ABSTRACT
The present cross-sectional, population-based study was designed to evaluate the performance of the FEV1/FEV6 ratio for the detection of airway-obstructed subjects compared to the FEV1/FVC <0.70 fixed ratio test, as well as the lower limit of normality (LLN) for 1000 subjects ³40 years of age in the metropolitan area of São Paulo, SP, Brazil. After the exclusion of 37 (3.7 percent) spirometries, a total of 963 pre-bronchodilator (BD) and 918 post-BD curves were constructed. The majority of the post-BD curves (93.1 percent) were of very good quality and achieved grade A (762 curves) or B (93 curves). The FEV1/FEV6 and FEV1/FVC ratios were highly correlated (r² = 0.92, P < 0.000). Two receiver operator characteristic curves were constructed in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction: equal to 70 (area under the curve = 0.98, P < 0.0001) and the LLN (area under the curve = 0.97, P < 0.0001), in the post-BD curves. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, both using a fixed cut-off point or below the LLN as reference. The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.
Subject(s)
Adult , Humans , Middle Aged , Airway Obstruction/diagnosis , Forced Expiratory Volume , Vital Capacity , Epidemiologic Methods , Surveys and Questionnaires , Spirometry/methodsABSTRACT
Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including São Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of São Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8 percent) met the diagnostