objective: To compare two models of pulmonary hypertension (monocrotaline and monocrotaline+pneumonectomy) regarding hemodynamic severity, structure of pulmonary arteries, inflammatory markers (IL-1 and PDGF), and 45-day survival. Methods: We used 80 Sprague-Dawley rats in two study protocols: structural analysis; and survival analysis. The rats were divided into four groups: control; monocrotaline (M), pneumonectomy (P), and monocrotaline+pneumonectomy (M+P). In the structural analysis protocol, 40 rats (10/group) were catheterized for the determination of hemodynamic variables, followed by euthanasia for the removal of heart and lung tissue. The right ventricle (RV) was dissected from the interventricular septum (IS), and the ratio between RV weight and the weight of the left ventricle (LV) plus IS (RV/LV+IS) was taken as the index of RV hypertrophy. In lung tissues, we performed histological analyses, as well as using ELISA to determine IL-1 and PDGF levels. In the survival protocol, 40 animals (10/group) were followed for 45 days. Results: The M and M+P rats developed pulmonary hypertension, whereas the control and P rats did not. The RV/LV+IS ratio was significantly higher in M+P rats than in M rats, as well as being significantly higher in M and M+P rats than in control and P rats. There were no significant differences between the M and M+P rats regarding the area of the medial layer of the pulmonary arteries; IL-1 and PDGF levels; or survival. Conclusions: On the basis of our results, we cannot conclude that the monocrotaline+pneumonectomy model is superior to the monocrotaline model.

 


Keywords: Monocrotaline; Hypertension, pulmonary; Pneumonectomy; Interleukin-1; Receptor, platelet-derived growth factor beta.

 


Comparison between reference values for FVC, FEV1, and FEV1/FVC ratio in White adults in Brazil and those suggested by the Global Lung Function Initiative 2012

Comparação entre os valores de referência para CVF, VEF1 e relação VEF1/CVF em brasileiros caucasianos adultos e aqueles sugeridos pela Global Lung Function Initiative 2012

Carlos Alberto de Castro Pereira, Andrezza Araujo Oliveira Duarte, Andrea Gimenez, Maria Raquel Soares

J Bras Pneumol.2014;40(4):397-402

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Objective: To evaluate the spirometry values predicted by the 2012 Global Lung Function Initia-tive (GLI) equations, which are recommended for international use, in comparison with those obtained for a sample of White adults used for the establishment of reference equations for spirometry in Brazil. Methods: The sample comprised 270 and 373 healthy males and females, respectively. The mean differences between the values found in this sample and the predicted values calculated from the GLI equations for FVC, FEV1, and VEF1/FVC, as well as their lower lim-its, were compared by paired t-test. The predicted values by each pair of equations were com-pared in various combinations of age and height. Results: For the males in our study sample, the values obtained for all of the variables studied were significantly higher than those predicted by the GLI equations (p < 0.01 for all). These differences become more evident in subjects who were shorter in stature and older. For the females in our study sample, only the lower limit of the FEV1/FVC ratio was significantly higher than that predicted by the GLI equation. Conclusions: The predicted values suggested by the GLI equations for White adults were significantly lower than those used as reference values for males in Brazil. For both genders, the lower limit of the FEV1/FVC ratio is significantly lower than that predicted by the GLI equations.

 


Keywords: Respiratory function tests/statistics and numerical data; Respiratory function tests/diagnosis; Reference values.

 


Comparisons among parameters of maximal respiratory pressures in healthy subjects

Comparação entre parâmetros de pressões respiratórias máximas em indivíduos saudáveis

Cristina Martins Coelho, Rosa Maria de Carvalho, David Sérgio Adães Gouvêa, José Marques Novo Júnior

J Bras Pneumol.2012;38(5):605-613

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Objective: To investigate four parameters defining maximal respiratory pressures and to evaluate their correlations and agreements among those parameters for the determination of MIP and MEP. Methods: This was a cross-sectional study involving 49 healthy, well-nourished males and females. The mean age was 23.08 ± 2.5 years. Measurements were carried out using a pressure transducer, and the estimated values for the parameters peak pressure (Ppeak), plateau pressure (Pplateau), mean maximal pressure (Pmean), and pressure according to the area (Parea) were determined with an algorithm developed for the study. To characterize the study sample, we used descriptive statistics, followed by repeated measures ANOVA and Bonferroni post hoc test or by the Friedman test and the Wilcoxon post hoc test, as well as by Pearson's or Spearman's correlation coefficients, depending on the normality of the data. The agreement between the variables was assessed with Bland  Altman plots. Results: There were significant differences among all of the parameters studied for MIP (Ppeak = 95.69 ± 27.89 cmH2O; Parea = 88.53 ± 26.45 cmH2O; Pplateau = 82.48 ± 25.11 cmH2O; Pmean = 89.01 ± 26.41 cmH2O; p < 0.05 for all) and for MEP (Ppeak = 109.98 ± 40.67 cmH2O; Parea = 103.85 ± 36.63 cmH2O; Pplateau = 98.93 ± 32.10 cmH2O; Pmean = 104.43 ± 36.74 cmH2O; p < 0.0083 for all). Poor agreement was found among almost all of the parameters. Higher pressure values resulted in larger differences between the variables. Conclusions: The maximal respiratory pressure parameters evaluated do not seem to be interchangeable, and higher pressure values result in larger differences among the parameters.

 


Keywords: Respiratory system; Muscle strength; Respiratory function tests.

 


Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease

Completude das fichas de notificações de tuberculose em cinco capitais do Brasil com elevada incidência da doença

Normeide Pedreira dos Santos, Monique Lírio, Louran Andrade Reis Passos, Juarez Pereira Dias, Afrânio Lineu Kritski, Bernardo Galvão-Castro, Maria Fernanda Rios Grassi

J Bras Pneumol.2013;39(2):221-225

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The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010-Salvador, Rio de Janeiro, Cuiabß, Porto Alegre, and BelÚm-using tabulations obtained from the Sistema Nacional de InformaþÒo de Agravos de NotificaþÒo (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabß, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes.

 


Keywords: Tuberculosis; Public health surveillance; Disease notification.

 


Completeness of tuberculosis control program records in the case registry database of the state of Espírito Santo, Brazil: analysis of the 2001-2005 period

Completude dos dados do Programa de Controle da Tuberculose no Sistema de Informação de Agravos de Notificação no Estado do Espírito Santo, Brasil: uma análise do período de 2001 a 2005

Cláudia Maria Marques Moreira, Ethel Leonor Noia Maciel

J Bras Pneumol.2008;34(4):225-229

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Objective: To investigate the completeness of tuberculosis control program records for the 2001-2005 period in the case registry database of the state of Espírito Santo, Brazil. Methods: A descriptive study using secondary data analysis. The following variables were studied: race/color; educational level, supervised treatment, sputum culture at treatment outcome, HIV status, smear sputum microscopy at the sixth month of treatment and treatment outcome. Results: Using technical parameters of the case registry database of the Brazilian National Ministry of Health regarding the percentage of completeness of data on the reporting forms, the tuberculosis database of the state of Espírito Santo can be classified as fair to excellent. The state of Espírito Santo has 78 cities, 8 of which are considered priorities for tuberculosis control. For the variables studied, the cities not considered priorities presented better completeness of records than did those considered priorities, the exception being the variable treatment outcome, for which the percentage of completeness was comparable among all of the cities. Conclusions: Since the cities that are considered priorities accounted for 70.2% of the total number of reports, the responsible officials in those cities should improve the quality of those reports in terms of the completeness of forms and the updating of data, which are fundamental to the reliability of epidemiological analyses. That will make it possible to plan activities aimed at the prevention and control of tuberculosis in the state.

 


Keywords: Tuberculosis; Disease notification; Information systems; Databases as topic.

 


Complexity of autonomic nervous system function in individuals with COPD

Complexidade do sistema nervoso autônomo em indivíduos com DPOC

Laís Manata Vanzella1,f, Aline Fernanda Barbosa Bernardo1,d, Tatiana Dias de Carvalho3,e, Franciele Marques Vanderlei2,a, Anne Kastelianne França da Silva1,c, Luiz Carlos Marques Vanderlei2,b

J Bras Pneumol.2018;44(1):24-30

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Objective: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. Methods: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. Results: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. Conclusions: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.

 


Keywords: Pulmonary disease, chronic obstructive; Autonomic nervous system; Nonlinear dynamics; Recurrence; Heart rate; Sympathetic nervous system.

 


Dynamic hyperinflation during treadmill exercise testing in patients with moderate to severe COPD

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

Priscila Kessar Cordoni, Danilo Cortozi Berton, Selma Denis Squassoni, Maria Enedina Aquino Scuarcialupi, José Alberto Neder, Elie Fiss

J Bras Pneumol.2012;38(1):13-23

Abstract PDF PT PDF EN Portuguese Text

Objective: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. Methods: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1= 43 ± 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. Results: Of the 30 patients studied, 19 (63.3%) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH− group). None of the variables studied correlated with exercise tolerance in the DH− group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔICTlim,2min = −0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). Conclusions: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.

 


Keywords: Pulmonary disease, chronic obstructive; Exercise; Exercise test; Inspiratory capacity.

 


Cellular composition of induced sputum in healthy adults

Composição celular do escarro induzido em adultos saudáveis

Tiago Neves Veras, Emilio Pizzichini, Leila John Marques Steidle, Cristiane Cinara Rocha, Pablo Moritz, Márcia Margarete Menezes Pizzichini

J Bras Pneumol.2011;37(3):348-353

Abstract PDF PT PDF EN Portuguese Text

Objective: To establish reference values for cellularity in induced sputum samples collected from healthy adults. Methods: Induced sputum samples were obtained from 88 healthy adult never-smokers (39 males). The mean age was 36 years (range, 18-68 years). The participants had been residing in the city of Florianópolis, Brazil (a medium-sized non-industrial city) for at least two years. After the samples had been processed, we obtained total and differential cell counts. Results: The mean total cell count was 4.8 ± 4.2 × 106 cells/g. There was a predominance of macrophages (mean, 77.5 ± 14.7%) and neutrophils (mean, 23.4 ± 14.3%). Eosinophils were virtually absent (mean, 0.1 ± 0.3%). Lymphocytes and bronchial epithelial cells were scarce. Neither age nor atopy had any effect on the total or differential cell counts. Conclusions: In the induced sputum of this healthy adult population, macrophages and neutrophils predominated. However, the proportion of neutrophils was lower than that reported in previous studies, which suggests that reference values might vary depending on geographic location.

 


Keywords: Sputum; Reference values; Brazil.

 


Pulmonary involvement in Crohn's disease

Comprometimento pulmonar na doença de Crohn

Rodolfo Augusto Bacelar de Athayde1,a, Felipe Marques da Costa1,b, Ellen Caroline Toledo do Nascimento2,c, Roberta Karla Barbosa de Sales1,d, Andre Nathan Costa1,e

J Bras Pneumol.2018;44(6):519-521

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Reliability of a rapid hematology stain for sputum cytology

Confiabilidade da coloração hematológica rápida para citologia de escarro

Jéssica Gonçalves, Emilio Pizzichini, Marcia Margaret Menezes Pizzichini, Leila John Marques Steidle, Cristiane Cinara Rocha, Samira Cardoso Ferreira, Célia Tânia Zimmermann

J Bras Pneumol.2014;40(3):250-258

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the reliability of a rapid hematology stain for the cytological analysis of induced sputum samples. Methods: This was a cross-sectional study comparing the standard technique (May-Grünwald-Giemsa stain) with a rapid hematology stain (Diff-Quik). Of the 50 subjects included in the study, 21 had asthma, 19 had COPD, and 10 were healthy (controls). From the induced sputum samples collected, we prepared four slides: two were stained with May-Grünwald-Giemsa, and two were stained with Diff-Quik. The slides were read independently by two trained researchers blinded to the identification of the slides. The reliability for cell counting using the two techniques was evaluated by determining the intraclass correlation coefficients (ICCs) for intraobserver and interobserver agreement. Agreement in the identification of neutrophilic and eosinophilic sputum between the observers and between the stains was evaluated with kappa statistics. Results: In our comparison of the two staining techniques, the ICCs indicated almost perfect interobserver agreement for neutrophil, eosinophil, and macrophage counts (ICC: 0.98-1.00), as well as substantial agreement for lymphocyte counts (ICC: 0.76-0.83). Intraobserver agreement was almost perfect for neutrophil, eosinophil, and macrophage counts (ICC: 0.96-0.99), whereas it was moderate to substantial for lymphocyte counts (ICC = 0.65 and 0.75 for the two observers, respectively). Interobserver agreement for the identification of eosinophilic and neutrophilic sputum using the two techniques ranged from substantial to almost perfect (kappa range: 0.91-1.00). Conclusions: The use of Diff-Quik can be considered a reliable alternative for the processing of sputum samples.

 


Keywords: Sputum\analysis; Sputum\cytology; Azure stains.

 


Knowledge and perceptions of tuberculosis transmission and prevention among physicians and nurses in three Brazilian capitals with high incidence of tuberculosis

Conhecimento e percepção de médicos e enfermeiros em três capitais brasileiras com alta incidência de tuberculose a respeito da transmissão e prevenção da doença

Jonas Ramos1,a, Maria F Wakoff-Pereira1,b, Marcelo Cordeiro-Santos2,3,c, Maria de Fátima Militão de Albuquerque4,d, Philip C Hill5,e, Dick Menzies6,f, Anete Trajman,6,7,g

J Bras Pneumol.2018;44(2):168-170

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Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem

Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

Barbara Riquena1,a, Luciana de Freitas Velloso Monte2,b, Agnaldo José Lopes3,c, Luiz Vicente Ribeiro Ferreira da Silva-Filho4,5,d, Neiva Damaceno6,e, Evanirso da Silva Aquino7,f, Paulo Jose Cauduro Marostica8,9,g, José Dirceu Ribeiro10,h

J Bras Pneumol.2019;45(3):e20170351-e20170351

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Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

 


Keywords: Cystic fibrosis; Pseudomonas aeruginosa; Nebulizers and vaporizers; Equipment contamination; Decontamination.

 


Contribution of flow-volume curves to the detection of central airway obstruction

Contribuição da curva de fluxo-volume na detecção de obstrução da via aérea central

Liliana Bárbara Perestrelo de Andrade e Raposo, António Bugalho, Maria João Marques Gomes

J Bras Pneumol.2013;39(4):-

Abstract PDF PT PDF EN Portuguese Text Vídeo

Objective: To assess the sensitivity and specificity of flow-volume curves in detecting central airway obstruction (CAO), and to determine whether their quantitative and qualitative criteria are associated with the location, type and degree of obstruction. Methods: Over a four-month period, we consecutively evaluated patients with bronchoscopy indicated. Over a one-week period, all patients underwent clinical evaluation, flow-volume curve, bronchoscopy, and completed a dyspnea scale. Four reviewers, blinded to quantitative and clinical data, and bronchoscopy results, classified the morphology of the curves. A fifth reviewer determined the morphological criteria, as well as the quantitative criteria. Results: We studied 82 patients, 36 (44%) of whom had CAO. The sensitivity and specificity of the flow-volume curves in detecting CAO were, respectively, 88.9% and 91.3% (quantitative criteria) and 30.6% and 93.5% (qualitative criteria). The most prevalent quantitative criteria in our sample were FEF50%/FIF50% ≥ 1, in 83% of patients, and FEV1/PEF ≥ 8 mL . L−1 . min−1, in 36%, both being associated with the type, location, and degree of obstruction (p < 0.05). There was concordance among the reviewers as to the presence of CAO. There is a relationship between the degree of obstruction and dyspnea. Conclusions: The quantitative criteria should always be calculated for flow-volume curves in order to detect CAO, because of the low sensitivity of the qualitative criteria. Both FEF50%/FIF50% ≥ 1 and FEV1/PEF ≥ 8 mL . L−1 . min−1 were associated with the location, type and degree of obstruction.

 


Keywords: Bronchoscopy; Maximal expiratory flow-volume curves; Sensitivity and specificity; Lung neoplasms.

 


Smoking control: challenges and achievements

Controle do tabagismo: desafios e conquistas

Luiz Carlos Corrêa da Silva, Alberto José de Araújo, Ângela Maria Dias de Queiroz, Maria da Penha Uchoa Sales, Maria Vera Cruz de Oliveira Castellano; Comissão de Tabagismo da SBPT

J Bras Pneumol.2016;42(4):290-298

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Smoking is the most preventable and controllable health risk. Therefore, all health care professionals should give their utmost attention to and be more focused on the problem of smoking. Tobacco is a highly profitable product, because of its large-scale production and great number of consumers. Smoking control policies and treatment resources for smoking cessation have advanced in recent years, showing highly satisfactory results, particularly in Brazil. However, there is yet a long way to go before smoking can be considered a controlled disease from a public health standpoint. We can already perceive that the behavior of our society regarding smoking is changing, albeit slowly. Therefore, pulmonologists have a very promising area in which to work with their patients and the general population. We must act with greater impetus in support of health care policies and social living standards that directly contribute to improving health and quality of life. In this respect, pulmonologists can play a greater role as they get more involved in treating smokers, strengthening anti-smoking laws, and demanding health care policies related to lung diseases.

 


Keywords: Tobacco products; Smoking; Health policy; Smoking cessation; Health personnel.

 


Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

Correlação entre a gravidade de pacientes críticos e preditores clínicos de risco para a broncoaspiração

Gisele Chagas de Medeiros1, Fernanda Chiarion Sassi2, Lucas Santos Zambom3, Claudia Regina Furquim de Andrade2

J Bras Pneumol.2016;42(2):114-120

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

 


Keywords: Deglutition; Deglutition disorders; Intubation, intratracheal; Pneumonia, aspiration; Intensive care units.

 


Correlation between resistance to pyrazinamide and resistance to other antituberculosis drugs in Mycobacterium tuberculosis strains isolated at a referral hospital

Correlação entre a resistência a pirazinamida e a resistência a outros fármacos antituberculose em cepas de Mycobacterium tuberculosis isoladas em um hospital de referência

Leila de Souza Fonseca, Anna Grazia Marsico, Gisele Betzler de Oliveira Vieira, Rafael da Silva Duarte, Maria Helena Féres Saad, Fernanda de Carvalho Queiroz Mello

J Bras Pneumol.2012;38(5):630-633

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The correlation between resistance to pyrazinamide (PZA) and resistance to other first-line antituberculosis drugs was investigated in 395 Mycobacterium tuberculosis strains isolated from clinical specimens, representing 14% of the overall number of M. tuberculosis isolates obtained between 2003 and 2008 at the laboratory of a referral university hospital for tuberculosis. A high correlation was found between resistance to PZA and multidrug resistance, as well as between PZA resistance and resistance to rifampin, isoniazid, and ethambutol (p < 0.01 for all). These results highlight the importance of performing PZA susceptibility testing prior to the prescription of this drug in order to treat drug-resistant and multidrug-resistant tuberculosis.

 


Keywords: Tuberculosis/drug therapy; Tuberculosis/microbiology; Antibiotics, antitubercular.

 


Correlation between inflammatory mediators in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection caused by respiratory syncytial virus and disease severity

Correlação entre mediadores inflamatórios na secreção nasofaríngea e no soro de crianças com infecção do trato respiratório inferior por vírus sincicial respiratórioe a gravidade da doença

Renata Amato Vieira, Edna Maria de Albuquerque Diniz,Maria Esther Jurfest Rivero Ceccon

J Bras Pneumol.2010;36(1):59-66

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Objective: To determine whether the concentrations of inflammatory mediators (CCL5, soluble intercellular adhesion molecule type 1 [sICAM-1], TNF-α, IL-6 and IL-10) in the nasopharyngeal secretion and in the serum of children with lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) correlate with the clinical markers of disease severity. Methods: Between July of 2004 and December of 2005, 30 children less than three months of age, diagnosed with LRTI caused by RSV and admitted to a neonatal ICU, were included in this study. Results: The severity of disease at hospital admission, as determined with a modified clinical scoring system, presented a significant positive correlation with sICAM-1 and IL-10 concentrations in the nasopharyngeal secretion, as well as with IL-6 concentrations in the serum, of the patients. In addition, serum IL-6 concentrations presented a significant positive correlation with the duration of oxygen therapy and with the length of hospital stay. Conclusions: At hospital admission, the concentrations of sICAM-1 and IL-10 in the nasopharyngeal secretion, as well as the concentration of IL-6 in the serum, could be used as markers of severity in patients with LRTI caused by RSV. The serum levels of IL-6 determined at admission could also be used to predict prolonged oxygen supplementation and hospital stay.

 


Keywords: Respiratory syncytial virus, human; Chemokine CCL5; Intercellular adhesion molecule-1; Interleukin-6; Interleukin-10; Tumor necrosis factor-alpha.

 


Pulmonary cryptosporidiosis in AIDS patients, an underdiagnosed disease

Criptosporidiose pulmonar em pacientes com AIDS, uma doença subdiagnosticada

Yvana Maria Maia de Albuquerque, Márcia Cristina Fraga Silva, Ana Luiza Magalhães de Andrade Lima, Vera Magalhães

J Bras Pneumol.2012;38(4):530-532

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Psychological criteria for contraindication in lung transplant candidates: a five-year study

Critérios psicológicos para contraindicação em candidatos a transplante pulmonar: um estudo de cinco anos

Elaine Marques Hojaij1, Bellkiss Wilma Romano1, André Nathan Costa2, Jose Eduardo Afonso Junior3, Priscila Cilene Leon Bueno de Camargo3, Rafael Medeiros Carraro3, Silvia Vidal Campos4, Marcos Naoyuki Samano5, Ricardo Henrique de Oliveira Braga Teixeira6

J Bras Pneumol.2015;41(3):246-249

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Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

 


Keywords: Lung transplantation; Interview, psychological; Psychological tests; Preoperative care.

 


Quantitative culture of endotracheal aspirate and BAL fluid samples in the management of patients with ventilator-associated pneumonia: a randomized clinical trial

Cultura quantitativa de amostras de aspirado endotraqueal e lavado broncoalveolar no manejo de pacientes com pneumonia associada à ventilação mecânica: um ensaio clínico randomizado

Ricardo de Amorim Corrêa, Carlos Michel Luna, José Carlos Fernandez Versiani dos Anjos, Eurípedes Alvarenga Barbosa, Cláudia Juliana de Rezende, Adriano Pereira Rezende, Fernando Henrique Pereira, Manoel Otávio da Costa Rocha

J Bras Pneumol.2014;40(6):643-651

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare 28-day mortality rates and clinical outcomes in ICU patients with ventilator-associated pneumonia according to the diagnostic strategy used. Methods: This was a prospective randomized clinical trial. Of the 73 patients included in the study, 36 and 37 were randomized to undergo BAL or endotracheal aspiration (EA), respectively. Antibiotic therapy was based on guidelines and was adjusted according to the results of quantitative cultures. Results: The 28-day mortality rate was similar in the BAL and EA groups (25.0% and 37.8%, respectively; p = 0.353). There were no differences between the groups regarding the duration of mechanical ventilation, antibiotic therapy, secondary complications, VAP recurrence, or length of ICU and hospital stay. Initial antibiotic therapy was deemed appropriate in 28 (77.8%) and 30 (83.3%) of the patients in the BAL and EA groups, respectively (p = 0.551). The 28-day mortality rate was not associated with the appropriateness of initial therapy in the BAL and EA groups (appropriate therapy: 35.7% vs. 43.3%; p = 0.553; and inappropriate therapy: 62.5% vs. 50.0%; p = 1.000). Previous use of antibiotics did not affect the culture yield in the EA or BAL group (p = 0.130 and p = 0.484, respectively). Conclusions: In the context of this study, the management of VAP patients, based on the results of quantitative endotracheal aspirate cultures, led to similar clinical outcomes to those obtained with the results of quantitative BAL fluid cultures. (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-86DCDX [http://www.ensaiosclinicos.gov.br])

 


Keywords: Bronchoalveolar lavage fluid/diagnosis; Respiratory aspiration; Pneumonia, ventilator-associated.

 


Alpha-1 antitrypsin deficiency: diagnosis and treatment

Deficiência de alfa-1 antitripsina: diagnóstico e tratamento

Aquiles A Camelier, Daniel Hugo Winter, José Roberto Jardim, Carlos Eduardo Galvão Barboza, Alberto Cukier, Marc Miravitlles

J Bras Pneumol.2008;34(7):514-527

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Alpha-1 antitrypsin deficiency is a recently identified genetic disease that occurs almost as frequently as cystic fibrosis. It is caused by various mutations in the SERPINA1 gene, and has numerous clinical implications. Alpha-1 antitrypsin is mainly produced in the liver and acts as an antiprotease. Its principal function is to inactivate neutrophil elastase, preventing tissue damage. The mutation most commonly associated with the clinical disease is the Z allele, which causes polymerization and accumulation within hepatocytes. The accumulation of and the consequent reduction in the serum levels of alpha-1 antitrypsin cause, respectively, liver and lung disease, the latter occurring mainly as early emphysema, predominantly in the lung bases. Diagnosis involves detection of low serum levels of alpha-1 antitrypsin as well as phenotypic confirmation. In addition to the standard treatment of chronic obstructive pulmonary disease, specific therapy consisting of infusion of purified alpha-1 antitrypsin is currently available. The clinical efficacy of this therapy, which appears to be safe, has yet to be definitively established, and its cost-effectiveness is also a controversial issue that is rarely addressed. Despite its importance, in Brazil, there are no epidemiological data on the prevalence of the disease or the frequency of occurrence of deficiency alleles. Underdiagnosis has also been a significant limitation to the study of the disease as well as to appropriate treatment of patients. It is hoped that the creation of the Alpha One International Registry will resolve these and other important issues.

 


Keywords: alpha 1-antitrypsin; Emphysema; Pulmonary disease, chronic obstructive.

 


Disability and its clinical correlates in pulmonary hypertension measured through the World Health Organization Disability Assessment Schedule 2.0: a prospective, observational study

Deficiência e seus correlatos clínicos na hipertensão pulmonar medidos pelo World Health Organization Disability Assessment Schedule 2.0: um estudo prospectivo e observacional

Abílio Reis1,a, Mário Santos1,2,3,b, Inês Furtado4,c, Célia Cruz4,d, Pedro Sa-Couto5,e, Alexandra Queirós6,7,f, Luís Almeida8,g, Nelson Rocha7,9,h

J Bras Pneumol.2019;45(4):e20170355-e20170355

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To characterise the degree of disability in pulmonary hypertension (PH) patients based on the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). Method: A prospective and observational study of patients with documented PH (N = 46). Patients completed the WHODAS 2.0 questionnaire during a scheduled routine clinical visit, and their demographic and clinical characteristics were retrieved from electronic medical records (EMR). In subsequent visits, selected clinical variables were registered to assess disease progression. Results: WHODAS 2.0 scores were indicative of mild to moderate disability for the domains of mobility (22.0 ± 23.2), life activities (23.7 ± 25.5), and participation in society (17.2 ± 15.9), as well as total WHODAS 2.0 score (15.3 ± 15.2). For the domains of cognition (9.1 ± 14.1), self-care (8.3 ± 14.4), and interpersonal relationships (11.7 ± 15.7), scores were lower. Disability scores were, generally, proportional to the PH severity. The main baseline correlates of disability were World Health Organisation (WHO) functional class, fatigue, dyspnoea, 6-minute walking distance (6MWD), and N-terminal pro b-type natriuretic peptide (NT-proBNP). Baseline WHODAS 2.0 scores showed significant associations with disease progression. However, this effect was not transversal to all domains, with only a few domains significantly associated with disease progression variables. Conclusions: This PH population shows mild disability, with higher degree of disability in the domains of mobility and life activities. This study is the first one to assess disability in PH using WHODAS 2.0. Further studies should apply this scale to larger PH populations with suitable representations of more severe PH forms.

 


Keywords: Pulmonary hypertension; International Classification of Functioning, Disability and Health; Disability evaluation; Quality of Life.

 


Derrame pleural com elevado teor de amilase

Célia Mallart Llarges, Jaqueline Maria Lima, Luís Felipe F. da Silva, Carlos Eduardo P. Barreto

J Bras Pneumol.1998;24(5):342-344

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Uncommon pleural effusion: pleuropulmonary metastasis from primitive neuroectodermal tumor

Derrame pleural incomum: metástase pleuropulmonar de tumor neuroectodérmico primitivo

Leila Antonangelo, Adriana Gonçalves Rosa, Aline Pivetta Corá, Milena Marques Pagliarelli Acencio, Luís César Moreira, Francisco Vargas Suso

J Bras Pneumol.2009;35(6):606-609

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Primitive neuroectodermal tumor is an invasive neoplasm with neuronal differentiation, which frequently results in metastasis in various organs. We report the case of a patient with primitive neuroectodermal tumor whose primary site was the axilla. The patient presented with metastases in the lung, pleura, bone, iliac muscle and bone marrow. We highlight the uncommon finding in the pleural fluid cytology.

 


Keywords: Neuroectodermal tumors, primitive; Neoplasm metastasis; Cytology; Pleural effusion.

 


Pleural effusion following ovarian hyperstimulation

Derrame pleural secundário à hiperestimulação ovariana

Jader Joel Machado Junqueira, Ricardo Helbert Bammann, Ricardo Mingarini Terra, Ana Cristina Pugliesi de Castro, Augusto Ishy, Angelo Fernandez

J Bras Pneumol.2012;38(3):400-403

Abstract PDF PT PDF EN Portuguese Text

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

 


Keywords: Fertilization in vitro; Ovarian hyperstimulation syndrome; Pleural effusion.

 


Exercise performance and differences in physiological response to pulmonary rehabilitation in severe chronic obstructive pulmonary disease with hyperinflation

Desempenho ao exercício e diferenças na resposta fisiológica à reabilitação pulmonar em doença pulmonar obstrutiva crônica grave com hiperinsuflação

Andre Luis Pereira de Albuquerque1, Marco Quaranta2, Biswajit Chakrabarti3, Andrea Aliverti2, Peter M. Calverley3

J Bras Pneumol.2016;42(2):121-129

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: Pulmonary rehabilitation (PR) improves exercise capacity in most but not all COPD patients. The factors associated with treatment success and the role of chest wall mechanics remain unclear. We investigated the impact of PR on exercise performance in COPD with severe hyperinflation. Methods: We evaluated 22 COPD patients (age, 66 ± 7 years; FEV1 = 37.1 ± 11.8% of predicted) who underwent eight weeks of aerobic exercise and strength training. Before and after PR, each patient also performed a six-minute walk test and an incremental cycle ergometer test. During the latter, we measured chest wall volumes (total and compartmental, by optoelectronic plethysmography) and determined maximal workloads. Results: We observed significant differences between the pre- and post-PR means for six-minute walk distance (305 ± 78 vs. 330 ± 96 m, p < 0.001) and maximal workload (33 ± 21 vs. 39 ± 20 W; p = 0.02). At equivalent workload settings, PR led to lower oxygen consumption, carbon dioxide production (VCO2), and minute ventilation. The inspiratory (operating) rib cage volume decreased significantly after PR. There were 6 patients in whom PR did not increase the maximal workload. After PR, those patients showed no significant decrease in VCO2 during exercise, had higher end-expiratory chest wall volumes with a more rapid shallow breathing pattern, and continued to experience symptomatic leg fatigue. Conclusions: In severe COPD, PR appears to improve oxygen consumption and reduce VCO2, with a commensurate decrease in respiratory drive, changes reflected in the operating chest wall volumes. Patients with severe post-exercise hyperinflation and leg fatigue might be unable to improve their maximal performance despite completing a PR program.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise therapy; Respiratory therapy.

 


Performance of nested PCR in the specific detection of Mycobacterium tuberculosis complex in blood samples of pediatric patients

Desempenho da técnica nested PCR na detecção específica do complexo Mycobacterium tuberculosis em amostras sanguíneas de pacientes pediátricos

Juliana Figueirêdo da Costa Lima, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Marta Maciel Lyra Cabral, Andrea Santos Lima, Frederico Guilherme Coutinho Abath (in memoriam), Haiana Charifker Schindler

J Bras Pneumol.2009;35(7):690-697

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the performance of nested PCR (nPCR) in detecting the Mycobacterium tuberculosis complex in blood samples of patients suspected of having TB, in order to determine its potential for use as an auxiliary tool in the laboratory diagnosis of TB in children. Methods: Detection of the M. tuberculosis complex in blood samples using as a target the insertion sequence IS6110 of the genomic DNA of the bacillus. Blood samples of 120 patients were evaluated. All of the patients were under 15 years of age at the time of their treatment at public hospitals in the city of Recife, Brazil (between January of 2003 and August of 2005). Attending physicians at the hospitals diagnosed TB based on the criteria recommended by the American Thoracic Society. The nPCR amplified a 123-bp fragment with outer oligonucleotides (IS1/IS2) and, in the subsequent reaction, using inner oligonucleotides (IS3/IS4), generating an 81-bp amplicon. Results: Active or latent TB was found in 65 patients, TB was ruled out in 28 suspected cases, and 27 patients were TB-free (controls). The sensitivity of nPCR was 26.15% and was significantly higher for the extrapulmonary form of the disease (55.56%) than for the pulmonary form (18.18%). The specificity was 92.73%. Conclusions: Despite the difficulties in diagnosing TB in children and the low number of cases evaluated in the present study, nPCR in blood samples proved to be a rapid and specific technique, albeit one with low sensitivity. In order to establish its true usefulness in the diagnosis of paucibacillary forms, especially extrapulmonary TB, further studies need to be carried out with a larger sample of children and analyzing biological specimens other than blood.

 


Keywords: Tuberculosis; Diagnosis; Blood; Polymerase chain reaction.

 


Performance of instruments aimed at detecting obstructive sleep apnea syndrome among individuals in Chile

Desempenho de instrumentos de detecção da síndrome da apneia obstrutiva do sono em indivíduos no Chile

Gonzalo Labarca1,a, Jorge Dreyse2,3,b, Constanza Salas2,3,c, Maria Ines Gaete4,d, Jorge Jorquera2,3,e

J Bras Pneumol.2020;46(1):e20190015-e20190015

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Development of an experimental model of neutrophilic pulmonary response induction in mice

Desenvolvimento de um modelo experimental de indução de resposta pulmonar neutrofílica em camundongos

Leonardo Araújo Pinto, Camila Camozzato, Monique Avozani, Denise Cantarelli Machado, Marcus Herbert Jones, Renato Tetelbom Stein, Paulo Márcio Condessa Pitrez

J Bras Pneumol.2003;29(4):213-216

Abstract PDF PT

Background: Several lung diseases are characterized by a predominantly neutrophilic inflammation. A better understanding of the mechanisms of action of some drugs on the airway inflammation of such diseases may bring advances to the treatment. Objective: To develop a method to induce pulmonary neutrophilic response in mice, without active infection. Methods: Eight adult Swiss mice were used. The study group (n = 4) received an intranasal challenge with 1 x 1012 CFU/ml of Pseudomonas aeruginosa (Psa), frozen to death. The control group (n = 4) received an intranasal challenge with saline solution. Two days after the intranasal challenge, a bronchoalveolar lavage (BAL) was performed with total cell and differential cellularity counts. Results: The total cell count was significantly higher in the group with Psa, as compared to the control group (median of 1.17 x 106 and 0.08 x 106, respectively, p = 0.029). In addition to this, an absolute predominance of neutrophils was found in the differential cellularity of the mice that had received the Psa challenge. Conclusion: The model of inducing a neutrophilic pulmonary disease using frost-dead bacteria was successfully developed. This neutrophilic inflammatory response induction model in Swiss mice lungs may be an important tool for testing the anti-inflammatory effect of some antimicrobial drugs on the inflammation of the lower airways.

 


Keywords: Animal experimentation. Lung disesases. Inflammation. Neutrophils. Pseudomonas.

 


Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases

Destaques das Diretrizes de Doenças Pulmonares Intersticiais da Sociedade Brasileira de Pneumologia e Tisiologia

Bruno Guedes Baldi, Carlos Alberto de Castro Pereira, Adalberto Sperb Rubin, Alfredo Nicodemos da Cruz Santana, André Nathan Costa, Carlos Roberto Ribeiro Carvalho, Eduardo Algranti, Eduardo Mello de Capitani, Eduardo Pamplona Bethlem, Ester Nei Aparecida Martins Coletta, Jaquelina Sonoe Ota Arakaki, José Antônio Baddini Martinez, Jozélio Freire de Carvalho, Leila John Marques Steidle, Marcelo Jorge Jacó Rocha, Mariana Silva Lima, Maria Raquel Soares, Marlova Luzzi Caramori, Miguel Abidon Aidé, Rimarcs Gomes Ferreira, Ronaldo Adib Kairalla, Rudolf Krawczenko Feitoza de Oliveira, Sérgio Jezler, Sílvia Carla Sousa Rodrigues, Suzana Pinheiro Pimenta

J Bras Pneumol.2012;38(3):282-291

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Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.

 


Keywords: Lung diseases, interstitial; Guidelines as topic; Brazil.

 


Cord factor detection and macroscopic evaluation of mycobacterial colonies: an efficient combined screening test for the presumptive identification of Mycobacterium tuberculosis complex on solid media

Detecção do fator corda e avaliação do aspecto macroscópico das colônias de micobactérias: um eficiente teste de triagem combinado para a identificação presuntiva do complexo Mycobacterium tuberculosis em meios sólidos

Fernanda Cristina dos Santos Simeão, Erica Chimara, Rosângela Siqueira Oliveira, Jonas Umeoka Yamauchi, Fábio Oliveira Latrilha, Maria Alice da Silva Telles

J Bras Pneumol.2009;35(12):-

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Objective: The rapid differentiation between Mycobacterium tuberculosis and nontuberculous mycobacteria is fundamental for patients co-infected with tuberculosis and HIV. To that end, we use two methods in our laboratory: detection of cord factor and PCR-restriction enzyme analysis (PRA). The objective of this study was to evaluate the accuracy of a screening test on solid medium as a rapid method for the presumptive identification of M. tuberculosis complex, considering costs and turnover time. Methods: A total of 152 strains were submitted to a combined screening test, consisting of the detection of cord factor under microscopy (Ziehl-Neelsen staining) and evaluation of the macroscopic aspect of colonies, as well as to PRA, which was used as the gold standard. Costs were estimated by calculating the price of all of the materials needed for each test. Results: The overall accuracy of cord factor detection alone was 95.4% (95% CI: 90.7-98.1%), and that of the combined screening test was 99.3% (95% CI: 96.4-100%). Cord factor detection costs US$ 0.25, whereas the PRA costs US$ 7.00. Results from cord factor detection are ready in 2 days, whereas PRA requires 4 days to yield results. Conclusions: The presumptive identification of M. tuberculosis using the macroscopic evaluation of colonies combined with cord factor detection under microscopy is a simple, rapid and inexpensive test. We recommend the combined screening test to rapidly identify M. tuberculosis in resource-poor settings and in less well-equipped laboratories while awaiting a definite identification by molecular or biochemical methods.

 


Keywords: Tuberculosis; Mycobacterium/classification; Polymerase chain reaction; Diagnostic tests, routine.

 


Determination of the inflammatory component of airway diseases by induced sputum cell counts: use in clinical practice

Determinação do componente inflamatório das doenças das vias aéreas através do escarro induzido: utilização na prática clínica

Pablo Moritz, Leila John Marques Steidle, Manuela Brisot Felisbino, Túlia Kleveston, Marcia Margaret Menezes Pizzichini, Emilio Pizzichini

J Bras Pneumol.2008;34(11):913-921

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Objective: To evaluate the usefulness of determining the inflammatory component of airway diseases (inflammometry) by induced sputum cell counts, as well as its influence on treatment decisions in a tertiary facility for the treatment of respiratory diseases. Methods: We analyzed 151 sputum samples from 132 consecutive patients referred for clinical sputum induction by five pulmonologists between July of 2006 and February of 2007. A structured questionnaire related to the reasons for requesting the test and to the therapeutic decision making based on test results was completed by each attending physician upon receiving the test results. Induced sputum was obtained and processed according to a technique previously described. Results: The principal motives for ordering the test were inhaled corticosteroid dose titration in patients with moderate-to-severe asthma (in 54.3%), investigation of chronic cough (in 30.5%), and monitoring airway inflammation in patients with bronchiectasis (in 7.3%) or chronic obstructive pulmonary disease (in 6%). Of the 82 patients with asthma, 47 (57%) presented eosinophilic bronchitis (>3% eosinophils). Nonasthmatic eosinophilic bronchitis was diagnosed in 9 (19%) of the 46 patients with chronic cough. Neutrophilic bronchitis (>65% neutrophils) was found in 13 patients, of which 5 had asthma, 2 had chronic cough, and 6 had chronic obstructive pulmonary disease/bronchiectasis. Based on the induced sputum results, the corticosteroid dose was modified in 48 asthma patients (64.7%). Conclusions: The systematic application of inflammometry using induced sputum cell counts can be beneficial for patients with airway diseases, particularly those with asthma or chronic cough.

 


Keywords: Sputum; Asthma; Bronchitis.

 


Morphological prognostic factors in nosocomial pneumonia:an autopsy study

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Luiz Mário Baptista Martinelli, Paulo José Fortes Villas Boas, Thais Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.2010;36(1):51-58

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Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco‑associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.

 


Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality.

 


Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul

Sandra Christo dos Santos, Ana Maria Campos Marques, Roselene Lopes de Oliveira, Rivaldo Venâncio da Cunha

J Bras Pneumol.2013;39(1):84-91

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Resumo

Objetivo: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. Métodos: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. Resultados: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração ≥ 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. Conclusões: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

 


Palavras-chave: Tuberculose pulmonar/diagnóstico; Serviços de saúde do indígena/normas; Serviços de saúde do indígena/organização & administração.

 


Diagnosis and treatment of latent tuberculosis in patients with chronic inflammatory diseases: use of TNF-alpha-targeting biological products

Diagnóstico e tratamento da tuberculose latente em pacientes com doenças inflamatórias crônicas e uso de imunobiológicos inibidores do TNF-α

Diana Maria de Almeida Lopes, Valéria Goes Ferreira Pinheiro, Helena Serra Azul Monteiro, José Ajax Nogueira Queiroz, Lucivaldo dos Santos Madeira, Mônica Maria de Almeida Lopes

J Bras Pneumol.2011;37(3):308-316

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Objective: To determine the clinical and epidemiological profile of patients who are candidates for TNF-α inhibitor use and are classified as having latent tuberculosis (LTB), as well as to evaluate the outcomes of prophylactic treatment with isoniazid. Methods: A prospective descriptive analysis followed by an analytical, observational, cross-sectional study of the outcomes of prophylactic treatment in a group of 45 candidates for TNF-α inhibitor use. We evaluated the patients through anamnesis, clinical examination, chest X-ray, and tuberculin skin test (TST) using the Mantoux method. Results: The mean age was 45 years, and 56.0% of the patients were female. Chronic rheumatic diseases, chronic dermatological diseases, and Crohn's disease were present in 46.7%, 40.0%, and 13.3% of the patients, respectively. The mean TST induration was 14.6 mm (range: 5-30 mm). The majority (n = 30) of the 45 patients (66.7%) had an induration > 10 mm. In the 16 patients with BCG vaccination scars, the mean induration was 15.7 mm, and 14 of those patients had an induration > 10 mm. Chest X-ray results were considered normal, with minimal alterations, in 64.4% and 35.6% of the patients, respectively. The treatment with isoniazid was abandoned by 1 patient (2.2%) and completed by 41 (91.2%), whereas it was interrupted because of drug-induced hepatitis in 2 (4.4%), and 1 patient (2.2%) was transferred to another hospital. Of those who completed the treatment, 5 experienced mild side effects. Conclusions: Determining the profile of candidates for TNF-α inhibitor use is important for the management of LTB treatment and for the establishment of clinical protocols for the use and monitoring of the use of these medications.

 


Keywords: Tuberculosis; Latent tuberculosis; Tuberculin test; Isoniazid; Tumor necrosis factor-alpha.

 


Immunological diagnosis of tuberculosis: problems and strategies for success

Diagnóstico imunológico da tuberculose: problemas e estratégias para o sucesso

Henrique Couto Teixeira, Clarice Abramo, Martin Emilio Munk

J Bras Pneumol.2007;33(3):323-334

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Tuberculosis remains a serious social and public health problem, affecting millions of people annually. The bacille Calmette-Guerin (BCG) vaccine, used prophylactically, does not impede the progression of the disease, which usually manifests as decreased cellular immunity. Early diagnosis, together with polychemotherapy, can control the dissemination of the tuberculosis infection. The current diagnostic methods present certain problems. Such problems include the low sensitivity of sputum smear microscopy, the fact that performing microbiological cultures is quite time-consuming, and the low specificity of the skin test with the purified protein derivative of Mycobacterium tuberculosis. New diagnostic methods, which use specific antigens such as the early secreted antigenic target 6-kDa and culture filtrate protein 10‑kDa, are being evaluated. The genes that encode these antigens are located in the DNA region of difference 1 of M. tuberculosis, M. africanum and M. bovis. However, they are absent from the M. bovis (BCG) and from most environmental mycobacteria. Diagnostic methods such as QuantiFERON-TB® and T SPOT.TB®, which are based on the production of interferon-gamma by T lymphocytes, in response to those antigens, are being tested and have been found to outstrip the purified protein derivative skin test in the following characteristics: greater sensitivity; lower cross-reactivity due to BCG vaccination or infection with environmental mycobacteria; and execution time. The introduction of diagnostic methods that are more specific and sensitive, together with gaining a better understanding of the molecular and cellular mechanisms that regulate the parasite-host interaction, can increase the efficiency of strategies devised to combat tuberculosis.

 


Keywords: Tuberculosis; Mycobacterium tuberculosis; Diagnosis; Antigens, bacterial/ESAT-6 protein; Immunity.

 


Tomographic and functional findings in severe COPD: comparison between the wood smoke-relatedand smoking-related disease

Diferencias tomográficas y funcionales entre la EPOC severa relacionada con humo deleña y con cigarrillo

Mauricio González-García, Dario Maldonado Gomez, Carlos A. Torres-Duque, Margarita Barrero,Claudia Jaramillo Villegas, Juan Manuel Pérez, Humberto Varon

J Bras Pneumol.2013;39(2):147-154

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Objective: Wood smoke exposure is a risk factor for COPD. For a given degree of airway obstruction, the reduction in DLCO is smaller in individuals with wood smoke-related COPD than in those with smoking-related COPD, suggesting that there is less emphysema in the former. The objective of this study was to compare HRCT findings between women with wood smoke-related COPD and women with smoking-related COPD. Methods:áTwenty-two women with severe COPD (FEV1/FVC ratio < 70% and FEV1 < 50%) were divided into two groups: those with wood smoke-related COPD (n = 12) and those with smoking-related COPD (n = 10). The two groups were compared regarding emphysema scores and airway involvement (as determined by HRCT); and functional abnormalities-spirometry results, DLCO, alveolar volume (VA), the DLCO/VA ratio, lung volumes, and specific airway resistance (sRaw). Results: There were no significant differences between the two groups in terms of FEV1, sRaw, or lung hyperinflation. Decreases in DLCO and in the DLCO/VA ratio were greater in the smoking-related COPD group subjects, who also had higher emphysema scores, in comparison with the wood smoke-related COPD group subjects. In the wood smoke-related COPD group, HRCT scans showed no significant emphysema, the main findings being peribronchial thickening, bronchial dilation, and subsegmental atelectasis. Conclusions: Female patients with severe wood smoke-related COPD do not appear to develop emphysema, although they do show severe airway involvement. The reduction in DLCO and VA, with a normal DLCO/VA ratio, is probably due to severe bronchial obstruction and incomplete mixing of inspired gas during the determination of single-breath DLCO.

 


Palavras-chave: Enfermedad pulmonar obstructiva crónica; Tomografía; Contaminación del aire; Biomasa; Humo; Pruebas de función respiratoria.

 


Primary ciliary dyskinesia: Considerations regarding six cases of Kartagener syndrome

Discinesia ciliar primária: Considerações sobre seis casos da síndrome de Kartagener

Hugo Alejandro Vega Ortega, Nelson de Araujo Vega, Bruno Quirino dos Santos, Guilherme Tavares da Silva Maia

J Bras Pneumol.2007;33(5):602-608

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Primary ciliary dyskinesia (PCD), previously known as immotile cilia syndrome, is an autosomal recessive hereditary disease that includes various patterns of ciliary ultrastructural defects. The most serious form is Kartagener syndrome (KS), which accounts for 50% of all cases of PCD. The incidence of PCD ranges from 1:20,000 to 1:60,000. Since PCD causes deficiency or even stasis of the transport of secretions throughout the respiratory tract, it favors the growth of viruses and bacteria. As a result, patients have lifelong chronic and recurrent infections, typically suffering from bronchitis, pneumonia, hemoptysis, sinusitis, and infertility. Bronchiectasis and other chronic conditions infections can be the end result of the irreversible bronchial alterations, leading to chronic cor pulmonale and its consequences. Only half of the patients affected by PDC present all of the symptoms, a condition designated complete KS, compared with incomplete KS, typically defined as cases in which situs inversus does not occur. The diagnosis is made clinically and confirmed through transmission electron microscopy. Since there is no specific therapy for PCD, it is recommended that, upon diagnosis, secondary infections be treated with potent antibiotics and prophylactic interventions be implemented. In this paper, we report six cases of PCD (five cases of complete KS and one case of KS) and review the related literature, focusing on the diagnostic, therapeutic and clinical aspects of this disease.

 


Keywords: Kartagener syndrome; Ciliary motility disorders; Bronchiectasis; Dextrocardia.

 


Dispnéia crônica, distúrbio restritivo e tomografia computadorizada de tórax de alta resolução normal em paciente de 74 anos

Alessandra Sandrini Lopes de Souza, Georgino Henderson Pereira Lemos, Raquel Hermes Rosa Oliveira, Carlos Alberto de C. Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(3):153-156

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Pulmonary hypertension and pulmonary artery dissection

Dissecção da artéria pulmonar e hipertensão pulmonar

Ricardo de Amorim Corrêa, Luciana Cristina dos Santos Silva, Cláudia Juliana Rezende, Rodrigo Castro Bernardes, Tarciane Aline Prata, Henrique Lima Silva

J Bras Pneumol.2013;39(2):238-241

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Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients with pulmonary hypertension, new chest pain, acute chest pain, or cardiogenic shock should raise the suspicion of pulmonary artery dissection, which can result in sudden death.

 


Keywords: Hypertension, pulmonary; Chest pain; Pulmonary artery.

 


Six-minute walk distance and survival time in patients with idiopathic pulmonary fibrosis in Brazil

Distância no teste de caminhada de seis minutos e sobrevida na fibrose pulmonar idiopática no Brasil

Eliane Viana Mancuzo1,2,a, Maria Raquel Soares3,b, Carlos Alberto de Castro Pereira4,c

J Bras Pneumol.2018;44(4):267-272

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the cut-off point for the six-minute walk distance (6MWD) that indicates lower survival time in patients with idiopathic pulmonary fibrosis (IPF) in Brazil. Methods: This was retrospective study carried out in two referral centers for IPF. The 6MWT was performed twice, considering the highest value of the 6MWD. Various cut-off points were estimated, in absolute values and in percentage of predicted values, using ROC curves, the Kaplan-Meier method, and data from other studies. Results: The sample comprised 70 patients with IPF. The mean age was 71.9 ± 6.4 years, and 50 patients (71.4%) were male. The mean FVC was 76.6 ± 18.2% of predicted value. The mean SpO2 at rest before and after 6MWT were 93.8 ± 2.5% and 85.3 ± 6.5%, respectively. The median survival time was 44 months (95% CI: 37-51 months). The mean 6MWD was 381 ± 115 m (79.2 ± 24.0% of predicted). After the analyses, the best cut-off points for estimating survival were 6MWD < 330 m and < 70% of predicted. The median survival time of patients with a 6MWD < 330 m was 24 months (95% CI: 3-45 months), whereas that of those with a 6MWD ≥ 330 m was 59 months (95% CI: 41-77 months; p = 0.009). Similarly, the median survival times of those with a 6MWD < 70% and ≥ 70% of predicted, respectively, were 24 months (95% CI: 13-35 months) and 59 months (95% CI: 38-80 months; p = 0.013). Cox multivariate regression models including age, sex, smoking status, SpO2 at the end of the 6MWT, and FVC% showed that 6MWD remained significantly associated with survival (p = 0.003). Conclusions: Values of 6MWD < 330 m and < 70% of predicted value were associated with lower survival time in IPF patients in Brazil.

 


Keywords: Lung diseases, interstitial; Pulmonary fibrosis; Exercise tolerance.

 


Six-minute walk distance is not related to quality of life in patients with non-cystic fibrosis bronchiectasis

Distância percorrida no teste de caminhada de seis minutos não se relaciona com qualidade de vida em pacientes com bronquiectasias não fibrocísticas

Patrícia Santos Jacques, Marcelo Basso Gazzana, Dora Veronisi Palombini, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2012;38(3):346-355

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Objective: To evaluate physical performance on the six-minute walk test (6MWT) in patients with non-cystic fibrosis bronchiectasis and to investigate its relationship with quality of life (QoL). To identify predictors of exercise performance, we also investigated whether six-minute walk distance (6MWD) is associated with clinical and spirometric findings. Methods: This was a cross-sectional study involving patients with non-cystic fibrosis bronchiectasis (age,  18 years), with at least one respiratory symptom for  2 years and an FEV1  70% of predicted. Patients underwent clinical evaluation, pulmonary function tests, the 6MWT, and QoL assessment with the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Results: We included 70 patients (48 females). Mean age was 54.5 ± 17.7 years, and mean FEV1 was 44.9 ± 14.5% of predicted. The patients were divided into two groups: 6MWD-low (6MWD below the predicted lower limit; n = 23); and 6MWD-norm (normal 6MWD; n = 47). The following variables were significantly lower in the 6MWD-low group than in the 6MWD-norm group: age; age at diagnosis of bronchiectasis; proportion of former smokers; body mass index (BMI); FEV1% of predicted; and MEP% of predicted. There were no significant differences in the SF-36 scores between the groups. In the logistic regression model, lower age and lower BMI were significantly associated with lower 6MWD. Conclusions: In this sample, there was a high proportion of patients who had a lower than expected 6MWD. Although 6MWD was not related to QoL, it was associated with age and BMI.

 


Keywords: Bronchiectasis; Quality of life; Respiratory function tests; Exercise tolerance.

 


Expansion of a lung bulla caused by cystic adenomatoid malformation during air travel

Distensão de bolha pulmonar por malformação adenomatoide cística durante viagem aérea

Fernando Luiz Westphal, Luís Carlos de Lima, José Corrêa Lima Netto, Márcia dos Santos da Silva, Ingrid Loureiro de Queiroz Lima, Danielle Cristine Westphal

J Bras Pneumol.2012;38(2):272-274

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Single Nucleotide Polymorphisms (SNPs) of the TNF-á (-238/-308) gene among TB and nom TB patients: Susceptibility markers of TB occurrence?

Distribuição de Polimorfismos de Base única (SNPs) no gene de TNF-a (-238/-308) entre pacientes com TB e outras pneumopatias: marcadores genéticos de susceptibilidade a ocorrência de TB?

Martha Maria de Oliveira; Jocilea C. S. da Silva; Joseane F. Costa; Lúcia Helena Amim; Carla C. S. Loredo; Hedi Melo; Luiz F. Queiroz; Fernanda C. Q. Mello; José Roberto Lapa e Silva; Afrânio Lineu Kritski; Adalberto Rezende Santos

J Bras Pneumol.2004;30(4):461-467

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Background: Host genetic factors may play a role in the susceptibility to active tuberculosis (TB), and several polymorphisms in different cytokine coding genes have been described and associated with diseases to date. Objectives: To investigate whether polymorphisms within the promoter region of the TNF-á (-238/-308) coding genes are associated to the occurrence of active TB. Methods: SNPs within the TNF-á gene were analyzed by PCR-RFLP among two groups of individuals: patients with TB (n = 234, and patients non TB (n = 113). Results: In this study, the presence of the -238A allele was associated with susceptibility to TB disease occurrence and severity (p = 0,00002; OR = 0,15; IC = 0,06-0,36. On the contrary, the -308A allele was associated with protection to the occurrence of another pulmonary diseases. Conclusions: These results suggest the importance of genetics studies on TB occurrence. Further studies are needed pursuing a better understanding of the human pathogenesis of M. tb.

 


Keywords: Tuberculosis/genetics. Polymorphism, single nucleotide/genetics. Tumor necrosis factor/genetics. Alleles. Genotype. Lung diseases.

 


Doença alveolar infreqüente em mulher de 55 anos

Maria Conceição C.A.M. Queiroz, Maria Auxiliadora Carmo Moreira, Maurício Sérgio Brasil Leite, Karla C.M.A. Curado, Fernanda Miranda de Oliveira

J Bras Pneumol.1997;23(5):271-274

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Castleman's disease accompanied by pleural effusion

Doença de Castleman associada a derrame pleural

Valéria Góes Ferreira Pinheiro, Geórgea Hermógenes Fernandes, Lia Cavalcante Cezar, Newton de Albuquerque Alves, Dalgimar Beserra de Menezes

J Bras Pneumol.2008;34(8):626-630

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Castleman's disease is a rare disorder of the lymphoid tissue. We report the case of a female patient with bilateral otosclerosis, no respiratory symptoms, and pleural effusion discovered as an incidental finding on a chest X-ray. Computed tomography of the chest revealed a mediastinal mass. The biopsy findings demonstrated that it was a plasmacytic variant of Castleman's disease. The patient underwent mediastinal mass resection. This resulted in near-total resolution of the effusion, which remained as a small loculation within the left pleural space.

 


Keywords: Giant lymph node hyperplasia; Pleural effusion; Case reports.

 


Madelung's disease as a rare cause of obstructive sleep apnea

Doença de Madelung como causa rara de apneia obstrutiva do sono

Vitor Alexandre Oliveira Fonseca, Carlos Alves, Helena Marques, Elvira Camacho, António Pinto Saraiva

J Bras Pneumol.2009;35(10):1053-1056

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Madelung's disease, or multiple symmetric lipomatosis, is a rare disease, characterized by accumulation of unencapsulated fat, generally located symmetrically around the neck and shoulders. Here, we present the case of a patient with diffuse lipomatosis accompanied by obstructive sleep apnea due to cervical involvement and facial deformity, which made it necessary to use nasal pillows for ventilation. The patient was hospitalized with a diagnosis of pneumonia and required noninvasive ventilation due to severe hypercapnia. A brief review of the literature was made, and we describe and discuss the investigation of this rare clinical case.

 


Keywords: Lipomatosis, multiple symmetrical; Sleep apnea, obstructive; Continuous positive airway pressure; Masks.

 


Gastroesophageal reflux disease and airway hyperresponsiveness: concomitance beyond the realm of chance?

Doença do refluxo gastroesofágico e hiperresponsividade das vias aéreas: coexistência além da chance?

Jaqueline Cavalcanti de Albuquerque Ratier, Emilio Pizzichini, Marcia Pizzichini

J Bras Pneumol.2011;37(5):680-688

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Gastroesophageal reflux disease and asthma are both quite common the world over, and they can coexist. However, the nature of the relationship between these two diseases remains unclear. In this study, we review controversial aspects of the relationships among asthma, airway hyperresponsiveness, and gastroesophageal reflux disease in adults and in children.

 


Keywords: Asthma; Bronchial hyperreactivity; Gastroesophageal reflux.

 


Hard metal lung disease in an oil industry worker

Doença pulmonar por metal duro em trabalhador da indústria petrolífera

Patrícia Nunes Bezerra, Ana Giselle Alves Vasconcelos, Lílian Loureiro Albuquerque Cavalcante,Vanessa Beatriz de Vasconcelos Marques, Teresa Neuma Albuquerque Gomes Nogueira,Marcelo Alcantara Holanda

J Bras Pneumol.2009;35(12):-

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Hard metal lung disease, which manifests as giant cell interstitial pneumonia, is caused by exposure to hard metal dust. We report the case of an oil industry worker diagnosed with hard metal lung disease. The diagnosis was based on the clinical, radiological and anatomopathological analysis, as well as on pulmonary function testing.

 


Keywords: Alloys/adverse effects; Cobalt; Tungsten; Occupational exposure; Lung diseases, interstitial.

 


Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique

Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África

Elizabete Abrantes Nunes, Eduardo Mello De Capitani, Elizabete Coelho, Alessandra Costa Panunto, Orvalho Augusto Joaquim, Marcelo de Carvalho Ramos

J Bras Pneumol.2008;34(10):822-828

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Objective: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. Methods: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. Results: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA) of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%), followed by mediastinal lymph node enlargement (in 30%), bronchiectasis (in 28%), miliary nodules (in 18%) and cavitation (in 12%). Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm3. Conclusions: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate choice for initial therapy.

 


Keywords: Tuberculosis; Mycobacteria, atypical; HIV; Acquired immunodeficiency syndrome; Drug Resistance, Multiple; Mozambique.

 


Dores articulares, pleurite, dispnéia, nódulos broncovasculares, centrolobulares e padrão em mosaico em paciente de 47 anos

Veronica Moreira Amado, Roseli Rocha Brito, Jaquelina Sonoe Ota, Rimarcs G. Ferreira, Carlos Alberto de Castro Pereira

J Bras Pneumol.1998;24(1):57-60

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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):-

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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.

 


Doxycycline use in patients with lymphangioleiomyomatosis: safety and efficacy in metalloproteinase blockade

Doxiciclina em pacientes com linfangioleiomiomatose: segurança e eficácia no bloqueio de metaloproteinases

Suzana Pinheiro Pimenta, Bruno Guedes Baldi, Milena Marques Pagliarelli Acencio, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2011;37(4):424-430

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Objective: To determine the frequency of near-fatal asthma in a group of severe asthma patients, as well as the clinical characteristics and prognosis of these patients within a one-year follow-up period. Methods: A prospective study involving 731 low-income patients with severe asthma treated at a referral outpatient clinic located in the city of Salvador, Brazil. The patients were submitted to spirometry at admission, received medications for asthma, and were monitored regarding the frequency of asthma exacerbations during the follow-up period. A subsample of 511 patients also completed questionnaires regarding asthma symptoms and asthma-related quality of life. Results: Of the 731 patients studied, 563 (77%) were female. The median age was 47 years, and 12% were illiterate. Most of the patients had rhinitis, and 70 patients (10%) reported near-fatal asthma prior to admission. Of these 70 patients, 41 (59%) reported having been intubated previously. The patients reporting a history of near-fatal asthma at admission were more likely to have asthma exacerbations during the follow-up period and to respond poorly to therapy than were those not reporting such a history. At the end of the follow-up period, the scores on the two questionnaires were similar between the two groups of patients. Conclusions: The frequency of near-fatal asthma was high in this group of low-income patients with severe asthma. The patients with a history of near-fatal asthma had a worse prognosis than did those without such a history, although both groups had received the same kind of treatment. Curiously, the intensity of symptoms and the quality of life at the end of the study were similar between the two groups.

 


Keywords: Asthma/prevention and control; Asthma/complications; Quality of life; Prognosis.

 


Antituberculosis drugs: Drug interactions, adverse effects, and use in special situations. Part 1: First-line drugs*

Drogas antituberculose: Interações medicamentosas, efeitos adversos e utilização em situações especiais. Parte 1: Fármacos de primeira linha

Marcos Abdo Arbex, Marília de Castro Lima Varella, Hélio Ribeiro de Siqueira, Fernando Augusto Fiúza de Mello

J Bras Pneumol.2010;36(5):626-640

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The main objectives of tuberculosis therapy are to cure the patients and to minimize the possibility of transmission of the bacillus to healthy subjects. Adverse effects of antituberculosis drugs or drug interactions (among antituberculosis drugs or between antituberculosis drugs and other drugs) can make it necessary to modify or discontinue treatment. We briefly review the new guidelines for the pharmacological treatment of tuberculosis, introduced by the Brazilian National Ministry of Health in 2009, and describe the general mechanism of action, absorption, metabolization, and excretion of the first-line drugs used in the basic regimen. We describe adverse drug reactions and interactions (with other drugs, food, and antacids), as well as the most appropriate approach to special situations, such as pregnancy, breastfeeding, liver failure, and kidney failure. We also describe the mechanisms by which the interactions among the antituberculosis drugs used in the basic regimen can cause drug-induced hepatitis, and we discuss the alternatives in this situation.

 


Keywords: Tuberculosis; Drug interactions; Antibiotics, antitubercular; Pharmacologic actions; Drug toxicity; Drug-induced liver injury.

 


Antituberculosis drugs: Drug interactions, adverse effects, and use in special situations. Part 2: Second line drugs

Drogas antituberculose: Interações medicamentosas, efeitos adversos e utilização em situações especiais. Parte 2: Fármacos de segunda linha

Marcos Abdo Arbex, Marília de Castro Lima Varella, Hélio Ribeiro de Siqueira, Fernando Augusto Fiúza de Mello

J Bras Pneumol.2010;36(5):641-656

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The main objectives of tuberculosis therapy are to cure the patients and to minimize the possibility of transmission of the bacillus to healthy subjects. Adverse effects of antituberculosis drugs or drug interactions (among antituberculosis drugs or between antituberculosis drugs and other drugs) can make it necessary to modify or discontinue treatment. We describe the general mechanism of action, absorption, metabolization, and excretion of the drugs used to treat multidrug resistant tuberculosis (aminoglycosides, fluoroquinolones, cycloserine/terizidone, ethionamide, capreomycin, and para-aminosalicylic acid). We describe adverse drug reactions and interactions (with other drugs, food, and antacids), as well as the most appropriate approach to special situations, such as pregnancy, breastfeeding, liver failure, and kidney failure.

 


Keywords: Tuberculosis; Drug interactions; Antibiotics, antitubercular; Pharmacologic actions; Drug toxicity, Tuberculosis, multidrug-resistant.

 


Differentiating between tuberculosis-related and lymphoma&#8209;related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible?

É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

Leila Antonangelo, Francisco Suso Vargas, Eduardo Henrique Genofre, Caroline Maris Neves de Oliveira, Lisete Ribeiro Teixeira, Roberta Karla Barbosa de Sales

J Bras Pneumol.2012;38(2):181-187

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Objective: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphoma-related lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. Methods: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. Results: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. Conclusions: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.

 


Keywords: Pleural effusion; Tuberculosis; Lymphoma; Adenosine deaminase; Diagnosis, differential.

 


Reexpansion pulmonary edema

Edema pulmonar de reexpansão

Eduardo Henrique Genofre, Francisco S. Vargas, Lisete R. Teixeira, Marcelo Alexandre Costa Vaz, Evaldo Marchi

J Bras Pneumol.2003;29(2):101-106

Abstract PDF PT

Reexpansion pulmonary edema (RPE) is a rare, but frequently lethal, clinical entity. The precise pathophysiologic abnormalities associated with this disorder are still unknown: decreased surfactant levels and a pro-inflammatory status are putative mechanisms. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment. Considering the high mortality rates related to RPE, preventive measures are still the best available strategy for patient handling. This review provides a brief overview of the pathophysiology, diagnosis, treatment, and prevention of RPE, with practical recommendations for adequate intervention.

 



Bronchodilator effect on maximal breath-hold time in patients with obstructive lung disease

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos

Raqueli Biscayno Viecili, Paulo Roberto Stefani Sanches, Denise Rossato Silva, Danton Pereira da Silva, André Frota Muller, Sergio Saldanha Menna Barreto

J Bras Pneumol.2011;37(6):745-751

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Objective: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). Methods: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHTmaxVEI and BHTmaxVEE, respectively) were determined from the acquired signal. Results: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHTmaxVEI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHTmaxVEE values were significantly lower in the OLD group than in the control group, in the pre- and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). Conclusions: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test.

 


Keywords: Respiratory function tests; Pulmonary disease, chronic obstructive; Bronchodilator agents; Apnea.

 


Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

Efeito do exercício passivo em cicloergômetro na força muscular, tempo de ventilação mecânica e internação hospitalar em pacientes críticos: ensaio clínico randomizado

Aline dos Santos Machado1, Ruy Camargo Pires-Neto2, Maurício Tatsch Ximenes Carvalho3, Janice Cristina Soares4,5, Dannuey Machado Cardoso6, Isabella Martins de Albuquerque3

J Bras Pneumol.2017;43(2):134-139

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Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/])

 


Keywords: Physical therapy modalities; Intensive care units; Early ambulation; Muscle strength.

 


Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

Efeitos da pressão expiratória positiva na depuração pulmonar do ácido dietilenotriaminopentacético marcado com tecnécio-99m em aerossol em indivíduos saudáveis

Isabella Martins de Albuquerque1, Dannuey Machado Cardoso2, Paulo Ricardo Masiero3, Dulciane Nunes Paiva4, Vanessa Regiane Resqueti5, Guilherme Augusto de Freitas Fregonezi5, Sérgio Saldanha Menna-Barreto6

J Bras Pneumol.2016;42(6):404-408

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Objective: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects.

 


Keywords: Lung/metabolism; Technetium Tc 99m pentetate/pharmacokinetics; Radiopharmaceuticals; Positive-pressure respiration.

 


Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a systematic review and meta-analysis of six randomized controlled trials

Efeitos da pressão positiva contínua nas vias aéreas na pressão arterial em pacientes com hipertensão resistente e apneia obstrutiva do sono: revisão sistemática e meta-análise de seis ensaios clínicos controlados aleatórios

Qiang Lei1, Yunhui Lv2, Kai Li1, Lei Ma1, Guodong Du1, Yan Xiang1, Xuqing Li1

J Bras Pneumol.2017;43(5):373-379

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Objective: To evaluate systematically the effects of continuous positive airway pressure (CPAP) on blood pressure in patients with resistant hypertension and obstructive sleep apnea (OSA). Methods: The Cochrane Library, PubMed, ScienceDirect, and the Web of Science were searched for studies investigating the effects of CPAP on blood pressure in patients with resistant hypertension and OSA. The selected studies underwent quality assessment and meta-analysis, as well as being tested for heterogeneity. Results: Six randomized controlled trials were included in the meta-analysis. The pooled estimates of the changes in mean systolic blood pressure and mean diastolic blood pressure (as assessed by 24-h ambulatory blood pressure monitoring) were −5.40 mmHg (95% CI: −9.17 to −1.64; p = 0.001; I2 = 74%) and −3.86 mmHg (95% CI: −6.41 to −1.30; p = 0.00001; I2 = 79%), respectively. Conclusions: CPAP therapy can significantly reduce blood pressure in patients with resistant hypertension and OSA.

 


Keywords: Continuous positive airway pressure; Sleep apnea, obstructive; Hypertension; Meta-analysis.

 


Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients

Efeitos da pressão positiva expiratória nas vias aéreas sobre a atividade eletromiográfica da musculatura acessória da inspiração em portadores de DPOC

Dannuey Machado Cardoso, Dulciane Nunes Paiva, Isabella Martins de Albuquerque, Renan Trevisan Jost, Andréia Vanessa da Paixão

J Bras Pneumol.2011;37(1):46-53

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Objective: To evaluate the electromyographic activity (EA) of sternocleidomastoid (SCM) and scalene muscles during and after the use of expiratory positive airway pressure (EPAP) in patients with COPD. Methods: This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min after the mask removal. Results: We found that the behavior of the EA of SCM and scalene muscles was comparable between the controls and the COPD patients (p = 0.716 and p = 0.789, respectively). However, during the use of EPAP, both muscles showed a trend toward an increase in the EA. In addition, there was a significant decrease in the EA of the SCM between the baseline and final measurements (p = 0.034). Conclusions: The use of EPAP promoted a significant reduction in the EA of the SCM in the controls and in the patients with stable COPD. However, this did not occur regarding the EA of the scalene muscle.

 


Keywords: Electromyography; Respiratory muscles; Pulmonary disease, chronic obstructive; Positive-pressure respiration.

 


Effects of breathing exercises on breathing pattern and thoracoabdominal motion after gastroplasty

Efeitos de exercícios respiratórios sobre o padrão respiratório e movimento toracoabdominal após gastroplasti

Georgia Miranda Tomich, Danielle Corrêa França, Marco Túlio Costa Diniz, Raquel Rodrigues Britto, Rosana Ferreira Sampaio, Verônica Franco Parreira

J Bras Pneumol.2010;36(2):197-204

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Objective: To evaluate breathing pattern and thoracoabdominal motion during breathing exercises. Methods: Twenty-four patients with class II or III obesity (18 women; 6 men) were studied on the second postoperative day after gastroplasty. The mean age was 37 ± 11 years, and the mean BMI was 44 ± 3 kg/m2. Diaphragmatic breathing, incentive spirometry with a flow-oriented device and incentive spirometry with a volume-oriented device were performed in random order. Respiratory inductive plethysmography was used in order to measure respiratory variables and thoracoabdominal motion. Results: Comparisons among the three exercises showed significant differences: tidal volume was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing; the respiratory rate was lower during incentive spirometry with the volume-oriented device than during incentive spirometry with the flow-oriented device; and minute ventilation was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing. Rib cage motion did not vary during breathing exercises, although there was an increase in thoracoabdominal asynchrony, especially during incentive spirometry with the flow-oriented device. Conclusions: Among the breathing exercises evaluated, incentive spirometry with the volume-oriented device provided the best results, because it allowed slower, deeper inhalation.

 


Keywords: Breathing exercises; Physical therapy (Specialty); Bariatric surgery; Obesity, morbid.

 


Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer

Efeitos de um programa de reabilitação de alta intensidade no comando VE/VCO2 durante exercício em um grupo de pacientes submetidos à ressecção para câncer de pulmão de células não pequenas

Fabio Perrotta1,a, Antonio Cennamo2,b, Francesco Saverio Cerqua2,c, Francesco Stefanelli3,d, Andrea Bianco2,e, Salvatore Musella3,f, Marco Rispoli4,g, Rosario Salvi5,h, Ilemando Meoli3,i

J Bras Pneumol.2019;45(6):e20180132-e20180132

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Objective: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.

 


Keywords: Carcinoma, non-small-cell lung; Pulmonary disease, chronic obstructive/rehabilitation; Carbon dioxide/metabolism; Oxygen consumption/physiology; Risk assessment.

 


Effects of indacaterol versus tiotropium on exercise tolerance in patients with moderate COPD: a pilot randomized crossover study

Efeitos do indacaterol versus tiotrópio na tolerância ao exercício em pacientes com DPOC moderada: estudo cruzado randomizado piloto

Danilo Cortozi Berton1, Álvaro Huber dos Santos2, Ivo Bohn Jr.2, Rodrigo Quevedo de Lima2, Vanderléia Breda2, Paulo José Zimermann Teixeira2,3,4

J Bras Pneumol.2016;42(5):362-366

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Objective: To compare a once-daily long-acting β2 agonist (indacaterol 150 µg) with a once-daily long-acting anticholinergic (tiotropium 5 µg) in terms of their effects on exercise endurance (limit of tolerance, Tlim) in patients with moderate COPD. Secondary endpoints were their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Methods: This was a randomized, single-blind, crossover pilot study involving 20 patients (mean age, 60.9 ± 10.0 years; mean FEV1, 69 ± 7% of predicted). Spirometric parameters, Transition Dyspnea Index scores, Tlim, and exertional dyspnea were compared after three weeks of each treatment (with a one-week washout period between treatments). Results: Nineteen patients completed the study (one having been excluded because of COPD exacerbation). Improvement in Tlim from baseline tended to be greater after treatment with tiotropium than after treatment with indacaterol (96 ± 163 s vs. 8 ± 82 s; p = 0.06). Tlim significantly improved from baseline after treatment with tiotropium (having increased from 396 ± 319 s to 493 ± 347 s; p = 0.010) but not after treatment with indacaterol (having increased from 393 ± 246 to 401 ± 254 s; p = 0.678). There were no differences between the two treatments regarding improvements in Borg dyspnea scores and lung hyperinflation at "isotime" and peak exercise. There were also no significant differences between treatments regarding Transition Dyspnea Index scores (1.5 ± 2.1 vs. 0.9 ± 2.3; p = 0.39). Conclusions: In patients with moderate COPD, tiotropium tends to improve Tlim in comparison with indacaterol. No significant differences were observed between the two treatments regarding their effects on lung hyperinflation, exercise-related dyspnea, and daily-life dyspnea. Future studies, including a larger number of patients, are required in order to confirm our findings and explore mechanistic explanations. (ClinicalTrials.gov identifier: NCT01693003 [http://www.clinicaltrials.gov/])

 


Keywords: Pulmonary disease, chronic obstructive; Exercise; Bronchodilator agents.

 


Effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis

Efeitos do método Pilates na força muscular e na função pulmonar de pacientes com fibrose cística

Caroline Buarque Franco, Antonio Fernando Ribeiro, André Moreno Morcillo, Mariana Porto Zambon, Marina Buarque Almeida, Tatiana Rozov

J Bras Pneumol.2014;40(5):521-527

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). Methods: This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clínicas or the Children's Institute of the University of São Paulo School of Medicine Hospital das Clínicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). The variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. Results: After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. Conclusions: Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients. (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-86vp8x [http://www.ensaiosclinicos.gov.br])

 


Keywords: Cystic fibrosis; Muscle strength; Exercise movement techniques; Respiratory function tests.

 


Air stacking: effects on pulmonary function in patients with spinal muscular atrophy and in patients with congenital muscular dystrophy

Efeitos do treinamento de empilhamento de ar na função pulmonar de pacientes com amiotrofia espinhal e distrofia muscular congênita

Tanyse Bahia Carvalho Marques, Juliana de Carvalho Neves, Leslie Andrews Portes, João Marcos Salge, Edmar Zanoteli, Umbertina Conti Reed

J Bras Pneumol.2014;40(5):528-534

Abstract PDF PT PDF EN Portuguese Text

Objective: Respiratory complications are the main causes of morbidity and mortality in patients with neuromuscular disease (NMD). The objectives of this study were to determine the effects that routine daily home air-stacking maneuvers have on pulmonary function in patients with spinal muscular atrophy (SMA) and in patients with congenital muscular dystrophy (CMD), as well as to identify associations between spinal deformities and the effects of the maneuvers. Methods: Eighteen NMD patients (ten with CMD and eight with SMA) were submitted to routine daily air-stacking maneuvers at home with manual resuscitators for four to six months, undergoing pulmonary function tests before and after that period. The pulmonary function tests included measurements of FVC; PEF; maximum insufflation capacity (MIC); and assisted and unassisted peak cough flow (APCF and UPCF, respectively) with insufflations. Results: After the use of home air-stacking maneuvers, there were improvements in the APCF and UPCF. In the patients without scoliosis, there was also a significant increase in FVC. When comparing patients with and without scoliosis, the increases in APCF and UPCF were more pronounced in those without scoliosis. Conclusions: Routine daily air-stacking maneuvers with a manual resuscitator appear to increase UPCF and APCF in patients with NMD, especially in those without scoliosis.

 


Keywords: Neuromuscular diseases; Cough; Respiratory function tests; Respiratory therapy.

 


Eliminating tuberculosis in Latin America: making it the point

Eliminação da tuberculose na América Latina: considerações

Raquel Duarte1,2,3,a, Denise Rossato Silva4,b, Adrian Rendon5,c, Tatiana Galvẫo Alves6,d, Marcelo Fouad Rabahi7,e, Rosella Centis8,f, Afrânio Kritski9,g, Giovanni Battista Migliori8,h

J Bras Pneumol.2018;44(2):73-76

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Pulmonary cement embolism

Embolia pulmonar por cimento ósseo

Manuel Lessa Ribeiro Neto1, Marcel Lima Albuquerque1, Daniela Barboza Santos Cavalcante1, João Ricardo Maltez de Almeida2

J Bras Pneumol.2015;41(4):395-396

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Use of breath carbon monoxide as an indicator of smoking status

Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco

Ubiratan P. Santos, Silmar Gannam, Julie M. Abe, Patricia B. Esteves, Marco Freitas Filho, Thais B. Wakassa, Jaqueline S. Issa, Mario Terra-Filho, Rafael Stelmach, Alberto Cukier

J Bras Pneumol.2001;27(5):231-236

Abstract PDF PT

Introduction: Smoking is the major preventable risk of morbidity and mortality. However, its prevalence is high in developed countries and increasing in developing countries, even though its effects are now better known. The purpose of this study was to compare the exhaled carbon monoxide concentration (exCO) between smokers and nonsmokers, evaluate the factors that influence this parameter among smokers and the potential influence of passive smoking by measuring exCO in workers and patients of Instituto do Coração HC-FMUSP. Materials and methods: This cross study included 256 volunteers who responded to a questionnaire and were submitted to exCO measuring with the MicroCo meter device. Results: There were 106 males and 150 females. Mean age was 43.4 years (Vmin-max: 15-83). There were 107 smokers, 118 nonsmokers and 31 passive smokers. Mean exCO was 14.01 ppm (Vmin-max: 1-44) among smokers, 2.03 ppm (Vmin-max: 0-5) among passive smokers and 2.50 ppm (Vmin-max: 0-9) among nonsmokers. Significant statistical difference was observed between smokers and the other groups (p < 0.001), but not between nonsmokers and passive smokers. A positive correlation was found between the number of cigarettes smoked per day and exCO values while there was a negative correlation between the exCO values and the timing of the last cigarette. For a reference limit value of 6 ppm, sensitivity was 70% and specificity was 96%. Conclusion: exCO metering is easy to perform, low-cost, noninvasive and allows the obtention of immediate results and the reference limit value of 6 ppm has good specificity to evaluate the smoking habit.

 


Keywords: Smoking. Carbon monoxide. Tobacco smoke pollution. Brazil.

 


Escarro induzido, recomendações do Programa de Controle de Tuberculose do Estado do Rio de Janeiro*

Marneili Martins, Eliane Dale Sucupira, Lísia M. R. de Freitas, Lia Selig, Eduardo Pamplona Bethlem Rodrigo Siqueira Batista

J Bras Pneumol.2004;30(6):591-592

PDF PT Portuguese Text



High-resolution computed tomography scores in cystic fibrosis patients colonized with Pseudomonas aeruginosa or Staphylococcus aureus

Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

Tania Wrobel Folescu, Elizabeth de Andrade Marques, Márcia Cristina Bastos Boechat, Pedro Daltro, Laurinda Yoko Shinzato Higa, Renata Wrobel Folescu Cohen

J Bras Pneumol.2012;38(1):41-49

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare HRCT findings in cystic fibrosis (CF) patients chronically colonized with Pseudomonas aeruginosa or Staphylococcus aureus using the modified Bhalla CT scoring system, as well as to evaluate intraobserver and interobserver reliability of the method. Methods: This was a retrospective cross-sectional study involving 41 CF patients, 26 of whom were chronically colonized with P. aeruginosa (Pa group), and 15 of whom were colonized with S. aureus (Sa group).Two independent radiologists evaluated the HRCT scans of these patients using the modified Bhalla CT scoring system in two different moments. Intraobserver and interobserver reliability was calculated using the intraclass correlation coefficient (ICC). Results: There was good intraobserver and interobserver agreement (ICC > 0.8). Scores were higher in the Pa group than in the Sa group for observer 1 (mean, 13.50 ± 3.90; median, 13.5 vs. mean, 5.00 ± 5.28; median, 3.0) and for observer 2 (mean, 11.96 ± 5.07; median, 12.0 vs. mean, 5.07 ± 5.65; median, 5.0). In addition, HRCT findings, such as bronchiectasis, bronchial wall thickening, mucus plugging, generation of bronchial divisions, and mosaic attenuation/perfusion pattern, were more prevalent in the Pa group. Conclusions: The modified Bhalla CT scoring system was reproducible and reliable for use in the evaluation of HRCT scans, allowing distinctions to be drawn between the two groups of patients under study. The higher scores in the Pa group provided evidence of greater pulmonary impairment in that group.

 


Keywords: Cystic fibrosis; Tomography; Staphylococcus aureus; Pseudomonas aeruginosa.

 


Tuberculous spondylitis in teenager

Espondilite tuberculosa em adolescente

Marta Maciel Lyra Cabral, Bruno Canto C. de A. Azevedo, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Andrea Santos Lima, Haiana Charifker Schindler

J Bras Pneumol.2005;31(3):261-264

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This article presents a case report of osteoarticular tuberculosis affecting lumbar sacral column non-typical attack. The diagnosis remains a medical challenge because the symptoms and bone lesions are not specific and can be mislead with other morbidity such as inflammatory, circulatory, metabolic, traumatic, congenital and tumoral diseases. The disease is degenerative and the prognosis not satisfactory. Besides the clinical aspects and laboratory, imaging results, including computed tomography and magnetic ressonance, are discussed. A PCR system targeting the IS 6110 of M. tuberculosis was positive, strongly suggesting the presence of this pathogen. This assay would be particularly indicated when quick and sensitive diagnosis of tuberculosis is required.

 


Keywords: Tuberculosis. Spondylitis. PCR. Diagnostic.

 


Estimated rates of recurrence, cure, and treatment abandonment in patients with pulmonary tuberculosis treated with a ­four&#8209;drug fixed-dose combination regimen at a tertiary health care facility in the city of Rio de Janeiro, Brazil

Estimativas das taxas de recidiva, cura e abandono de tratamento em pacientes com tuberculose pulmonar tratados com esquema de dose fixa combinada de quatro drogas em uma unidade de saúde terciária na cidade do Rio de Janeiro

Vangie Dias da Silva1, Fernanda Carvalho de Queiroz Mello2, Sonia Catarina de Abreu Figueiredo2

J Bras Pneumol.2017;43(2):113-120

Abstract PDF PT PDF EN Portuguese Text

Objective: To estimate the rates of recurrence, cure, and treatment abandonment in patients with pulmonary tuberculosis treated with a four-drug fixed-dose combination (FDC) regimen, as well as to evaluate possible associated factors. Methods: This was a retrospective observational study involving 208 patients with a confirmed diagnosis of pulmonary tuberculosis enrolled in the Hospital Tuberculosis Control Program at the Institute for Thoracic Diseases, located in the city of Rio de Janeiro, Brazil. Between January of 2007 and October of 2010, the patients were treated with the rifampin-isoniazid-pyrazinamide (RHZ) regimen, whereas, between November of 2010 and June of 2013, the patients were treated with the rifampin-isoniazid-pyrazinamide-ethambutol FDC (RHZE/FDC) regimen. Data regarding tuberculosis recurrence and mortality in the patients studied were retrieved from the Brazilian Case Registry Database and the Brazilian Mortality Database, respectively. The follow-up period comprised two years after treatment completion. Results: The rates of cure, treatment abandonment, and death were 90.4%, 4.8%, and 4.8%, respectively. There were 7 cases of recurrence during the follow-up period. No significant differences in the recurrence rate were found between the RHZ and RHZE/FDC regimen groups (p = 0.13). We identified no factors associated with the occurrence of recurrence; nor were there any statistically significant differences between the treatment groups regarding adverse effects or rates of cure, treatment abandonment, or death. Conclusions: The adoption of the RHZE/FDC regimen produced no statistically significant differences in the rates of recurrence, cure, or treatment abandonment; nor did it have any effect on the occurrence of adverse effects, in comparison with the use of the RHZ regimen.

 


Keywords: Tuberculosis, pulmonary, Drug combinations; Recurrence.

 


Study of inhaler technique in asthma patients: differences between pediatric and adult patients

Estudio sobre la técnica inhalatoria en pacientes asmáticos: diferencias entre pacientes pediátricos y adultos

Pablo Manríquez1, Ana María Acuña2, Luis Muñoz3, Alvaro Reyes4

J Bras Pneumol.2015;41(5):405-409

Abstract PDF PT PDF EN Portuguese Text

Objective: Inhaler technique comprises a set of procedures for drug delivery to the respiratory system. The oral inhalation of medications is the first-line treatment for lung diseases. Using the proper inhaler technique ensures sufficient drug deposition in the distal airways, optimizing therapeutic effects and reducing side effects. The purposes of this study were to assess inhaler technique in pediatric and adult patients with asthma; to determine the most common errors in each group of patients; and to compare the results between the two groups. Methods: This was a descriptive cross-sectional study. Using a ten-step protocol, we assessed inhaler technique in 135 pediatric asthma patients and 128 adult asthma patients. Results: The most common error among the pediatric patients was failing to execute a 10-s breath-hold after inhalation, whereas the most common error among the adult patients was failing to exhale fully before using the inhaler. Conclusions: Pediatric asthma patients appear to perform most of the inhaler technique steps correctly. However, the same does not seem to be true for adult patients.

 


Keywords: Administration, inhalation; Aerosols/administration & dosage; Asthma/prevention & control.

 


A case-control study about indicators of non-compliance in patients with tuberculosis

Estudo caso-controle de indicadores de abandono em doentes com tuberculose

Sandra A. Ribeiro, Verônica M. Amado, Aquiles A. Camelier, Márcia M.A. Fernandes, Simone Schenkman

J Bras Pneumol.2000;26(6):291-296

Abstract PDF PT

Non-compliance of tuberculosis treatment has social and epidemiological implications. Purpose: To compare characteristics of patients that were compliant (control group) and non-compliant with the treatment at the Health Care Center at the Federal University of São Paulo, Brazil, between 1995 and 1997, and to verify if patients who had joined in educational classes on tuberculosis had enhanced chances to a positive outcome after expiration of the six months of treatment. Method: The authors conducted a retrospective and controlled study with 100 patients (38 non-compliant and 62 compliant) registered for tuberculosis treatment in order to verify the variables related to non-compliance. Sixty patients (16 non-compliant and 44 compliant) had educational classes. Results: The risk factors most related to non-compliance were: male sex, cigarette smoking, alcohol and drug abuse, risk factors for HIV, and previous hospitalization. Patients who had attended educational classes had the same characteristics as all patients, but they had lower frequency of non-compliance (p < 0.05). Conclusion: The authors conclude that, if they had adequate access to means of diagnosis and follow-up for the treatment of tuberculosis, all extra efforts should be concentrated on avoiding non-compliance, mainly in patients with risk factors, as mentioned above. The patients at risk of non-compliance should have educational classes about their disease.

 


Keywords: Prevalence. Diagnosis-related groups.

 


Asthma management in a public referral center in Porto Alegre in comparison with the guidelines established in the III Brazilian Consensus on Asthma Management

Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS) e as proposições do III Consenso Brasileiro no Manejo da Asma

Waldo Mattos, Luciano Bauer Grohs, Fabíola Roque, Maurício Ferreira, Gabriela Mânica, Ernesto Soares

J Bras Pneumol.2006;32(5):385-390

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Objective: To determine whether the guidelines put forth in the III Brazilian Consensus on Asthma Management are being applied in a population of asthma patients treated at a public hospital that is a referral center for asthma in the city of Porto Alegre, Brazil. Methods: All adult asthma patients who began their treatment between 1999 and 2002 were evaluated. The treatment given was classified as consistent or inconsistent with the Consensus guidelines. The clinical features of asthma and the frequency of treatment provided by a specialist were compared between the two groups (those receiving guideline-consistent treatment and those receiving guideline-inconsistent treatment). Results: The charts of 357 patients were evaluated. The study sample consisted of 106 males (29.9%) and 251 females (70.3%). The mean age was 41 years, and 33 (9.2%) of the patients were smokers. The treatment was considered inconsistent with the Consensus guidelines in 246 cases (70%). Of those 246, 174 (71%) had presented persistent asthma and were not treated with an inhaled corticosteroid. Normal forced expiratory volume in one second, being from 12 to 18 years of age, and having intermittent asthma were more frequently observed among the patients receiving guideline-consistent treatment (p < 0.01). No correlations were found between guideline-inconsistent treatment and being treated by a pulmonologist, severity of persistent asthma or number of emergency room visits. Conclusion: Most of the asthma patients treated at the public referral center in Porto Alegre did not receive treatment that was consistent with the Consensus guidelines. Undertreatment with inhaled corticosteroids was the principal source of that inconsistency.

 


Keywords: Asthma/therapy; Guidelines; Comparative study

 


Comparative study of high resolution computer-assisted tomography with chest radiograph in the diagnosis of silicosis incipient cases

Estudo comparativo entre tomografia computadorizada de alta resolução e radiografia de tórax no diagnóstico da silicose em casos incipientes

Ana Paula Scalia Carneiro, Arminda Lucia Siqueira, Eduardo Algranti, Cid Sérgio Ferreira, Jorge Issamu Kavakama, Maria Luiza Bernardes, Thaís Abreu de Castro, René Mendes

J Bras Pneumol.2001;27(4):-

Abstract PDF PT

Introduction: At present, chest radiography (CR) is the main instrument used in the diagnosis of silicosis, following the International Labor Organization (ILO) recommendations. In incipient cases, the interpretation of radiographs is difficult and disagreement may occur, even among experienced readers. Recently, the possibility of evaluating incipient cases by using high resolution computed tomography (HRCT) has been considered. Objective: To compare CR with HRCT results. Patients and methods: An original group of 135 ex-miners were evaluated by CR, according to ILO recommendations, examined by three readers, from November 1997 to December 1999. HRCT was indicated to 68 patients whose median profusion readings was 1/0 or below. HRCT results were examined by two readers and, in cases of disagreement, a third reader was consulted. HRCT results were classified according to micronodule profusion into categories 0 to 3. CR and HRCT results were compared using McNemar test, weighed Kappa coefficient and log-linear models. Results and conclusion: There was good agreement among the methods in category 0, so it was concluded that both methods are similar in excluding the diagnosis of silicosis. However, in category 1 or greater (diagnosis of the disease) a good agreement among the methods was not observed.

 


Keywords: Silicosis. Thoracic radiography. Tomography X-ray computed. Pneumoconiosis.

 


Immunoglobulins, complements and autoantibodies in 58 workers exposed to silica

Estudo de imunoglobulinas, complementos e auto-anticorpos em 58 trabalhadores expostos à sílica

Hermano Albuquerque de Castro, Carolina Gimenes da Silva, Alfred Lemle

J Bras Pneumol.2004;30(3):201-206

Abstract PDF PT

Background: The primary work-related lung disease in Brazil is silicosis. Its pathogenic agent is the dust of crystalline free silica (SiO2; silicon dioxide). The inflammatory process of silicosis is not yet well understood. Objective: To analyze, through immunologic laboratory evaluation, including nonspecific and specific immunity, the profile of IgG, IgM, IgA, C3, C4 and autoantibodies in the serum of workers, with or without silicosis, exposed to silica. Methods: Fifty-eight male workers were studied. All had been exposed to silica. Immunologic, radiologic and functional evaluations were made. The immunoglobulins IgG, IgA, and IgM, the complement system components C3 and C4, and the autoantibodies were assessed. Results: Chest X-rays were normal in 20 of the 58 workers and compatible with silicosis in 38. Among the 38 who were positive, IgG values were, on average, higher than in the group with normal X-rays (p < 0.05). There were no significant differences in average values of IgA, IgM, C3 or C4 (p > 0.05). The percentage of autoantibody positivity was higher in the silicosis group than in the group with normal X-rays. Conclusion: The increased levels of IgG in patients with silicosis constitutes an important discovery. It may represent continuity of the granulomatous reaction, even when the individual is no longer being exposed to silica. However, further studies are necessary in order to increase understanding of the mechanism involved in the silicosis immunologic process.

 


Keywords: Lung diseases. Silicosis. Occupational diseases. Immunoglobulins

 


Descriptive study of the implementation and impact of the directly observed treatment, short-course strategy in the São José do Rio Preto municipal tuberculosis control program (1998-2003)

Estudo descritivo sobre a implantação da estratégia de tratamento de curta duração diretamente observado no controle da tuberculose em São José do Rio Preto e seus impactos (1998-2003)

Cláudia Eli Gazetta, Silvia Helena Fiqueiredo Vendramini, Antônio Ruffino-Netto, Maria Rita de Cássia Oliveira, Tereza Cristina Scatena Villa

J Bras Pneumol.2007;33(2):192-198

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Objective: To describe treatment outcomes (cure, noncompliance or death) after the implementation of the Directly Observed Treatment, Short-course (DOTS) strategy for tuberculosis control in the city of São José do Rio Preto, Brazil, between 1998 and 2003. Methods: A descriptive study, based on secondary data (National Case Registry database, Tuberculosis Epidemiology database, and the 'Black Book' Registry), was conducted using a specific instrument. The data were analyzed using descriptive statistics. Results: After the implementation of the DOTS strategy, there was a decrease in noncompliance and case detection rates as well as an increase in cure and death rates. The increase in the number of tuberculosis-related deaths might be attributable to three factors: the predominance of the disease in individuals over 50 years of age, tuberculosis/HIV co-infection, and the presence of accompanying diseases. Conclusion: The implementation of the DOTS strategy strengthened the decentralization of the tuberculosis control plans as well as the integration of the Basic Health Care Clinic teams with the Tuberculosis Control Program team. Political commitment of the administrator to tuberculosis control, in conjunction with the policy of benefits and incentives, is essential for the sustainability of the DOTS strategy.

 


Keywords: Tuberculosis; Epidemiology; Health services; Politics; Directly observed therapy.

 


Study on the effect of amiodarone on the body weight and on lung morphologic and cytopathologic parameters of male and female Wistar, Wistar-Kyoto, and SHR rats

Estudo do efeito da amiodarona sobre o peso corpóreo e sobre determinantes morfológicos e citopatológicos do pulmão em ratos machos e fêmeas das linhagens Wistar, Wistar-Kyoto e SHR

Thais Thomaz Queluz, Maria Helena de Castro e Silva, Silméia Garcia Zanatti, Frederico Sobral de Oliveira, Rodrigo Bazan, Júlio Defaveri

J Bras Pneumol.2002;28(6):309-316

Abstract PDF PT

Introduction: Most of the experimental studies on amiodarone-induced pulmonary toxicity have been performed in male Fischer-344 rats. Objective: To investigate the effect of amiodarone on body weight and on lung morphological and cytopathologic parameters in both genders of other rat strains. Methods: Groups of male and female Wistar, Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats received, 175 mg/kg/day of amiodarone suspended in saline by gavage for four weeks. Controls received saline alone. Body weight gain, total cellularity, and differential of the bronchoalveolar lavage (BAL) and lung histopathology were studied. Results: Mortality due to amiodarone was observed in treated WKY rats, mostly in males. Treated male and female SHR animals had less body weight gain among all strains studied. Male Wistar and SHR treated rats presented more body weight gain than females of the respective strains. BAL of treated SHR rats were hemorrhagic. BAL cellularity was higher in treated males (WKY > Wistar > SHR). In WKY males and females, however, the differential count showed a lesser percent of macrophages and higher of neutrophils than in the other strains. BAL macrophages of treated Wistar rats presented phospholipidosis, whereas most macrophages of treated SHR rats were normal. In lung anatomicopathologic examination, no difference was found related to gender and no pneumonitis was observed. In Wistar rats, the examination was characterized by a marked quantity of intra-alveolar "foamy" macrophages, numerous intraparenchymal abscesses were found in WKY rats, and alveolar hemorrhage was present in SHR rats. Conclusions: 1) amiodarone induces more foamy macrophages in Wistar rats than in the WKY and SHR strains, although they do not develop pneumonitis in the model used; 2) amiodarone has greater effect on lung morphological and cytopathologic parameters of male rats.

 



Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma

Eventos adversos locais associados ao uso de corticosteroides inalatórios em pacientes com asma moderada ou grave

Charleston Ribeiro Pinto, Natalie Rios Almeida, Thamy Santana Marques, Laira Lorena Lima Yamamura, Lindemberg Assunção Costa, Adelmir Souza-Machado

J Bras Pneumol.2013;39(4):-

Abstract PDF PT PDF EN Portuguese Text

To describe and characterize local adverse effects (in the oral cavity, pharynx, and larynx) associated with the use of inhaled corticosteroids (ICSs) in patients with moderate or severe asthma. Methods: This was a cross-sectional study involving a convenience sample of 200 asthma patients followed in the Department of Pharmaceutical Care of the Bahia State Asthma and Allergic Rhinitis Control Program Referral Center, located in the city of Salvador, Brazil. The patients were ≥ 18 years of age and had been using ICSs regularly for at least 6 months. Local adverse effects (irritation, pain, dry throat, throat clearing, hoarseness, reduced vocal intensity, loss of voice, sensation of thirst, cough during ICS use, altered sense of taste, and presence of oral candidiasis) were assessed using a 30-day recall questionnaire. Results: Of the 200 patients studied, 159 (79.5%) were women. The mean age was 50.7 ± 14.4 years. In this sample, 55 patients (27.5%) were using high doses of ICS, with a median treatment duration of 38 months. Regarding the symptoms, 163 patients (81.5%) reported at least one adverse effect, and 131 (65.5%) had a daily perception of at least one symptom. Vocal and pharyngeal symptoms were identified in 57 (28.5%) and 154 (77.0%) of the patients, respectively. The most commonly reported adverse effects were dry throat, throat clearing, sensation of thirst, and hoarseness. Conclusions: Self-reported adverse effects related to ICS use were common among the asthma patients evaluated here.

 


Keywords: Asthma; Glucocorticoids; Administration, inhalation; Pharmaceutical services.

 


Clinical evolution of a group of patients with multidrug-resistant TB treated at a referral center in the city of Rio de Janeiro, Brazil

Evolução clínica de um grupo de pacientes com TB multirresistente atendidos em um centro de referência na cidade do Rio de Janeiro

Helio Ribeiro de Siqueira, Flávia Alvim Dutra de Freitas, Denise Neves de Oliveira, Angela Maria Werneck Barreto, Margareth Pretti Dalcolmo, Rodolpho Mattos Albano

J Bras Pneumol.2009;35(1):54-62

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the clinical characteristics and evolution of a group of patients with positive sputum cultures for multidrug-resistant (MDR) Mycobacterium tuberculosis and treated at a referral center in the city of Rio de Janeiro, Brazil. Methods: Based on the positive results in sputum cultures for MDR M. tuberculosis, 50 patients were selected, and their clinical data were obtained from the Brazilian Ministry of Health MDR-TB Database. The frequencies of noncompliance, relapses, failures and previous treatments for TB up to diagnosis of MDR-TB were compiled. The radiological patterns were classified as unilateral or bilateral, and with or without cavitation. Two years after the end of the standard treatment for MDR-TB, the outcome (cure, failure, noncompliance or death) for each patient was evaluated and reassessed every two years. The post-treatment follow-up period was eight years. Results: The mean number of previous treatments was 2.3 ± 0.9. The mean interval between the initial diagnosis and the development of MDR-TB was 2.0 ± 1.7 years. Two years after the initial treatment for MDR-TB, 2 patients had abandoned treatment, 8 had died, 18 had been cured, and 22 had presented treatment failure. The bivariate analysis showed that bilateral pulmonary involvement and cavitary pattern markedly reduced the chances for cure, with a relative risk of 1-0.6 (40%) and 1-0.7 (30%), respectively. At the end of the follow-up period, 2 patients had abandoned treatment, 9 had presented treatment failure, 17 had been cured, and 22 had died. Conclusions: Bilateral pulmonary involvement and cavity pattern greatly reduced the chances for cure of the patients with MDR-TB. Most patients who presented treatment failure died within the 8-year follow-up period.

 


Keywords: Tuberculosis, multidrug-resistant; Treatment outcome; Disease-free survival; Treatment refusal; Treatment failure.

 


Evolution of exogenous lipoid pneumonia in children: clinical aspects, radiological aspects and the role of bronchoalveolar lavage

Evolução da pneumonia lipoide exógena em crianças: aspectos clínicos e radiológicos e o papel da lavagem broncoalveolar

Selma Maria de Azevedo Sias, Angela Santos Ferreira, Pedro Augusto Daltro, Regina Lúcia Caetano, José da Silva Moreira, Thereza Quirico-Santos

J Bras Pneumol.2009;35(9):838-845

Abstract PDF PT PDF EN Portuguese Text

Objective: To present aspects of the evolution of lipoid pneumonia in children, based on clinical, radiological and bronchoalveolar lavage fluid findings, emphasizing the importance of bronchoalveolar lavage for the diagnosis and treatment. Methods: We included 28 children, with a mean age of 20 months (range, 1-108 months), diagnosed with chronic pneumonia refractory to antimicrobial therapy, with TB or with a combination of the two. Most of the children had at least one risk factor for aspiration, and all of them had a history of mineral oil ingestion for intestinal constipation (23/28) or complicated ascaridiasis (5/28). Clinical evaluations, tomographic evaluations and analyses of bronchoalveolar lavage fluid were carried out at the beginning of treatment and throughout a follow-up period of 24 months. Results: Tachypnea and cough were the most common symptoms. The most common radiological alterations were areas of consolidation (23/28), perihilar infiltrates (13/28) and hyperinflation (11/28). Chest CT scans showed areas of consolidation with air bronchogram (24/28), decreased attenuation in the areas of consolidation (16/28), ground-glass opacities (3/28) and crazy-paving pattern (1/28). In the analysis of the bronchoalveolar lavage fluid, Sudan staining revealed foamy macrophages, confirming the diagnosis of lipoid pneumonia. After treatment with multiple bronchoalveolar lavages (mean = 9.6), 20 children became asymptomatic, 18 of those presenting normal tomographic images. Conclusions: A diagnosis of lipoid pneumonia should be considered in patients with chronic refractory pneumonia or TB, especially if there is a history of mineral oil ingestion. Bronchoscopy with multiple bronchoalveolar lavages was an efficient treatment for the clearance of mineral oil from the lung parenchyma and the prevention of fibrosis. This strategy contributed to reducing the morbidity of lipoid pneumonia, which remains a rare diagnosis.

 


Keywords: Pneumonia, lipid; Bronchoalveolar lavage; Treatment outcome.

 


Temporal evolution of and factors associated with asthma and wheezing in schoolchildren in Brazil

Evolução temporal e fatores associados a asma e sibilância em escolares no Brasil

Gabriela Ávila Marques1,2,a, Andrea Wendt2,b, Fernando César Wehrmeister2,c

J Bras Pneumol.2019;45(3):e20180138-e20180138

Abstract PDF PT PDF EN Portuguese Text

Objective: To estimate the evolution of the prevalence of asthma and wheezing among schoolchildren in Brazil from 2012 to 2015, as well as to identify factors associated with both conditions. Methods: This was a cross-sectional study using data from the Brazilian National School-Based Adolescent Health Survey for 2012 and 2015. To characterize the evolution of the prevalence of asthma and wheezing, we used linear regression with weighted-least-squares estimation and presented the annual percent change (APC). Results: During the study period, there was a reduction in the prevalence of wheezing, from 23.2% in 2012 to 22.4% in 2015 (APC, −0.27). The prevalence of asthma increased from 12.4% in 2012 to 16.0% in 2015 (APC, 1.20). The increase in the prevalence of asthma was greatest in the southern region of the country (APC, 2.17). Having any history of smoking and having consumed alcohol in the last 30 days were factors that influenced the prevalence of wheezing and the prevalence of a self-reported diagnosis of asthma during the two years evaluated. Conclusions: There has been an increase in the prevalence of asthma in recent years in Brazil. Our data underscore the importance of improving health strategies and policies aimed at the control of asthma.

 


Keywords: Asthma/epidemiology; Respiratory sounds; Students.

 


Patients admitted to the ICU for acute exacerbation of COPD: two-year mortality and functional status

Exacerbação aguda da DPOC: mortalidade e estado funcional dois anos após a alta da UTI

Cassiano Teixeira, Cláudia da Rocha Cabral, Jaqueline Sangiogo Hass, Roselaine Pinheiro de Oliveira, Mara Ambrosina de Oliveira Vargas, Ana Paula da Rocha Freitas, Alessandra Hofstadler Deiques Fleig, Erika Cristine Treptow, Márcia Inês Boff Rizzotto

J Bras Pneumol.2011;37(3):334-340

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Objective: To assess ICU patients with COPD, in terms of in-hospital characteristics, two-year mortality and two-year functional status of survivors. Methods: A prospective cohort study involving patients with acute exacerbation of COPD admitted to the ICUs of two hospitals in the city of Porto Alegre, Brazil, between July of 2005 and July of 2006. At two years after discharge, survivors were interviewed by telephone in order to determine Karnofsky scores and scores on a scale regarding activities of daily living (ADL). Results: The sample comprised 231 patients. In-hospital mortality was 37.7%, and two-year post-discharge mortality was 30.3%. Of the 74 survivors, 66 were interviewed (89%). The mean age at ICU admission was 74 ± 10 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 18 ± 7. Two or more comorbidities were present in 87.8% of the patients. Of the 66 interviewees, 57 (86.3%) lived at home, 58 (87.8%) were self-sufficient, 12 (18.1%) required oxygen therapy, and 4 (6.1%) still required ventilatory support. There was a significant reduction in the quality of life and autonomy of the survivors, as evidenced by the Karnofsky scores (85 ± 9 vs. 79 ± 11, p = 0.03) and ADL scale scores (29 ± 5 vs. 25 ± 7; p = 0.01), respectively. Conclusions: In this patient sample, two-year mortality was quite high. Although there was a noticeable reduction in the functional status of the survivors, they remained self-sufficient.

 


Keywords: Pulmonary disease, chronic obstructive/mortality; Quality of life; Intensive care units.

 


Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

Exactitud de la biopsia pleural cerrada para el diagnóstico de derrame pleural maligno

Renata Báez-Saldaña1,2, Uriel Rumbo-Nava1, Araceli Escobar-Rojas2, Patricia Castillo-González1, Santiago León-Dueñas1, Teresa Aguirre-Pérez1, María Eugenia Vázquez-Manríquez3

J Bras Pneumol.2017;43(6):424-430

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Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

 


Keywords: Biopsy; Pleural effusion, malignant/diagnosis; Pleural effusion, malignant/epidemiology.

 


Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

Existe razão para reabilitação pulmonar após o tratamento quimioterápico bem-sucedido para tuberculose?

Marcela Muñoz-Torrico1, Adrian Rendon2, Rosella Centis3, Lia D'Ambrosio3,4, Zhenia Fuentes5, Carlos Torres-Duque6, Fernanda Mello7, Margareth Dalcolmo8, Rogelio Pérez-Padilla9, Antonio Spanevello10,11, Giovanni Battista Migliori3

J Bras Pneumol.2016;42(5):367-373

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The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae.

 


Keywords: Tuberculosis/complications; Tuberculosis/rehabilitation, Tuberculosis/therapy; Quality of life; Diagnostic imaging; Respiratory function tests.

 


Experimentation with and knowledge regarding water-pipe tobacco smoking among medical students at a major university in Brazil

Experimentação de e conhecimento sobre narguilé entre estudantes de medicina de uma importante universidade do Brasil

Stella Regina Martins, Renato Batista Paceli, Marco Antônio Bussacos, Frederico Leon Arrabal Fernandes, Gustavo Faibischew Prado, Elisa Maria Siqueira Lombardi, Mário Terra-Filho, Ubiratan Paula Santos

J Bras Pneumol.2014;40(2):-

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Objective: Water-pipe tobacco smoking is becoming increasingly more common among young people. The objective of this study was to estimate the prevalence of the use of water pipes and other forms of tobacco use, including cigarette smoking, among medical students, as well as to examine the attitudes, beliefs, and knowledge of those students regarding this issue. Methods: We administered a questionnaire to students enrolled in the University of São Paulo School of Medicine, in São Paulo, Brazil. The respondents were evaluated in their third and sixth years of medical school, between 2008 and 2013. Comparisons were drawn between the two years. Results: We evaluated 586 completed questionnaires. Overall, the prevalence of current cigarette smokers was low, with a decline among males (9.78% vs. 5.26%) and an increase among females (1.43% vs. 2.65%) in the 3rd and 6th year, respectively. All respondents believed that health professionals should advise patients to quit smoking. However, few of the medical students who smoked received physician advice to quit. Experimentation with other forms of tobacco use was more common among males (p<0.0001). Despite their knowledge of its harmful effects, students experimented with water-pipe tobacco smoking in high proportions (47.32% and 46.75% of the third- and sixth-year students, respectively). Conclusions: The prevalence of experimentation with water-pipe tobacco smoking and other forms of tobacco use is high among aspiring physicians. Our findings highlight the need for better preventive education programs at medical schools, not only to protect the health of aspiring physicians but also to help them meet the challenge posed by this new epidemic.

 


Keywords: Tobacco products; Smoking/prevention & control; Education, medical, undergraduate; Health knowledge, attitudes, practice.

 


Nonadherence to treatment in lung transplant recipients: a matter of life and death

Falta de adesão ao tratamento em pacientes submetidos a transplante pulmonar: uma questão de vida ou morte

André Nathan Costa, Elaine Marques Hojaij, Liliane Saraiva de Mello, Felipe Xavier de Melo, Priscila Cilene Leon Bueno de Camargo, Silvia Vidal Campos, Jose Eduardo Afonso Junior, Rafael Medeiros Carraro, Ricardo Henrique de Oliveira Braga Teixeira

J Bras Pneumol.2015;41(1):95-97

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Lack of association between viral load and severity of acute bronchiolitis in infants

Falta de associação entre carga viral e gravidade da bronquiolite aguda em lactentes

Ana Paula Duarte de Souza, Lidiane Alves de Azeredo Leitão, Fernanda Luisi, Rodrigo Godinho Souza, Sandra Eugênia Coutinho, Jaqueline Ramos da Silva, Rita Mattiello, Paulo Márcio Condessa Pitrez, Renato Tetelbom Stein, Leonardo Araújo Pinto

J Bras Pneumol.2016;42(4):261-265

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Objective: To investigate the correlation between respiratory syncytial viral load and length of hospitalization in infants with acute wheezing episodes. Methods: This was a two-year, cross-sectional study of infants ≤ 12 months of age with bronchiolitis at the time of admission to a tertiary hospital. For the identification of respiratory viruses, nasopharyngeal secretions were collected. Samples were analyzed (throughout the study period) by direct immunofluorescence and (in the second year of the study) by quantitative real-time PCR. We screened for three human viruses: rhinovirus, respiratory syncytial virus, and metapneumovirus. Results: Of 110 samples evaluated by direct immunofluorescence, 56 (50.9%) were positive for a single virus, and 16 (14.5%) were positive for two or more viruses. Among those 72 samples, the most prevalent virus was respiratory syncytial virus, followed by influenza. Of 56 samples evaluated by quantitative real-time PCR, 24 (42.8%) were positive for a single virus, and 1 (1.7%) was positive for two viruses. Among those 25 samples, the most prevalent virus was again respiratory syncytial virus, followed by human rhinovirus. Coinfection did not influence the length of the hospital stay or other outcome s. In addition, there was no association between respiratory syncytial virus load and the length of hospitalization. Conclusions: Neither coinfection nor respiratory syncytial viral load appears to influence the outcomes of acute bronchiolitis in infants.

 


Keywords: Bronchiolitis; Coinfection; Viral load; Hospitalization; Respiratory syncytial virus, human.

 


Factors associated with nonadherence to TB chemoprophylaxis in Vitória, Brazil: a historical cohort study

Fatores associados ao abandono da quimioprofilaxia de TB no município de Vitória (ES): um estudo de coorte histórica

Ethel Leonor Noia Maciel, Ana Paula Brioschi, Letícia Molino Guidoni, Anne Caroline Barbosa Cerqueira, Thiago Nascimento do Prado, Geisa Fregona, Reynaldo Dietze

J Bras Pneumol.2009;35(9):884-891

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Objective: To describe the factors associated with nonadherence to TB chemoprophylaxis in patients older than 15 years of age treated via referral TB control programs. Methods: A historical cohort study was carried out based on medical charts related to cases treated via referral TB control programs in the city of Vitória, Brazil, between 2002 and 2007. Cases of infection with Mycobacterium tuberculosis were stratified into two groups: health care workers (HCW group); and individuals who were not health care workers (NHCW group). Results: A total of 395 patients were included in the study: 35 in the HCW group and 360 in the NHCW group. The mean age in the HCW and NHCW groups was 34.8 and 32.4 years, respectively (p = 0.36). Of the 35 patients in the HCW group, 29 (82.9%) were female, compared with 180 (50.0%) of the 360 patients in the NHCW group. In the HCW and NHCW groups, respectively, 15 (42.9%) and 169 (46.9%) of the patients were contacts of TB cases. In addition, 9 (25.7%) and 157 (78.5%) the HCW and NHCW group patients, respectively, were HIV-infected. Nonadherence to chemoprophylaxis was 37.1% and 21.9% in the HCW and NHCW groups, respectively (p = 0.045). In the multivariate analysis, the factors associated with nonadherence were being a health care worker (OR = 8.60; 95% CI: 2.09-35.41), being HIV-infected (OR = 4.57; 95% CI: 1.2-17.5) and having had contact with a TB patient (OR = 2.65; 95% CI: 1.15-6.12). Conclusions: In order to improve adherence to TB chemoprophylaxis, new TB control program strategies are needed, especially for health care workers and HIV-infected patients.

 


Keywords: Tuberculosis; Chemoprevention; Isoniazid.

 


Factors associated with death by tuberculosis in the eastern part of São Paulo city, 2001

Fatores associados ao óbito por tuberculose na zona leste da cidade de São Paulo, 2001

Monica Hid Haddad Pelaquin, Rebeca Souza e Silva, Sandra Aparecida Ribeiro

J Bras Pneumol.2007;33(3):311-317

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Objective: To identify factors associated with death from TB, evaluating TB cases reported for 2001 in the city of São Paulo (specifically in the neighborhoods of Cidade Tiradentes, Guaianazes, Itaquera and São Mateus) and comparing those evolving to death with those evolving to cure. Methods: We investigated all deaths in which TB was given as the principal cause (n = 48), analyzing medical charts and conducting home visits to interview the caregiver(s). In parallel, we investigated 96 TB cases in which the patient had been discharged after a cure had been achieved. Patients with HIV were excluded from both groups. Results: There were no differences between the two groups in terms of the clinical form of tuberculosis, laboratory test confirmation of the diagnosis and type of treatment. Death from TB was found to be associated, in a statistically significant manner, with being male, being over 50 years of age, having had less than 3 years of schooling, suffering from alcoholism and being unemployed. The logistic regression showed that the variables presenting the strongest associations with death from TB were suffering from alcoholism and being over 50, whereas being a new treatment and being employed were found to be protective. The combination of suffering from alcoholism, being unemployed and being over 50 increased the chance of evolving to death by 25 times (95%CI: 6.43-97.20). Conclusion: Ongoing education of health professionals, prompt epidemiological interventions and efficient patient referral systems could improve the indices related to this disease.

 


Keywords: Tuberculosis/mortality; Epidemiologic studies; Death certificates.

 


Risk factors for death in patients with severe asthma

Fatores de risco de morte em pacientes portadores de asma grave

Andréia Guedes Oliva Fernandes, Carolina Souza-Machado, Renata Conceição Pereira Coelho, Priscila Abreu Franco, Renata Miranda Esquivel, Adelmir Souza-Machado, Álvaro Augusto Cruz

J Bras Pneumol.2014;40(4):364-372

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Objective: To identify risk factors for death among patients with severe asthma. Methods: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. Results: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. Conclusions: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

 


Keywords: Asthma/mortality; Asthma/therapy; Risk factors.

 


Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs

Fatores de risco para tuberculose: diabetes, tabagismo, álcool e uso de outras drogas

Denise Rossato Silva1,a, Marcela Muñoz-Torrico2,b, Raquel Duarte3,4,c, Tatiana Galvão5,d, Eduardo Henrique Bonini6,7,e, Flávio Ferlin Arbex6,f, Marcos Abdo Arbex6,g, Valéria Maria Augusto8,h, Marcelo Fouad Rabahi9,i, Fernanda Carvalho de Queiroz Mello10,j

J Bras Pneumol.2018;44(2):145-152

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Tuberculosis continues to be a major public health problem. Although efforts to control the epidemic have reduced mortality and incidence, there are several predisposing factors that should be modified in order to reduce the burden of the disease. This review article will address some of the risk factors associated with tuberculosis infection and active tuberculosis, including diabetes, smoking, alcohol use, and the use of other drugs, all of which can also contribute to poor tuberculosis treatment results. Tuberculosis can also lead to complications in the course and management of other diseases, such as diabetes. It is therefore important to identify these comorbidities in tuberculosis patients in order to ensure adequate management of both conditions.

 


Keywords: Tuberculosis/epidemiology; Tuberculosis/prevention & control; Diabetes mellitus/prevention & control; Smoking/adverse effects; Alcohol drinking/adverse effects; Street drugs/adverse effects.

 


Risk factors for ER visits due to asthma exacerbations in patients enrolled in a program for the control of asthma and allergic rhinitis in Feira de Santana, Brazil

Fatores de risco para visitas à emergência por exacerbações de asma em pacientes de um programa de controle da asma e rinite alérgica em Feira de Santana, BA

Heli Vieira Brandão, Constança Sampaio Cruz, Murilo Cerqueira Pinheiro, Edgar Adolfo Costa, Armênio Guimarães, Adelmir Souza-Machado, Álvaro Augusto Cruz

J Bras Pneumol.2009;35(12):-

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Objective: To determine the risk factors for ER visits due to asthma exacerbations in patients monitored at a referral center. Methods: Prospective cohort study of 253 outpatients (children and adults) with asthma who were monitored for 12 months at the Referral Center of the Program for the Control of Asthma and Allergic Rhinitis in the city of Feira de Santana, Brazil. Results: Exacerbations were common, and 36.5% of the patients sought ER treatment within the twelve-month period. The risk factors for asthma exacerbations were being over 20 years of age (OR = 1.34: (95% CI: 1.06-1.70), residing in an urban area (OR = 1.19; 95% CI: 1.06-1.33); having a low level of education (OR = 1.53: 95% CI: 1.00-2.39); having severe asthma (OR = 1.65; 95% CI: 1.24-2.18); and having chronic rhinitis (OR = 2.20; 95% CI: 1.00-4.80). Conclusions: In this cohort, having chronic rhinitis, having asthma that is more severe and having a low level of education were the main risk factors for ER visits due to asthma exacerbations. These results are similar to those reported for asthma patients who are receiving no regular treatment.

 


Keywords: Asthma/etiology; Health services; Program evaluation.

 


Factors predictive of the development of acute asthma attacks in children

Fatores preditivos da evolução da asma aguda em crianças

Maria Luisa Zocal Paro, Joaquim Carlos Rodrigues

J Bras Pneumol.2005;31(5):373-381

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Objective: To use clinical and functional characteristics observed upon admission to an emergency room to identify factors predictive of the occurrence and course of acute asthma attacks in children. Methods: We prospectively studied 130 asthmatic children, from 1 to 13 years of age, who were treated for acute asthma attacks in an emergency room, evaluating status determined at admission and over the course of the crisis. Clinical scores were determined and arterial oxygen saturation by pulse oximetry was measured, as was peak expiratory flow. Results: The initial clinical score, arterial oxygen saturation by pulse oximetry and peak expiratory flow correlated with the number of inhalations performed, as well as with the need for corticosteroid treatment. Mean initial clinical score and mean arterial oxygen saturation by pulse oximetry of the hospitalized patients were statistically different from those of patients who were not hospitalized. Initial clinical score, arterial oxygen saturation and prior treatment for the same exacerbation were predictive of the need for hospitalization. Conclusion: The measurement of arterial oxygen saturation by pulse oximetry and the clinical score were useful in predicting the occurrence and course of acute asthma attacks in children. The measurement and interpretation of peak expiratory flow is difficult in children and, under these conditions, served no practical application.

 


Keywords: Asthma; Acute disease; Prospective studies; Predictive value of tests; Child

 


Factors related to the use of hookah among medical students

Fatores relacionados ao consumo do narguilé entre estudantes de medicina

Roseliane de Souza Araújo1,a, Yves de Oliveira Milhomem1,b, Henrique Falcão Silva Pereira1,c, José Laerte Rodrigues da Silva Junior2,3,d

J Bras Pneumol.2019;45(5):e20180184-e20180184

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Objective: This study evaluated the factors related to the use of hookah among medical students, the level of knowledge about the involved harms, and their relationship with the use and intention to stop using it. Methods: Students of the 1st and 6th year of medical school were evaluated. A multivariate logistic regression model was used to evaluate the association between the outcome (use of hookah in the last 30 days) and demographic, subjective psychosocial data and level of knowledge about the harms of hookah use. Results: The experimentation rate of hookah and current use was high (59.6% and 27.7%, respectively), with no difference between the 1st and 6th year groups (p=0.70). The 6th grade students were more knowledgeable about the harm of using hookah when compared to the 1st year students (p <0.0001), and there was no association between the use of hookah in the last 30 days and the knowledge about its harms. Cigarette smoking and the use of alcoholic beverages were associated with the use of hookah in the last 30 days, with unadjusted Odds Ratio (OR) of 11.3; 95% CI 4.62‑27.7; p <0.0001 and OR 8.74; 95% CI 3.78-20.2; p <0.0001; respectively. Conclusion: There is a high experimentation, current use of hookah and cigarettes among medical students. Sixth year students are more knowledgeable about the harms involved. There was no association between the use of hookah in the last 30 days and the knowledge about its harms. Smoking and the use of alcoholic beverages are independent predictors of use of hookah.

 


Keywords: Water pipe smoking; Tobacco for water-pipe; Smoking; Medical education.

 


Primary sclerosing epithelioid fibrosarcoma of the pleura

Fibrossarcoma epitelioide esclerosante primário da pleura

Erlon de Ávila Carvalho1, Daniel Oliveira Bonomi1, Astunaldo Júnior Macedo Pinho1, Paulo Guilherme Oliveira Salles1, Henrique Cunha Vieira1

J Bras Pneumol.2017;43(6):490-491

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Respiratory physiotherapy in the ICU: Effectiveness and professional certification

Fisioterapia respiratória em UTI: Efetividade e habilitação profissional

Wellington P. S.Yamaguti, Luiz A. Alves, Lucienne T. Q. Cardoso, Carrie C. R. Galvan, Antonio F. Brunetto

J Bras Pneumol.2005;31(1):-

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Gastrobronchial fistula as a rare complication of gastroplasty for obesity. A report of two cases

Fístula gastrobrônquica como complicação rara de gastroplastia para obesidade. Relato de dois casos

Josemberg Marins Campos, Luciana Teixeira de Siqueira, Marconi Roberto de Lemos Meira, Álvaro Antônio Bandeira Ferraz, Edmundo Machado Ferraz, Murilo José de Barros Guimarães

J Bras Pneumol.2007;33(4):475-479

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Gastrobronchial fistula is a rare condition as a complication following bariatric surgery. The management of this condition requires the active participation of a pulmonologist, who should be familiar with aspects of the main types of bariatric surgery. Herein, we report the cases of two patients who presented recurrent subphrenic and lung abscess secondary to fistula at the angle of His for an average of 19.5 months. After relaparotomy was unsuccessful, cure was achieved by antibiotic therapy and, more importantly, by stenostomy and endoscopic dilatation, together with the use of clips and fibrin glue in the fistula. These pulmonary complications should not be treated in isolation without a gastrointestinal evaluation since this can result in worsening of the respiratory condition, thus making anesthetic management difficult during endoscopic procedures.

 


Keywords: Fistula; Lung abscess; Subphrenic abscess; Obesity, surgery; Endoscopy.

 


Nephrobronchial fistula due to Pastereula aerogenes infection

Fístula nefrobrônquica em paciente com infecção por "Pasteurella aerogenes"

Renato Della Santa, Cláudio Leo Gelape, Felipe Duborqc, Ricardo Lira, João Cabral

J Bras Pneumol.2002;28(2):109-112

Abstract PDF PT

The authors report the case of a 58 year-old woman with nephrolithiasis, who after being submitted to percutaneous lithotripsy developed xantogranulomatous pyelonephritis, lung abscess and sepsis. Initially, treatment included open drainage of the retroperitoneum, nephrectomy and tubular drainage of the lung abscess and pleural space, through right lateral thoracotomy. Pastereula aerogenes was isolated from both lung and retroperitoneal secretions. To our knowledge, this is the first case of nephrobronchial fistula related with this bacteria in medical literature.

 


Keywords: Bronchial fistula. Xantogranulomatous pyelonephritis. Lung abscess. Gram-negative bacterial infections. Lithiasis. Kidney.

 


Video-assisted thoracoscopic thoracic duct ligation with near-infrared fluorescence imaging with indocyanine green

Fluorescência com verde de indocianina para auxiliar na ligadura do ducto torácico por videotoracoscopia

Benoit Jacques Bibas1,a, Rafael Lucas Costa-de-Carvalho1,b, Flavio Pola-dos-Reis1,c, Leticia Leone Lauricella1,d, Paulo Manoel Pêgo-Fernandes1,e, Ricardo Mingarini Terra1,f

J Bras Pneumol.2019;45(4):e20180401-e20180401

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Accelerated form of interstitial pulmonary fibrosis in the native lung after single lung transplantation

Forma acelerada da fibrose pulmonar idiopática no pulmão nativo após transplante pulmonar unilateral

Rogério Rufino, Kalil Madi, Omar Mourad, Angelo Judice, Giovanni Marsico, Carlos Henrique Boasquevisque

J Bras Pneumol.2007;33(6):733-737

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We report the case of a 56-year-old patient who underwent left single lung transplantation for idiopathic pulmonary fibrosis (IPF). Despite the high level of immunosuppression after the surgery, there was rapid progression to IPF in the native (right) lung as demonstrated by thoracoscopic lung biopsy. After 104 days on mechanical ventilation, the patient underwent right lung transplant and was discharged from the hospital on postoperative day 26.

 


Keywords: Idiopathic pulmonary fibrosis; Lung transplantation; Case reports [publication type].

 


Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores

Iara Nely Fiks, Leonardo Carlos Araujo Santos, Telma Antunes, Raquel Calvo Gonçalves, Celso Ricardo Fernandes de Carvalho, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2009;35(3):206-212

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Objective: To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. Methods: The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. Results: The overall incidence of asthma symptoms (ISAAC score ≥ 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score ≥ 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids. Conclusions: The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.

 


Keywords: Asthma/therapy; Asthma/diagnosis; Child; Swimming; Exercise.

 


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):-

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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

 


Lung function in the absence of respiratory symptoms in overweight children and adolescents

Função pulmonar de crianças e adolescentes sem sintomas respiratórios e com excesso de peso

Silvana Neves Ferraz de Assunção, Carla Hilário da Cunha Daltro, Ney Christian Boa Sorte, Hugo da Costa Ribeiro Júnior, Maria de Lourdes Bastos, Cleriston Farias Queiroz, Antônio Carlos Moreira Lemos

J Bras Pneumol.2014;40(2):-

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Objective: To describe lung function findings in overweight children and adolescents without respiratory disease. Methods: This was a cross-sectional study involving male and female overweight children and adolescents in the 8-18 year age bracket, without respiratory disease. All of the participants underwent anthropometric assessment, chest X-ray, pulse oximetry, spirometry, and lung volume measurements. Individuals with respiratory disease were excluded, as were those who were smokers, those with abnormal chest X-rays, and those with an SpO2 ≤ 92%. Waist circumference was measured in centimeters. The body mass index-for-age Z score for boys and girls was used in order to classify the individuals as overweight, obese, or severely obese. Lung function variables were expressed in percentage of the predicted value and were correlated with the anthropometric indices. Results: We included 59 individuals (30 males and 29 females). The mean age was 11.7 ± 2.7 years. Lung function was normal in 21 individuals (35.6%). Of the 38 remaining individuals, 19 (32.2%), 15 (25.4%), and 4 (6.7%) presented with obstructive, restrictive, and mixed ventilatory disorder, respectively. The bronchodilator response was positive in 15 individuals (25.4%), and TLC measurements revealed that all of the individuals with reduced VC had restrictive ventilatory disorder. There were significant negative correlations between the anthropometric indices and the Tiffeneau index in the individuals with mixed ventilatory disorder. Conclusions: Lung function was abnormal in approximately 65% of the individuals evaluated here, all of whom were overweight. Obstructive ventilatory disorder and positive bronchodilator response predominated.

 


Keywords: Obesity/complications; Respiratory function tests; Lung diseases/etiology.

 


Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

Função pulmonar em crianças e adolescentes com doença falciforme: temos dado atenção adequada a esse problema?

Ana Karine Vieira1, Cristina Gonçalves Alvim2, Maria Cristina Marquez Carneiro3, Cássio da Cunha Ibiapina4

J Bras Pneumol.2016;42(6):409-415

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Objective: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. Methods: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Results: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. Conclusions: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter.

 


Keywords: Anemia, sickle cell; Respiratory function tests; Exercise test.

 


Pulmonary function in advanced uncomplicated singleton and twin pregnancy

Função pulmonar em mulheres com gestação única ou gemelar avançada e sem complicações

Anwar Hasan Siddiqui, Nazia Tauheed, Aquil Ahmad, Zehra Mohsin

J Bras Pneumol.2014;40(3):244-249

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Objective: Pregnancy brings about significant changes in respiratory function, as evidenced by alterations in lung volumes and capacities, which are attributable to the mechanical impediment caused by the growing foetus. This study was undertaken in order to identify changes in respiratory function during normal pregnancy and to determine whether such changes are more pronounced in twin pregnancy than in singleton pregnancy. Methods: Respiratory function was assessed in 50 women with twin pregnancies and in 50 women with singleton pregnancies (during the third trimester in both groups), as well as in 50 non-pregnant women. We measured the following pulmonary function test parameters: FVC; FEV1; PEF rate; FEV1/FVC ratio; FEF25-75%; and maximal voluntary ventilation. Results: All respiratory parameters except the FEV1/FVC ratio were found to be lower in the pregnant women than in the non-pregnant women. We found no significant differences between women with twin pregnancies and those with singleton pregnancies, in terms of respiratory function. Conclusions: Despite its higher physiological demands, twin pregnancy does not appear to impair respiratory function to any greater degree than does singleton pregnancy.

 


Keywords: Respiratory function tests; Respiratory mechanics; Pregnancy, twin; Pregnancy.

 


Lung function in post-poliomyelitis syndrome: a cross-sectional study

Função pulmonar em pessoas com síndrome pós-poliomielite: um estudo transversal

Claudio Andre Barbosa de Lira, Fábio Carderelli Minozzo, Bolivar Saldanha Sousa, Rodrigo Luiz Vancini, Marília dos Santos Andrade, Abrahão Augusto Juviniano Quadros, Acary Souza Bulle Oliveira, Antonio Carlos da Silva

J Bras Pneumol.2013;39(4):-

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Objective: To compare lung function between patients with post-poliomyelitis syndrome and those with sequelae of paralytic poliomyelitis (without any signs or symptoms of post-poliomyelitis syndrome), as well as between patients with post-poliomyelitis syndrome and healthy controls. Methods: Twenty-nine male participants were assigned to one of three groups: control; poliomyelitis (comprising patients who had had paralytic poliomyelitis but had not developed post-poliomyelitis syndrome); and post-poliomyelitis syndrome. Volunteers underwent lung function measurements (spirometry and respiratory muscle strength assessment). Results: The results of the spirometric assessment revealed no significant differences among the groups except for an approximately 27% lower mean maximal voluntary ventilation in the post-poliomyelitis syndrome group when compared with the control group (p = 0.0127). Nevertheless, the maximal voluntary ventilation values for the post-poliomyelitis group were compared with those for the Brazilian population and were found to be normal. No significant differences were observed in respiratory muscle strength among the groups. Conclusions: With the exception of lower maximal voluntary ventilation, there was no significant lung function impairment in outpatients diagnosed with post-poliomyelitis syndrome when compared with healthy subjects and with patients with sequelae of poliomyelitis without post-poliomyelitis syndrome. This is an important clinical finding because it shows that patients with post-poliomyelitis syndrome can have preserved lung function.

 


Keywords: Respiratory function tests; Postpoliomyelitis syndrome; Muscle strength.

 


Pregnancy as a risk factor for hospitalization due to pandemic influenza A (H1N1) 2009

Gestação como fator de risco para internação hospitalar na influenza pandêmica A (H1N1) 2009

Lessandra Michelim Rodriguez Nunes Vieira, Juliano Fracasso, Viviane Raquel Buffon, Mariana Menegotto, Thaiana Pezzi

J Bras Pneumol.2012;38(3):415-416

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Gratitude for my time at the Jornal de Pneumologia

Gratidão pelo Jornal de Pneumologia que vivi

Thais Helena Abrahão Thomaz Queluz1

J Bras Pneumol.2015;41(5):400-400

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Hemangioendothelioma: a rare tumor of the mediastinum

Hemangioendotelioma:tumor raro de mediastino

Marcelo Loze de Queiroz, Petrucio Arantes Sarmento de Souza, Carlos Jogi Imaeda, Vicente Forte

J Bras Pneumol.2004;30(2):147-149

Abstract PDF PT

A 30 year old Caucasian male from São Paulo was admitted to the hospital He had been complaining about constant, moderate pain in the anterior and lateral left hemi-thoracic region for the last three months as well as associated great effort dyspnea over the last month.Investigation with chest X-rays, CT scans and MRI revealed a large anterior and medial mediastinal tumor suggesting large vessel invasion. The patient was submitted to a left side parasternal mediastinostomy and a biopsy of the mediastinal mass which was complicated by severe bleeding. An immediate median full sternotomy was elected in addition to a left anterior-lateral thoracotomy for total tumor resection and control of the bleeding. Evolution was good, with hospital discharge on the ninth postoperative day. The anatomical-pathological essay disclosed a hemangioendothelioma of the mediastinum.

 


Keywords: Hemangioendothelioma/diagnosis. Mediastinal neoplasms.

 


Subglottic and mediastinal hemangioma in a child:treatment with propranolol

Hemangioma subglótico e mediastinal em criança:tratamento com propranolol

Mauro Tamagno, Benoit Jacques Bibas, Helio Minamoto,Fernanda Sobreiro Alfinito, Ricardo Mingarini Terra, Fabio Biscegli JateneCarta

J Bras Pneumol.2011;37(3):416-418

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Pulmonary capillary hemangiomatosis. A rare cause of pulmonary hypertension. The first Brazilian case

Hemangiomatose capilar pulmonar, uma rara causa de hipertensão pulmonar. Primeiro caso brasileiro

Helano Neiva de Castro, Mara Rúbia Fernandes de Figueiredo, Norma Selma Santos, Teresa Neuma Albuquerque Gomes Nogueira, Maria da Penha Uchoa, Marcelo Alcântara Holanda

J Bras Pneumol.2005;31(4):360-364

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Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.

 


Keywords: Hemangioma, capillary/etiology; Hemangioma capillary/diagnosis; Hypertension, pulmonary/complications; Tomography, Emission-Computed; Case report

 


Alveolar hemorrhage after parenteral injection of industrial silicone

Hemorragia alveolar após injeção parenteral de silicone industrial

Ronaldo Ferreira Macedo, Ricardo Ananias Lobão, Eduardo Mello De Capitani, Maira Eliza Petrucci Zanovello, Paula Catarina Caruso, Maurício Souza de Toledo Leme, Elza Maria Figueiras Pedreira de Cerqueira, Lair Zambon

J Bras Pneumol.2013;39(3):387-389

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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

Abstract PDF PT

Alveolar hemorrhage leading to respiratory failure is uncommon. Various etiologies have been reported, including systemic lupus erythematosus, which generally presents as pulmonary-renal syndrome. It is believed that the pathogenesis of microangiopathy is related to deposits of immune complexes that lead to activation of cellular apoptosis. The authors report two cases of alveolar hemorrhage and respiratory failure, both requiring mechanical ventilation. The two cases had opposite outcomes after pharmacological therapy. The presence of anti-glomerular basement membrane antibodies in one of the cases demonstrates the multiplicity of physiopathological mechanisms that may be involved. This multiplicity of mechanisms provides a possible explanation for the heterogeneous responses to the available treatments.

 


Keywords: Lupus erythematosus systemic/etiology. Lupus nephritis/etiology. Respiratory insufficiency/complications.

 


Diffuse alveolar hemorrhage resulting from pauci-immune pulmonary capillaritis

Hemorragia alveolar difusa por capilarite pulmonar pauci-imune

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Wilhermo Torres, Carlos Alberto de Barros Franco

J Bras Pneumol.2003;29(4):217-220

Abstract PDF PT

A 27 year-old female patient, cocaine user, presenting hemoptysis and progressive dyspnea with onset 48 hours prior to hospital admission, without any other signs or symptoms. Serum tests for infectious diseases, collagen disorders and vasculitis were negative. Urinalysis was type I. Computed tomography of the chest showed diffuse alveolar infiltrate, affecting mainly the lower left lobe. A thoracoscopic lung biopsy was performed to clarify the diagnosis. The histopathological findings showed capillaritis and diffuse intra-alveolar hemorrhage. Treated with steroid and cyclophosphamide pulse therapy, a good clinical and radiographical response was obtained. The recently described pauci-immune pulmonary capillaritis is characterized by the presence of isolated pulmonary capillaritis and negative serum testing for auto-immune diseases.

 


Keywords: Hemorrhage. Pulmonary alveoli/physiopathology.

 


Pulmonary hemosiderosis associated with celiac disease: improvement after a gluten-free diet

Hemossiderose pulmonar associada à doença celíaca: melhora após dieta livre de glúten

José Wellington Alves dos Santos, Abdias Baptista de Mello Neto, Roseane Cardoso Marchiori, Gustavo Trindade Michel, Ariovaldo Leal Fagundes, Leonardo Gonçalves Marques Tagliari, Tiago Cancian

J Bras Pneumol.2012;38(3):412-414

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Transdiaphragmatic intercostal hernia: imaging aspects in three cases

Hérnia intercostal transdiafragmática: aspectos de imagem em três casos

Ana Carolina Sandoval Macedo, Fernando Uliana Kay, Ricardo Mingarini Terra, José Ribas Milanez de Campos, André Galante Alencar Aranha, Marcelo Buarque de Gusmão Funari

J Bras Pneumol.2013;39(4):-

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Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.

 


Keywords: Hernia, diaphragmatic; Radiography; Ultrasonography; Tomography; Magnetic resonance imaging.

 


Dynamic hyperinflation on exertion: much remains unknown

Hiperinsuflação dinâmica no esforço: ainda muito a ser esclarecido

André Luís Pereira de Albuquerque, Bruno Guedes Baldi

J Bras Pneumol.2012;38(1):1-3

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Lung hyperinflation after single lung transplantation to treat emphysema

Hiperinsuflação pulmonar após transplante unilateral por enfisema

Marcos Naoyuki Samano, Jader Joel Machado Junqueira, Ricardo Henrique de Oliveira Braga Teixeira, Marlova Luzzi Caramori, Paulo Manuel Pêgo-Fernandes, Fabio Biscegli Jatene

J Bras Pneumol.2010;36(2):265-269

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Despite preventive measures, lung hyperinflation is a relatively common complication following single lung transplantation to treat pulmonary emphysema. The progressive compression of the graft can cause mediastinal shift and respiratory failure. In addition to therapeutic strategies such as independent ventilation, the treatment consists of the reduction of native lung volume by means of lobectomy or lung volume reduction surgery. We report two cases of native lung hyperinflation after single lung transplantation. Both cases were treated by means of lobectomy or lung volume reduction surgery.

 


Keywords: Lung transplantation; Postoperative complications; Pulmonary emphysema; Pneumonectomy.

 


Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia accompanied by airflow obstruction

Hiperplasia de células neuroendócrinas pulmonares difusas com obstrução ao fluxo aéreo

Ester Nei Aparecida Martins Coletta, Larissa Rêgo Voss, Mariana Silva Lima, Jaquelina Sonoe Ota Arakaki, Juvêncio Câmara, Carlos D'Andretta Neto, Carlos Alberto de Castro Pereira

J Bras Pneumol.2009;35(5):489-494

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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia with airflow obstruction is a rare form of lung injury. All of the reported cases have been diagnosed by surgical lung biopsy. Only three of the reported cases presented with diffuse interstitial lung opacities on HRCT scans. We report three additional cases of this entity. All of the patients were female and presented with mild-to-moderate airflow obstruction. In the first case, transbronchial biopsy and imaging data were sufficient to make the diagnosis. Although the HRCT scans of all three cases revealed a mosaic pattern, that of the third patient also revealed diffuse interstitial infiltrate. In extremely rare cases, HRCT findings can simulate those seen in other interstitial lung diseases.

 


Keywords: Neuroendocrine cells; Carcinoid tumor; Bronchiolitis obliterans.

 


Pulmonary arterial hypertension and thyroid disease

Hipertensão arterial pulmonar e doenças da tireoide

Denise Rossato Silva, Marcelo Basso Gazzana, Ângela Beatriz John, Débora Rodrigues Siqueira, Ana Luiza Silva Maia, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2009;35(2):179-185

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Recent studies have suggested an association between pulmonary arterial hypertension (PAH) and thyroid diseases (hypothyroidism and hyperthyroidism). This combination has a good prognosis, because the increase in the pulmonary artery pressure is usually slight and reverses after the treatment of the thyroid disease. Although the exact mechanism involved in the pathogenesis of this combination has not yet been established, it has been hypothesized that thyroid hormones and autoimmunity have a direct influence. Due to the high prevalence of thyroid disease in patients with PAH, thyroid function tests should be considered in the investigation of every patient with PAH. In this review, we describe the prevalence of PAH in patients with thyroid diseases and the prevalence of thyroid disease in patients with PAH, as well as addressing the principal effects that thyroid diseases have on the respiratory system. In addition, we report the treatment effects in patients with these diseases.

 


Keywords: Hypertension, pulmonary; Graves disease; Hyperthyroidism; Hypothyroidism; Thyroid hormones; Echocardiography.

 


Acute disseminated histoplasmosis in an immunocompetent patient

Histoplasmose disseminada aguda em indivíduo imunocompetente

Simone Castelo Branco Fortaleza, Silvia Karine de Albuquerque Lopes, Tereza de Jesus Bandeira, Teresa Neuma Albuquerque Gomes Nogueira, Marcelo Alcântata Holanda

J Bras Pneumol.2004;30(3):270-273

Abstract PDF PT

Histoplasmosis is a fungal disease caused by inhalation of Histoplasma capsulatum fungus. The disease does not normally affect immunocompetent individuals after a single, transient inhalation exposure. However, longer exposure may cause chronic or disseminated acute pulmonary infection. In immunocompromised patients, the infection is disseminated and severe. We report the case of a 13-year-old immunocompetent patient, presenting with fever, cough and dyspnea for one month. The chest X-ray and computed tomography scan revealed interstitial infiltrate and diffuse micronodules. The patient reported having had close and prolonged contact with birds. He was submitted to an open lung biopsy and the tissue culture was positive for Histoplasma capsulatum sp. He was treated with amphotericin B for 28 days, followed by treatment with itraconazole for 6 months, and there was complete resolution of the disease.

 


Keywords: Histoplasmosis, Immunocompetence, Birds.

 


Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

Identificação da diminuição da mobilidade diafragmática e do espessamento diafragmático na doença pulmonar intersticial: utilidade da ultrassonografia

Pauliane Vieira Santana1,2, Elena Prina1, André Luis Pereira Albuquerque1, Carlos Roberto Ribeiro Carvalho1, Pedro Caruso1,2

J Bras Pneumol.2016;42(2):88-94

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Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound.

 


Keywords: Diaphragm/ultrasonography; Lung diseases, interstitial; Respiratory muscles; Respiratory function tests.

 


Identifying activating mutations in the EGFR gene: prognostic and therapeutic implications in non-small cell lung cancer

Identificação de mutações ativadoras no gene EGFR: implicações no prognóstico e no tratamento do carcinoma pulmonar de células não pequenas

Gabriel Lima Lopes1, Edoardo Filippo de Queiroz Vattimo2, Gilberto de Castro Junior2,3

J Bras Pneumol.2015;41(4):365-375

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Lung cancer is the leading cause of cancer-related deaths worldwide. Promising new therapies have recently emerged from the development of molecular targeted drugs; particularly promising are those blocking the signal transduction machinery of cancer cells. One of the most widely studied cell signaling pathways is that of EGFR, which leads to uncontrolled cell proliferation, increased cell angiogenesis, and greater cell invasiveness. Activating mutations in the EGFR gene (deletions in exon 19 and mutation L858R in exon 21), first described in 2004, have been detected in approximately 10% of all non-squamous non-small cell lung cancer (NSCLC) patients in Western countries and are the most important predictors of a response to EGFR tyrosine-kinase inhibitors (EGFR-TKIs). Studies of the EGFR-TKIs gefitinib, erlotinib, and afatinib, in comparison with platinum-based regimens, as first-line treatments in chemotherapy-naïve patients have shown that the EGFR-TKIs produce gains in progression-free survival and overall response rates, although only in patients whose tumors harbor activating mutations in the EGFR gene. Clinical trials have also shown EGFR-TKIs to be effective as second- and third-line therapies in advanced NSCLC. Here, we review the main aspects of EGFR pathway activation in NSCLC, underscore the importance of correctly identifying activating mutations in the EGFR gene, and discuss the main outcomes of EGFR-TKI treatment in NSCLC.

 


Keywords: Molecular targeted therapy; Receptor, epidermal growth factor; Lung neoplasms/drug therapy; Mutation; Oncogenes.

 


Pulmonary tuberculosis imaging

Imagem em tuberculose pulmonar

Sidney Bombarda, Cláudia Maria Figueiredo, Marcelo Buarque de Gusmão Funari, José Soares Júnior, Márcia Seiscento, Mário Terra Filho

J Bras Pneumol.2001;27(6):329-340

Abstract PDF PT

Tuberculosis is a disease of high incidence and prevalence in Brazil. Imaging methods can reveal signs suggestive of tuberculosis activity or sequelae. Chest radiographs can reveal active lung tuberculosis through consolidations, cavitations, interstitial patterns (nodular and reticulo-nodular), mediastinal or hilar lymphadenopathy and pleural effusions. Images compatible with the active disease, such as centrilobular nodules segmentarily distributed, thick-walled cavities, thickened bronchial or bronchiolar walls, bronchiectasis and lymphadenopathy can be observed by computerized tomography. Thin-walled cavities, traction bronchiectasis, parenchymal bands, emphysema and mosaic pattern are signs suggestive of inactive disease. Gallium-67 citrate scyntigraphy is a complementary method useful in the detection of infectious diseases, including tuberculosis, especially in immunocompromised patients. Inhalation / perfusion analyses are used in the pre-operative assessment of patients carrying tuberculosis sequelaes and multiresistant tuberculosis. Positron emission tomography with fluorine-18 labeled deoxyglucose allows the detection of the inflammatory process that takes place during the active stage of tuberculosis and may persist, not so intense, after specific treatment is over. Imaging methods are valuable tools to be used in the diagnosis and follow up of pulmonary tuberculosis.

 


Keywords: Tuberculosis. Radiography. Computed tomography. Scintigraphy. Emission-computed tomography.

 


Clinical impact of sepsis at admission to the ICU of a private hospital in Salvador, Brazil

Impacto clínico do diagnóstico de sepse à admissão em UTI de um hospital privado em Salvador, Bahia

Verena Ribeiro Juncal, Lelivaldo Antonio de Britto Neto, Aquiles Assunção Camelier, Octavio Henrique Coelho Messeder, Augusto Manoel de Carvalho Farias

J Bras Pneumol.2011;37(1):85-92

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Objective: To describe the clinical characteristics, laboratory data, and clinical outcomes of patients with and without sepsis admitted to the ICU of a private hospital in the city of Salvador, Brazil, and to identify clinical variables related to a worse prognosis in those with sepsis. Methods: This was a longitudinal study including all patients admitted to the general ICU of the Hospital Português, in the city of Salvador, Brazil, between June of 2008 and March of 2009. At ICU admission, two groups of patients were identified: with sepsis and without sepsis. Epidemiological, clinical and laboratory data were collected, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score was calculated. Results: Of the 144 patients in the study, 29 (20.1%) had sepsis. Among the patients with sepsis, males accounted for 55.2%, the mean age was 73.1 ± 14.6 years, and the mean APACHE II score was 23.8 ± 9.1, compared with 36.3%, 68.7 ± 17.7 years, and 18.4 ± 9.5, respectively, among those without sepsis. There were significant associations between a diagnosis of sepsis and the following variables: APACHE II score; in-hospital mortality; ICU mortality; HR; mean arterial pressure; hematocrit level; white blood cell count; and antibiotic use. The use of life support measures and lower hematocrit levels were associated with a worse prognosis in the patients with sepsis. Conclusions: The patients diagnosed with sepsis presented worse clinical outcomes, probably due to their greater severity. Hematocrit level was the only variable that was a predictor of mortality risk in the patients with sepsis.

 


Keywords: Sepsis/epidemiology; Sepsis/mortality; Intensive care units.

 


Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year

Impacto da adesão à oxigenoterapia de longa duração em pacientes com DPOC e hipoxemia decorrente do esforço acompanhados durante um ano

Carolina Bonfanti Mesquita1,a, Caroline Knaut1,b, Laura Miranda de Oliveira Caram1,c, Renata Ferrari1,d, Silmeia Garcia Zanati Bazan2,e, Irma Godoy1,f, Suzana Erico Tanni3,g

J Bras Pneumol.2018;44(5):390-397

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Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George's Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR‑9b4v63 [http://www.ensaiosclinicos.gov.br])

 


Keywords: Respiratory insufficiency; Pulmonary disease, chronic obstructive; Patient compliance; Hypoxia; Oxygen inhalation therapy.

 


Impact of continuous positive airway pressure on the pulmonary changes promoted by immersion in water

Impacto da pressão positiva contínua nas vias aéreas sobre as alterações pulmonares promovidas pela imersão em água

Danize Aparecida Rizzetti1, Janayna Rodembuch Borba Quadros1, Bruna Esmerio Ribeiro1, Letícia Callegaro1, Aline Arebalo Veppo2, Giulia Alessandra Wiggers1, Franck Maciel Peçanha1

J Bras Pneumol.2017;43(6):409-415

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether different levels of CPAP improve the lung volumes and capacities of healthy subjects immersed in water. Methods: This was a randomized clinical trial, conducted between April and June of 2016, involving healthy female volunteers who were using oral contraceptives. Three 20-min immersion protocols were applied: control (no CPAP); CPAP5 (CPAP at 5 cmH2O); and CPAP10 (CPAP at 10 cmH2O). We evaluated HR, SpO2, FVC, FEV1, the FEV1/FVC ratio, peak expiratory flow rate (PEFR), and FEF25-75%) at three time points: pre-immersion; 10 min after immersion; and 10 min after the end of each protocol. Results: We evaluated 13 healthy volunteers. The CPAP10 protocol reversed the restrictive pattern of lung function induced by immersion in water, maintaining pulmonary volumes and capacities for a longer period than did the CPAP5 protocol. Conclusions: When the hemodynamic change causing a persistent lung disorder, only the application of higher positive pressures is effective in maintaining long-term improvements in the pulmonary profile.

 


Keywords: Physical therapy modalities; Noninvasive ventilation; Continuous positive airway pressure.

 


Impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer

Impacto da radioterapia torácica na função respiratória e capacidade de exercício em pacientes com câncer de mama

Milena Mako Suesada1,a, Heloisa de Andrade Carvalho2,b, André Luis Pereira de Albuquerque1,c, João Marcos Salge1,d, Silvia Radwanski Stuart2,e, Teresa Yae Takagaki1,f

J Bras Pneumol.2018;44(6):469-476

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the impact of thoracic radiotherapy on respiratory function and exercise capacity in patients with breast cancer. Methods: Breast cancer patients in whom thoracic radiotherapy was indicated after surgical treatment and chemotherapy were submitted to HRCT, respiratory evaluation, and exercise capacity evaluation before radiotherapy and at three months after treatment completion. Respiratory muscle strength testing, measurement of chest wall mobility, and complete pulmonary function testing were performed for respiratory evaluation; cardiopulmonary exercise testing was performed to evaluate exercise capacity. The total radiotherapy dose was 50.4 Gy (1.8 Gy/fraction) to the breast or chest wall, including supraclavicular lymph nodes (SCLN) or not. Dose-volume histograms were calculated for each patient with special attention to the ipsilateral lung volume receiving 25 Gy (V25), in absolute and relative values, and mean lung dose. Results: The study comprised 37 patients. After radiotherapy, significant decreases were observed in respiratory muscle strength, chest wall mobility, exercise capacity, and pulmonary function test results (p < 0.05). DLCO was unchanged. HRCT showed changes related to radiotherapy in 87% of the patients, which was more evident in the patients submitted to SCLN irradiation. V25% significantly correlated with radiation pneumonitis. Conclusions: In our sample of patients with breast cancer, thoracic radiotherapy seemed to have caused significant losses in respiratory and exercise capacity, probably due to chest wall restriction; SCLN irradiation represented an additional risk factor for the development of radiation pneumonitis.

 


Keywords: Breast neoplasms; Radiotherapy; Radiation pneumonitis; Respiratory function tests; Exercise test.

 


Impact of bacteremia in a cohort of patients with pneumococcal pneumonia

Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica

Ileana Palma, Ricardo Mosquera, Carmen Demier, Carlos Vay, Angela Famiglietti, Carlos Luna

J Bras Pneumol.2012;38(4):422-430

Abstract PDF PT PDF EN Portuguese Text

Objective: Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV). Methods: Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP). Results: Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs 28.2%). Conclusions: In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.

 


Keywords: Pneumococcal vaccines; Pneumonia, bacterial; Streptococcus pneumoniae; Pneumococcal infections; Mortality; Epidemiology.

 


Importance of slow vital capacity in the detection of airway obstruction

Importância da capacidade vital lenta na detecção de obstrução das vias aéreas

Ana Raquel Gonçalves de Barros, Margarida Batista Pires, Nuno Miguel Ferreira Raposo

J Bras Pneumol.2013;39(3):317-322

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the presence of airway obstruction by determining the FEV1/FVC and FEV1/slow vital capacity (SVC) ratios. Methods: This was a quantitative, retrospective cross-sectional study. The sample comprised 1,084 individuals who underwent spirometry and plethysmography in a central hospital in Lisbon, Portugal. The study sample was stratified into six groups, by pulmonary function. Results: The analysis of the FEV1/FVC ratio revealed the presence of airway obstruction in 476 individuals (43.9%), compared with 566 individuals (52.2%) for the analysis of the FEV1/SVC ratio. In the airway obstruction, airway obstruction plus lung hyperinflation, and mixed pattern groups, the difference between SVC and FVC (SVC − FVC) was statistically superior to that in the normal pulmonary function, reduced FEF, and restrictive lung disease groups. The SVC − FVC parameter showed a significant negative correlation with FEV1 (in % of the predicted value) only in the airway obstruction plus lung hyperinflation group. Conclusions: The FEV1/SVC ratio detected the presence of airway obstruction in more individuals than did the FEV1/FVC ratio; that is, the FEV1/SVC ratio is more reliable than is the FEV1/FVC ratio in the detection of obstructive pulmonary disease.

 


Keywords: Airway Obstruction; Spirometry; Plethysmography.

 


Immunophenotyping and extracellular matrix remodeling in pulmonary and extrapulmonary sarcoidosis

Imunofenotipagem e remodelamento da matriz extracelular na sarcoidose pulmonar e extrapulmonar

Pedro Henrique Ramos Quintino da Silva, Edwin Roger Parra, William Sanches Zocolaro, Ivy Narde, Fabíola Rodrigues, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro de Carvalho, Vera Luiza Capelozzi

J Bras Pneumol.2012;38(3):321-330

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the significance of cellular immune markers, as well as that of collagen and elastic components of the extracellular matrix, within granulomatous structures in biopsies of patients with pulmonary or extrapulmonary sarcoidosis. Methods: We carried out qualitative and quantitative evaluations of inflammatory cells, collagen fibers, and elastic fibers in granulomatous structures in surgical biopsies of 40 patients with pulmonary and extrapulmonary sarcoidosis using histomorphometry, immunohistochemistry, picrosirius red staining, and Weigert's resorcin-fuchsin staining. Results: The extrapulmonary tissue biopsies presented significantly higher densities of lymphocytes, macrophages, and neutrophils than did the lung tissue biopsies. Pulmonary granulomas showed a significantly higher number of collagen fibers and a lower density of elastic fibers than did extrapulmonary granulomas. The amount of macrophages in the lung samples correlated with FVC (p < 0.05), whereas the amount of CD3+, CD4+, and CD8+ lymphocytes correlated with the FEV1/FVC ratio and VC. There were inverse correlations between TLC and the CD1a+ cell count (p < 0.05), as well as between DLCO and collagen/elastic fiber density (r = −0.90; p = 0.04). Conclusions: Immunophenotyping and remodeling both showed differences between pulmonary and extrapulmonary sarcoidosis in terms of the characteristics of the biopsy samples. These differences correlated with the clinical and spirometric data obtained for the patients, suggesting that two different pathways are involved in the mechanism of antigen clearance, which was more effective in the lungs and lymph nodes.

 


Keywords: Sarcoidosis; Granulomatous disease, chronic; Extracellular matrix; Immunophenotyping; Respiratory function tests.

 


Incidence of acute lung injury and acute respiratory distress syndrome in the intensive care unit of a university hospital: a prospective study

Incidência de lesão pulmonar aguda e síndrome da angústia respiratória aguda no centro de tratamento intensivo de um hospital universitário: um estudo prospectivo

Raquel Hermes Rosa Oliveira, Aníbal Basille Filho

J Bras Pneumol.2006;32(1):35-42

Abstract PDF PT PDF EN Portuguese Text

Objective: To establish the incidence of acute lung injury and acute respiratory distress syndrome, as well as related risk factors and mortality in an intensive care unit. To compare patients developing lung injury with at-risk patients not presenting acute lung injury or acute respiratory distress syndrome. Methods: The study was conducted in the intensive care unit of the Ribeirão Preto Hospital das Clínicas Emergency Room. All patients admitted between May 2001 and April 2002 were monitored prospectively. Clinical data, Acute Physiologic and Chronic Health Evaluation II score, complications, length of stay in the intensive care unit and lung injury data were recorded. Results: Of the 524 patients admitted, 175 (33.4%) presented risk factors for acute lung injury and acute respiratory distress syndrome, 33 (6.3%) developed acute respiratory distress syndrome, and 12 (2.3%) developed acute lung injury. The main risk factors were pneumonia (37.7%), shock (32.0%), multiple trauma (24.6%) and sepsis (21.1%). Patients developing acute lung injury had higher Acute Physiologic and Chronic Health Evaluation II scores (p < 0.05), more frequently presented sepsis (p = 0.001), developed more complications (p = 0.001) and presented greater mortality (p = 0.001). The main cause of death was multiple organ failure (38.5%). Conclusion: The incidence of acute lung injury and acute respiratory distress syndrome was 2.3% and 6.3%, respectively.

 


Keywords: Respiratory distress syndrome, adult/epidemiology; Respiratory distress syndrome, adult/mortality;

 


The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

Índice de respiração rápida e superficial como previsor de sucesso de desmame da ventilação mecânica: utilidade clínica quando mensurado a partir de dados do ventilador

Luiz Alberto Forgiarini Junior1, Antonio M. Esquinas2

J Bras Pneumol.2016;42(4):306-306

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Latent tuberculosis infection in patients with rheumatic diseases

Infecção latente por tuberculose em pacientes com doenças reumatológicas

Camila Anton1,2,a, Felipe Dominguez Machado1,2,b, Jorge Mario Ahumada Ramirez1,2,c, Rafaela Manzoni Bernardi1,2,d, Penélope Esther Palominos3,e, Claiton Viegas Brenol3,f, Fernanda Carvalho de Queiroz Mello4,g, Denise Rossato Silva1,2,h

J Bras Pneumol.2019;45(2):e20190023-e20190023

Abstract PDF PT PDF EN Portuguese Text

Most people infected by Mycobacterium tuberculosis (Mtb) do not have any signs or disease symptoms, a condition known as latent tuberculosis infection (LTBI). The introduction of biological agents, mainly tumor necrosis factor (TNF) inhibitors, for the treatment of immune-mediated diseases such as Rheumatoid Arthritis (RA) and other rheumatic diseases, increased the risk of reactivation of LTBI, leading to development of active TB. Thus, this review will approach the aspects related to LTBI in patients with rheumatologic diseases, especially those using iTNF drugs. For this purpose it will be considered the definition and prevalence of LTBI, mechanisms associated with diseases and medications in use, criteria for screening, diagnosis and treatment. Considering that reactivation of LTBI accounts for a large proportion of the incidence of active TB, adequate diagnosis and treatment are crucial, especially in high-risk groups such as patients with rheumatologic diseases.

 


Keywords: Tuberculosis; Latent tuberculosis; Tuberculin skin test; Anti-TNF therapy; Tumor necrosis factor-alpha; Rheumatoid arthritis.

 


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.

 


Rhodococcus equi infection in acquired immunodeficiency syndrome. Computed tomography aspects

Infecção pulmonar pelo Rhodococcus equi na síndrome da imunodeficiência adquirida. Aspectos na tomografia computadorizada

Edson Marchiori, Renato Gonçalves de Mendonça, Domenico Capone, Elza Maria de Cerqueira, Arthur Soares Souza Júnior, Gláucia Zanetti, Dante Escuissato, Emerson Gasparetto

J Bras Pneumol.2006;32(5):405-409

Abstract PDF PT PDF EN Portuguese Text

Objective: To present the computed tomography aspects of Rhodococcus equi pneumonia in seven patients with acquired immunodeficiency syndrome. Methods: A retrospective study of the computed tomography scans of seven patients with acquired immunodeficiency syndrome and Rhodococcus equi infection. Results: The most common findings were consolidation (n = 7), consolidation with cavitation (n = 6), ground glass opacities (n = 6), peribronchial nodules (n = 4) and centrilobular nodules presenting a "tree-in-bud" pattern (n = 3). Conclusion: The most common finding in patients with Rhodococcus equi pulmonary infection and acquired immunodeficiency syndrome was consolidation with cavitation.

 


Keywords: Acquired immunodeficiency syndrome; Rhodococcus equi; Actimomycetales infections; Lung diseases, fungal; Tomography, emission-computed

 


Airway inflammation in steroid-naïve asthmatics: characteristics of induced sputum

Inflamação das vias aéreas em asmáticos virgens de tratamento com esteróides: características do escarro induzido

Simone Van de Sande Lee, Marcia Margaret Menezes Pizzichini, Leila John Marques, Samira Cardoso Ferreira, Emilio Pizzichini

J Bras Pneumol.2003;29(4):188-195

Abstract PDF PT

Background: Airway inflammation, acknowledged as an important feature of asthma, can be assessed by the examination of induced sputum. Objective: To determine the pattern of inflammatory cells in induced sputum from stable steroid-naïve asthmatics, in Florianópolis, Santa Catarina. Method: The induced sputum from 34 asthmatics using exclusively inhaled bronchodilators on demand was examined. The patients' clinical characteristics were obtained at visit 1, and sputum was induced at visit 2. Differential cell count was performed on Giemsa-stained cytospins. Sputum was considered to be eosinophilic if there were ³ 3% eosinophils, and neutrophilic if there were ³ 65% neutrophils. Results: Results are expressed by median and interquartile range. The total cell count was 3.4 (3.7) x 106 cells/ml, and cell viability was 80.0 (16.4) %. The proportion of neutrophils was 14.4 (22.1) %, of eosinophils 6.4 (17.2) %, of macrophages 60.3 (37.5) %, and of lymphocytes 1.1 (1.2) %. Eosinophilic sputum was observed in 24 subjects (70.6%); none of them had neutrophilic sputum. There were no significant differences between the eosinophilic and non-eosinophilic groups concerning the measured clinical outcomes, total cell count and proportions of cells in the sputum, except for the proportion of eosinophils (14.4 [19.3] vs 0.4 [1.1], p < 0.001). Conclusions: In our environment, steroid-naïve asthmatics present a higher proportion of sputum eosinophils, as compared to the established reference values. The clinical and physiological parameters analyzed were unable to predict the presence of eosinophilic inflammation of the airways.

 


Keywords: Asthma. Inflammation. Sputum. Eosinophils. Neutrophils.

 


Influence that oscillating positive expiratory pressure using predetermined expiratory pressures has on the viscosity and transportability of sputum in patients with bronchiectasis

Influência da técnica de pressão expiratória positiva oscilante utilizando pressões expiratórias pré-determinadas na viscosidade e na transportabilidade do escarro em pacientes com bronquiectasia

Ercy Mara Cipulo Ramos, Dionei Ramos, Daniela Mizusaki Iyomasa, Graciane Laender Moreira, Kátia Cristina Teixeira Melegati, Luiz Carlos Marques Vanderlei, José Roberto Jardim, Adriana Siqueira de Oliveira

J Bras Pneumol.2009;35(12):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the effectiveness of oscillating positive expiratory pressure (OPEP) using predetermined expiratory pressures on the viscosity and transportability of sputum in patients with bronchiectasis. Methods: The study involved 15 stable patients with bronchiectasis (7 males; mean age = 53 ± 16 years), submitted to two consecutive OPEP interventions, with a 24-h interval between the two, using positive expiratory pressures set at 15 cmH2O (P15) and 25 cmH2O (P25). The protocol consisted of a voluntary cough; another voluntary cough 20 min later, designated time zero (T0); a 10-min rest period; and two 10-min series (S1 and S2, using OPEP at P15 and P25 in both), with a 10-min interval between the two. The viscosity and transportability of sputum were evaluated by viscometry, relative transport velocity on frog palate, transport in a simulated cough machine and contact angle. Sputum samples were collected at T0, after S1 and after S2. Specific statistical tests were performed depending on the type of data distribution. Results: In comparison with the values obtained at T0, sputum viscosity decreased significantly after S1 at P15 and after S2 at P25. There were no significant differences among all of the samples in terms of transportability. Conclusions: The fact that sputum viscosity decreased whether OPEP was performed at P15 or at P25 suggests that there is no need to generate high expiratory pressure to achieve the desired result.

 


Keywords: Viscosity; Bronchiectasis; Physical therapy (specialty); Sputum.

 


Influence of general clinical parameters on the quality of life of chronic obstructive pulmonary disease patients

Influência de características gerais na qualidade de vida de pacientes com doença pulmonar obstrutiva crônica

Victor Zuniga Dourado, Letícia Cláudia de Oliveira Antunes, Lídia Raquel de Carvalho, Irma Godoy

J Bras Pneumol.2004;30(3):207-214

Abstract PDF PT Portuguese Text

Background: There is currently no consensus regarding which factors influence the quality of life of patients suffering from chronic obstructive pulmonary disease (COPD). However, identifying such factors could orient approaches to improving the quality of the lives of these patients. Objective: To evaluate factors that can interfere with quality of life in COPD patients selected for pulmonary rehabilitation. Methods: Twenty-one patients with moderate to severe COPD were evaluated. Maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), body mass index (BMI), pulmonary function, blood gases, grip strength (measured with a dynamometer), quadriceps strength and St. George's Respiratory Questionnaire (SGRQ) scores were assessed. Results: Statistically significant negative correlations with quality of life were found for the following factors: "impact" scores of: forced expiratory volume in one second (FEV1) (r = -0.68; p = 0.004), FEV1 to forced vital capacity ratio (FEV1/FVC) (r = -0.61; p = 0.014), peak expiratory flow (PEF) (r = -0.53 (p = 0.015), 6MWT (r = -0.63; p = 0.001) and BMI (r = -0.64; p = 0.002); "activity" scores for: MIP (r = -0.57; p = 0.007), baseline arterial oxygen saturation by pulse oximetry (SpO2) (r = -0.52; p = 0.018) and 6MWT (r = -0.58; p = 0.007); "symptom" score for: BMI (r = -0.60; p = 0.005); and "total" scores for: FEV1 (r = -0.64; p = 0.01), PEF (r = -0.47; p = 0.033) and BMI (r = -0.57; p = 0.009). Multiple linear regression revealed the primary factors influencing quality of life to be: BMI, which presented a significant influence on "symptom", "impact" and "total" scores (p = 0.002, p = 0.009 and p = 0.024, respectively); and 6MWT, which had a significant influence on "activity" and "impact" scores (p = 0.048 and p = 0.010, respectively). Conclusions: The BMI and 6MWT were shown to have an influence on quality of life in the COPD patients studied. Therefore, therapeutic approaches to improving the quality of life of COPD patients should take these indices into consideration.

 


Keywords: Lung diseases, obstructive/rehabilitation. Quality of life

 


Influence of the ventilatory mode on acute adverse effects and facial thermography after noninvasive ventilation

Influência do modo ventilatório nos efeitos adversos agudos e na termografia da face após ventilação não invasiva

Suzy Maria Montenegro Pontes1, Luiz Henrique de Paula Melo2, Nathalia Parente de Sousa Maia3, Andrea da Nóbrega Cirino Nogueira3, Thiago Brasileiro Vasconcelos4, Eanes Delgado Barros Pereira5, Vasco Pinheiro Diógenes Bastos3, Marcelo Alcantara Holanda5

J Bras Pneumol.2017;43(2):87-94

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To compare the incidence and intensity of acute adverse effects and the variation in the temperature of facial skin by thermography after the use of noninvasive ventilation (NIV). Methods: We included 20 healthy volunteers receiving NIV via oronasal mask for 1 h. The volunteers were randomly divided into two groups according to the ventilatory mode: bilevel positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP). Facial thermography was performed in order to determine the temperature of the face where it was in contact with the mask and of the nasal dorsum at various time points. After removal of the mask, the volunteers completed a questionnaire about adverse effects of NIV. Results: The incidence and intensity of acute adverse effects were higher in the individuals receiving BiPAP than in those receiving CPAP (16.1% vs. 5.6%). Thermographic analysis showed a significant cooling of the facial skin in the two regions of interest immediately after removal of the mask. The more intense acute adverse effects occurred predominantly among the participants in whom the decrease in the mean temperature of the nasal dorsum was lower (14.4% vs. 7.2%). The thermographic visual analysis of the zones of cooling and heating on the face identified areas of hypoperfusion or reactive hyperemia. Conclusions: The use of BiPAP mode was associated with a higher incidence and intensity of NIV-related acute adverse effects. There was an association between acute adverse effects and less cooling of the nasal dorsum immediately after removal of the mask. Cutaneous thermography can be an additional tool to detect adverse effects that the use of NIV has on facial skin.

 


Keywords: Masks; Noninvasive ventilation; Thermography.

 


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.

 


Yoga versus aerobic activity: effects on spirometry results and maximal inspiratory pressure

Ioga versus atividade aeróbia: efeitos sobre provas espirométricas e pressão inspiratória máxima

Dagoberto Vanoni de Godoy, Raquel Lonchi Bringhenti, Andréi Severa, Ricardo de Gasperi, Leonardo Vieira Poli

J Bras Pneumol.2006;32(2):130-135

Abstract PDF PT PDF EN Portuguese Text

Objective: To clarify whether, in healthy individuals, practicing yoga can modify maximal inspiratory pressure and spirometric indices when compared with the practice of aerobic exercise. Methods: A controlled clinical trial. A total of 31 healthy volunteers were allocated to practice aerobic exercise (n = 15) or to practice yoga (n = 16). Those in the first group served as controls and engaged in aerobic exercise for 45-60 minutes, twice a week for three months. Those in the second group practiced selected yogic techniques, also in sessions of 45-60 minutes, twice a week for three months. Forced vital capacity, forced expiratory volume in one second and maximal inspiratory pressure were measured before and after the three months of training. Results: No significant alterations were seen in the spirometric indices. A slight, although not significant, improvement in maximal inspiratory pressure was seen in both groups. However, there was a significant difference, seen in both genders, between the absolute delta (final value minus baseline value) of maximal inspiratory pressure for the group practicing yoga and that obtained for the group engaging in aerobic exercise (males: 19.5 cm H2O versus 2.8 cm H2O, p = 0.05; females: 20 cm H2O versus 3.9 cm H2O, p = 0.01). Conclusion: Neither yoga nor aerobic exercise provided a statistically significant improvement in maximal inspiratory pressure after three months. However, the absolute variation in maximal inspiratory pressure was greater among those practicing yoga.

 


Keywords: Yoga; Exercise; Respiratory muscles; Respiratory function tests; Maximal voluntary ventilation; Spirometry; Inspiratory capacity/physiology

 


Jornal de Pneumologia: agora também on-line

Thais Helena A. Thomaz Queluz

J Bras Pneumol.2001;27(1):5-7

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Bronchoalveolar lavage versus transbronchial biopsy in patients infected with the human immunodeficiency virus: comparative analysis of 287 examinations

Lavado broncoalveolar "versus" biópsia transbrônquica em pacientes HIV-positivos: análise comparativa de 287 exames

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Altamiro R. Dias

J Bras Pneumol.1998;24(3):112-118

Abstract PDF PT

A total of 287 bronchoscopies were performed in 267 patients infected with the human immunodeficiency virus (HIV). Bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) were sequentially performed in the same lung, in all cases. Specimens were examined after routine laboratory procedures for microbiologic and histologic analysis. Age ranged from 16 to 78 (median 37.2); 228 were men (85.4%) and 39 were women. Dyspnea was the main symptom in 198 cases (69.0%) and interstitial infiltrates (diffuse or localized) were the most common findings at chest radiographs (179 patients, 62.4%). Endoscopic view was normal in 246 patients (85.7%). Mucosal lesions suggestive of Kaposi's sarcoma (KS) were visible in 12 cases (4.2%). BAL detected 97 infectious agents, simultaneous co-infection occurred in 3 cases. TBB identified 165 pathogens (9 of them in association), anticipating a better yield than BAL in the diagnosis of P. carinii (84 versus 51, respectively) and cytomegalovirus (35 v. 0). Biopsies were unique in establishing the appropriate diagnosis of extrabronchial cancer and describing inespecific pneumonitis. Altogether, a definite diagnosis was obtained by bronchoscopic examination (including endoscopic view, BAL and TBB) in 271 of 287 cases (94.4%). Infections were caused by P. carinii in 105 patients (36.6%), Mycobacterium sp in 40 (13.9%), cytomegalovirus in 35 (12.2%), C. neoformans in 13 (4.5%) etc. Malignancies (including KS) were found in 16 patients (5.6%). More than one pathologic process was present in 28 (9.8%). Nonspecific pneumonitis was diagnosed in 56 cases (19.5%) and normal lung in 20 (7.0%). Complications related to bronchoscopy were pneumothorax (8 patients, 2.8%), haemorrhage (8), thoracic pain (2) and distal pneumonia (2). Chest tubes were required in 4 patients, including one fatal case (mortality rate of 0.3%). Combining BAL and TBB results increases the diagnostic yield of bronchoscopy in AIDS, with a low complication rate. If both techniques are performed, a higher number of infectious agents and more multiple causes of pulmonary disease may be identified.

 


Keywords: Bronchoscopy/methods. Acquired Immunodeficiency Syndrome/complications. Opportunistic infections related to AIDS/diagnosis.

 


Solitary benign metastasizing leiomyoma: imaging features and pathological findings

Leiomioma metastático benigno solitário: aspectos de imagem e achados anatomopatológicos

Bernardo Corrêa de Almeida Teixeira, Kássia Mahfouz, Dante Luiz Escuissato, Ana Flávia Cardoso Buarque Costa, Lúcia de Noronha

J Bras Pneumol.2014;40(2):-

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Infiltration of old scars: a manifestation of sarcoidosis

Lesões sobre cicatrizes, uma das manifestações da sarcoidose

Paulo Ricardo Martins Souza, Rodrigo Pereira Duquia, Gerson Vetoratto, Hiram Larangeira de Almeida Junior

J Bras Pneumol.2004;30(6):585-587

Abstract PDF PT PDF EN

We report the case of a 41 year-old black woman who presented a sudden infiltration of old scars of her face. These scars were from a car accident 10 years prior. Histological analysis of a skin biopsy revealed non-caseous granulomas consistent with sarcoidosis, and computed tomography of the thorax revealed enlarged mediastinal lymph nodes. The lesions regressed spontaneously and no treatment was required.

 


Keywords: Sarcoidosis/complications. Cicatrix/ethiology. Granuloma/complications.

 


Cystic lymphangioma of the mediastinum

Linfangioma cístico do mediastino

Filipa Maria Arruda Viveiros Correia, Bárbara Seabra, Ana Rego, Raquel Duarte, José Miranda

J Bras Pneumol.2008;34(11):982-984

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Cystic lymphangioma is a rare congenital benign tumor. It results from focal proliferation of well-differentiated lymphatic tissue originating from abnormal development of the lymphatic system. Most cystic lymphangiomas occur in the primitive lymph sacs of children or young adults. They generally appear in the neck (75%) and axillary region (20%). Only 1% are located in the mediastinum. Acquired lymphangiomas, which are principally seen in middle-aged adults, are caused by a process of chronic lymphatic obstruction secondary to surgery, chronic infection, or radiation. Here, we present the case of a 50-year-old male with cystic lymphangioma of the mediastinum, detected on a routine chest X-ray.

 


Keywords: Lymphangioma, cystic; Mediastinum; Incidental findings.

 


Pulmonary mucosa-associated lymphoid tissue lymphoma presenting with a diffuse micronodular pattern in an HIV-infected patient

Linfoma do tecido linfoide associado à mucosa no pulmão com padrão micronodular difuso em paciente HIV positivo

João Pedro Steinhauser Motta, Leonardo Palermo Bruno, Luana de Souza Andrade, Monique França, Rafael Barcelos Capone, Edson Marchiori, Domenico CaponeFigura

J Bras Pneumol.2011;37(3):412-415

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Fatal outcome in bronchus-associated lymphoid tissue lymphoma

Linfoma do tecido linfóide associado ao brônquio com evolução fatal

Romulo Loss Mattedi, Fabiola del Carlo Bernardi, Carlos Eduardo Bacchi, Sheila Aparecida Coelho Siqueira, Thais Mauad

J Bras Pneumol.2007;33(4):487-491

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Primary pulmonary lymphoma is rare. The most common histological type is the bronchus-associated lymphoid tissue lymphoma. This type of lymphoma has an indolent course and excellent response to therapy. One-third of all cases are diagnosed incidentally. However, due to the rarity of this disease, little is known about its natural history in terms of dissemination and evolution. Herein, we report the unusual case of a 61-year-old man who refused treatment after being diagnosed with bronchus-associated lymphoid tissue lymphoma and died 2 years later from massive lung infiltration without dissemination to other organs.

 


Keywords: Lung; Autopsy; Lymphoma.

 


Intrapulmonary lymph node: a common and underrecognized tomography finding

Linfonodo intrapulmonar: um achado tomográfico comum e pouco reconhecido

Bruno Hochhegger, Daniela Quinto dos Reis Hochhegger, Klaus Irion, Ana Paula Sartori, Fernando Ferreira Gazzoni, Edson Marchiori

J Bras Pneumol.2013;39(6):757-758

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Mediastinal liposarcoma: a case report

Lipossarcoma de mediastino: relato de caso

Roberto Saad Junior, Vicente Dorgan Neto, Roberto Gonçalves, Márcio Botter, Leticia Cristina Dalledone Siqueira

J Bras Pneumol.2008;34(1):55-58

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Here, we describe the case of a 51-year-old female with mediastinal liposarcoma. Liposarcoma is the most common malignant mesenchymal neoplasm in adults, although a mediastinal location is extremely rare. It has a large volume and varied histologic subtypes. It is characterized by the compression of neighboring structures. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. Tissue biopsy and histological typing are very important in determining the treatment and are needed for the final diagnosis. Radiotherapy and chemotherapy are ineffective treatment modalities. According to the literature, surgical resection is the treatment of choice. Long-term follow-up evaluation is indicated since there is a high rate of recurrence.

 


Keywords: Liposarcoma; Mediastinal neoplasms; Case reports [publication type].

 


Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

Lobectomia pulmonar robótica para tratamento do câncer de pulmão e de metástases pulmonares: implantação do programa e experiência inicial

Ricardo Mingarini Terra1, Pedro Henrique Xavier Nabuco de Araujo2, Leticia Leone Lauricella2, José Ribas Milanez de Campos1, Herbert Felix Costa2, Paulo Manuel Pego-Fernandes1

J Bras Pneumol.2016;42(3):185-190

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Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

 


Keywords: Pneumonectomy; Robotic surgical procedures; Thoracic surgery; Minimally invasive surgical procedures; Lung neoplasms.

 


Another parameter for identifying obstructive respiratory disorder - FEV1/FEV6 in focus

Mais um parâmetro para identificar o distúrbio ventilatório obstrutivo - VEF1/VEF6 na berlinda

Ricardo Marques Dias

J Bras Pneumol.2007;33(2):13-14

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Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation

Malformação de Chiari e síndrome de apneia central do sono: eficácia do tratamento com servoventilação adaptativa

Jorge Marques do Vale, Eloísa Silva, Isabel Gil Pereira, Catarina Marques, Amparo Sanchez-Serrano, António Simões Torres

J Bras Pneumol.2014;40(5):574-578

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The Chiari malformation type I (CM-I) has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

 


Keywords: Sleep apnea, central; Arnold-Chiari malformation; Noninvasive ventilation.

 


Pulmonary arteriovenous malformations: diagnostic and treatment characteristics

Malformações arteriovenosas pulmonares: características diagnósticas e de tratamento

William Salibe-Filho1,a, Bruna Mamprim Piloto1,b, Ellen Pierre de Oliveira1,c, Marcela Araújo Castro1,d, Breno Boueri Affonso2,e, Joaquim Maurício da Motta-Leal-Filho2,f, Edgar Bortolini2,g, Mário Terra-Filho1,h

J Bras Pneumol.2019;45(4):e20180137-e20180137

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Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.

 


Keywords: Telangiectasia, hereditary hemorrhagic; Arteriovenous malformations/diagnosis; Arteriovenous malformations/therapy.

 


Respiratory manifestations in late-onset Pompe disease: a case series conducted in Brazil

Manifestações respiratórias na doença de Pompe de início tardio: uma série de casos no Brasil

Bruna de Souza Sixel1,2, Luanda Dias da Silva3, Nicolette Celani Cavalcanti4, Glória Maria Cardoso de Andrade Penque5, Sandra Lisboa3, Dafne Dain Gandelman Horovitz6, Juan Clinton Llerena Jr6

J Bras Pneumol.2017;43(1):54-59

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Objective: To describe respiratory function in a series of patients with late-onset Pompe disease after the definitive diagnosis and before enzyme replacement therapy. Methods: This was a cross-sectional study involving patients with a definitive molecular diagnosis of late-onset Pompe disease. The data analyzed included age at symptom onset; age at definitive diagnosis; type of initial symptoms; time from symptom onset to diagnosis; FVC in the sitting and supine positions; six-minute walk distance; and locomotor ability. Analyses were carried out using frequencies, medians, minimum values, and maximum values. Results: Six patients were included in the study. The median age at symptom onset was 15 years (range, 13-50 years), and the median age at diagnosis was 39.5 years (range, 10-64 years). The median time from symptom onset to diagnosis was 8 years (range, 0-45 years). In all cases, the initial manifestation of the disease had been motor weakness. The median FVC in percentage of the predicted value (FVC%) in the sitting and supine positions was 71.0% (range, 22.9-104.6%) and 58.0% (range, 10.9-106.9%), respectively. The median ΔFVC% was 24.5% (range, −4.59 to 52.40%).The median six-minute walk distance was 391.7 m (range, 97-702 m). Conclusions: In this case series, the time from symptom onset to diagnosis was long. Although respiratory signs or symptoms were not the initial manifestations of the disease, 66.7% of the patients showed reduced FVC% in the sitting and supine positions at diagnosis.

 


Keywords: Glycogen storage disease type II; Respiratory function tests; Respiratory muscles/pathology.

 


Inflammatory and immunogenetic markers in correlation with pulmonary tuberculosis

Marcadores inflamatórios e imunogenéticos e sua relação com tuberculose pulmonar

Beatriz Lima Alezio Muller, Daniela Maria de Paula Ramalho, Paula Fernanda Gonçalves dos Santos, Eliene Denites Duarte Mesquita, Afranio Lineu Kritski, Martha Maria Oliveira

J Bras Pneumol.2013;39(6):719-727

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Objective: To describe serum levels of the cytokines IL-10, TNF-, and IFN-, as well as polymorphisms in the genes involved in their transcription, and their association with markers of the acute inflammatory response in patients with pulmonary tuberculosis. Methods: This was a descriptive, longitudinal study involving 81 patients with pulmonary tuberculosis treated at two referral hospitals. We collected data on sociodemographic variables and evaluated bacteriological conversion at the eighth week of antituberculosis treatment, gene polymorphisms related to the cytokines studied, and serum levels of those cytokines, as well as those of C-reactive protein (CRP). We also determined the ESR and CD4+ counts. Results: The median age of the patients was 43 years; 67 patients (82.7%) were male; and 8 patients (9.9%) were infected with HIV. The ESR was highest in the patients with high IFN- levels and low IL-10 levels. IFN- and TNF- gene polymorphisms at positions +874 and −238, respectively, showed no correlations with the corresponding cytokine serum levels. Low IL-10 levels were associated with IL-10 gene polymorphisms at positions −592 and −819 (but not −1082). There was a negative association between bacteriological conversion at the eighth week of treatment and CRP levels. Conclusions: Our results suggest that genetic markers and markers of acute inflammatory response are useful in predicting the response to antituberculosis treatment

 


Keywords: Tuberculosis; Cytokines; Immune system; Polymorphism, single nucleotide.

 


Medications to the north, patients to the south

Medicamentos ao Norte, doentes ao Sul

Paulo Augusto Moreira Camargos, Álvaro Augusto Cruz, Jean Bousquet

J Bras Pneumol.2009;35(7):615-617

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Effective tobacco control measures: agreement among medical students

Medidas eficazes de controle do tabagismo: concordância entre estudantes de medicina

Stella Regina Martins1, Renato Batista Paceli1, Marco Antônio Bussacos2, Frederico Leon Arrabal Fernandes1, Gustavo Faibischew Prado1, Elisa Maria Siqueira Lombardi1, Mário Terra-Filho1, Ubiratan Paula Santos1

J Bras Pneumol.2017;43(3):202-207

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Objective: To determine the level of agreement with effective tobacco control measures recommended by the World Health Organization and to assess the attitudes toward, knowledge of, and beliefs regarding smoking among third-year medical students at University of São Paulo School of Medicine, located in the city of São Paulo, Brazil. Methods: Between 2008 and 2012, all third-year medical students were invited to complete a self-administered questionnaire based on the Global Health Professionals Student Survey and its additional modules. Results: The study sample comprised 556 students. The level of agreement with the World Health Organization recommendations was high, except for the components "received smoking cessation training" and "raising taxes is effective to reduce the prevalence of smoking". Most of the students reported that they agree with banning tobacco product sales to minors (95%), believe that physicians are role models to their patients (84%), and believe that they should advise their patients to quit cigarette smoking (96%) and using other tobacco products (94%). Regarding smoking cessation methods, most of the students were found to know more about nicotine replacement therapy than about non-nicotine therapies (93% vs. 53%). Only 37% of the respondents were aware of the importance of educational antismoking materials, and only 31% reported that they believe in the effectiveness of encouraging their patients, during medical visits. In our sample, the prevalence of current cigarette smoking was 5.23%; however, 43.82% of the respondents reported having experimented with water-pipe tobacco smoking. Conclusions: Our results revealed the need to emphasize to third-year medical students the importance of raising the prices of and taxes on tobacco products. We also need to make students aware of the dangers of experimenting with tobacco products other than cigarettes, particularly water-pipe tobacco smoking.

 


Keywords: Tobacco products; Health policy; Education, medical, undergraduate; Health knowledge, attitudes, practice.

 


Diagnostic methods to assess inspiratory and expiratory muscle strength

Métodos diagnósticos para avaliação da força muscular inspiratória e expiratória

Pedro Caruso, André Luis Pereira de Albuquerque, Pauliane Vieira Santana, Leticia Zumpano Cardenas, Jeferson George Ferreira, Elena Prina, Patrícia Fernandes Trevizan, Mayra Caleffi Pereira, Vinicius Iamonti, Renata Pletsch, Marcelo Ceneviva Macchione, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2015;41(2):110-123

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Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.

 


Keywords: Respiratory muscles; Muscle weakness; Diaphragm; Respiratory function tests; Diagnostic tests, routine.

 


Pulmonary nontuberculous mycobacterial infections: presumptive diagnosis based on the international microbiological criteria adopted in the state of São Paulo, Brazil, 2011-2014

Micobacterioses pulmonares: diagnóstico presuntivo pelos critérios microbiológicos internacionais adotados no estado de São Paulo, Brasil, 2011-2014

Lilian Regina Macelloni Marques1,a, Lucilaine Ferrazoli2,b, Érica Chimara2,c

J Bras Pneumol.2019;45(2):e20180278-e20180278

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Objective: Pulmonary nontuberculous mycobacterial infections are caused by nontuberculous mycobacteria (NTM), the microbiological diagnosis of which involves the isolation and identification of the same species in at least two sputum samples, one BAL fluid sample, or one lung biopsy sample. The objective of the present study was to determine the frequency at which the various NTM species are identified among selected individuals and in potential cases of pulmonary nontuberculous mycobacterial infection. Methods: This was a retrospective analysis of the data on species isolated from respiratory specimens collected from 2,843 individuals between 2011 and 2014. Potential NTM infection cases were identified on the basis of the international microbiological criteria adopted in the state of São Paulo. Results: A total of 50 species were identified using the molecular method PCR-restriction enzyme analysis. Samples collected from 1,014 individuals were analyzed in relation to the microbiological criteria, and 448 (44.18%) had a presumptive diagnosis of pulmonary nontuberculous mycobacterial infection, the species identified most frequently being, in descending order, Mycobacterium kansasii, M. abscessus, M. intracellulare, M. avium, and M. szulgai. Conclusions: Although various NTM species were identified among the individuals studied, those presumptively identified most frequently on the basis of the microbiological criteria adopted in the state of São Paulo were the ones that are most commonly associated with pulmonary nontuberculous mycobacterial infection worldwide or in specific geographic regions.

 


Keywords: Nontuberculous mycobacteria/classification; Mycobacterium infections, nontuberculous/diagnosis; Lung.

 


The pulmonary microbiome: challenges of a new paradigm

Microbioma pulmonar: desafios de um novo paradigma

André Nathan Costa1,a, Felipe Marques da Costa1,b, Silvia Vidal Campos1,c, Roberta Karla Salles1,d, Rodrigo Abensur Athanazio1,e

J Bras Pneumol.2018;44(5):424-432

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The study of the human microbiome-and, more recently, that of the respiratory system-by means of sophisticated molecular biology techniques, has revealed the immense diversity of microbial colonization in humans, in human health, and in various diseases. Apparently, contrary to what has been believed, there can be nonpathogenic colonization of the lungs by microorganisms such as bacteria, fungi, and viruses. Although this physiological lung microbiome presents low colony density, it presents high diversity. However, some pathological conditions lead to a loss of that diversity, with increasing concentrations of some bacterial genera, to the detriment of others. Although we possess qualitative knowledge of the bacteria present in the lungs in different states of health or disease, that knowledge has advanced to an understanding of the interaction of this microbiota with the local and systemic immune systems, through which it modulates the immune response. Given this intrinsic relationship between the microbiota and the lungs, studies have put forth new concepts about the pathophysiological mechanisms of homeostasis in the respiratory system and the potential dysbiosis in some diseases, such as cystic fibrosis, COPD, asthma, and interstitial lung disease. This departure from the paradigm regarding knowledge of the lung microbiota has made it imperative to improve understanding of the role of the microbiome, in order to identify possible therapeutic targets and to develop innovative clinical approaches. Through this new leap of knowledge, the results of preliminary studies could translate to benefits for our patients.

 


Keywords: Microbiota; Microbiology; Immune system.

 


Diaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Wellington Pereira dos Santos Yamaguti, Eliana Takahama Sakamoto, Danilo Panazzolo, Corina da Cunha Peixoto, Giovanni Guido Cerri, André Luis Pereira Albuquerque

J Bras Pneumol.2010;36(6):738-745

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Objective: To compare the diaphragmatic mobility of healthy subjects during incentive spirometry with a volume-oriented device, during incentive spirometry with a flow-oriented device, and during diaphragmatic breathing. To compare men and women in terms of diaphragmatic mobility during these three types of breathing exercises. Methods: We evaluated the pulmonary function and diaphragmatic mobility of 17 adult healthy volunteers (9women and 8 men). Diaphragmatic mobility was measured via ultrasound during diaphragmatic breathing and during the use of the two types of incentive spirometers. Results: Diaphragmatic mobility was significantly greater during the use of the volume-oriented incentive spirometer than during the use of the flow-oriented incentive spirometer (70.16 ± 12.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). Diaphragmatic breathing led to a greater diaphragmatic mobility than did the use of the flow-oriented incentive spirometer (69.62 ± 11.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). During all three types of breathing exercises, the women showed a higher mobility/FVC ratio than did the men. Conclusions: Incentive spirometry with a volume-oriented device and diaphragmatic breathing promoted greater diaphragmatic mobility than did incentive spirometry with a flow-oriented device. Women performed better on the three types of breathing exercises than did men.

 


Keywords: Diaphragm; Breathing exercises; Respiratory function tests; Ultrasonography; Respiratory muscles.

 


An experimental rat model of ex vivo lung perfusion for the assessment of lungs after prostacyclin administration: inhaled versus parenteral routes

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação de desempenho de pulmões submetidos à administração de prostaciclina inalada versus parenteral

Paulo Francisco Guerreiro Cardoso, Rogério Pazetti, Henrique Takachi Moriya, Paulo Manuel Pêgo-Fernandes, Francine Maria de Almeida, Aristides Tadeu Correia, Karina Fechini, Fabio Biscegli Jatene

J Bras Pneumol.2011;37(5):589-597

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Objective: To present a model of prostaglandin I2 (PGI2) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. Methods: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI2 (IPGI2); and parenteral PGI2 (PPGI2). The dose of PGI2 used in the IPGI2 and PPGI2 groups was 20 and 10 µg/kg, respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4°C for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. Results: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. Conclusions: The experimental model of inhaled PGI2 administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI2 than that with the use of saline.

 


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

 


A murine model of elastase- and cigarette smoke-induced emphysema

Modelo murino de enfisema induzido por instilação de elastase e exposição a fumaça de cigarro

Rubia Rodrigues1, Clarice Rosa Olivo1, Juliana Dias Lourenço1, Alyne Riane1, Daniela Aparecida de Brito Cervilha1, Juliana Tiyaki Ito1, Milton de Arruda Martins1, Fernanda Degobbi Tenório Quirino dos Santos Lopes1

J Bras Pneumol.2017;43(2):95-100

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Objective: To describe a murine model of emphysema induced by a combination of exposure to cigarette smoke (CS) and instillation of porcine pancreatic elastase (PPE). Methods: A total of 38 C57BL/6 mice were randomly divided into four groups: control (one intranasal instillation of 0.9% saline solution); PPE (two intranasal instillations of PPE); CS (CS exposure for 60 days); and CS + PPE (two intranasal instillations of PPE + CS exposure for 60 days). At the end of the experimental protocol, all animals were anesthetized and tracheostomized for calculation of respiratory mechanics parameters. Subsequently, all animals were euthanized and their lungs were removed for measurement of the mean linear intercept (Lm) and determination of the numbers of cells that were immunoreactive to macrophage (MAC)-2 antigen, matrix metalloproteinase (MMP)-12, and glycosylated 91-kDa glycoprotein (gp91phox) in the distal lung parenchyma and peribronchial region. Results: Although there were no differences among the four groups regarding the respiratory mechanics parameters assessed, there was an increase in the Lm in the CS + PPE group. The numbers of MAC-2-positive cells in the peribronchial region and distal lung parenchyma were higher in the CS + PPE group than in the other groups, as were the numbers of cells that were positive for MMP-12 and gp91phox, although only in the distal lung parenchyma. Conclusions: Our model of emphysema induced by a combination of PPE instillation and CS exposure results in a significant degree of parenchymal destruction in a shorter time frame than that employed in other models of CS-induced emphysema, reinforcing the importance of protease-antiprotease imbalance and oxidant-antioxidant imbalance in the pathogenesis of emphysema.

 


Keywords: Tobacco; Models, animal; Emphysema; Respiratory physiological phenomena; Lung injury.

 


Epidemiological monitoring of tuberculosis in a general teaching hospital

Monitoramento epidemiológico da tuberculose em um hospital geral universitário

Berenice das Dores Gonçalves, Luciana Tricai Cavalini, Joaquim Gonçalves Valente

J Bras Pneumol.2010;36(3):-

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Objective: To describe the epidemiological monitoring of exposure to tuberculosis in a hospital environment and to analyze the profile of the disease in a general teaching hospital. Methods: A descriptive and retrospective study of tuberculosis cases diagnosed between 2000 and 2006, with the determination of indicators of morbidity and mortality, which were compared with the general population of patients treated at the hospital and with the hospital employees who developed active tuberculosis. Results: There were 763 patients who were treated for active tuberculosis (mean, 109 patients/year), 481 (63.1%) of whom were male. Most of the patients were in the 30-59 year age bracket. Tuberculosis that was exclusively pulmonary or extrapulmonary predominated. However, among the hospitalized patients, the combination of pulmonary and extrapulmonary tuberculosis, as well as exclusively noninfectious tuberculosis, predominated. Comorbidities were more prevalent among the hospitalized patients and among those who evolved to death. Only 52.8% of the cases treated at the hospital were reported. The overall hospital indicators showed longer length of hospital stay and greater mortality among the patients with tuberculosis. The incidence and prevalence show that there was a high risk of exposure to tuberculosis in the hospital during the period studied. Conclusions: The proposed indicators can potentially help standardize epidemiological monitoring procedures for nosocomial tuberculosis, and the epidemiological profile described in this study can contribute to a better understanding of the situation of tuberculosis in Brazil.

 


Keywords: Tuberculosis/epidemiology; Cross infection/prevention & control; Epidemiologic surveillance/statistics & numerical data; Risk management.

 


Tuberculosis-related mortality in the state of Espírito Santo, Brazil, 1985-2004

Mortalidade específica por tuberculose no estado do Espírito Santo, no período de 1985 a 2004

Cláudia Maria Marques Moreira, Eliana Zandonade, Reynaldo Dietze, Ethel Leonor Noia Maciel

J Bras Pneumol.2008;34(8):601-606

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Objective: The purpose of this study was to describe tuberculosis-related mortality in Espírito Santo, Brazil, evaluating its tendencies in relation to clinical presentation, gender and age bracket. Methods: We conducted a retrospective, descriptive study based on secondary data. For the 1985-2004 period, we investigated all deaths of residents of Espírito Santo in which tuberculosis was given as the underlying cause, as reported in the Brazilian National Mortality Database. Results: The adjusted mortality rates for all forms of tuberculosis paralleled the overall mortality rates in the state, decreasing from 5.6/100,000 inhabitants in 1985 to 2.0/100,000 inhabitants in 2004. Pulmonary tuberculosis was the predominant form of the disease (89.7% of tuberculosis-related deaths) throughout the period studied, and the male/ female mortality rate ratio ranged from 1.1 in 1998 to 3.19 in 2004. Conclusions: We observed a decrease in the mortality rates in all age brackets. Predominance of the pulmonary form, male gender and advanced age was similar to that of overall tuberculosis-related mortality in Brazil.

 


Keywords: Tuberculosis/epidemiology; Mortality; Information systems.

 


Mortality due to pneumoconioses in macro regions of Brazil in the 1979-1998 period

Mortalidade por pneumoconioses nas macrorregiões do Brasil no período de 1979-1998

Hermano Albuquerque de Castro, Genésio Vicentin, Kellen Cristina Xavier Pereira

J Bras Pneumol.2003;29(2):82-88

Abstract PDF PT

Pneumoconioses make up a group of lung diseases related to exposure to mineral dusts in work environments. This is a public health problem as such diseases could have already been eradicated in Brazil with the use of control measures in such environments. The aim in this paper was to map the distribution of deaths due to pneumoconioses in the different Brazilian geographical areas and states through an ecological survey carried out among the working population older than 15 years. The preliminary results of this investigation in the Brazilian macro regions in the period from 1979 to 1998 are presented. This study used mortality data from the Mortality Information System of Datasus - Data Processing Department of the Unified Health System, including codes from International Classification of Diseases (ICD) 9 and ICD 10. The results showed an increase of the coefficient of deaths due to pneumoconioses per 1 million inhabitants per year throughout this period. The shift from ICD 9 to ICD 10 showed an increase in the frequency of deaths, which was twice as high. As a conclusion, the coefficients of deaths due to pneumoconiosis does not describe this problem adequately, thus obscuring the transcendence and magnitude of the disease. To obtain more representative indicators it is necessary to know the population really exposed and the territorial distribution of the disease.

 



Much more than cigarette smoking

Muito além do tabaco

Jaqueline Scholz Issa, Gabriel Magalhães Lopes

J Bras Pneumol.2014;40(2):-

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Respiratory muscles in COPD: be aware of the diaphragm

Músculos respiratórios na DPOC: atenção para o diafragma

Pauliane Vieira Santana1,a, Andre Luis Pereira de Albuquerque1,b

J Bras Pneumol.2018;44(1):1-2

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Cystic fibrosis transmembrane conductance regulator gene mutations and glutathione S-transferase null genotypes in cystic fibrosis patients in Brazil

Mutações do gene cystic fibrosis transmembrane conductance regulator e deleções dos genes glutationa S-transferase em pacientes com fibrose cística no Brasil

Carmen Silvia Passos Lima, Manoela Marques Ortega, Fernando Augusto Lima Marson, Roberto Zulli, Antônio Fernando Ribeiro, Carmen Silvia Bertuzzo

J Bras Pneumol.2012;38(1):50-56

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the effects that mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene and deletion of the glutathione S-transferase (GST) genes mu-1 (GSTM1) and theta-1 (GSTT1) have on the clinical course of cystic fibrosis (CF) in patients residing in the southeastern region of Brazil. Methods: The study sample consisted of all consecutive CF patients treated at the Hospital de Clínicas School of Medical Sciences of the State University at Campinas between March of 2002 and March of 2005. We included 66 CF patients. Genomic DNA was analyzed by polymerase chain reaction and restriction endonuclease digestion for the identification of the genotypes. Results: The F508 mutation of the CFTR gene was found in 44 patients (66.7%). The null genotypes GSTM1, GSTT1 and GSTM1/GSTT1 were found in 40.9%, 15.2%, and 3.0% of the patients, respectively. The F508 CFTR mutation was more common in patients diagnosed with CF before 2.5 years of age than in those diagnosed later (75.5% vs. 41.2%; p = 0.008). The frequency of the F508 CFTR mutation, as well as of the GSTM1 and GSTT1 genotypes, was not found to be associated with gender, ethnicity, pulmonary disease status, or pancreatic disease status. Conclusions: When the patients were stratified by clinical and epidemiological features, the frequencies of the GSTM1 and GSTT1 null genotypes were similar, suggesting that the inherited absence of these enzymatic pathways does not alter the course of CF. However, the high frequency of the F508 CFTR mutation found in younger children suggests that it influences the age at diagnosis of CF in this region of Brazil.

 


Keywords: : Cystic fibrosis; Cystic fibrosis transmembrane conductance regulator; Glutathione transferase.

 


Human pulmonary adiaspiromycosis: a new case diagnosed by transbronchial biopsy

Novo caso de adiaspiromicose humana diagnosticado por biópsia transbrônquica

Terezinha do Socorro M. Lima, Mário A.P. Moraes, Hebe Quezado Magalhães, Norma Suely G. Athayde

J Bras Pneumol.1998;24(5):339-341

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A case of human pulmonary adiaspiromycosis - the 18th from Brazil - is reported for two purposes: to contribute to the knowledge of the clinical course of the disease and to discuss the basis for using the transbronchial biopsy in demonstrating the causative organism. The patient, an 18 year old male, lived in the Paranoa village, near Brasilia, DF, where he worked in a joinery, making straw-brooms. In February 1997, he was admitted to the Brasilia University Hospital, with severe respiratory manifestations. The main symptom was a ventilatory-dependent thoracic pain. A chest roentgenogram showed a diffuse interstitial infiltrate, in both lungs, with micronodular pattern suggestive of a miliary process. No bacterial or fungal organisms could be found in the sputum or bronchial lavages of the patient. A transbronchial biopsy was then performed and the microscopic examination of the lung tissue revealed several large adioconidia. Adiaspiromycosis is believed to be a self-healing condition, since in the great majority of the so far known cases spontaneous remission of the pulmonary lesions has been the rule. Transbronchial biopsy, due to its simplicity, is indicated as the procedure of choice to demonstrate the adiaconidia of the agent in tissue sections - the only way to definitely establish the diagnosis of adiaspiromycosis.

 


Keywords: Adiaspiromycosis. Pulmonary mycosis. Emmonsia crescens. Emmonsia parva var crescens. Chrysosporium parvum var crescens.

 


New and repurposed drugs to treat multidrug- and extensively drug-resistant tuberculosis

Novos fármacos e fármacos repropostos para o tratamento da tuberculose multirresistente e extensivamente resistente

Denise Rossato Silva1,a, Margareth Dalcolmo2,b, Simon Tiberi3,c, Marcos Abdo Arbex4,5,d, Marcela Munoz-Torrico6,e, Raquel Duarte7,8,9,f, Lia D'Ambrosio10,11,g, Dina Visca12,h, Adrian Rendon13,i, Mina Gaga14,j, Alimuddin Zumla15,k, Giovanni Battista Migliori10,l

J Bras Pneumol.2018;44(2):153-460

Abstract PDF PT PDF EN Portuguese Text

Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the "white plague", and promising results are being reported.

 


Keywords: Tuberculosis/therapy; Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents.

 


O "bug" do ano 2000: foi melhor prevenir do que remediar

Thais Helena A. Thomaz Queluz

J Bras Pneumol.2000;26(1):1-2

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Linear growth in asthmatic children

O crescimento de crianças com asma

Maria Ângela Reis de Góes Monteiro Antonio, José Dirceu Ribeiro, Adyléia Aparecida Dalbo Contrera Toro, Aquiles Eugenico Piedrabuena, André Moreno Morcillo

J Bras Pneumol.2003;29(1):36-42

Abstract PDF PT

The growth of children with asthma has attracted great interest because it is a chronic respiratory illness whose prevalence in childhood has increased during the last decades. The relationship between asthma and growth has been studied for a long time, but the great variability of diagnosis, therapy, and different methods of investigation make it difficult to disentangle the factors that are responsible for the growth retardation detected by some authors. As a result of different observations, there remain many doubts about the impact of asthma on child and adolescent growth. The aim of this paper is to provide a general view on the issue.

 



The challenge of managing extensively drug-resistant tuberculosis at a referral hospital in the state of São Paulo, Brazil: a report of three cases

O desafio do tratamento da tuberculose extensivamente resistente em um hospital de referência no estado de São Paulo: um relato de três casos

Marcos Abdo Arbex1,2, Hélio Ribeiro de Siqueira3,4, Lia D'Ambrosio5,6, Giovanni Battista Migliori5

J Bras Pneumol.2015;41(6):554-559

Abstract PDF PT PDF EN Portuguese Text Appendix

Here, we report the cases of three patients diagnosed with extensively drug-resistant tuberculosis and admitted to a referral hospital in the state of São Paulo, Brazil, showing the clinical and radiological evolution, as well as laboratory test results, over a one-year period. Treatment was based on the World Health Organization guidelines, with the inclusion of a new proposal for the use of a combination of antituberculosis drugs (imipenem and linezolid). In the cases studied, we show the challenge of creating an acceptable, effective treatment regimen including drugs that are more toxic, are more expensive, and are administered for longer periods. We also show that treatment costs are significantly higher for such patients, which could have an impact on health care systems, even after hospital discharge. We highlight the fact that in extreme cases, such as those reported here, hospitalization at a referral center seems to be the most effective strategy for providing appropriate treatment and increasing the chance of cure. In conclusion, health professionals and governments must make every effort to prevent cases of multidrug-resistant and extensively drug-resistant tuberculosis.

 


Keywords: Tuberculosis, multidrug-resistant; Extensively drug-resistant tuberculosis; Antitubercular agents; Antibiotics, antitubercular.

 


The role of the Brazilian Tuberculosis Research Network in national and international efforts to eliminate tuberculosis

O papel da Rede Brasileira de Pesquisas em Tuberculose nos esforços nacionais e internacionais para a eliminação da tuberculose

Afranio Kritski1,a, Margareth Pretti Dalcolmo2,b, Fernanda Carvalho Queiroz Mello3,c, Anna Cristina Calçada Carvalho4,d, Denise Rossato Silva5,e, Martha Maria de Oliveira6,f, Julio Croda7,8,g

J Bras Pneumol.2018;44(2):77-81

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O redescobrimento luso-brasileiro

Maria João Marques Gomes, Francisco Elmano Marques de Souza, Renato Soto-Mayor, Luiz Carlos Corrêa da Silva, Antônio Ramalho de Almeida, Bruno Carlos Palombini

J Bras Pneumol.1999;25(6):5-

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Repeated treatment of tuberculosis in the city of Recife, 1997: an epidemiological approach

O retratamento da tuberculose no município do Recife, 1997: uma abordagem epidemiológica

Hermira Maria Amorim Campos, Maria de Fátima Militão de Albuquerque, Antônio Roberto Leite Campelo, Wayner Souza, Ana M. Brito

J Bras Pneumol.2000;26(5):235-240

Abstract PDF PT

Objectives: This study describes the epidemiological profile of cases of repeated treatment of tuberculosis occurring among residents of the city of Recife in the year of 1997. Material and methods: A cross-sectional study was performed and 240 cases of repeated treatment were studied, representing 16.2% of all cases of tuberculosis. Results: Interruption of previous treatment was the principal reason for repeated treatments (55.8%), followed by cases of recurrence of the disease (39.2%). Patients undergoing repeated treatment for tuberculosis are characterized as predominantly male, ages between 30 and 49, with little or no school education, with a significant predominance of pulmonary tuberculosis. It is striking that 42.7% of the cases of repeated treatment had a history of two or more previous courses of treatment. With regard to the outcome of the repeated treatment, 52.5% of the cases showed unfavorable results. Among these, 44.2% of the patients gave up the course of treatment and 39.6% followed it for the first month. The cases that returned for treatment following recurrence showed a higher percentage of successful outcomes (56.7%), in comparison to those that returned after interrupting previous treatment (40.2%), this difference being statistically significant (χ2 = 19,55; p < 0,01). It was found that, among the cases of pulmonary tuberculosis, 27.1% resumed chemotherapy without undergoing the Koch bacillus catarrh test and only 27.1% carried out BK culture with sensitivity test. Conclusions: The results show the need to enhance tuberculosis treatment and follow-up procedures within the sphere of the health care service. An adequate treatment is the cheapest method to avoid drug resistance and should be understood as a strategy to improve the tuberculosis surveillance system.

 


Keywords: Tuberculosis. Pulmonary tuberculosis. Repeated treatment.

 


Women and smoking: Risks, impacts, and challenges

O tabagismo e a mulher: Riscos, impactos e desafios

Elisa Maria Siqueira Lombardi, Gustavo Faibichew Prado, Ubiratan de Paula Santos, Frederico Leon Arrabal Fernandes

J Bras Pneumol.2011;37(1):118-128

Abstract PDF PT PDF EN Portuguese Text

Smoking among women has drawn increasing attention because of the increase (or less pronounced decrease) in its prevalence when compared with that observed for men, as well as because of the specific effects that smoking has on women's health. For the 2010 "World No Tobacco Day", the World Health Organization chose the theme "Gender and tobacco with an emphasis on marketing to women", with the aim of encouraging policies to combat marketing strategies employed by the tobacco industry and to curb the epidemic of smoking among women. In this article, we discuss the characteristics of smoking among women, addressing factors such as smoking prevalence, nicotine dependence, the role of the tobacco industry, health risks, approaches to smoking cessation, treatment strategies, and prevention measures.

 


Keywords: Smoking; Women's health; Tobacco industry.

 


The use of step tests for the assessment of exercise capacity in healthy subjects and in patients with chronic lung disease

O uso de testes do degrau para a avaliação da capacidade de exercício em indivíduos saudáveis e pacientes com doenças pulmonares crônicas

Carlos Henrique Silva de Andrade, Reinaldo Giovanini Cianci, Carla Malaguti, Simone Dal Corso

J Bras Pneumol.2012;38(1):116-124

Abstract PDF PT PDF EN Portuguese Text

Step tests are typically used to assess exercise capacity. Given the diversity of step tests, the aim of this review was to describe the protocols that have been used in healthy subjects and in patients with chronic lung disease. Step tests for use in healthy subjects have undergone a number of modifications over the years. In most step tests, the duration is variable (90 s-10 min), but the step height (23.0-50.8 cm) and stepping rate (22.5-35.0 steps/min) remain constant throughout the test. However, the use of a fixed step height and constant stepping rate might not provide adequate work intensity for subjects with different levels of fitness, the workload therefore being above or below individual capacity. Consequently, step test protocols have been modified by introducing changes in step heights and stepping rates during the test. Step tests have been used in patients with chronic lung diseases since the late 1970s. The protocols are quite varied, with adjustments in step height (15-30 cm), pacing (self-paced or externally paced), and test duration (90 s-10 min). However, the diversity of step test protocols and the variety of outcomes studied preclude the determination of the best protocol for use in individuals with chronic lung disease. Shorter protocols with a high stepping rate would seem to be more appropriate for assessing exercise-related oxygen desaturation in chronic lung disease. Symptom-limited testing would be more appropriate for evaluating exercise tolerance. There is a need for studies comparing different step test protocols, in terms of their reliability, validity, and ability to quantify responses to interventions, especially in individuals with lung disease.

 


Keywords: Pulmonary disease, chronic obstructive; Asthma; Cystic fibrosis; Idiopathic pulmonary fibrosis; Exercise tolerance; Exercise test.

 


Obesity and asthma: clinical and laboratory characterization of a common combination

Obesidade e asma: caracterização clínica e laboratorial de uma associação frequente

Juliana Pires Viana de Jesus1,2,a, Aline Silva Lima-Matos2,3,b, Paula Cristina Andrade Almeida2,c, Valmar Bião Lima2,d, Luane Marques de Mello4,e, Adelmir Souza-Machado2,5,f, Eduardo Vieira Ponte5,6,g, Álvaro Augusto Cruz2,7,h

J Bras Pneumol.2018;44(3):207-212

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the relationship between obesity and asthma. Methods: This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires. Results: Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02). Conclusions: Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

 


Keywords: Asthma; Obesity; Overweight; Eosinophilia.

 


Mitral valve obstruction by tumor embolus as a cause of irreversible cardiac arrest during right pneumonectomy

Obstrução de valva mitral por embolização tumoral per-operatória (pneumectomia direita) com parada cardíaca irreversível

Rui Haddad, Carlos Henrique Ribeiro Boasquevisque, Tadeu Diniz Ferreira, Mario Celso Martins Reis, Fernando D'Imperio Teixeira

J Bras Pneumol.2008;34(7):537-540

Abstract PDF PT PDF EN Portuguese Text

A 26-year-old patient with a voluminous primary pulmonary hemangiopericytoma in the right lung, diagnosed through previous surgical biopsy, presented irreversible cardiac arrest during the hilar dissection portion of a right pneumonectomy. The patient did not respond to resuscitation efforts. Autopsy showed total obstruction of the mitral valve by a tumor embolism. In cases of large lung masses with hilar involvement, as in the case presented, we recommend preoperative evaluation using transesophageal echocardiography, magnetic resonance imaging or angiotomography. If injury to the pulmonary vessels or atrial cavities is detected, surgery with extracorporeal circulation should be arranged in order to allow resection of the intravascular or cardiac mass, together with pulmonary resection. We recommend that care be taken in order to recognize and treat this problem in patients not receiving a preoperative diagnosis.

 


Keywords: Embolism; Heart arrest; Pneumonectomy.

 


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.

 


Occurrence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age

Ocorrência de sintomas asmáticos e de distúrbio obstrutivo em nadadores amadores de 8 a 17 anos de idade

Iara Nely Fiks, André Luis Pereira de Albuquerque, Leonardo Dias, Celso Ricardo Fernandes de Carvalho, Carlos Roberto Ribeiro de Carvalho

J Bras Pneumol.2012;38(1):24-32

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of asthma symptoms and of airflow obstruction in amateur swimmers between 8 and 17 years of age, as well as to assess the awareness of asthma and asthma management among these swimmers, their parents, and their coaches. Methods: Our sample comprised 1,116 amateur swimmers who completed a modified version of the International Study of Asthma and Allergies in Childhood written questionnaire, to which questions regarding the reasons to initiate swimming and regarding asthma management had been added. In addition, the participants underwent spirometry prior to a swimming competition. Results:   The prevalence of asthma symptoms in the last 12 months was 11.5%, and 327 (29.4%) of the participants reported "wheezing or whistling" in the past. Of the 223 swimmers who reported "asthma ever" or "bronchitis ever", only 102 (45.7%) reported having ever been treated: the most common "treatment" was swimming (in 37.3%), and only 12.7% used inhaled corticosteroids. Of the 254 participants (22.7%) with airflow obstruction, only 52  (20.5%) reported having asthma symptoms. Conclusions: Asthma symptoms are present in amateur swimmers, and a considerable number of such swimmers have airflow obstruction without symptoms. It is therefore likely that the prevalence of asthma is underestimated in this population. It is worrisome that, in our study sample, the swimmers previously diagnosed with asthma were not using the recommended treatments for asthma. The clinical implications of these findings underscore the importance of implementing educational measures for amateur swimmers, as well as for their parents and coaches, to help them recognize asthma symptoms and the consequent risks in the sports environment, in order to allow prompt diagnosis and early clinical intervention.

 


Keywords: Asthma/diagnosis; Asthma/prevention & control; Sports.

 


Tuberculosis in a Psychiatric Hospital in the state of Goiás, Brazil

Ocorrência de tuberculose em um hospital psiquiátrico do interior de Goiás

Hindenburg Cruvinel Guimarães da Costa, Ana Carolina Malaspina, Fernando Augusto Fiúza de Mello, Clarice Queico Fujimura Leite

J Bras Pneumol.2006;32(6):566-572

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the prevalence of infection, disease and eventual institutional outbreak of tuberculosis in a psychiatric hospital using the PPD test, as well as testing for mycobacteria in material collected from the respiratory tree and using molecular tracking technique based on insertion sequence 6110 (IS6110). Methods: Between February and August of 2002, PPD tests were given to 74 inpatients and 31 staff members at a psychiatric hospital in the city of Rio Verde, located in the state of Goiás, Brazil. In addition, respiratory tree material collected from the inpatients was submitted to testing for Mycobacterium tuberculosis. Results: Among the patients analyzed, mycobacteria were isolated from five (6.8%): four identified as M. tuberculosis and one as M. chelonae. The M. tuberculosis isolates were sensitive to isoniazid and rifampicin, and, when submitted to the restriction fragment length polymorphism/IS6110 technique, presented unique genetic profiles, totally distinct from one another, suggesting that all of the tuberculosis cases were due to endogenous reactivation. It was not possible to characterize this group of cases as an institutional outbreak. Performing the two-step tuberculin test in the patients, the infection rates were 23% and 31%, compared with 42% among staff members, who were submitted to the one-step test. Conclusion: The results indicate a high incidence of tuberculosis infection among inpatients and hospital staff, as well as a high occurrence of the disease among inpatients.

 


Keywords: Tuberculosis/epidemiology; Hospitals, psychiatric; Mycobacterium tuberculosis; Tuberculin test;

 


Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?

Os broncodilatadores podem melhorar a tolerância ao exercício na ausência de hiperinsuflação dinâmica em pacientes com DPOC?

Maria Enedina Aquino Scuarcialupi, Danilo Cortozi Berton, Priscila Kessar Cordoni, Selma Denis Squassoni, Elie Fiss, José Alberto Neder

J Bras Pneumol.2014;40(2):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the modulatory effects that dynamic hyperinflation (DH), defined as a reduction in inspiratory capacity (IC), has on exercise tolerance after bronchodilator in patients with COPD. Methods: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometry and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed ΔIC(peak-rest) < 0 were considered to present with DH (DH+). Results: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without DH (DH−). Despite equivalent improvement in FEV1 after bronchodilator, the DH− group showed higher ΔIC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to ΔIC at peak exercise between DH+ and DH− groups (0.19 ± 0.17 L vs. 0.17 ± 0.15 L, p > 0.05). In addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60%] vs. 10% [3-53%]; p > 0.05). Conclusions: Improvement in TLim was associated with an increase in IC at rest after bronchodilator in HD− patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.

 


Keywords: Pulmonary disease, chronic obstructive; Bronchodilator agents; Exercise test; Exercise tolerance; Inspiratory capacity.

 


Exhaled nitric oxide for the diagnosis and monitoring of respiratory diseases

Óxido nítrico exalado no diagnóstico e acompanhamento das doenças respiratórias

José Miguel Chatkin, Per Djupesland, Wei Qian, James Haight, Noe Zamel

J Bras Pneumol.2000;26(1):36-43

Abstract PDF PT

This paper reviews in brief the role of nitric oxide in the respiratory physiology and in the pathology of some pulmonary diseases. The potential diagnostic and monitoring uses in several clinical situations are also discussed.

 


Keywords: respiratory tract diseases; lung diseases, obstructive; asthma; smoking; cystic fibrosis; bronchiectasis lung; lung transplantation

 


Hospitalized patients with COPD: analysis of prior treatment

Pacientes portadores de DPOC hospitalizados: análise do tratamento prévio

Irai Luis Giacomelli, Leila John Marques Steidle, Frederico Fernandes Moreira, Igor Varela Meyer, Ricardo Goetten Souza, Mariângela Pimentel Pincelli

J Bras Pneumol.2014;40(3):229-237

Abstract PDF PT PDF EN Portuguese Text

Objective: Although COPD is a prevalent disease, it is undertreated, and there are no available data regarding previous treatment of COPD in Brazil. This study aimed to determine the appropriateness of maintenance treatment in COPD patients prior to their hospitalization and to identify variables associated with inappropriate treatment. Methods: This was an observational, cross-sectional, analytical study involving 50 inpatients with COPD at two hospitals in the city of Florianópolis, Brazil. The patients completed a questionnaire on parameters related to the maintenance treatment of COPD. Non-pharmacological management and pharmacological treatment were assessed based on the recommendations made by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2011 and by the Brazilian National Ministry of Health in the chronic respiratory diseases section of its Caderno de Atenção Básica (CAB, Primary Care Guidebook). Results: In most of the patients, the COPD was classified as being severe or very severe. Regarding non-pharmacological management, 33% of the patients were smokers, only 32% had been advised to receive the flu vaccine, 28% had received pneumococcal vaccine, and only 6.5% of the patients in the B, C, and D categories received pulmonary rehabilitation. Regarding GOLD and CAB recommendations, pharmacological treatment was inappropriate in 50% and 74% of the patients, respectively. Based on GOLD recommendations, 38% were undertreated. A low level of education, low income, not receiving oxygen therapy, and not receiving the flu vaccine were associated with inappropriate treatment. Conclusions: The application of various non-pharmacological management recommendations was unsatisfactory. Regarding the GOLD recommendations, the high rate of inappropriate maintenance treatment was mainly due to undertreatment. In Brazil, even in severe COPD cases, optimizing treatment to achieve greater benefits continues to be a challenge.

 


Keywords: Pulmonary disease, chronic obstructive/therapy; Pulmonary disease, chronic obstructive/prevention and control; Clinical protocols.

 


Wheezing phenotypes from birth to adolescence: a cohort study in Pelotas, Brazil, 1993-2004

Padrões de sibilância respiratória do nascimento até o início da adolescência: coorte de Pelotas (RS) Brasil, 1993-2004

Adriana Muiño, Ana Maria Baptista Menezes, Felipe Fossati Reichert, Rodrigo Pereira Duquia, Moema Chatkin

J Bras Pneumol.2008;34(6):347-355

Abstract PDF PT PDF EN Portuguese Text

Objective: To study the prevalence of wheezing patterns and their associations with independent variables. Methods: Cohort study of live births in 1993 in Pelotas, Brazil. A systematic subsample (20%) of the original cohort was evaluated at 6 months, 12 months and 4 years. At 10-12 years, 87.5% of the original cohort was contacted. Wheezing was categorized: transient, wheezing at 4 years but not at 10-12; persistent, wheezing at all evaluations; late-onset, wheezing at 10-12 years. Independent variables were analyzed: gender; skin color; family income; smoking/asthma during pregnancy; breastfeeding; respiratory infection/diarrhea (during the 1st year); family members with asthma/ allergy (at 4 years and at 10-12); physician-diagnosed rhinitis/eczema (at 10-12 years). Results: The subsample comprised 897 adolescents. Wheezing patterns were expressed as prevalence (95% CI): transient, 43.9% (40.7-47.2); persistent, 6.4% (4.8-8.0); and late-onset, 3.3% (2.2-4.5). The transient pattern was more common in children from low-income families, children breastfed for less time, children with a history of respiratory infections (during the 1st year) and children with asthma in the family (at 4 years). The persistent pattern was almost twice as common in males, in children whose mothers had asthma during pregnancy, in children with respiratory infections (during the 1st year) and in children with asthma in the family (at 4 and 10-12 years). The late-onset pattern was more prevalent among those with asthma in the family (at 10-12 years) and those diagnosed with rhinitis (at 10-12 years), being less prevalent among those reporting respiratory infections (during the 1st year) and those diagnosed with eczema (at 10-12 years). Conclusions: Knowledge of the associations of wheezing patterns allows us to adopt preventive and therapeutic measures.

 


Keywords: Respiratory sounds; Asthma; Epidemiology; Hypersensitivity.

 


Nonfunctional middle mediastinal paraganglioma: diagnostic and surgical management

Paraganglioma não funcional de mediastino médio: diagnóstico e manejo cirúrgico

Marcelo Cunha Fatureto, João Paulo Vieira dos Santos, Evelyne Gabriela Schmaltz Chaves Marques, Tarcísio Barcelos Evangelista, Wilson Alves Marques da Costa

J Bras Pneumol.2011;37(5):700-702

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Pediatric Asthma Control and Communication Instrument: translation into Portuguese and cross-cultural adaptation for use in Brazil

Pediatric Asthma Control and Communication Instrument: tradução e adaptação transcultural para a língua portuguesa falada no Brasil

Thayla Amorim Santino1,a, João Carlos Alchieri2,b, Raquel Emanuele de França Mendes1,c, Ada Cristina Jácome1,d, Tácito Zaildo de Morais Santos1,e, Linda Kahn-D'Angelo3,f, Cecilia M. Patino4,g, Karla Morganna Pereira Pinto de Mendonça1,h

J Bras Pneumol.2019;45(3):e20180169-e20180169

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Pediatric Asthma Control and Communication Instrument (PACCI) to Portuguese and adapt it for use in Brazil, ensuring the cultural validity of the content and semantic equivalence of the target version. Methods: The Brazilian Portuguese-language version of the PACCI was developed according to the most commonly used methodology, which included the following steps: translation; synthesis of the translation; review by the author of the original questionnaire; back-translation; synthesis of the back-translation; review by a native external researcher who is a native speaker of English; approval of the author of the original questionnaire; review by a specialist in Portuguese; review by a multidisciplinary committee of experts to determine the agreement of the items, considering the clarity of each and its appropriateness in the cultural context; cognitive debriefing; and development of the final version. The cognitive debriefing involved 31 parents/legal guardians of children 1-21 years of age with a clinical diagnosis of asthma, as defined by the Global Initiative for Asthma, with the objective of determining the comprehensibility and clarity of the items for the target population. Results: The multidisciplinary committee of experts indicated that the items on the questionnaire were clear and comprehensible, with kappa values above 0.61, indicating substantial agreement. In the cognitive debriefing, the parents/legal guardians presented no difficulties in understanding any of the items (agreement > 0.90); therefore, no further changes were needed.Conclusions: The translation and cross-cultural adaptation of the PACCI for use in Brazil were successful.

 


Keywords: Surveys and questionnaires; Translating; Asthma; Child; Adolescent.

 


Perception of disease severity in adult patients with cystic fibrosis

Percepção da gravidade da doença em pacientes adultos com fibrose cística

Paulo de Tarso Roth Dalcin, Greice Rampon, Lílian Rech Pasin, Sinara Corrêa Becker, Gretchem Mesquita Ramon, Viviane Ziebell de Oliveira

J Bras Pneumol.2009;35(1):27-34

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the perception of disease severity in patients with cystic fibrosis (CF), investigating its relationship with clinical score, radiographic score, respiratory function tests, adherence to treatment and perception of self-care practices. Methods: Prospective, cross-sectional study involving CF patients treated in a program for adults with CF. The perception of disease severity, adherence to treatment and reported self-care practices were evaluated by means of questionnaires. Clinical data, Shwachman-Kulczycki clinical score, Brasfield radiographic score and spirometry were obtained for all of the patients. Results: Of the 38 patients studied, 3 (7.9%) patients rated their perception of health status as well below average; 5 (13.2%), as below average; 15 (39.5%), as average; 10 (26.3%), as above average; and 5 (13.2%), as well above average. The perception of disease severity correlated significantly with clinical score (r = 0.43, p = 0.007), FVC (r = 0.34, p = 0.034), FEV1 (r = 0.38, p = 0.019) and self-care practices (r = 0.33, p = 0.044), but not with degree of adherence (r = -0.03, p = 0.842) and radiographic score (r = 0.33, p = 0.51). Conclusions: The perception of disease severity correlated with objective measurements of disease severity (clinical score and respiratory function tests) and with reported self-care practices, but not with adherence to treatment.

 


Keywords: Severity of illness index; Cystic fibrosis; Patient compliance; Respiratory function tests.

 


Induced sputum and peripheral blood cell profile in chronic obstructive pulmonary disease

Perfil celular do escarro induzido e sangue periférico na doença pulmonar obstrutiva crônica

Rogerio Rufino, Cláudia Henrique da Costa, Heitor Siffert Pereira de Souza, Kalil Madi, José Roberto Lapa e Silva

J Bras Pneumol.2007;33(5):510-518

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine cell profiles, as well as to identify CD4+ and CD8+ lymphocyte subgroups, in induced sputum (IS) and peripheral venous blood (PVB) of patients with chronic obstructive pulmonary disease (COPD). Methods: Total cell counts and counts of individual cell types, including CD4+ and CD8+ T lymphocytes, were determined in the IS and PVB of 85 subjects (38 with COPD without exacerbation, 29 smokers without obstruction and 18 nonsmokers). Mann-Whitney and Spearman non-parametric tests were used in the statistical analysis, and values of p < 0.05 were considered statistically significant. Results: Comparing the IS of subjects with COPD to that of nonsmokers, neutrophil, eosinophil and CD8+ T lymphocyte counts were higher (respectively p = 0.005, p < 0.05 and p < 0.05), whereas the percentage of macrophages was lower (p = 0.003). There were weak linear correlations (r2 < 0.1) between each cell type in IS and forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. Eosinophil and CD8+ T lymphocyte counts were also higher in PVB (p = 0.04 and p = 0.02). Conclusions: In patients with stable COPD, CD8+ T lymphocyte counts were higher in PVB, whereas total leukocyte counts were similar to those of the other two groups analyzed, suggesting systemic inflammatory involvement. The CD8+ T lymphocyte count in blood can be a useful marker of systemic inflammation and can help identify smokers who already present a COPD inflammatory pattern.

 


Keywords: Sputum; T-lymphocytes; Neutrophils; Macrophages; Eosinophils; Pulmonary disease, chronic obstructive.

 


Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumaré microregion of Brazil

Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP

Maria Rita Donalisio, Carlos Henrique Mamud Arca, Paulo Roberto de Madureira

J Bras Pneumol.2011;37(2):200-208

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the clinical, etiological, and epidemiological aspects of community-acquired pneumonia (CAP) in hospitalized individuals. Methods: We prospectively studied 66 patients (> 14 years of age) with CAP admitted to the Hospital Estadual Sumaré, located in the Sumaré microregion of Brazil, between October of 2005 and September of 2007. We collected data related to clinical history, physical examination, pneumonia severity index (PSI) scores, and laboratory tests (blood culture; sputum smear microscopy and culture; serology for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; and detection of Legionella sp. and Streptococcus pneumoniae antigens in urine). Results: The mean age of patients was 53 years. Most had a low level of education, and 55.7% presented with at least one comorbidity at the time of hospitalization. The proportion of elderly people vaccinated against influenza was significantly lower among the inpatients than in the general population of the Sumaré microregion (52.6% vs. > 70%). Fever was less common among the elderly patients (p < 0.05). The clinical evolution was associated with the PSI scores but not with age. The etiology was confirmed in 31 cases (50.8%) and was attributed to S. pneumoniae, principally detected by the urinary antigen test, in 21 (34.4%), followed by C. pneumoniae, in 5 (8.2%). The mortality rate was 4.9%, and 80.3% of the patients were classified as cured at discharge. Conclusions: The knowledge of the etiologic profile of CAP at the regional level favors the appropriate choice of empirical treatment, which is particularly relevant in elderly patients and in those with comorbidities. The lack of influenza vaccination in elderly patients is a risk factor for hospitalization due to CAP.

 


Keywords: Chlamydophila pneumoniae; Community-acquired infections; Pneumonia; Streptococcus pneumoniae; Influenza vaccines.

 


Profile of research published in the annals of the Brazilian Pulmonology and Phthisiology Conferences held over the last twenty years

Perfil da atividade de pesquisa publicada nos anais dos congressos brasileiros de pneumologia e tisiologia nos últimos vinte anos

Alexandre Todorovic Fabro, Hugo Hyung Bok Yoo, Thaís Helena Abrahão Thomaz Queluz

J Bras Pneumol.2006;32(4):309-315

Abstract PDF PT PDF EN Portuguese Text

Objective: To increase the knowledge base regarding pulmonology research in Brazil. Methods: A retrospective, observational study of the abstracts published in the Annals of the Brazilian Pulmonology and Phthisiology Conferences held from 1986 to 2004, quantifying the institutions of origin by geographic distribution and type, as well as categorizing the abstracts by study design and topic. Results: A total of 6467 abstracts were published. The institutions of origin were located, variously, in the Southeast (3870 abstracts), South (1309), Northeast (783), Central-West (267) and North (84). There were 94 abstracts originating from foreign institutions, especially from institutions in Portugal (56.3%) and the United States (13.8%). Most of the studies (5825) were conducted in public Brazilian institutions. There were 4234 clinical studies, 1994 case reports and 239 original research articles. A marked, progressive increase was observed in the number of clinical studies and case reports during the period evaluated. Overall, the most common themes were tuberculosis and other infections diseases (25.2%), following by oncology (11.6%), interstitial lung diseases (8.8%) and thoracic surgery (8.5%). Nevertheless, the number of abstracts on each topic varied widely from year to year. Conclusion: Public Brazilian institutions are the principal sources of pulmonology research in Brazil. Such research activity is concentrated in the southeastern part of the country. Case reports account for one-third of this activity. Although there was great variability in the subjects addressed, diseases that are highly prevalent in Brazil, such as tuberculosis and other infections diseases, were the most common topics.

 


Keywords: Biomedical research/statistics & numerical data; Respiratory tract diseases; Pulmonary disease (Speciality); Bibliometrics; Scientific and technical publications/statistics & numerical data; Brazil

 


Resistance profile of strains of Mycobacterium fortuitum isolated from clinical specimens

Perfil de resistência de cepas de Mycobacterium fortuitum isoladas de espécimes clínicos

Debora Ribeiro de Souza Santos, Maria Cristina Silva Lourenço, Fábrice Santana Coelho, Fernanda Carvalho Queiroz Mello, Rafael Silva Duarte

J Bras Pneumol.2016;42(4):299-301

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Drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, 2000-2006

Perfil de resistência de Mycobacterium tuberculosis no estado de Mato Grosso do Sul, 2000-2006

Marli Marques, Eunice Atsuko Totumi Cunha, Antonio Ruffino-Netto, Sonia Maria de Oliveira Andrade

J Bras Pneumol.2010;36(2):224-231

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the drug resistance profile of Mycobacterium tuberculosis in the state of Mato Grosso do Sul, Brazil, between 2000 and 2006. Methods: Descriptive study of reported tuberculosis cases in the Brazilian Case Registry Database. We included only those cases in which M. tuberculosis culture was positive and sensitivity to drugs (rifampicin, isoniazid, streptomycin and ethambutol) was tested. Löwenstein-Jensen and Ogawa-Kudoh solid media were used for cultures, as was an automated liquid medium system. Sensitivity tests were based on the proportion method. Results: Among the 783 cases evaluated, males predominated (69.7%), as did patients in the 20-49 year age bracket (70%), a diagnosis of pulmonary tuberculosis (94.4%) and positive HIV serology (8.6%); 645 (82.4%) were new cases, and 138 (17.6%) had previously been treated. Resistance to at least one drug was found in 143 cases (18.3%). The primary resistance (PR) rate was, respectively, 8.1%, 1.6%, 2.8% and 12.4%, for monoresistance, multidrug resistance (MDR), other patterns of resistance and resistance to at least one drug, whereas the acquired resistance (AR) rate was 14.5%, 20.3%, 10.9% and 45.7%, respectively, and the combined resistance (CR) rate was 9.2%, 4.9%, 4.2% and 18.3%, respectively. In PR, streptomycin was the most common drug, whereas isoniazid was the most common in AR and CR (7.2% and 3.7%, respectively). Conclusions: These high levels of resistance undermine the efforts for tuberculosis control in Mato Grosso do Sul. Acquired MDR was 12.7 times more common than was primary MDR, demonstrating that the previous use of drug therapy is an indicator of resistance. These levels reflect the poor quality of the health care provided to these patients, showing the importance of using the directly observed treatment, short course strategy, as well as the need to perform cultures and sensitivity tests for the early diagnosis of drug resistance.

 


Keywords: Tuberculosis; Drug resistance, multiple; Mycobacterium tuberculosis.

 


Lung donor profile in the state of São Paulo, Brazil, in 2006

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006

Paulo Manuel Pêgo Fernandes, Marcos Naoyuki Samano, Jader Joel Machado Junqueira, Daniel Reis Waisberg, Gustavo Sousa Noleto, Fabio Biscegli Jatene

J Bras Pneumol.2008;34(7):497-505

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. Methods: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. Results: According to the clinical charts, lungs were not offered for transplant in 149 cases (30%), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 ± 16.1 years, and 56.9% were males. The main causes of brain death among the donors were stroke (in 40.5%), skull-brain trauma (in 34.2%) and subarachnoid hemorrhage (in 10.9%). The great majority of these lung donors (90.5%) received vasoactive agents, and 13.5% presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 ± 6,467 cells/mm3, 67.8% of the donors received anti-bacterial agents, and 26.1% presented lung infection. Nearly 40% of the lung donors presented chest X-ray abnormalities. Only 4.9% of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4%). The causes for donor exclusion were gas exchange alterations (in 30.1%), infection (in 23.7%) and distance (in 10.9%). Conclusions: The lung utilization rate in the state of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.

 


Keywords: Lung transplantation; Donor selection; Tissue donors.

 


Epidemiological profile of adult patients with tuberculosis and AIDS in the state of Espírito Santo, Brazil: Cross-referencing tuberculosis and AIDS databases

Perfil epidemiológico de pacientes adultos com tuberculose e AIDS no estado do Espírito Santo, Brasil: Relacionamento dos bancos de dados de tuberculose e AIDS

Thiago Nascimento do Prado, Antonio Luiz Caus, Murilo Marques, Ethel Leonor Maciel, Jonathan E. Golub, Angélica Espinosa Miranda

J Bras Pneumol.2011;37(1):93-99

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the epidemiological profile of patients with tuberculosis (TB) only and that of patients with TB/AIDS in the state of Espírito Santo, Brazil, between 2000 and 2006. Methods: For the patients of interest, we collected demographic and clinical data from the Epidemiological Surveillance Center (TB database), Brazilian Case Registry Database, and Brazilian National Mortality Database, as well as the Brazilian National CD4+/CD8+ T Lymphocyte Count and Viral Load Network Laboratory Test Control System and the Logistic Medication Monitoring System (HIV/AIDS databases). All of the compiled data were cross-referenced. Results: During the study period, we identified 9,543 TB patients > 15 years of age, 437 of whom (4.6%) had AIDS. The median age did not differ between TB/AIDS and TB-only patients (35 years vs. 38 years). Of the 437 TB/AIDS patients, 298 (68.2%) were male, and 156 (35.8%) were in the 30-39 age bracket. In terms of TB treatment outcome, 79.0% were cured, 9.7% were referred to other facilities, 6.0% died, 5.2% abandoned treatment, and 0.2% developed multidrug-resistant TB. Death was 4.75 times more common in patients with TB/AIDS than in those with TB only. Pulmonary TB accounted for 82.4% of the cases. The combination of pulmonary and extrapulmonary TB was 8.2 times more common in the TB/AIDS patients than in the TB-only patients (95% CI: 6.2-10.8). Conclusions: Our results emphasize the significance of AIDS among TB patients in Brazil, as well as the importance of evaluating secondary data in order to improve their quality and develop public health interventions.

 


Keywords: Tuberculosis; Acquired immunodeficiency syndrome; Brazil.

 


Functional profile of patients with tuberculosis sequelae in a university hospital

Perfil funcional de pacientes portadores de seqüela de tuberculose de um hospital universitário

Lucia Maria Macedo Ramos, Nara Sulmonett, Cid Sergio Ferreira, Juliana Fulgêncio Henriques, Silvana Spíndola de Miranda

J Bras Pneumol.2006;32(1):43-47

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe data related to the pulmonary function of patients with sequelae of pulmonary tuberculosis, pleural tuberculosis or both. Methods: In the outpatient clinic of a university hospital, 218 patients were evaluated. Of those 218, 56 had sequelae of tuberculosis (pulmonary, pleural or both), and 162 had other types of tuberculosis. All patients were evaluated in the pulmonary function laboratory between February 2000 and July 2004, and 43 were found to be eligible for inclusion in the study. Patients with a history of asthma, chronic pulmonary obstructive disease, cardiac insufficiency, collagen diseases, silicosis or thoracic surgery, as well as those for whom spirometry yielded unacceptable results or was not performed, were excluded. The lung fields were divided into six zones, and radiographic results were classified by degree: I (involvement of only one zone with no cavitation); II (involvement of two or three zones or of one zone with cavitation); or III (extensive involvement of three or more zones with or without cavitation). Results: The final study sample comprised 50 patients, 44 (88%) of whom had pulmonary tuberculosis. The most prevalent form (17/50; 34%) was mixed ventilatory disturbance. Severe disturbances were more significant in degree III radiographs (p = 0.0002) and normal pulmonary function was predominant among patients presenting degree I and II radiographs (p = 0.002). Conclusion: The early discovery and treatment of tuberculosis contribute to reduce the number of cases, as well as the incidence of tuberculosis sequelae, thereby improving the quality of life of tuberculosis patients. Further studies, involving longitudinal, sequential analysis and larger samples of patients with tuberculosis sequelae, should be conducted in referral centers in Brazil.

 


Keywords: Tuberculosis, pulmonary/diagnosis; Tuberculosis, pleural/diagnosis; Respiratory function tests; Spirometry;

 


Inflammatory and immunological profiles in patients with COPD: relationship with FEV1 reversibility

Perfil inflamatório e imunológico em pacientes com DPOC: relação com a reversibilidade do VEF1

Cleriston Farias Queiroz, Antonio Carlos Moreira Lemos, Maria de Lourdes Santana Bastos, Margarida Célia Lima Costa Neves, Aquiles Assunção Camelier, Natália Barbosa Carvalho, Edgar Marcelino de Carvalho

J Bras Pneumol.2016;42(4):241-274

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether COPD severity correlates with sputum cell counts, atopy, and asthma. Methods: This was a cross-sectional study involving 37 patients with COPD and 22 healthy subjects with normal lung function (controls). Sputum cell counts were determined by microscopy after centrifugation of samples. Skin prick tests were performed, and serum cytokines were determined by ELISA. Results: Patients were stratified by bronchodilator response: a non-reversible airflow limitation (nonRAL) group comprised 24 patients showing no significant post-bronchodilator change in FEV1; and a partially reversible airflow limitation (partialRAL) group comprised 13 patients showing FEV1 reversibility (post-bronchodilator FEV1 increase ≥ 12%). The proportion of eosinophils in sputum was higher in the partialRAL group than in the nonRAL group (p < 0.01), and there was an inverse correlation between the proportion of eosinophils and FEV1 (p < 0.05). However, none of the patients had a history of asthma and skin prick test results did not differ between the two groups. In the patient sputum samples, neutrophils predominated. Serum levels of TNF, IL-6, IL-8, and RANTES (CCL5) were higher in patients than in controls (p < 0.001) but did not differ between the two patient groups. Conclusions: COPD patients with partial FEV1 reversibility appear to have higher sputum eosinophil counts and greater airway hyperresponsiveness than do those with no FEV1 reversibility. However, we found that COPD severity did not correlate with atopy or with the cytokine profile.

 


Keywords: Pulmonary disease, chronic obstructive; Cytokines; Chemokines; Eosinophils; Sputum/cytology; Forced expiratory volume.

 


Radiological profile of the ideal candidate for lung volume reduction surgery to treat emphysema: a systematic review

Perfil radiológico do candidato ideal à cirurgia redutora de volume pulmonar no enfisema: uma revisão sistemática

Paula Antonia Ugalde Figueroa, Martha Silvia Martinez-Silveira, Eduardo Ponte, Aquiles Camelier, Jorge L. Pereira-silva

J Bras Pneumol.2005;31(3):197-204

Abstract PDF PT PDF EN Portuguese Text

Background: Lung volume reduction surgery is an alternative treatment for advanced pulmonary emphysema. Radiological evaluation of the type and distribution of emphysema, together with the results of pulmonary function testing, seem to be the main criteria used in deciding whether or not the procedure is indicated. Objective: To determine the extent of scientific evidence available regarding the radiological profile of the ideal candidate for lung volume reduction surgery. Method: A systematic review of the literature from January 1994 to January 2004 using the following databases: MEDLINE, EMbase, LILACS, The Cochrane Library and EBM Reviews. Results: Of 208 articles identified, 16 met the study criteria. Two were randomized (one multicentric, named the 'National Emphysema Treatment Trial' and including 1218 patients, and the other including only 30 patients). The other 14 articles were observational studies. The National Emphysema Treatment Trial identified a subgroup of patients with favorable prognoses when submitted to lung volume reduction surgery. This group consisted of patients with advanced heterogeneous pulmonary emphysema with upper lobe predominance, diffuse pulmonary distention and low exercise capacity. The pattern of the results obtained in the remainder of the studies was consistent with the individual analyses, despite their heterogeneity. In the observational studies, surgical benefit, mortality rates and quality of life were assessed. Conclusion: The radiological pattern, characterized by the type, heterogeneity, distribution and diffuse distention, together with the degree of emphysema severity, represents the main predictor of a positive surgical outcome. Due to the paucity of studies in the literature, this is a grade B recommendation.

 


Keywords: Pulmonary emphysema. Lung surgery. Tomography X-ray computed. Review.

 


Pesquisa brasileira no Congresso da American Thoracic Society

Thais Helena A. Thomaz Queluz

J Bras Pneumol.1999;25(5):3-

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Determination of levels of specific IgA to the HspX recombinant antigen of Mycobacterium tuberculosis for the diagnosis of pleural tuberculosis

Pesquisa de IgA contra o antígeno recombinante HspX de Mycobacterium tuberculosis no diagnóstico de tuberculose pleural

Loanda Carvalho Sant' Ana Limongi, Liliane Olival, Marcus Barreto Conde, Ana Paula Junqueira-Kipnis

J Bras Pneumol.2011;37(3):302-307

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the accuracy of determining specific IgA to HspX recombinant antigen in pleural fluid and serum samples for the diagnosis of pleural tuberculosis in patients with pleural effusion. Methods: This was a cross-sectional study. Serum and pleural fluid samples of patients with pleural effusion and suspected of having pleural tuberculosis were tested with indirect ELISA in order to determine the optical density of specific IgA to HspX. Results: We evaluated serum and pleural fluid samples from 132 patients: 97 diagnosed with pleural tuberculosis (study group) and 35 diagnosed with pleural effusion due to other causes (control group). The determination of IgA in pleural fluid satisfactorily discriminated between pleural tuberculosis patients and control patients. The sensitivity of the test in pleural fluid and in serum was 69% and 30%, respectively, whereas the specificity was 83% and 84%, respectively. Conclusions: Our data suggest that this test can be used in the diagnosis of pleural tuberculosis. Further studies, involving larger patient samples and different epidemiological scenarios, are warranted.

 


Keywords: Pleural effusion; Tuberculosis/diagnosis; Enzyme-linked immunosorbent assay.

 


Cigarette smoking survey among physicians of Rio Grande, Rio Grande do Sul: prevalence and smoker's profile

Pesquisa sobre tabagismo entre médicos de Rio Grande, RS: prevalência e perfil do fumante

Luís Suárez Halty, Maura Dumont Hüttner, Isabel de Oliveira Netto, Thaís Fenker, Tatiana Pasqualini, Berenice Lempek, Adriana Santos, Alessandra Muniz

J Bras Pneumol.2002;28(2):77-83

Abstract PDF PT

Smoking is a serious public health problem. The campaign against tobacco is largely supported by health professionals, especially doctors. The physician is a model for the community and therefore should give the example avoiding smoking. Objectives: This work seeks to evaluate the magnitude and the distribution of smoking habit among physicians in Rio Grande, state of Rio Grande do Sul, southern Brazil, and characterize the smoking doctor's profile. Method: Data were obtained, in 1999, through application and analysis of a questionnaire, based on the model proposed by WHO, among 333 physicians of whom 213 (64%) were men and 120 (36%) were women. The average age of the sample was 43 (± 10.5) years with 65.1% between 30 and 50 years. Results: Smoking prevalence was 18.3% (15.9% regular smokers and 2.4% occasional smokers). Regular smoking prevalence was 17.8% among males and 12.5% among females, with no significant statistic difference (p > 0.05). The mean number of cigarettes smoked was 24.3 packets/years, being superior among men and increasing with age. It was verified that 86.8% of the smokers began smoking before 20 years of age, due to their desire or friends' influence in 63.2% of the cases. Conclusion: Although smoking prevalence among Rio Grande physicians is lower than in other countries, it is still unacceptable. Since this class has a decisive role in the prevention and fight against smoking, a specific campaign against tobacco among these professionals would greatly justify.

 


Keywords: Smoking. Prevalence. Physicians. Epidemiological

 


Pesquisar é inerente ao ser humano

Thais Helena A; Yhomaz Queluz

J Bras Pneumol.1999;25(4):3-4

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Pulmonary research recently published in Brazilian journals

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

Ariane Maris Gomes, Daniela Aquemi Higa

J Bras Pneumol.2012;38(5):634-642

Abstract PDF PT PDF EN Portuguese Text

We reviewed original articles in the field of pulmonary medicine that had been recently published in 12 Brazilian journals-general or specialty journals-excluding the Brazilian Journal of Pulmonology. All were journals indexed for the Institute for Scientific Information Web of Knowledge. The selection of articles was based on the "continuously variable rating" concept. We have organized the articles by category.

 


Keywords: Pulmonary medicine; Medical oncology; Research; Infectious disease medicine.

 


Using the interrupter technique to evaluate airway resistance in cystic fibrosis patients

Pletismografia respiratória por indutância: estudo comparativo entre calibração por manobra de isovolume e calibração qualitativa diagnóstica em voluntários saudáveis avaliados em diferentes posturas

Renata Cléia Claudino Barbosa, Celso Ricardo Fernandes de Carvalho, Henrique Takachi Moriya

J Bras Pneumol.2012;38(2):194-201

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare two methods of respiratory inductive plethysmography (RIP) calibration in three different positions. Methods: We evaluated 28 healthy subjects (18 women and 10 men), with a mean age of 25.4 ± 3.9 years. For all of the subjects, isovolume maneuver calibration (ISOCAL) and qualitative diagnostic calibration (QDC) were used in the orthostatic, sitting, and supine positions. In order to evaluate the concordance between the two calibration methods, we used ANOVA and Bland-Altman plots. Results: The values of the constant of proportionality (K) were significantly different between ISOCAL and QDC in the three positions evaluated: 1.6 ± 0.5 vs. 2.0 ± 1.2, in the supine position, 2.5 ± 0.8 vs. 0.6 ± 0.3 in the sitting position, and 2.0 ± 0.8 vs. 0.6 ± 0.3 in the orthostatic position (p < 0.05 for all). Conclusions: Our results suggest that QDC is an inaccurate method for the calibration of RIP. The K values obtained with ISOCAL reveal that RIP should be calibrated for each position evaluated.

 


Keywords: Plethysmography; Respiratory mechanics; Posture; Calibration.

 


Hard metal pneumoconiosis with spontaneous bilateral pneumothorax

Pneumoconiose por exposição a metal duro com pneumotórax bilateral espontâneo

Maria Auxiliadora Carmo Moreira, Amanda da Rocha Oliveira Cardoso, Daniela Graner Schuwartz Tannus Silva, Maria Conceição de Castro Antonelli Monteiro de Queiroz, Albino Alegro Oliveira, Tiago Marinho Almeida Noleto

J Bras Pneumol.2010;36(1):148-151

Abstract PDF PT PDF EN Portuguese Text

Hard metal pneumoconiosis, first described in 1964, is a diffuse disease caused by the inhalation of cobalt particles. The disease can manifest as occupational asthma, interstitial disease or allergic alveolitis. We report the case of a young male, working as a tool sharpener, who presented with dry cough and progressive dyspnea for one year, as well as with spontaneous bilateral pneumothorax at admission. The diagnosis was confirmed by open lung biopsy.

 


Keywords: Lung diseases, interstitial; Pneumoconiosis; Pneumothorax.

 


Rheumatoid pneumoconiosis (Caplan's syndrome) with a classical presentation

Pneumoconiose reumatoide (síndrome de Caplan) com apresentação clássica

Eduardo Mello De Capitani, Marcelo Schweller, Cristiane Mendes da Silva, Konradin Metze, Elza Maria Figueiras Pedreira de Cerqueira, Manoel Barros Bértol

J Bras Pneumol.2009;35(9):942-946

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Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.

 


Keywords: Pneumoconiosis; Arthritis, rheumatoid; Caplan's syndrome; Silicosis.

 


Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years

Pneumomediastino espontâneo: experiência adquirida com 18 pacientes nos últimos 12 anos

Patrícia Dionísio1, Luís Martins1, Susana Moreira1, Alda Manique1, Rita Macedo1, Fátima Caeiro1, Luísa Boal1, Cristina Bárbara1

J Bras Pneumol.2017;43(2):101-105

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Objetivo: Caracterizar clinicamente todos os pacientes com pneumomediastino espontâneo (PME) admitidos em uma enfermaria de pneumologia para adultos em Lisboa, Portugal. Métodos: Estudo descritivo retrospectivo no qual foram analisados todos os pacientes adultos (≥ 18 anos de idade) com diagnóstico de PME entre janeiro de 2004 e setembro de 2015. Resultados: Pelo menos um fator predisponente foi identificado na maioria (isto é, em 88,9%) dos 18 pacientes que apresentaram PME durante o período de estudo. No tocante a fatores precipitantes, crises de tosse ocorreram em 50,0% dos pacientes. Outros fatores precipitantes foram um aumento repentino do consumo de tabaco, uso de drogas inalatórias, inalação ocupacional de vapores de vernizes, exercício intenso e vômitos. As queixas mais comuns foram dispneia (em 83,3%) e dor torácica (em 77,8%). Outras queixas foram tosse, cervicalgia, disfagia e odinofagia. Constatou-se a presença de enfisema subcutâneo na maioria dos pacientes. O diagnóstico de PME baseou-se na radiografia de tórax em 61,1% dos pacientes. Conclusões: Embora seja uma doença rara, o PME deve ser levado em conta no diagnóstico diferencial de dor torácica e dispneia. O PME pode surgir sem um evento desencadeante e sem achados conclusivos na radiografia de tórax, que é geralmente suficiente para o diagnóstico.

 


Keywords: Enfisema mediastínico; Enfisema subcutâneo; Dispneia.

 


Severe pneumonia due to Chlamydia psittaci

Pneumonia grave por "Chlamydia psittaci"

Cristiane Moschioni, Henrique Pereira Faria, Marco Antônio Soares Reis, Estevão Urbano Silva

J Bras Pneumol.2001;27(4):219-222

Abstract PDF PT

Psittacosis, also known as ornithosis, is a disease caused by Chlamydia psittaci. The most common clinical presentation is insidious onset, mild symptoms resembling a nonspecific viral illness and preference for the lungs. It is rarely a systemic and fatal disease. It is described a rare case of pneumonia due to Chlamydia psittaci that progressively developed into respiratory failure, requiring mechanical ventilation. It is very important to consider psittacosis in cases of atypical pneumonia whose evolution is unsatisfactory, with no response to antimicrobial therapy and epidemiology is positive for exposure to birds. Prompt recognition is vital as the response to appropriate treatment is excellent. Delayed diagnosis may lead to a severe course and fatal outcome.

 


Keywords: Mycoplasma pneumonia. Ornithosis.

 


Exogenous lipoid pneumonia: importance of clinical history to the diagnosis

Pneumonia lipóide exógena: importância da história clínica no diagnóstico

Alfredo Pereira Leite de Albuquerque Filho

J Bras Pneumol.2006;32(6):596-598

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Lipoid pneumonia is a rare disease resulting from the micro-aspiration of lipid formulations. Making a diagnosis of lipoid pneumonia requires a high degree of clinical suspicion. Herein, we report the case of a female patient with a history of breast cancer, presenting progressive dyspnea and cough, together with radiological findings of bilateral pulmonary infiltrate. The working diagnosis of lymphangitic carcinomatosis, for which chemotherapy would be indicated, was called into question based on the high-resolution computed tomography findings and on the fact that the patient had a history of chronic ingestion of laxatives containing mineral oil. A lung biopsy confirmed a diagnosis of lipoid pneumonia, which should always be considered in patients with diffuse lung disease having been exposed to potential causative agents.

 


Keywords: Pneumonia, lipid; Tomography, X-Ray Computed; Mineral oil; Case Reports [Publication type]

 


Nosocomial pneumonia: importance of the oral environment

Pneumonia nosocomial: importância do microambiente oral

Simone Macedo Amaral, Antonieta de Queiróz Cortês, Fábio Ramôa Pires

J Bras Pneumol.2009;35(11):1116-1124

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Nosocomial pneumonia, especially ventilator-associated pneumonia, is a common infection in ICUs. The main etiologic factors involve colonizing and opportunistic bacteria from the oral cavity. Oral hygiene measures, including the use of oral antiseptic agents, such as chlorhexidine, have proven useful in reducing its incidence. The objective of this article was to review the literature on the importance of the oral environment in the development of nosocomial pneumonia.

 


Keywords: Intensive care; Oral hygiene; Cross infection; Pneumonia.

 


"Pneumocystis carinii" pneumonia: tumoral manifestation

Pneumonia por "Pneumocystis carinii": forma tumoral

Luiz Alberto Costa Barra, Eleni Aparecida Bedaque, Fabio Leoncio Bornstein Martinelli, Audrey Egypto Macedo, Renato Curti Jr., Ricardo Hanna

J Bras Pneumol.2000;26(3):149-152

Abstract PDF PT

Pneumocystosis is an opportunistic infection that occurs frequently in immunodeficient patients, mainly in those with the acquired immunological deficiency (AIDS). The authors report the case of a patient with insidious symptoms of fever, cough, and weight loss. Thorax radiography revealed a tumoral image in the right costophrenic angle. Treatment for tuberculosis (therapeutic test) presented no response. An open lung biopsy was performed and the histological examination revealed Pneumocystis carinii pneumonia. The patient presented significant clinical and radiological improvement with specific treatment.

 


Keywords: pneumocystis carinii pneumonia; AIDS-related opportunistic infections

 


Pneumothorax and tension pneumopericardium following cardiothoracic surgery

Pneumotorax e pneumopericárdio hipertensivo em cirurgia cardiotorácica

Rui Haddad, Carlos Eduardo Teixeira Lima, Carlos Henrique Boasquevisque, Guilherme Saraiva Haddad, Tadeu Diniz Ferreira

J Bras Pneumol.2006;32(1):84-87

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Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.

 


Keywords: Pneumopericardium/etiology; Pneumothorax/etiology; Thoracic surgical procedures/adverse effects; Postoperative complications

 


Can the single-breath helium dilution method predict lung volumes as measured by whole-body plethysmography?

Pode o método de diluição do hélio em respiração única estimar os volumes pulmonares medidos pela pletismografia de corpo inteiro?

Patrícia Chaves Coertjens, Marli Maria Knorst, Anelise Dumke, Adriane Schmidt Pasqualoto, João Riboldi, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2013;39(6):675-685

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Objective: To compare TLC and RV values obtained by the single-breath helium dilution (SBHD) method with those obtained by whole-body plethysmography (WBP) in patients with normal lung function, patients with obstructive lung disease (OLD), and patients with restrictive lung disease (RLD), varying in severity, and to devise equations to estimate the SBHD results. Methods: This was a retrospective cross-sectional study involving 169 individuals, of whom 93 and 49 presented with OLD and RLD, respectively, the remaining 27 having normal lung function. All patients underwent spirometry and lung volume measurement by both methods. Results: TLC and RV were higher by WBP than by SBHD. The discrepancy between the methods was more pronounced in the OLD group, correlating with the severity of airflow obstruction. In the OLD group, the correlation coefficient of the comparison between the two methods was 0.57 and 0.56 for TLC and RV, respectively (p < 0.001 for both). We used regression equations, adjusted for the groups studied, in order to predict the WBP values of TLC and RV, using the corresponding SBHD values. It was possible to create regression equations to predict differences in TLC and RV between the two methods only for the OLD group. The TLC and RV equations were, respectively, ∆TLCWBP-SBHD in L = 5.264 − 0.060 × FEV1/FVC (r2 = 0.33; adjusted r2 = 0.32) and ∆RVWBP-SBHD in L = 4.862 − 0.055 × FEV1/FVC (r2 = 0.31; adjusted r2 = 0.30). Conclusions: The correction of TLC and RV results obtained by SBHD can improve the accuracy of this method for assessing lung volumes in patients with OLD. However, additional studies are needed in order to validate these equations.

 


Keywords: Plethysmography, whole body; Total lung capacity; Residual volume.

 


Prone position

Posição prona

Kelly Cristina de Albuquerque Paiva, Osvaldo Shigueomi Beppu

J Bras Pneumol.2005;31(4):332-340

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The prone position is a maneuver used to combat hypoxemia in patients with acute respiratory distress syndrome. Despite the fact that this is currently considered an efficient way to improve oxygenation, the physiological mechanisms that bring about improvements in respiratory function are not yet fully understood. The aim of this review is to discuss the physiological and clinical aspects of the prone position in patients with acute respiratory distress syndrome.

 


Keywords: Prone position/physiology; Respiratory distress syndrome, adult; Lung/injuries; Posture/physiology; Supine position/physiology; Anoxemia; Pulmonary gas exchange; Hemodynamic processes

 


Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion

Posicionamento intrapleural, guiado por ultrassonografia, de cateteres pleurais: influência na expansão pulmonar imediata e na pleurodese em pacientes com derrame pleural maligno recorrente

Pedro Henrique Xavier Nabuco de Araujo1, Ricardo Mingarini Terra1, Thiago da Silva Santos1, Rodrigo Caruso Chate2, Antonio Fernando Lins de Paiva2, Paulo Manuel Pêgo-Fernandes1

J Bras Pneumol.2017;43(3):190-194

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Objective: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.

 


Keywords: Pleurodesis; Pleural effusion, malignant; Tomography; Catheters.

 


Reliability and accuracy of cirtometry in healthy adults

Precisão e acurácia da cirtometria em adultos saudáveis

Valéria da Silva Caldeira, Célia Cristina Duarte Starling, Raquel Rodrigues Britto, Jocimar Avelar Martins, Rosana Ferreira Sampaio, Verônica Franco Parreira

J Bras Pneumol.2007;33(5):519-526

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Objective: To determine the intrarater and interrater reliability of cirtometry (measurements of the circumference of the chest and abdomen taken during respiratory movements) as well as its correlation with pulmonary volumes measured by respiratory inductive plethysmography. Methods: A total of 40 healthy individuals were evaluated. The mean age was 28 years. The measurements were taken in the supine position at three different time points: at rest, at maximal inspiration, and at maximal expiration. Two trained investigators, each of whom was blinded as to the results obtained by the other, performed the measurements. The Friedman test was used to determine intrarater reliability, and the Wilcoxon test, together with the intraclass correlation coefficient, were used to determine interrater reliability. The correlation between the cirtometry measurements and the plethysmography results was obtained using Spearman's correlation coefficient. The level of significance was set at 0.05 for all tests. Results: Intrarater reliability was satisfactory. Regarding interrater reliability, statistically significant differences (2.8 cm at the most) were found in all sets of measurements. However, through the analysis of the intraclass correlation coefficient, the investigators were found to be responsible only for a small portion of the variability (1.2-5.08%) found among the measurements. When the cirtometry measurements were compared to the volumes measured by respiratory inductive plethysmography, low correlations (range, r = 0.170-0.343) were found. Conclusions: The findings of this study suggest that, although cirtometry is a reliable measurement, it does not accurately measure pulmonary volumes.

 


Keywords: Reproducibility of results; Lung volume measurements; Plethysmography; Statistics, nonparametric.

 


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):-

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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.

 


Presence of gas in an unusual place: spontaneous pneumomediastinum (Hamman's syndrome)

Presença de gás em um local incomum: pneumomediastino espontâneo (síndrome de Hamman)

Nicholas Oliveira Duarte1,a, Camila Hino Verdelho1,b, Rodolfo Mendes Queiroz2,3,c

J Bras Pneumol.2018;44(4):334-334

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Prevalence of tuberculin skin testing among medical students in Campos School of Medicine, Rio de Janeiro

Prevalência da prova tuberculínica positiva entre alunos da Faculdade de Medicina de Campos (RJ)

Luiz Clovis Parente Soares; Fernanda C. Queiroz Mello; Afrânio Lineu Kritski

J Bras Pneumol.2004;30(4):440-447

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Background: The Hospital Ferreira Machado, utilized, in part, as a clinical training center for graduate students from the Faculdade de Medicina de Campos, admitted 65 tuberculosis (TB) patients in 2001. Objective: To estimate the prevalence of positive tuberculin skin tests (TST) among medical students during distinct periods of their training and to identify and analyze correlated factors. To compare positivity rates, taking into account the booster effect, and estimate incidence of positive TST by class year. Methods: A cross-sectional study was conducted among 500 students registered in the first semester of 2002. Using a structured and validated questionnaire, data regarding demographics, BCG vaccination and potential exposure to TB patients were obtained. A professional licensed by the Health Department administered the TSTs, and the twostep Mantoux method (PPD Rt23) was used. Results: Of the 500 eligible subjects, 316 (63.2%) were excluded. Analysis showed increasing two-step TST positivity rates corresponding to extent of clinical experience (4%, 6.4% and 13.1%) and a tendency toward correlation with professional level. The highest percentage of positive TSTs was found during the period of clinical training, which corresponded to the time of greatest exposure to patients (1000 hours). Conclusions: a) the TST positivity rate was high (7.9%) among students; b) TST was correlated with in-hospital training stage; c) evaluation of the booster effect lead us to highly recommended boosters in order to reduce the number of false-negative TST results.

 


Keywords: Tuberculin. Tuberculin test. Tuberculosis. Students/Medical. Cross-sectional studies.

 


Prevalence of asthma in children and adolescents in a city in the Brazilian Amazon region

Prevalência de asma em escolares e adolescentes em um município na região da Amazônia brasileira

Antonia Maria Rosa, Eliane Ignotti, Sandra de Souza Hacon, Hermano Albuquerque de Castro

J Bras Pneumol.2009;35(1):7-13

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Objective: To analyze the prevalence of asthma and asthma symptoms in students of two distinct age brackets residing in the city of Tangará da Serra, Brazil. Methods: Cross-sectional, population-based study of the prevalence of asthma in children from 6 to 7 years of age and adolescents from 13 to 14, using the standardized International Study of Asthma and Allergies in Childhood, phase 1 questionnaire, validated for use in Brazil. Students who responded affirmatively to question 2 (presence of wheezing in the preceding 12 months) were classified as suffering from asthma. Results: The study comprised 3,362 students, of whom 1,634 (48.6%) were children and 1,728 (51.4%) were adolescents. Of the 1,634 children, 816 (49.9%) were male and 818 (50.1%) were female. Of the 1,728 adolescents, 773 (45.0%) were male and 955 (55.0%) were female. The prevalence of asthma among the children was 25.2%, whereas that among the adolescents was 15.9% (χ2 = 8.34; p = 0.00). The children presented higher prevalences of the following symptoms of asthma than did the adolescents: wheezing ever (54.3%), nocturnal dry cough (43.9%), wheezing in the preceding 12 months (25.2%), and from 1 to 3 attacks of wheezing in the preceding 12 months (19.1%). There were no differences between the two groups regarding physician-diagnosed asthma (approximately 4.5%). There were no statistical differences regarding the prevalence of asthma by gender in the two groups. Conclusions: Tangará da Serra has a high prevalence of asthma in children and adolescents, and this result is compatible with other studies carried out in Brazil and Latin America using the same methodology.

 


Keywords: Asthma/epidemiology; Child; Adolescent.

 


Asthma prevalence among employees of a university hospital as evaluated using a European Union respiratory health questionnaire

Prevalência de asma em funcionários de hospital universitário avaliada por meio de questionário de saúde respiratória da Comunidade Européia

Antônio Soares Aguiar Filho, Edmundo Pessoa Almeida Lopes Neto, Emanuel Sávio Cavalcanti Sarinho, Maria Magalhães Vasconcelos, Darla Siqueira Tenório Lima, Penélope Matos Wirtsbiki

J Bras Pneumol.2005;31(5):390-397

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Objective: To determine the prevalence of bronchial asthma among university hospital employees between the ages of 20 and 44 based on the criteria established in the European Community Respiratory Health Survey. Methods: A descriptive, prospective, randomized, stratified prevalence study was conducted, in which questionnaires completed between April and October of 2002 by 351 employees of the Universidade Federal de Pernambuco (Federal University at Pernambuco) Hospital das Clínicas were evaluated. For sample characterization, the independent variables used were the signs and symptoms of asthma, and one dependent variable (physician-diagnosed asthma, characterized by data related to attacks occurring within the 12 months preceding the study) was included. Results: The prevalence of asthma was 10.7%. Nocturnal dyspnea, chest tightness and nocturnal cough were the most frequent symptoms, although statistically significant correlations with asthma were found exclusively among females (p = 0.03, p = 0.04 and p = 0.001, respectively). Nocturnal dyspnea, wheezing within the last 12 months, dyspnea with wheezing and the use of asthma medication were more frequent among individuals between 20 and 29 years of age. The last two variables presented statistical significance (p < 0.001). Undertreatment of asthma was identified in 35 (10.7%) of the cases. Conclusions: The results of this pioneering study show that asthma prevalence in a sample composed of employees of a university hospital located in a developing country was slightly higher than that found in the literature and suggest that working in a university hospital does not reduce the frequency of undertreatment.

 


Keywords: Asthma/diagnosis; Asthma/epidemiology; Hospitals, university; Questionnnaires

 


Prevalence of temporary social security benefits due to respiratory disease in Brazil

Prevalência de benefícios de seguridade social temporários devido a doença respiratória no Brasil

Simone de Andrade Goulart Ildefonso, Anadergh Barbosa-Branco, Paulo Rogério Albuquerque-Oliveira

J Bras Pneumol.2009;35(1):44-53

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Objective: To determine the prevalence of temporary social security benefits due to respiratory disease granted to employees, as well as the number of lost workdays and costs resulting from those in Brazil between 2003 and 2004. Methods: Cross-sectional study using data obtained from the Unified System of Benefits of the Brazilian Institute of Social Security (INSS, Instituto Nacional de Seguro Social) and the Brazilian Social Registry Database. Data regarding gender, age, diagnosis and type of economic activity, as well as type, duration and cost of benefits, were compiled. Results: Respiratory diseases accounted for 1.3% of the total number of temporary social security benefits granted by INSS, with a prevalence rate of 9.92 (per 10,000 employment contracts). Females and individuals older than 50 years of age were the most affected. Non-work-related benefits were more common than were work-related benefits. The most prevalent diseases were pneumonia, asthma and COPD, followed by laryngeal and vocal cord diseases. The most prevalent types of economic activity were auxiliary transportation equipment manufacturing, tobacco product manufacturing and computer-related activities. The mean duration of benefits was 209.68 days, with a mean cost of R$ 4,495.30 per occurrence. Respiratory diseases caused by exogenous agents demanded longer sick leave (mean, 296.72 days) and greater cost (mean, R$ 7,105.74). Conclusions: The most prevalent diseases were airway diseases and pneumonia. Workers from auxiliary transportation equipment manufacturing, tobacco product manufacturing and computer-related activities were the most affected. Diseases caused by exogenous agents demanded longer sick leaves and resulted in greater costs.

 


Keywords: Respiratory tract diseases; Sick leave; Work; Workers' compensation; Social security.

 


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

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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.

 


Prevalence of primary drug resistance in pulmonary tuberculosis patients with no known risk factors for such

Prevalência de resistência primária em pacientes com tuberculose pulmonar sem fatores de risco conhecidos para resistência primária

Giselle Mota Bastos, Michelle Cailleaux Cezar, Fernanda Carvalho de Queiroz Mello, Marcus Barreto Conde

J Bras Pneumol.2012;38(6):733-739

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Objective: To estimate the prevalence of primary resistance to the drugs in the basic treatment regimen for tuberculosis in treatment-naïve patients with pulmonary tuberculosis and no known risk factors for such resistance, as well as to identify factors potentially associated with drug resistance. Methods: This was an exploratory cross-sectional study. We analyzed the medical records of the subjects enrolled in two clinical trials of treatments for drug-susceptible tuberculosis between November 1, 2004 and March 31, 2011 at the Prof. Newton Bethlem Outpatient Clinic of the Federal University of Rio de Janeiro Thoracic Diseases Institute, located in the city of Rio de Janeiro, Brazil. The inclusion criteria were being ≥ 18 years of age, testing positive for AFB in the first sputum sample, having a positive culture for Mycobacterium tuberculosis, having undergone drug susceptibility testing, and being treatment-naïve. Patients with a history of imprisonment or hospitalization were excluded, as were those who had been in contact with drug-resistant tuberculosis patients. Results: We included 209 patients. The overall prevalence of primary drug resistance was 16.3%. The overall prevalence of resistance to isoniazid and streptomycin was, respectively, 9.6% and 9.1%, compared with 5.8% and 6.8% for single-drug resistance to isoniazid and streptomycin, respectively. The prevalence of resistance to two or more drugs was 3.8%, and the prevalence of multidrug resistance was 0.5%. No statistically significant associations were found between the variables studied and drug susceptibility testing results. Conclusions: In this sample, the prevalence of primary drug resistance was high despite the absence of known risk factors.

 


Keywords: Tuberculosis, pulmonary; Tuberculosis, multidrug-resistant; Risk factors.

 


Prevalence of smoking and reasons for continuing to smoke: a population-based study

Prevalência de tabagismo e motivos para continuar a fumar: estudo de base populacional

Simone Aparecida Vieira Rocha1,a, Andréa Thives de Carvalho Hoepers1,b, Tânia Silvia Fröde2,c, Leila John Marques Steidle3,d, Emilio Pizzichini3,e, Márcia Margaret Menezes Pizzichini3,f

J Bras Pneumol.2019;45(4):e20170080-e20170080

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Objective: To investigate the prevalence of smoking and the reasons for continuing to smoke among adults in Brazil. Methods: This was a cross-sectional, population-based study including 1,054 individuals ≥ 40 years of age, residents of the city of Florianopolis, Brazil, of whom 183 were smokers. All of the smokers completed the University of São Paulo Reasons for Smoking Scale (USP-RSS). Depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale, and spirometry was performed to screen for COPD. Results: Of the 183 smokers, 105 (57.4%) were female, 138 (75.4%) were White, and 125 (63.8%) were in a low economic class. The mean level of education among the smokers was 9.6 ± 6.1 years. The mean smoking history was 29 ± 15 pack-years, 59% of the men having a ≥ 30 pack-year smoking history. Approximately 20% of the smokers had COPD, and 29% had depressive symptoms, which were more common in the women. The USP-RSS scores were highest for the pleasure of smoking (PS), tension reduction (TR), and physical dependence (PD) domains (3.9 ± 1.1, 3.6 ± 1.2, and 3.5 ± 1.3, respectively). Scores for the PS, TR, and weight control (WC) domains were significantly higher in women. Smokers with a > 20 pack-year smoking history scored significantly higher on the PD, PS, automatism, and close association (CA) domains. Smoking history was associated with the PD, PS, TR, and CA domains. Depressive symptoms were associated with the PD, social smoking, and CA domains (p = 0.001; p = 0.01; p = 0.09, respectively). Female gender and a low level of education were associated with the PS domain (p = 0.04) and TR domain (p < 0.001). Conclusions: The prevalence of smoking in our sample was relatively high (17.4%). The USP-RSS domains PS, TR, and WC explain why individuals continue smoking, as do depressive symptoms.

 


Keywords: Smoking/epidemiology; Tobacco use disorder/psychology; Smoking cessation/methods; Prevalence.

 


Prevalence of asthma attacks treated in public health facilities in the city of Juiz de Fora, Brazil

Prevalência dos atendimentos por crises de asma nos serviços públicos do Município de Juiz de Fora (MG)

Oscarina da Silva Ezequiel, Gilberto Salles Gazeta, Nicolau Maués da Serra Freire

J Bras Pneumol.2007;33(1):20-27

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the prevalence of asthma attacks treated in public health facilities in the city of Juiz de Fora, Brazil from February 1, 2002 to January 31, 2003. Methods: This was a cross-sectional study involving monthly analyses performed in order to evaluate the asthma attacks treated. The variables analyzed were patient gender, age, and place of residence, as well as the profile of the visits by age bracket and by the site of the visit. In addition, we attempted to determine whether asthma attacks correlated with temperature or relative humidity. Results: A total of 25,243 patients were treated for asthma attacks, accounting for 11.1% of the total number of visits to pediatric clinics and 2.7% of the total number visits to medical clinics. The mean age of the patients was 11.6 years (median, 4 years), and 52.9% of the patients were male. The analysis of the annual distribution revealed an increase in the number of asthma attacks treated in the months of May (11.5%), June (10.8%), and July (10.9%). Asthma attack presented a strong inverse correlation with temperature (-0.86) and a weak inverse correlation with relative humidity (-0.27). Statistically significant differences, in terms of mean age and gender, were found between patients with asthma attacks treated in emergency rooms and those treated in basic health clinics. The evaluation by age bracket revealed a predominance of males among patients younger than 12 years of age and a predominance of females among those aged 12 or older. Conclusion: We found that asthma represents a significant public health problem in this city. Local strategies are urgently needed in order to increase in the availability of prophylactic treatment.

 


Keywords: Asthma/epidemiology; Prevalence; Public Hospitals; Brazil

 


Prevalence of and variables related to smoking among medical students at a university in the city of Passo Fundo, Brazil

Prevalência e fatores associados ao tabagismo em estudantes de medicina de uma universidade em Passo Fundo (RS)

Leandro Mazzoleni Stramari, Munique Kurtz, Luiz Carlos Corrêa da Silva

J Bras Pneumol.2009;35(5):442-448

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of and factors associated with smoking among medical students, as well as to evaluate the profile of this group. Methods: A total of 316 medical students (98.7% of the total) at the University of Passo Fundo, in the city of Passo Fundo, Brazil, completed a self-report questionnaire with questions on tobacco intake and on attitudes related to smoking. In accordance with the World Health Organization guidelines, the students were classified as daily smokers, occasional smokers, former smokers or nonsmokers, those in the two first categories being considered active smokers. Results: We found that 16.5% of the students were active smokers (daily smokers, 5.4%; occasional smokers, 11.1%) and that 3.5% were former smokers. The mean age was 22.2 ± 2.4 years. Factors significantly associated with the smoking habit (p < 0.05) were male gender, paternal smoking, regular alcohol consumption and use of antidepressants or anxiolytics. For the majority (69.2%) of the smokers, the age at smoking onset was 15-19 years of age, and the main motivations to start smoking were self-initiative and influence of friends. The conceptualization of smoking as an illness was significantly higher among the nonsmokers. In 70.6% of the smokers, tobacco intake was 1-10 cigarettes a day. Among the smokers, 92.3% agreed that smoking is harmful to health, 67.3% had tried to quit smoking, 96.0% believed themselves able to do so, and 87.2% intended to quit smoking. Conclusions: The prevalence of smoking remains significant among medical students. Therefore, it is fundamental that we develop more effective strategies for smoking prevention and cessation in order to reduce the number of smokers among future doctors.

 


Keywords: Smoking; Prevalence; Students, medical; Behavior.

 


Prevalence of and risk factors for wheezing in the first year of life

Prevalência e fatores de risco para sibilância no primeiro ano de vida

João Antonio Bonfadini Lima, Gilberto Bueno Fischer, Edgar Enrique Sarria, Rita Mattiello, Dirceu Solé

J Bras Pneumol.2010;36(5):525-531

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of and the risk factors for wheezing in infants under one year of age and residing in the city of Porto Alegre, Brazil. Methods: This was a cross-sectional study and is part of a multicenter, multinational project. The parents or legal guardians of the infants were interviewed at primary health care clinics or during home visits. We used a standardized questionnaire, validated for use in Brazil. Potential risk factors were assessed by means of a Poisson regression model with robust variance estimation, using the Wald test to determine the significance of each variable in the model. Results: The sample comprised 1,013 infants. The majority of those were male (53%), and the mean age was 13.5 ± 1.2 months. In 61% of the infants, there had been at least one episode of wheezing, which had recurred at least three times in one third of those infants. The mean age at the first episode of wheezing was 5.16 months (median, 5 months). Over 40% of the infants with wheezing visited emergency rooms due to wheezing, and 17% of those were hospitalized at least once in the first year of life because of this symptom. In the multivariate analysis, the risk factors for wheezing were as follows: male gender; history of pneumonia; maternal smoking during pregnancy; day care center attendance; low maternal level of education; early weaning; multiple episodes of cold; first viral infection prior to 3 months of age; existence of siblings; and history of asthma in the nuclear family. Conclusions: The prevalence of wheezing is high among infants in the city of Porto Alegre. We identified various risk factors for wheezing in infants.

 


Keywords: Respiratory sounds/epidemiology; Asthma; Infant; Risk factors.

 


Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Márcio Martins de Queiroz Guimarães, José Rodolfo Rocco

J Bras Pneumol.2006;32(4):339-346

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%); and multidrug resistant organisms were identified in 43.4%. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95% confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). Conclusion: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length of intensive care unit and hospital stays, but did not affect mortality rates.

 


Keywords: Bacterial pneumonia; Hospital infection; Intensive care units; Prognosis; Prospective studies; Intensive care medicine

 


Proposed short-term model of acute allergic response, without adjuvant use, in the lungs of mice

Proposta de um modelo murino de curta duração de resposta pulmonar alérgica aguda sem utilização de adjuvante

Andrea Mendonça Rodrigues, Camila Zanelatto Parreira Schmidt, Lucien Peroni Gualdi, Raquel Giacomelli Cao, Rodrigo Godinho de Souza, Ana Cláudia Pereira, Nailê Karine Nuñez, Alisson Passos Schleich, Paulo Márcio Condessa Pitrez

J Bras Pneumol.2012;38(5):595-604

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether a short-term protocol using subcutaneous sensitization with ovalbumin, without the use of adjuvants, would induce an eosinophilic response in the lungs of mice similar to that observed in previous, well-established protocols. Methods: Adult female BALB/c mice were randomized and divided into groups according to the number of sensitizations with ovalbumin and the number/dosage of intranasal ovalbumin challenges. The short-term protocol (10 days) consisted of one sensitization with ovalbumin and three ovalbumin challenges (100 µg). Total and differential cell counts in BAL fluid, levels of eosinophil peroxidase in lung tissue, and histopathological examination of the lungs were performed 24 h after the last ovalbumin challenge. Results: No significant differences were found among the groups regarding the variables studied. The short-term protocol, as well as the other protocols studied, induced an eosinophilic response similar to that obtained in the positive control. Conclusions: Subcutaneous sensitization with ovalbumin and without the use of adjuvants resulted in a significant allergic response in the lungs of mice, even in the short-term protocol group. Our findings suggest that this short-term protocol can be used as a first-line pre-clinical test for the study of new medications, reducing the costs and observation periods.

 


Keywords: Ovalbumin; Mice; Asthma.

 


Pancreatic pseudocyst associated to massive pleural effusion

Pseudocisto de pâncreas associado a derrame pleural maciço

Evandro Monteiro S. de Magalhães, Joaquim Carlos Ávila Terra, Luciana Borém Pimenta de Figueiredo, Luís Henrique Serra Miranda

J Bras Pneumol.2002;28(3):-

Abstract PDF PT

The authors report a case of pancreatic pseudocyst associated with massive pleural effusion. The patient was submitted to X rays, REED, ultrasonography, thoracoabdominal computerized tomography and amylase dosing in the pleural liquid. Clinical treatment included dietary support and thoracocentesis with drainage of about 3,200 ml. Patient was submitted to laparotomy to remove the pseudocyst, and was discharged in good clinical conditions. Based on this report, the authors analyze and review the literature for the occurrence of pleural effusion associated with pancreatic diseases and diagnoses.

 


Keywords: Pancreatic pseudocyst. Pleural effusion. Computerized X-ray tomography. Laparotomy.

 


Traumatic pulmonary pseudocyst

Pseudocisto pulmonar traumático

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Carlos Alberto de Barros Franco

J Bras Pneumol.2005;31(1):-

Abstract PDF PT PDF EN Portuguese Text

Traumatic pulmonary pseudocyst is a rare lesion and is typically seen after blunt chest trauma. Although secondary infection is an uncommon complication, it presents high morbidity and requires immediate treatment. A 28-year-old male motorcycle accident victim was admitted to the hospital with hemoptysis, chest pain, dyspnea and hypoxemia. Computed tomography of the chest revealed pulmonary infiltrate and pseudocysts in the lower lobe of the right lung. The patient developed fever, purulent expectoration and an air-fluid level within the pseudocysts. After culture collection, a course of broad-spectrum antibiotics was started. Clinical improvement was observed, and the patient was discharged 15 days after admission.

 


Keywords: Key words: Chest trauma. Pseudocyst

 


Inflammatory pseudotumor of the posterior mediastinum

Pseudotumor inflamatório do mediastino posterior

Izabella Nobre Queiroz, Renata Mendonça Moreira Penna, Emanuelly Botelho Rocha Mota, Rafael Turano Mota, Vinícius Turano Mota

J Bras Pneumol.2013;39(1):113-115

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Quality of life in chronic pulmonary diseases: conceptual and methodological aspects

Qualidade de vida em doenças pulmonares crônicas: aspectos conceituais e metodológicos

Ana Teresa de Abreu Ramos-Cerqueira, André Luiz Crepaldi

J Bras Pneumol.2000;26(4):207-213

Abstract PDF PT

The present article purports to analyze aspects related to the concept of quality of life, taking into account the relevance of setting down parameters that allow for the evaluation of those aspects, especially in patients with chronic diseases. The analysis considered quality of life as one of the essential components of medical care, and pointed out the precautions that should be taken to choose instruments of evaluation, that should be sensitive and reliable to the dimensions they intend to evaluate.

 


Keywords: quality of life, chronic diseases, asthma, chronic obstructive pulmonary disease

 


Que sejamos cientificamente prósperos

Thais Helena A. Thomaz Queluz

J Bras Pneumol.1999;25(1):3-4

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Leicester Cough Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil

Questionário de Leicester sobre tosse crônica: tradução e adaptação cultural para a língua portuguesa falada no Brasil

Manuela Brisot Felisbino, Leila John Marques Steidle, Michelle Gonçalves-Tavares, Marcia Margaret Menezes Pizzichini, Emilio Pizzichini

J Bras Pneumol.2014;40(3):213-221

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To translate the Leicester Cough Questionnaire (LCQ) to Portuguese and adapt it for use in Brazil. Methods: Cross-cultural adaptation of a quality of life questionnaire requires a translated version that is conceptually equivalent to the original version and culturally acceptable in the target country. The protocol used consisted of the translation of the LCQ to Portuguese by three Brazilian translators who were fluent in English and its back-translation to English by another translator who was a native speaker of English and fluent in Portuguese. The back-translated version was evaluated by one of the authors of the original questionnaire in order to verify its equivalence. Later in the process, a provisional Portuguese-language version was thoroughly reviewed by an expert committee. In 10 patients with chronic cough, cognitive debriefing was carried out in order to test the understandability, clarity, and acceptability of the translated questionnaire in the target population. On that basis, the final Portuguese-language version of the LCQ was produced and approved by the committee. Results: Few items were questioned by the source author and revised by the committee of experts. During the cognitive debriefing phase, the Portuguese-language version of the LCQ proved to be well accepted and understood by all of the respondents, which demonstrates the robustness of the process of translation and cross-cultural adaptation. Conclusions: The final version of the LCQ adapted for use in Brazil was found to be easy to understand and easily applied.

 


Keywords: Quality of life; Translations; Questionnaires; Cough.

 


Radiation therapy in the treatment of unicentric Castleman's disease

Radioterapia no tratamento da doença de Castleman localizada

Fabiana Accioli Miranda, Victor Hugo Chiquetto Faria, Gustavo Viani Arruda, Lucas Godoi Bernardes da Silva

J Bras Pneumol.2013;39(1):116-118

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Pulmonary rehabilitation in severe COPD with hyperinflation: some insights into exercise performance

Reabilitação pulmonar em DPOC grave com hiperinsuflação: algumas percepções sobre desempenho ao exercício

Luiz Alberto Forgiarini Junior1, Antonio Matias Esquinas2

J Bras Pneumol.2016;42(5):397-397

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Mobility therapy and central or peripheral catheter-related adverse events in an ICU in Brazil

Realização de fisioterapia motora e ocorrência de eventos adversos relacionados a cateteres centrais e periféricos em uma UTI brasileira

Natália Pontes Lima1, Gregório Marques Cardim da Silva1, Marcelo Park2, Ruy Camargo Pires-Neto3

J Bras Pneumol.2015;41(3):225-230

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether mobility therapy is associated with central or peripheral catheter-related adverse events in critically ill patients in an ICU in Brazil. Methods: A retrospective analysis of the daily medical records of patients admitted to the Clinical Emergency ICU of the University of São Paulo School of Medicine Hospital das Clínicas Central Institute between December of 2009 and April of 2011. In addition to the demographic and clinical characteristics of the patients, we collected data related to central venous catheters (CVCs), hemodialysis (HD) catheters and indwelling arterial catheters (IACs): insertion site; number of catheter days; and types of adverse events. We also characterized the mobility therapy provided. Results: Among the 275 patients evaluated, CVCs were used in 49%, HD catheters were used in 26%, and IACs were used in 29%. A total of 1,268 mobility therapy sessions were provided to patients while they had a catheter in place. Catheter-related adverse events occurred in 20 patients (a total of 22 adverse events): 32%, infection; 32%, obstruction; and 32%, accidental dislodgement. We found that mobility therapy was not significantly associated with any catheter-related adverse event, regardless of the type of catheter employed: CVC-OR = 0.8; 95% CI: 0.7-1.0; p = 0.14; HD catheter-OR = 1.04; 95% CI: 0.89-1.21; p = 0.56; or IAC-OR = 1.74; 95% CI: 0.94-3.23; p = 0.07. Conclusions: In critically ill patients, mobility therapy is not associated with the incidence of adverse events involving CVCs, HD catheters, or IACs.

 


Keywords: Physical therapy modalities; Intensive care units; Catheters; Early ambulation.

 


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.

 


Association of tuberculosis with multimorbidity and social networks

Relação da tuberculose com multimorbidade e redes sociais

Hiram Valenzuela-Jiménez1, Edgar Fabian Manrique-Hernández2, Alvaro Javier Idrovo2

J Bras Pneumol.2017;43(1):51-53

Abstract PDF PT PDF EN Portuguese Text

The combination of tuberculosis with other diseases can affect tuberculosis treatment within populations. In the present study, social network analysis of data retrieved from the Mexican National Epidemiological Surveillance System was used in order to explore associations between the number of contacts and multimorbidity. The node degree was calculated for each individual with tuberculosis and included information from 242 contacts without tuberculosis. Multimorbidity was identified in 49.89% of individuals. The node degrees were highest for individuals with tuberculosis + HIV infection (p < 0.04) and lowest for those with tuberculosis + pulmonary edema (p < 0.07). Social network analysis should be used as a standard method for monitoring tuberculosis and tuberculosis-related syndemics.

 


Keywords: Tuberculosis/epidemiology; HIV; Nutrition, public health.

 


Efficiency of clinical, radiological and laboratory testing in the diagnosis of pleural tuberculosis

Rendimento de variáveis clínicas, radiológicas e laboratoriais para o diagnóstico da tuberculose pleural

Denise Duprat Neves; Ricardo Marques Dias; Antônio José Ledo Alves da Cunha; Antonio Monteiro da Silva Chibante

J Bras Pneumol.2004;30(4):409-416

Abstract PDF PT PDF EN

Background: In Brazil, tuberculosis is the major cause of pleural effusion. In more than 50% of cases, treatment has been initiated prior to confirmation of the diagnosis. Our objective was to identify factors that can contribute to the diagnosis. Method: We studied 215 consecutive patients with pleural effusion: 104 from tuberculosis (TB) and 111 from other causes (41 were from malignancies, 29 involved transudation, 28 were parapneumonic and 13 were from other etiologies). Clinical, radiological and laboratorial variables were evaluated for differences between the two groups, individually or in combination. Results: Male gender and PPD > 10 mm were significantly more frequent in the tuberculosis group. Radiological features were similar in both groups. Among the continuous variables, adenosine deaminase (ADA), percentile of cells, protein and age performed better as isolated diagnostic criteria. Between the group with tuberculosis and that with pleural effusion from other causes, no significant differences were found in Lactate dehydrogenase, total leukocytes or duration of disease. The correlation of ADA with any other welldeveloped continuous variable showed an LR+ > 10 and an LR- < 0.1, which effectively confirmed or ruled out a diagnosis of tuberculous pleural effusion. Conclusions: In patients with ADA levels > 39 at 95% sensitivity, the specificity can be improved to more than 90% if we consider non purulent effusion or effusion with a predominance of lymphocytes (> 50%).

 


Keywords: Tuberculosis, pleural/diagnosis. Adenosine deaminase/diagnosis use. Sensitivity and specificity.

 


Effects of pneumoperitoneum on the amplitude of diaphragmatic excursion in pigs

Repercussões do pneumoperitônio na amplitude da excursão diafragmática em suínos

Valéria Marques Ferreira Normando, Marcus Vinicius Henriques Brito, Francisco Alves de Araújo Júnior, Breno Costa Maciel Albuquerque

J Bras Pneumol.2006;32(1):16-22

Abstract PDF PT PDF EN Portuguese Text

Objective: To study the effects that pneumoperitoneum achieved through carbon dioxide insufflation has on diaphragmatic excursion in pigs. Methods: A total of 14 male Landrace pigs, 30 to 45 days of age and weighing five to seven kilograms each, were used. The sample was randomly and equally divided into two groups: one (n = 7) in which pneumoperitoneum was maintained at 10 mmHg for 60 minutes; and another (n = 7) in which pneumoperitoneum was maintained at 15 mmHg (also for 60 minutes). After anesthetic induction, the animals were intubated. Flow volume was monitored, and the amplitude of diaphragmatic excursion was analyzed using noninvasive ultrasound imaging of the right hemidiaphragm. Results: In both groups, restricted diaphragmatic excursion was observed only during the procedure. There was no statistical difference between the two pressure levels studied. Conclusion: The amplitude of diaphragmatic excursion was restricted during abdominal insufflation, independent of the pressure level (within the 10-15 mmHg range), during the study period.

 


Keywords: Pneumoperitoneum/chemically induced; Carbon dioxide; Diaphragm; Video-assisted surgery; Swine

 


Reliability of the Brazilian Portuguese version of the fatigue severity scale and its correlation with pulmonary function, dyspnea, and functional capacity in patients with COPD

Reprodutibilidade da versão brasileira da escala de gravidade da fadiga e sua correlação com função pulmonar, dispneia e capacidade funcional em pacientes com DPOC

Silvia Valderramas, Aquiles Assunção Camelier, Sinara Alves da Silva, Renata Mallmann, Hanna Karine de Paulo, Fernanda Warken Rosa

J Bras Pneumol.2013;39(4):-

Abstract PDF PT PDF EN Portuguese Text

To describe the intra-rater and inter-rater reliability of the Brazilian Portuguese version of the fatigue severity scale (FSS) in patients with COPD and to identify the presence of its association with parameters of pulmonary function, dyspnea, and functional capacity. Methods: This was an observational cross-sectional study involving 50 patients with COPD, who completed the FSS in interviews with two researchers in two visits. The FSS scores were correlated with those of the Medical Research Council (MRC) scale, as well as with FEV1, FVC, and six-minute walk distance (6MWD). Results: The mean age of the patients was 69.4 ± 8.23 years, whereas the mean FEV1 was 46.5 ± 20.4% of the predicted value. The scale was reliable, with an intraclass correlation coefficient of 0.90 (95% CI, 0.81-0.94; p < 0.01). The FSS scores showed significant correlations with those of MRC scale (r = 0.70; p < 0.01), as well as with 6MWD (r = −0.77; p < 0.01), FEV1 (r = −0.38; p < 0.01), FVC (r = −0.35; p < 0.01), and stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria (r = 0.37; p < 0.01). Conclusions: The Brazilian Portuguese version of the FSS proved reliable for use in COPD patients in Brazil and showed significant correlations with sensation of dyspnea, functional capacity, pulmonary function, and stage of the disease.

 


Keywords: Fatigue; Pulmonary disease, chronic obstructive; Reproducibility of results; Validation studies.

 


Drug-resistant Mycobacterium tuberculosis strains isolated at an AIDS reference center general hospital in Rio de Janeiro

Resistência aos medicamentos anti-tuberculose de cepas de Mycobacterium tuberculosis isoladas de pacientes atendidos em hospital geral de referência para tratamento de AIDS no Rio de Janeiro

Rossana Coimbra Brito; Celine Gounder; Dirce Bonfim de Lima; Hélio Siqueira; Hebe Rodrigues Cavalcanti; Maracy Marques Pereira; Afrânio Lineu Kritski

J Bras Pneumol.2004;30(4):425-432

Abstract PDF PT PDF EN

Background: Tuberculosis become important challenge to health care settings. Brazil has high prevalence of the disease and Rio de Janeiro has high incidence rates with 30% of cases notified at hospitals. Objective: To evaluate prevalence of initial and acquired drug resistance at a general hospital, reference for aids treatment in Rio de Janeiro and to identify associated factors. Methods: Mycobacterium tuberculosis strains from 165 patients were analyzed, between August 1996 and February 1998. Results: Twenty per cent (33/165) were resistant to at least one drug; 13% (12/165) to isoniazid; 3.64% (6/ 165) to rifampin and 3.64% (6/165) to both. Among HIV seropositive subjects (52/165); 28.85% (15/52) were resistant to at least one drug. Acquired resistance occurred in 15.79% of 19 patients that mentioned previous antiTB treatment. Association statistically significant was found with non cavitation on X-ray in bivariate analyses ( P=0.05). Eighty four patients refereed no previous treatment (NPT). Resistance to 1 or more drugs was found in 28.57% (24/84) of NPT patients. Association statistically significant with initial resistance was found with health care workers (P=0.004), unemployment (P=0.03), and diarrhea (P=0.01) in bivariate analyses. On multivariate analyses, health care workers ( P=0.002) remained significantly associated with initial resistance. Conclusions: High resistance rates was found. It corroborates that hospitals needs attention for TB control especially which concerns to health care works infection.

 


Keywords: Mycobacterium tuberculosis. Drug resistance. Disease transmission, patient to professional. Hospitals.

 


Mycobacterium tuberculosis resistance to antituberculosis drugs in Mozambique

Resistência de Mycobacterium tuberculosis aos tuberculostáticos em Moçambique

Germano Manuel Pires, Elena Folgosa, Ndlovu Nquobile, Sheba Gitta, Nureisha Cadir

J Bras Pneumol.2014;40(2):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the drug resistance profile of Mycobacterium tuberculosis in Mozambique. Methods: We analyzed secondary data from the National Tuberculosis Referral Laboratory, in the city of Maputo, Mozambique, and from the Beira Regional Tuberculosis Referral Laboratory, in the city of Beira, Mozambique. The data were based on culture-positive samples submitted to first-line drug susceptibility testing (DST) between January and December of 2011. We attempted to determine whether the frequency of DST positivity was associated with patient type or provenance. Results: During the study period, 641 strains were isolated in culture and submitted to DST. We found that 374 (58.3%) were resistant to at least one antituberculosis drug and 280 (43.7%) were resistant to multiple antituberculosis drugs. Of the 280 multidrug-resistant tuberculosis cases, 184 (65.7%) were in previously treated patients, most of whom were from southern Mozambique. Two (0.71%) of the cases of multidrug-resistant tuberculosis were confirmed to be cases of extensively drug-resistant tuberculosis. Multidrug-resistant tuberculosis was most common in males, particularly those in the 21-40 year age bracket. Conclusions: M. tuberculosis resistance to antituberculosis drugs is high in Mozambique, especially in previously treated patients. The frequency of M. tuberculosis strains that were resistant to isoniazid, rifampin, and streptomycin in combination was found to be high, particularly in samples from previously treated patients.

 


Keywords: Extensively drug-resistant tuberculosis; Tuberculosis; Tuberculosis, multidrug-resistant.

 


Isoniazid-resistant Mycobacterium tuberculosis strains arising from mutations in two different regions of the katG gene

Resistência do Mycobacterium tuberculosis à isoniazida por mutações em duas regiões diferentes do gene katG

Helio Ribeiro de Siqueira, Flávia Alvim Dutra de Freitas, Denise Neves de Oliveira, Angela Maria Werneck Barreto, Margareth Pretti Dalcolmo, Rodolpho Mattos Albano

J Bras Pneumol.2009;35(8):773-779

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze and compare the mutations in two different regions of the katG gene, which is responsible for isoniazid (INH) resistance. Methods: We analyzed 97 multidrug-resistant Mycobacterium tuberculosis strains isolated in cultures of sputum samples obtained from the Professor Hélio Fraga Referral Center, in Brasília, Brazil. Another 6 INH-sensitive strains did not present mutations and were included as controls. We used PCR to amplify two regions of the katG gene (GenBank accession no. U06258)-region 1, (from codon 1 to codon 119) and region 2 (from codon 267 to codon 504)-which were then sequenced in order to identify mutations. Results: Seven strains were resistant to INH and did not contain mutations in either region. Thirty strains carried mutations in region 1, which was characterized by a high number of deletions, especially at codon 4 (24 strains). Region 2 carried 83 point mutations, especially at codon 315, and there was a serine-to-threonine (AGC-to-ACC) substitution in 73 of those cases. The analysis of region 2 allowed INH resistance to be diagnosed in 81.4% of the strains. Nine strains had mutations exclusively in region 1, which allowed the proportion of INH-resistant strains identified to be increased to 90.6%. Conclusions: The number of mutations at codon 315 was high, which is consistent with cases described in Brazil and in other countries, and the analysis of region 1 resulted in a 9.2% increase in the rate at which mutations were identified.

 


Keywords: Isoniazid; Mutation; Tuberculosis; Drug resistance, multiple.

 


Determining respiratory system resistance and reactance by impulse oscillometry in obese individuals

Resistência e reatância do sistema respiratório por oscilometria de impulso em indivíduos obesos

Cláudio Gonçalves de Albuquerque1, Flávio Maciel Dias de Andrade1, Marcus Aurélio de Almeida Rocha1, Alina Farias França de Oliveira1, Waldemar Ladosky1, Edgar Guimarães Victor1, José Ângelo Rizzo1

J Bras Pneumol.2015;41(5):422-426

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate peripheral respiratory system resistance and reactance (Rrs and Xrs, respectively) in obese individuals. Methods: We recruited 99 individuals, dividing them into four groups by body mass index (BMI): < 30.0 kg/m2 (control, n = 31); 30.0-39.9 kg/m2 (obesity, n = 13); 40.0-49.9 kg/m2 (severe obesity, n = 28); and ≥ 50.0 kg/m2 (morbid obesity, n = 13). Using impulse oscillometry, we measured total Rrs, central Rrs, and Xrs. Peripheral Rrs was calculated as the difference between total Rrs and central Rrs. All subjects also underwent spirometry. Results: Of the 99 individuals recruited, 14 were excluded because they failed to perform forced expiratory maneuvers correctly during spirometry. The individuals in the severe obesity and morbid obesity groups showed higher peripheral Rrs and lower Xrs in comparison with those in the two other groups. Conclusions: Having a BMI ≥ 40 kg/m2 was associated with a significant increase in peripheral Rrs and with a decrease in Xrs.

 


Keywords: Obesity; Airway obstruction; Oscillometry; Respiratory function tests.

 


Resolution of right-to-left shunt after primary pulmonary hypertension treatment with sildenafil

Resolução do "shunt" direita-esquerda após uso do sildenafil como tratamento de hipertensão pulmonar primária

Sérgio Marques da Silva, Carla Bastos Valeri, Humberto Bassit Bogossian, Carlos Jardim, Sérgio Eduardo Demarzo, Rogério Souza

J Bras Pneumol.2003;29(5):305-308

Abstract PDF PT

Primary pulmonary hypertension is a rare, progressive disease with high mortality rates. The treatment of primary pulmonary hypertension is still based on high-cost drugs, not yet available in developing countries. Recently, the use of sildenafil as an alternative drug for primary pulmonary hypertension treatment has been reported. It is reported a case of a 21 year-old female patient with primary pulmonary hypertension, who presented an acute worsening of symptoms and decrease of oxygen saturation. The investigation revealed the existence of a patent oval foramen not previously seen, with right-to-left shunt. Sildenafil treatment was instituted in escalating doses. After 40 days of treatment, the echocardiogram showed resolution of the shunt, concomitant to oxygenation improvement. The authors believe that sildenafil is a feasible alternative for primary pulmonary hypertension treatment, although larger clinical trials are necessary to determine its clinical safety and efficacy.

 


Keywords: Pulmonary hypertension/therapy. Vasodilator agents/administration & dosage.

 


Resolução nº 251 - De 5 de agosto de 1997

Carlos César S. de Albuquerque

J Bras Pneumol.1999;25(2):99-101

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Resposta do autor

Simone Macedo Amaral, Antonieta de Queiróz Côrtes, Fábio Ramôa Pires

J Bras Pneumol.2010;36(2):272-

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Authors' reply

Resposta dos autores

Maria Conceição de Castro Antonelli Monteiro de Queiroz, Maria Auxiliadora Carmo Moreira,Marcelo Fouad Rabahi

J Bras Pneumol.2013;39(2):256-256

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Author's replay

Resposta dos autores

Andre Luis Pereira de Albuquerque1,2, Marco Quaranta3, Biswajit Chakrabarti4, Andrea Aliverti3, Peter M. Calverley4

J Bras Pneumol.2016;42(5):398-398

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Resection of a mediastinal schwannoma using video-assisted thoracoscopy

Ressecção de schwannoma mediastinal por cirurgia torácica videoassistida

Leonardo Ortigara, Nelson Rosemberg, Rafael Siqueira, Francisco Neto

J Bras Pneumol.2006;32(2):172-175

Abstract PDF PT PDF EN Portuguese Text

Schwannomas are tumors that are typically benign. They are derived from Schwann cells (glial cells of the peripheral nervous system that serve to separate and isolate nerve cells from adjacent structures). The most common type of schwannoma is a benign tumor of cranial nerve VIII and is referred to as an acoustic neuroma. When extradural, such tumors usually present as masses that can invade adjacent structures, thereby becoming symptomatic, as in the case of intrathoracic schwannomas (typically found in the posterior mediastinum). Herein, we present a case of a schwannoma treated through video-assisted thoracoscopy, and we review the literature on the subject.

 


Keywords: Mediastinal neoplasms/surgery; Neurilemmoma; Thoracic surgery, video-assisted; Case reports

 


Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

Ressecção pulmonar anatômica por videotoracoscopia: experiência brasileira (VATS Brasil)

Ricardo Mingarini Terra1, Thamara Kazantzis1, Darcy Ribeiro Pinto-Filho2, Spencer Marcantonio Camargo3, Francisco Martins-Neto4,5, Anderson Nassar Guimarães6, Carlos Alberto Araújo7, Luis Carlos Losso8, Mario Claudio Ghefter9, Nuno Ferreira de Lima10, Antero Gomes-Neto5, Flávio Brito-Filho10, Rui Haddad11, Maurício Guidi Saueressig12, Alexandre Marcelo Rodrigues Lima13, Rafael Pontes de Siqueira5, Astunaldo Júnior de Macedo e Pinho14, Fernando Vannucci15

J Bras Pneumol.2016;42(3):215-221

Abstract PDF PT PDF EN Portuguese Text

Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.

 


Keywords: Thoracic surgery, video-assisted; Thoracoscopy; Pneumonectomy.

 


Response to thymectomy in patients with myasthenia gravis

Resultado da timectomia em doentes com miastenia gravis

Roberto Saad Jr., Cristina Cordeiro Arranz, Vicente Dorgan Neto, Jaqueline Arantes Giannini, Márcio Botter

J Bras Pneumol.1997;23(4):189-192

Abstract PDF PT

The aim of this study was to analyze the results of 17 patients with myasthenia gravis who, from 1985 to 1994, were submitted to thymectomy at the Medical School of Santa Casa de São Paulo. Nine patients (52.9%) were female and the mean age was approximately 30.3 years. The most usual symptoms were ptoses, weakness, and diplopia. Other symptoms included: dyspnea, dysphonia, thoracic pain and loss of weight. The average development period of the disease was 17.5 months (between 3 and 96 months). The diagnostic methods use were chest X-ray, response to edrophonium chloride (Tensilon), electrophysiologic study and thoracic CT. All patients were submitted to thymectomy through medium sternotomy. Patients were followed up from one month to ten years. Only one patient did not return to the clinic. Twelve patients (75%) achieved good results. The others four patients presented little or no response after thymectomy.

 


Keywords: Thymectomy. Myasthenia gravis.

 


Postemetic rupture of the esophagus: Boerhaave's syndrome

Ruptura pós-emética do esôfago: a síndrome de Boerhaave

Henrique José da Mota, Manoel Ximenes Netto, Aldo da Cunha Medeiros

J Bras Pneumol.2007;33(4):480-483

Abstract PDF PT PDF EN Portuguese Text

Postemetic rupture of the esophagus, also known as spontaneous rupture or Boerhaave's syndrome, was first described by Herman Boerhaave in 1724. This is a severe disease that causes high mortality rates and is difficult to diagnose not only because it is rare but also because it is frequently confused with other severe clinical conditions, such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Herein, we describe three cases of patients with this syndrome. Two underwent primary repair of the rupture, and one underwent esophagectomy followed by reconstruction. There was one death due to septic shock in the immediate postoperative period. The other two patients presented favorable long-term evolution.

 


Keywords: Esophageal diseases; Rupture, spontaneous; Mediastinitis; Esophagectomy.

 


Renal sarcoidosis

Sarcoidose renal

Maria Enedina Claudino de Aquino, Roberta Karla Barbosa de Sales, José Antônio Freire dos Santos, Ana Lidia Régis, Nelson Morrone

J Bras Pneumol.2001;27(3):163-166

Abstract PDF PT

In a 62-year-old white woman, submitted to preoperative evaluation for facectomy, urinary alterations were detected. The diagnosis established included left-sided kidney stones and homolateral exclusion. At pre-nephrectomy, interstitial widespread lung disease and thoracic adenopathy were evidenced and their investigation was postponed to after surgery. In the removed kidney, non cascous epithelioid granulomas were found. Later, transbronchial biopsy disclosed this same aspect. The patient was treated with methylprednisolone and presented slight pulmonary improvement, though no amelioration in renal function occurred. Final diagnosis was sarcoidosis with lung, thoraco-lymphatic and renal involvement.

 


Keywords: Sarcoidosis. Kidney failure. Pulmonary sarcoidosis.

 


Benign schwannoma of the posterior mediastinum with a dumbbell-shaped lesion traversing the trachea

Schwannoma benigno do mediastino posterior com desenvolvimento em ampulheta para a traquéia

Fernando Luiz Westhhal, Augusto Castilho, Arteiro Queiroz Menezes

J Bras Pneumol.2002;28(3):-

Abstract PDF PT

Benign schwannoma tumors are the most common primary tumors of the posterior mediastinum. They may develop into a dumbbell-shaped involvement of the medullar channel, but rarely reach the tracheobronchial tree. The authors report a case of a 45-year-old female patient with a benign schwannoma in the posterior mediastinum, with a dumbbell-shaped lesion that traverses the intercartilaginous septa of the trachea. The tumor was resected by endoscopy in the endotracheal portion and afterwards by thoracotomy of the mediastinal tumor. Eight months after the surgery, there has been no recurrence of the lesion.

 


Keywords: Mediastinal neoplasms. Thoracotomy. Thoracoscopy. Mediastinal cyst.

 


Safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis in Brazil

Segurança e tolerabilidade de Nintedanibe em pacientes com fibrose pulmonar idiopática no Brasil

Carlos Alberto de Castro Pereira1,a, José Antonio Baddini-Martinez2,b, Bruno Guedes Baldi3,c, Sérgio Fernandes de Oliveira Jezler4,d, Adalberto Sperb Rubin5,e, Rogerio Lopes Rufino Alves6,f, Gilmar Alves Zonzin7,g, Manuel Quaresma8,h, Matthias Trampisch9,i, Marcelo Fouad Rabahi10,j

J Bras Pneumol.2019;45(5):e20180414-e20180414

Abstract PDF PT PDF EN Portuguese Text

Objective: Clinical trials have shown that nintedanib 150 mg twice daily (bid) reduces disease progression in patients with idiopathic pulmonary fibrosis (IPF), with an adverse event profile that is manageable for most patients. Prior to the approval of nintedanib as a treatment for IPF in Brazil, an expanded access program (EAP) was initiated to provide early access to treatment and to evaluate the safety and tolerability of nintedanib in this patient population. Methods: Patients with a diagnosis of IPF within the previous five years, forced vital capacity (FVC) ≥ 50% predicted and diffusing capacity of the lungs for carbon monoxide (DLco) 30% to 79% predicted were eligible to participate in the EAP. Patients received nintedanib 150 mg bid open-label. Safety assessments included adverse events leading to permanent discontinuation of nintedanib and serious adverse events. Results: The EAP involved 57 patients at eight centers. Most patients were male (77.2%) and white (87.7%). At baseline, mean (SD) age was 70.7 (7.5) years and FVC was 70.7 (12.5) % predicted. Mean (SD) exposure to nintedanib was 14.4 (6.2) months; maximum exposure was 22.0 months. The most frequently reported adverse events considered by the investigator to be related to nintedanib treatment were diarrhea (45 patients, 78.9%) and nausea (25 patients, 43.9%). Adverse events led to permanent discontinuation of nintedanib in 16 patients (28.1%). Sixteen patients (28.1%) had a serious adverse event. Conclusion: In the Brazilian EAP, nintedanib had an acceptable safety and tolerability profile in patients with IPF, consistent with data from clinical trials.

 


Keywords: Drug tolerance; Expanded access program; Interstitial lung disease; Tyrosine kinase inhibitor.

 


Postintubation injuries and open surgical tracheostomy: should we always perform isthmectomy?

Sequelas pós-intubação e traqueostomia cirúrgica aberta: devemos sempre fazer a istmectomia?

Alexandre Garcia de Lima, Ariovaldo Marques, Ivan Felizardo Contrera Toro

J Bras Pneumol.2009;35(3):227-233

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. Methods: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located in the city of Sumaré, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. Results: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stoma complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. Conclusions: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stoma complications.

 


Keywords: Tracheostomy; Intensive care units; Tracheal stenosis.

 


Diagnostic sequence in pulmonary thromboembolism

Seqüência diagnóstica no tromboembolismo pulmonar

Thais Helena A. Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.1999;25(3):181-186

Abstract PDF PT

Pulmonary thromboembolism (PTE) should be suspected in patients with risk factors for deep venous thrombosis (DVP) who present, either isolated or in association, malaise, dyspnea/tachypnea, sudden collapse or pulmonary hemorrhage syndrome. The diagnostic approach starts with basic tests (chest X-rays electrocardiographs, and arterial blood gas tensions) the results of which associated to medical history and to physical examination allow the classification of clinical suspicion as high, intermediate or low probability. This phase is important, both to support clinical suspicion of PTE and to exclude alternative diagnoses. In order to confirm or exclude PTE, one or several sophisticated imaging exams (lung isotope scanning, leg imaging, and pulmonary angiography) should be performed next, according to the findings of the chest X-ray. If there is undue delay in arranging investigations for patients with high clinical probability, heparin should be started, unless high risk to anticoagulation is present. In this review the diagnostic methods are discussed and some strategies for rapid investigation of PTE are shown with the main purpose of adapting them to Brazilian reality.

 


Keywords: Pulmonary thromboembolism. Diagnosis. Management strategy.

 


Tuberculosis series

Série tuberculose

Denise Rossato Silva1,a, Fernanda Carvalho de Queiroz Mello2,b, Afrânio Kritski3,c, Margareth Dalcolmo4,d, Alimuddin Zumla5,e, Giovanni Battista Migliori6

J Bras Pneumol.2018;44(2):71-72

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Tuberculosis series 2019

Série tuberculose 2019

Denise Rossato Silva1,a, Giovanni Battista Migliori2,b, Fernanda Carvalho de Queiroz Mello3,c

J Bras Pneumol.2019;45(2):e20190064-e20190064

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Silicosis among PIT diggers in the region of Ibiapaba, State of Ceará, Brazil: from detection to control

Silicose em cavadores de poços da região de Ibiapaba (CE): da descoberta ao controle

Márcia Alcântara Holanda, Ana Carolina Peixoto do Rego Barros, Alexandre Alcântara Holanda, Cristina Gomes do Monte, Elias Bezerra Leite, Luiz Ximenes Junior, Maria Zélia Maia Holanda, Pedro Henrique Felismino

J Bras Pneumol.1999;25(1):1-11

Abstract PDF PT

Silicosis among pit diggers was first described in 1984. Two years later, a focus of the disease was detected in the region of Ibiapaba, State of Ceará, Brazil. The aims of this study were: 1) to present the educational program to which these workers and their families were submitted; 2) to study, in this population, the impact of the educational program on the knowledge about silicosis and on the behavior changes in the pit digging activity. First, a primary preventing educational intervention (PPEI) was created as per the critical awareness-raising method by Paulo Freire, and applied to this population. Subsequently, the role of PPEI on silicosis control among the pit diggers was studied. In the region there were 1202 pit diggers, and 687 from 5 selected towns were submitted to PPEI. Out of these, 287 workers participated of the second part of the study. All of them were male, ages from 18 to 78 years, 115 were silicotic, 122 non-silicotic, and 46 did not know their health status. Results show that PPEI brought to silicotic and non-silicotic workers a deep knowledge about the relationship between pit digging and silicosis, and induced most of them (85.8%) to quit this activity. PPEI itself promoted an awareness of this population about silicosis, interrupting the epidemiological cycle of the disease in the region of Ibiapaba.

 


Keywords: Silicosis. Epidemiology. Occupational lung diseases.

 


The halo sign: HRCT findings in 85 patients

Sinal do halo: achados de TCAR em 85 pacientes

Giordano Rafael Tronco Alves1, Edson Marchiori1, Klaus Irion2, Carlos Schuler Nin3, Guilherme Watte3, Alessandro Comarú Pasqualotto3, Luiz Carlos Severo3, Bruno Hochhegger1,3

J Bras Pneumol.2016;42(6):435-439

Abstract PDF PT PDF EN Portuguese Text

Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.

 


Keywords: Tomography, X-ray computed; Aspergillosis; Lung neoplasms.

 


Acute chest syndrome as the first manifestation of sickle cell disease in a middle aged adult

Síndrome aguda do tórax como primeira manifestação de anemia falciforme em adulto

Hugo Hyung Bok Yoo, Nilva Regina Pelegrino, Ana Lúcia Oliveira de Carlos, Irma de Godoy, Thais Thomaz Queluz

J Bras Pneumol.2002;28(4):237-240

Abstract PDF PT

Acute chest syndrome is an affection, specially in young adults, of sickle cell disease and is responsible for 25% of the deaths. The authors report the case of an alcoholic 45-year-old mulatto man, without any previous manifestation of sickle cell disease, who presented with a pneumonia-like clinical picture with seven days of duration. The chest X-ray revealed bilateral lung infiltrates and spots of consolidation with air bronchograms, and left pleural effusion. The patient also had anemia and leukocytosis with neutrophilia. Treated with cefoxitin and amicacin, the patient developed acute respiratory insufficiency and died 14 hours after hospitalization. The necropsy showed lungs with intense congestion, intra-alveolar hemorrhage, diffuse alveolar damage, and sickle red blood cells. The progressive, fast, and severe character of the acute chest syndrome, which is frequently mimicked by other illnesses, makes the disease a dramatic and severe event of difficult earlier diagnosis. Therefore, in countries like Brazil, with a large black population, the physicians must always be aware of this possibility.

 



Obstructive sleep apnea syndrome in truck drivers

Síndrome da apneia obstrutiva do sono em motoristas de caminhão

Lucia Castro Lemos, Elaine Cristina Marqueze, Fernanda Sachi, Geraldo Lorenzi-Filho, Claudia Roberta de Castro Moreno

J Bras Pneumol.2009;35(6):500-506

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of obstructive sleep apnea syndrome (OSAS), as well as to identify factors associated with a greater risk of developing OSAS, among truck drivers. Methods: The study population comprised 209 truck drivers (mean age, 38.8 years; 98.5% males) at two branches of a transportation company. The mean body mass index was 26.5 ± 4.4 kg/m2. The participants completed questionnaires regarding sociodemographic data, physical activity and OSAS. The prevalence of OSAS was estimated using the Berlin Questionnaire, associations between OSAS and the factors studied being assessed through univariate and multivariate regression analysis. Results: The prevalence of OSAS in the population was 11.5%. Of the 209 truck drivers, 72 (34.5%) reported having fallen asleep while driving and 81 (38.7%) reported snoring. The following variables were found to present statistically significant associations with OSAS: informal employment (OR = 0.27; p = 0.01); body mass index ≥ 25 kg/m2 (OR = 13.64; p = 0.01); and poor sleep quality (OR = 3.00; p = 0.02). Conclusions: The prevalence of OSAS in this study was lower than that reported in other studies of truck drivers and yet higher that that observed for the general population. In addition, our results suggest that work characteristics, such as employment status, are associated with OSAS. These data show the relevance of considering work activity in studies of factors associated with OSAS.

 


Keywords: Sleep apnea, obstructive; Sleep disorders; Questionnaires.

 


Claude Bernard-Horner syndrome resulting from pleural empyema

Síndrome de Claude Bernard-Horner associada ao empiema pleural

Fernando Luiz Westphal, Luiz Carlos de Lima, Arteiro Queiroz Menezes, Dirany Leite Sacramento e Silva

J Bras Pneumol.2006;32(2):176-179

Abstract PDF PT PDF EN Portuguese Text

Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude Bernard-Horner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

 


Keywords: Pleural empyema/complications; Horner syndrome/etiology; Blepharoptosis; Thoracotomy;

 


Hamman's syndrome

Síndrome de Hamman

João Filipe Alves Mesquita Rosinhas1,a, Sara Maria Castelo Branco Soares1,b, Adelina Branca Madeira Pereira2,c

J Bras Pneumol.2018;44(5):433-433

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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

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.

 


Swyer-James-MacLeod's syndrome

Síndrome de Swyer-James-MacLeod

Nelson Perelman Rosenberg, Daniel Augusto Pavan, Leandro Almeida Streher, Alessandro Comarú Pasqualotto

J Bras Pneumol.1999;25(1):57-60

Abstract PDF PT

The hyperlucent lung syndrome, first described by Swyer and James, is considered a post-infectious complication related to bronchiolitis in infancy. The authors report a case of Swyer-James-MacLeod syndrome which was diagnosed in an adult male, and make a brief review of pertinent literature.

 


Keywords: Swyer-James-MacLeod. Syndrome. Bronchiolitis. Lung disease.

 


Hemophagocytic syndrome due to pulmonary sarcoidosis

Síndrome hemofagocítica devido a sarcoidose pulmonar

Thiago Prudente Bártholo, José Gustavo Pugliese, Thiago Thomaz Mafort, Vinicius Lemos da Silva, Cláudia Henrique da Costa, Rogério Rufino

J Bras Pneumol.2012;38(5):667-671

Abstract PDF PT PDF EN Portuguese Text

Although hemophagocytic syndrome is a rare clinical condition, it is associated with high mortality and the number of cases described in the literature has progressively increased. The diagnosis of hemophagocytic syndrome is made on the basis of a finding of hemophagocytosis. Sarcoidosis is a highly prevalent disease whose course and prognosis might correlate with the initial clinical presentation and the extent of the disease. We report the case of a patient with long-standing sarcoidosis who presented with intermittent fever and fatigue. The diagnosis of hemophagocytic syndrome was made by bone marrow aspiration, and specific treatment was ineffective. This is the third case of sarcoidosis-related hemophagocytic syndrome reported in the literature and the first reported in Latin America. All three cases had unfavorable outcomes.

 


Keywords: Lymphohistiocytosis, hemophagocytic; Ferritins; Sarcoidosis, pulmonary; Macrophage activation syndrome.

 


Symptoms of obstructive sleep apnea-hypopnea syndrome in children

Sintomas da síndrome de apnéia-hipopnéia obstrutiva do sono em crianças

Paloma Baiardi Gregório, Rodrigo Abensur Athanazio, Almir Galvão Vieira Bitencourt, Flávia Branco Cerqueira Serra Neves, Regina Terse5, Francisco Hora

J Bras Pneumol.2008;34(6):356-361

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the symptoms most frequently found in children with a polysomnographic diagnosis of obstructive sleep apneahypopnea syndrome (OSAHS). Methods: We evaluated 38 children consecutively referred to the sleep laboratory with suspicion of OSAHS between June of 2003 and December of 2004. The patients were submitted to a pre-sleep questionnaire and to polysomnography. Results: The mean age was 7.8 ± 4 years (range, 2-15 years), and 50% of the children were male. Children without apnea accounted for 7.9% of the sample. The obstructive sleep apnea observed in the remainder was mild in 42.1%, moderate in 28.9% and severe in 22.1%. Severe cases of apnea were most common among children under the age of six (pre-school age). In children with OSAHS, the most common symptoms were snoring and nasal obstruction, which were observed in 74.3 and 72.7% of the children, respectively. Excessive sleepiness and bruxism were seen in 29.4 and 34.3%, respectively, and reflux disease was seen in only 3.1%. Restless legs and difficulty in falling asleep were identified in 65 and 33%, respectively. All of the children diagnosed with severe OSAHS also presented snoring and bruxism. Conclusions: Snoring and nasal obstruction were the most common symptoms found in our sample of children and adolescents with OSAHS. In addition, OSAHS severity was associated with being in the lower age bracket.

 


Keywords: Obstructive sleep apnea; Polysomnography; Pediatrics; Snoring.

 


Symptoms of dysphagia in patients with COPD

Sintomas indicativos de disfagia em portadores de DPOC

Rosane de Deus Chaves, Celso Ricardo Fernandes de Carvalho, Alberto Cukier, Rafael Stelmach, Claudia Regina Furquim de Andrade

J Bras Pneumol.2011;37(2):176-183

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify symptoms of dysphagia in individuals with COPD, based on their responses on a self-perception questionnaire. Methods: The study comprised 35 individuals with COPD and 35 healthy individuals, matched for age and gender. The study group was assessed regarding COPD severity; sensation of dyspnea; body mass index (BMI); and symptoms of dysphagia. The control group was assessed regarding BMI and symptoms of dysphagia. Results: The most common symptoms of dysphagia in the study group were pharyngeal symptoms/airway protection (p < 0.001); esophageal symptoms/history of pneumonia (p < 0.001); and nutritional symptoms (p < 0.001). Positive correlations were found between the following pairs of variables: FEV1 and BMI (r = 0.567; p < 0.001); pharyngeal symptoms/airway protection and dyspnea (r = 0.408; p = 0.015); and esophageal symptoms/history of pneumonia and pharyngeal symptoms/airway protection (r = 0.531; p = 0.001). There was a negative correlation between nutritional symptoms and BMI (r = −0.046; p < 0.008). Conclusions: Our results show that the individuals with COPD presented with symptoms of dysphagia that were associated with the pharyngeal and esophageal phases of swallowing, as well as with the mechanism of airway protection, a history of pneumonia, and nutritional symptoms.

 


Keywords: Deglutition disorders; Pulmonary disease, chronic obstructive; Pathological conditions, signs and symptoms.

 


Underdiagnosis of COPD at primary health care clinics in the city of Aparecida de Goiânia, Brazil

Subdiagnóstico de DPOC na atenção primária em Aparecida de Goiânia, Goiás

Maria Conceição de Castro Antonelli Monteiro de Queiroz, Maria Auxiliadora Carmo Moreira, Marcelo Fouad Rabahi

J Bras Pneumol.2012;38(6):692-699

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Objective: To estimate the prevalence of undiagnosed COPD among individuals with risk factors for the disease treated at primary health care clinics (PHCCs) in the city of Aparecida de Goiânia, Brazil. Methods: Inclusion criteria were being ≥ 40 years of age, having a > 20 pack-year history of smoking or a > 80 hour-year history of exposure to biomass smoke, and seeking medical attention at one of the selected PHCCs. All subjects included in the study underwent spirometry for the diagnosis of COPD. Results: We successfully evaluated 200 individuals, mostly males. The mean age was 65.9 ± 10.5 years. The diagnosis of COPD was confirmed in 63 individuals, only 18 of whom had been previously diagnosed with COPD (underdiagnosis rate, 71.4%). There were no significant differences between the subgroups with and without a previous diagnosis of COPD in relation to demographics and risk factors. However, there were significant differences between these subgroups for the presence of expectoration, wheezing, and dyspnea (p = 0.047; p = 0.005; and p = 0.047, respectively). The FEV1 and FEV1/FVC ratio, expressed as percentages of the predicted values, were significantly lower in the subjects with a previous diagnosis of COPD, which was predominantly mild or moderate in both subgroups. Conclusions: The rate of underdiagnosis of COPD was high at the PHCCs studied. One third of the patients with risk factors for COPD met the clinical and functional criteria for the disease. It seems that spirometry is underutilized at such facilities.

 


Keywords: Pulmonary disease, chronic obstructive/diagnosis; Primary health care; Spirometry.

 


The importance of appropriate reference values in patients suspected of having obstructive lung disease.

Suspeita de doença obstrutiva: importância dos valores de referência adequados.

Carlos Alberto de Castro Pereira1,a, Maria Raquel Soares1,b, Andréa Gimenez2,c

J Bras Pneumol.2019;45(6):e20190299-e20190299

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Smoking and changes in body weight: can physiopathology and genetics explain this association?

Tabagismo e variação ponderal: a fisiopatologia e genética podem explicar esta associação?

Raquel Chatkin, José Miguel Chatkin

J Bras Pneumol.2007;33(6):-

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Tobacco use is the leading preventable cause of death in most countries, including Brazil. Smoking cessation is an important strategy for reducing the morbidity and mortality associated with tobacco-related diseases. An inverse relationship between nicotine use and body weight has been reported, in which body weight tends to be lower among smokers than among nonsmokers. Smoking abstinence results in an increase in body weight for both males and females. On average, sustained quitters gain from 5 to 6 kg, although approximately 10% gain more than 10 kg. Pharmacological treatment for smoking cessation attenuates weight gain. The importance of smoking cessation as a contributing cause of the current obesity epidemic has been little studied. In the USA, the rate of obesity attributable to smoking cessation has been estimated at approximately 6.0% and 3.2% for males and females, respectively. Although the mechanisms are unclear, there is evidence that dopamine and serotonin are appetite suppressants. The administration of nicotine, regardless of the delivery system, acutely raises the levels of these neurotransmitters in the brain, reducing the need for energy intake and consequently suppressing appetite. In addition, nicotine has a direct effect on adipose tissue metabolism, influencing the rate of weight gain following smoking cessation. Leptin, ghrelin and neuropeptide Y are substances that might constitute factors involved in the inverse relationship between nicotine and body mass index, although their roles as determinants or consequences of this relationship have yet to be determined.

 


Keywords: Smoking; Body weight changes; Nicotine; Body mass index; Leptin; Peptide hormones/ghrelin.

 


Smoking among medical students: temporal trends and related variables

Tabagismo em estudantes de Medicina: tendências temporais e fatores associados

Ana Maria Baptista Menezes, Pedro Curi Hallal, Fernando Silva, Marcos Souza, Luciene Paiva, Aline D'Ávila, Bianca Weber, Viviane Vaz, Fernando Marques, Bernardo L. Horta

J Bras Pneumol.2004;30(3):223-228

Abstract PDF PT

Background: Although the prevalence of smoking among medical students declined steadily between the 1960s and 1980s, it seems to have stabilized in recent years. Objectives: To evaluate temporal trends, over the last 17 years, in the smoking habits of medical students at the Universidade Federal de Pelotas, in the state of Rio Grande do Sul, Brazil, and to identify some possible risk factors for smoking. Method: Cross-sectional surveys with comparable methodologies were conducted in 1986, 1991, 1996 and 2002. Self-administered questionnaires were used. Smokers were defined as those who were smoking at least one cigarette per day for at least one month. Descriptive analyses were carried out, as well as crude evaluations using chi-square tests for heterogeneity and linear trend. In addition, Poisson regression, adjusted for age, was used in order to evaluate the effect of medical school class year on the incidence of smoking. Results: The prevalence of smoking among UFPel medical students was 10.1%, statistically similar to values found in 1991 and 1996. No differences in smoking frequency were found relating to sex, age, or parental smoking. The prevalence of smoking was found to increase progressively over the course of medical school. Conclusions: The downward trend in smoking prevalence among UFPel medical students is being replaced by a stable rate of approximately 10-15%. Anti-smoking campaigns are still necessary in university environments, especially in medical schools.

 


Keywords: Smoking/trends. Smoking/epidemiology. Medical students/tobacco use cessation. Cross-sectional studies. Questionnaires.

 


Smoking in elderly patients admitted to long-term care facilities

Tabagismo em idosos internados em instituições de longa permanência

Anderson Albuquerque de Carvalho, Lucy Gomes, Altair Macedo Lahud Loureiro

J Bras Pneumol.2010;36(3):-

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Objective: To determine the prevalence of smoking among elderly patients admitted to long-term care facilities (LTCFs) and to determine whether the degree of nicotine dependence is associated with sociodemographic variables, affective ties, motivation for smoking cessation and depression. Methods: Cross-sectional, population-based study involving 573 individuals over the age of 60, admitted to 13 LTCFs in the Federal District of Brasília, Brazil. We analyzed the following variables: type of LTCF, gender, age, level of education, monthly income, marital status, retirement status, affective ties, probable depression, motivation for smoking cessation and degree of nicotine dependence. In order to collect these data, the following instruments were used: a sociodemographic questionnaire; the Flanagan Quality of Life Scale; the Mini-Mental State Examination; the Geriatric Depression Scale; the Richmond test; and the Fagerström Test for Nicotine Dependence. Results: The prevalence of smokers in the study sample (573 individuals) was 23.0%. Of the 132 smokers, there were 90 males (25.8%) and 42 females (18.7%). Of these, 116 smokers were included in the study, 70 of whom (60.3%) presented with probable depression. The degree of nicotine dependence was found to be significantly associated with level of education, monthly income, affective ties, motivation for smoking cessation and probable depression, although not with the type of LTCF, gender, age, retirement status or marital status. Conclusions: Among elderly patients admitted to LTCFs in the Federal District of Brasília, the prevalence of smoking is high and the motivation for smoking cessation is low.

 


Keywords: Smoking; Homes for the aged; Health services for the aged.

 


Smoking among inpatients at a university hospital

Tabagismo em pacientes internados em um hospital universitário

Ângela Santos Ferreira, Antonio Carlos Ferreira Campos, Isabela Pereira Arraes dos Santos, Mariana Roque Beserra, Eduardo Nani Silva, Vilma Aparecida da Silva Fonseca

J Bras Pneumol.2011;37(4):488-494

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Objective: To determine the prevalence and characteristics of smoking among inpatients at a university hospital, as well as to evaluate their motivation, interest, and need for help in quitting smoking. Methods: A prospective study involving inpatients treated between May of 2008 and April of 2009 on the cardiovascular disease wards at the Antonio Pedro University Hospital, located in the city of Niterói, Brazil. All inpatients were asked to complete a questionnaire designed to collect data regarding demographics, reasons for admission, and smoking status. The smokers also responded to additional questions regarding their smoking habits. The level of nicotine dependence was determined with the Fagerström Test for Nicotine Dependence. Results: Of the 136 inpatients who participated in the study, 68 (50.0%) were male. The mean age was 60.7 years. The prevalence of smoking was 13.2%. Among the 49 patients with coronary disease, 36 (73.5%) were smokers or former smokers. The majority of the patients presented with a high level of nicotine dependence and reported withdrawal symptoms during hospitalization. Although most smokers were motivated to quit smoking, they admitted that they needed help to do so. Conclusions: Because smoking is forbidden in the hospital environment and most inpatients who smoke are highly motivated to quit, health professionals should view the hospitalization period as an opportunity to promote smoking cessation.

 


Keywords: Smoking; Inpatients; Smoking cessation.

 


Self-reported smoking status and urinary cotinine levels in patients with asthma

Tabagismo entre asmáticos: avaliação por autorrelato e dosagem de cotinina urinária

Gabriela Pimentel Pinheiro1,2,a, Carolina de Souza-Machado1,3,b, Andréia Guedes Oliva Fernandes4,c, Raquel Cristina Lins Mota5,d, Liranei Limoeiro Lima2,e, Diego da Silva Vasconcellos6,f, Ives Pereira da Luz Júnior7,g, Yvonbergues Ramon dos Santos Silva7,h, Valmar Bião Lima1,4,i, Sérgio Telles de Oliva8,j, Luane Marques de Mello9,k, Ricardo David Couto10,l, José Miguel Chatkin11,m, Constança Margarida Sampaio Cruz12,13,n, Álvaro Augusto Cruz1,14,o

J Bras Pneumol.2018;44(6):477-485

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Objective: To determine the frequency of active smoking among patients with asthma and individuals without asthma by self-report and urinary cotinine measurement. Methods: This was a cross-sectional study conducted in the city of Salvador, Brazil, and involving 1,341 individuals: 498 patients with severe asthma, 417 patients with mild-to-moderate asthma, and 426 individuals without asthma. Smoking status was determined by self-report (with the use of standardized questionnaires) and urinary cotinine measurement. The study variables were compared with the chi-square test and the Kruskal-Wallis test. Results: Of the sample as a whole, 55 (4.1%) reported being current smokers. Of those, 5 had severe asthma, 17 had mild-to-moderate asthma, and 33 had no asthma diagnosis. Of the 55 smokers, 32 (58.2%) were daily smokers and 23 (41.8%) were occasional smokers. Urinary cotinine levels were found to be high in self-reported nonsmokers and former smokers, especially among severe asthma patients, a finding that suggests patient nondisclosure of smoking status. Among smokers, a longer smoking history was found in patients with severe asthma when compared with those with mild-to-moderate asthma. In addition, the proportion of former smokers was higher among patients with severe asthma than among those with mild-to-moderate asthma. Conclusions: Former smoking is associated with severe asthma. Current smoking is observed in patients with severe asthma, and patient nondisclosure of smoking status occurs in some cases. Patients with severe asthma should be thoroughly screened for smoking, and findings should be complemented by objective testing.

 


Keywords: Asthma; Smoking; Cotinine.

 


Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change

Tabagismo entre pacientes internados em um hospital universitário no sul do Brasil: prevalência, grau de dependência e estágio motivacional

Rafael Balsini Barreto, Mariângela Pimental Pincelli, Rafael Steinwandter, André Pacheco Silva, Jóice Manes, Leila John Marques Steidle

J Bras Pneumol.2012;38(1):72-80

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Objective: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. Methods: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. Results: We interviewed 235 patients: 44 (18.7%) were smokers; 77 (32.8%) were former smokers; 114 (48.5%) were nonsmokers; and 109 (46.7%) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9%) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9%) smoked up to 20 cigarettes/day; 20 (45.4%) had a high or very high degree of nicotine dependence; 32 (72.7%) had already tried to quit smoking; 39 (88.7%) would like to quit smoking; 32 (72.7%) would accept smoking cessation treatment; 13 (29.5%) smoked during hospitalization; and 13 (29.5%) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8% to 54.8%). Conclusions: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.

 


Keywords: Smoking/epidemiology; Hospitalization; Smoking cessation.

 


Trends in asthma mortality in the 0- to 4-year and 5- to 34-year age groups in Brazil

Tendências da mortalidade da asma nas faixas etárias de 0 a 4 anos e 5 a 34 anos no Brasil

Gustavo Silveira Graudenz1,2, Dominique Piacenti Carneiro1, Rodolfo de Paula Vieira1

J Bras Pneumol.2017;43(1):24-31

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Objective: To provide an update on trends in asthma mortality in Brazil for two age groups: 0-4 years and 5-34 years. Methods: Data on mortality from asthma, as defined in the International Classification of Diseases, were obtained for the 1980-2014 period from the Mortality Database maintained by the Information Technology Department of the Brazilian Unified Health Care System. To analyze time trends in standardized asthma mortality rates, we conducted an ecological time-series study, using regression models for the 0- to 4-year and 5- to 34-year age groups. Results: There was a linear trend toward a decrease in asthma mortality in both age groups, whereas there was a third-order polynomial fit in the general population. Conclusions: Although asthma mortality showed a consistent, linear decrease in individuals ≤ 34 years of age, the rate of decline was greater in the 0- to 4-year age group. The 5- to 34-year group also showed a linear decline in mortality, and the rate of that decline increased after the year 2004, when treatment with inhaled corticosteroids became more widely available. The linear decrease in asthma mortality found in both age groups contrasts with the nonlinear trend observed in the general population of Brazil. The introduction of inhaled corticosteroid use through public policies to control asthma coincided with a significant decrease in asthma mortality rates in both subsets of individuals over 5 years of age. The causes of this decline in asthma-related mortality in younger age groups continue to constitute a matter of debate.

 


Keywords: Asthma/epidemiology; Asthma/mortality; Asthma/drug therapy.

 


Inhalation therapy in mechanical ventilation

Terapia inalatória em ventilação mecânica

Ângelo Roncalli Miranda Rocha1,2,3, Caio Henrique Veloso da Costa1

J Bras Pneumol.2016;42(3):235-235

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Mediastinal teratoma with malignant degeneration

Teratoma de mediastino com degeneração maligna

Fabiano Alves Squeff, Eduardo Salvador Gerace, Roberto Saad Júnior, Márcio Botter, Roberto Gonçalves, Juliana Fracalossi Paes

J Bras Pneumol.2008;34(8):631-634

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Here, we report the case of a patient with a slowly-progressing anterior mediastinal teratoma submitted to surgical resection. The anatomopathological examination of the sample revealed malignant degeneration to carcinoid tumor. Such evolution is very rare, and we have found only three related studies in the literature. We describe the clinicopathological features of the tumor and discuss the treatment administered. The evolution was satisfactory, and the patient was submitted to oncological treatment.

 


Keywords: Mediastinal neoplasms; Teratoma; Carcinoid tumor; Mediastinum/surgery.

 


Mediastinal teratoma mimicking pleural effusion on chest X-rays

Teratoma do mediastino simulando derrame pleural no estudo radiológico do tórax

Miguel Angelo Martins de Castro Júnior, Nelson Perelman Rosemberg, Miguel Angelo Martins de Castro, Angela Potter de Castro, Cacio Wietzycoscki, Cleiton Mespaque

J Bras Pneumol.2007;33(1):113-115

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Teratomas account for 8-13% of all mediastinal tumors. A 27-year-old patient presented with chest pain and dyspnea of prolonged evolution. A chest X-ray revealed near total opacification of the right hemithorax. On a tomography scan of the chest, a collection of heterogeneous fluid, with irregular borders and 10.1 x 11.7 cm in size, was seen in the pleura of the lower two-thirds of the right hemithorax but was not encroaching on any of the adjacent structures. Based on the hypothesis that these findings represented a benign mediastinal teratoma, an exploratory thoracotomy was performed, during which such a teratoma was found and completely excised. The post-operative evolution was favorable. The atypical presentation and considerable growth of the tumor hindered the pre-operative diagnosis.

 


Keywords: Teratoma; Mediastinal neoplasms; Pleural effusion; Radiography thoracic

 


Six-minute walk test: reference values for healthy adults in Brazil

Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil

Maria Raquel Soares, Carlos Alberto de Castro Pereira

J Bras Pneumol.2011;37(5):576-583

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Objective: To develop regression equations for six-minute walk distance (6MWD) in healthy adults (20-80 years of age) in Brazil. Methods: We included 132 volunteers (66 males) without respiratory disease, cardiac disease, or comorbidities that affect ambulation. The volunteers completed three six-minute walk tests. Prior to and at the end of each test, we obtained SpO2 and maximal HR, as well as the Borg scale scores for sensation of dyspnea and lower limb fatigue. The data included in the final analysis were derived from the test with the greatest 6MWD. Results: The mean 6MWD values were 566 ± 87 m and 538 ± 95 m in males and females, respectively (p = 0.08). The 6MWD was greater in taller individuals and decreased in parallel with increases in age or body index mass (BMI). The best adjusted model was the quadratic model. We derived the following equation (valid for both genders): 6MWD = 511 + stature2 (cm) × 0.0066 − age2 × 0.030 − BMI2 × 0.068. This equation explained 55% of the variance in 6MWD. Conclusions: Reference values explaining a high proportion of the variance were derived by a quadratic regression model in healthy adults (of a wide range of ages) in Brazil. Keywords: Reference values; Exercise test; Walking.

 


Keywords: Reference values; Exercise test; Walking.

 


Negative expiratory pressure test: a new, simple method to identify patients at risk for obstructive sleep apnea

Teste de pressão negativa expiratória: um novo método simples para identificar pacientes com risco para apneia obstrutiva do sono

Luis Vicente Franco de Oliveira, Salvatore Romano, Raquel Pastréllo Hirata, Newton Santos de Faria Júnior, Lílian Chrystiane Giannasi, Sergio Roberto Nacif, Fernando Sergio Studart Leitão Filho, Giuseppe Insalaco

J Bras Pneumol.2011;37(5):659-663

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The objective of this article was to describe a new method for assessing expiratory flow limitation during spontaneous breathing, using the negative expiratory pressure test to identify patients at risk for obstructive sleep apnea. Upper airway collapsibility is evaluated by measuring decreases in flow and in expired volume in the first 0.2 seconds after negative expiratory pressure application at 10 cmH2O. The negative expiratory pressure test is easily applied and could be adopted for the evaluation of expiratory flow limitation caused by upper airway obstruction in patients with obstructive sleep apnea.

 


Keywords: Sleep apnea, obstructive/diagnosis; Sleep apnea, obstructive/prevention and control; Airway resistance.

 


Rapid molecular test for tuberculosis: impact of its routine use at a referral hospital

Teste rápido molecular para tuberculose: avaliação do impacto de seu uso na rotina em um hospital de referência

Marilda Casela1,a, Silvânia Maria Andrade Cerqueira1,b, Thais de Oliveira Casela2,c, Mariana Araújo Pereira3,d, Samanta Queiroz dos Santos3,e, Franco Andres Del Pozo4,f, Songeli Menezes Freire3,g, Eliana Dias Matos5,h

J Bras Pneumol.2018;44(2):112-117

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Objective: To evaluate the impact of the use of the molecular test for Mycobacterium tuberculosis and its resistance to rifampin (Xpert MTB/RIF), under routine conditions, at a referral hospital in the Brazilian state of Bahia. Methods: This was a descriptive study using the database of the Mycobacteriology Laboratory of the Octávio Mangabeira Specialized Hospital, in the city of Salvador, and georeferencing software. We evaluated 3,877 sputum samples collected from symptomatic respiratory patients, under routine conditions, between June of 2014 and March of 2015. All of the samples were submitted to sputum smear microscopy and the Xpert MTB/RIF test. Patients were stratified by gender, age, and geolocation. Results: Among the 3,877 sputum samples evaluated, the Xpert MTB/RIF test detected M. tuberculosis in 678 (17.5%), of which 60 (8.8%) showed resistance to rifampin. The Xpert MTB/RIF test detected M. tuberculosis in 254 patients who tested negative for sputum smear microscopy, thus increasing the diagnostic power by 59.9%. Conclusions: The use of the Xpert MTB/RIF test, under routine conditions, significantly increased the detection of cases of tuberculosis among sputum smear-negative patients.

 


Keywords: Tuberculosis/diagnosis; Molecular diagnostic techniques; Sputum.

 


Tuberculin skin test: operational research in the state of Mato Grosso do Sul, Brazil

Teste tuberculínico: pesquisa operacional no Mato Grosso do Sul

Sandra Maria do Valle Leone de Oliveira, Antônio Ruffino-Netto, Anamaria Mello Miranda Paniago, Olcinei Alves de Oliveira, Marli Marques, Rivaldo Venâncio da Cunha, Renato Andreotti

J Bras Pneumol.2011;37(5):646-654

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Objective: To investigate operational aspects of tuberculin skin test (TST) use in tuberculosis control programs and at specialized Brazilian National Sexually Transmitted Diseases/AIDS and Viral Hepatitis Program health care clinics in priority municipalities for tuberculosis control in the state of Mato Grosso do Sul, Brazil. Methods: This was a descriptive, cross-sectional, epidemiological survey. Data on qualifications/training of professionals administering TSTs, timing of the TST, procedures in cases of loss to follow-up (reading), material availability, and material storage were collected through interviews and technical visits. For the 2008-2009 period, we determined the numbers of screenings in vulnerable populations, of TSTs performed, and of patients treated for latent tuberculosis. Results: We interviewed 12 program managers in six municipalities. Some programs/clinics did not perform TSTs. Nursing teams administered the TSTs, results were read by non-specialists, and specialization/refresher courses were scarce. The PPD RT23 was stored in 5-mL flasks under appropriate conditions. Insulin syringes were commonly used. Testing was available during business hours, three times a week. In cases of loss to follow-up, telephone calls or home visits were made. Of the 2,305 TSTs evaluated, 1,053 (46%) were performed in indigenous populations; 831 (36%) were screenings in prisons, performed for training; and only 421 (18%) involved contacts of tuberculosis patients or vulnerable populations. Four vulnerable patients and 126 indigenous subjects were treated for latent tuberculosis. Conclusions: These priority municipalities showed operational difficulties regarding human resources, materials, and data records.

 


Keywords: Tuberculin test; Health services research; HIV; Latent tuberculosis; Chemoprevention.

 


18F-fluorodeoxyglucose positron emission tomography as a noninvasive method for the diagnosis of primary pulmonary artery sarcoma

Tomografia por emissão de pósitrons com 18F fluordesoxiglicose como exame não invasivo para o diagnóstico de sarcomas primários de artéria pulmonar

Olívia Meira Dias, Elisa Maria Siqueira Lombardi, Mauro Canzian, José Soares Júnior, Lucas de Oliveira Vieira, Mário Terra Filho

J Bras Pneumol.2011;37(6):817-822

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Pulmonary artery sarcomas are rare, difficult-to-diagnose tumors that frequently mimic chronic pulmonary thromboembolism. We report the cases of two female patients with clinical signs of dyspnea and lung masses associated with pulmonary artery filling defects on chest CT angiography. We performed 18F-fluorodeoxyglucose positron emission tomography, which revealed increased radiotracer uptake in those lesions. Pulmonary artery sarcoma was subsequently confirmed by anatomopathological examination. We emphasize the importance of this type of tomography as a noninvasive method for the diagnosis of these tumors.

 


Keywords: Positron-emission tomography; Pulmonary artery; Pulmonary embolism; Leiomyosarcoma; Histiocytoma, malignant fibrous.

 


Trauma-related thoracoplasty: case report

Toracoplastia traumática: relato de caso

Gabriela Addor, Andreia Salarini Monteiro, David Henrique Nigri, Luiz Felippe Judice, Rui Haddad, Carlos Alberto de Barros Franco

J Bras Pneumol.2007;33(3):351-354

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Trauma primarily affects young people and is the leading cause of death in the first three decades of life. Flail chest is observed in approximately 10% of all patients with severe chest trauma, and the mortality rate among such patients is 10-15%. We report herein the case of a car accident victim with chest trauma causing hemopneumothorax and multiple rib fractures, intense pain and deformity of the chest wall. Surgical stabilization was performed, with good results. Therapeutic options are also discussed.

 


Keywords: Thoracic injuries; Flail chest; Thoracoplasty.

 


Translating patient-reported outcome measures: a multi-step process is essential

Tradução de medidas de resultados relatados pelo paciente: um processo composto de várias etapas é essencial

Catherine Acquadro, Ana Bayles, Elizabeth Juniper

J Bras Pneumol.2014;40(3):211-212

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Translation of the quality-of-life measure for adults with primary ciliary dyskinesia and its application in patients in Brazil

Tradução do questionário de qualidade de vida para pacientes adultos com discinesia ciliar primária no Brasil

Ana Paula Lima de Queiroz1,a, Rodrigo Abensur Athanazio2,b, Mary Anne Kowal Olm3,c, Bruna Rubbo4,5,d, Yuri Reis Casal1,e, Jane Lucas4,5,f, Laura Behan4,5,6,g

J Bras Pneumol.2019;45(3):e20170358-e20170358

Abstract PDF PT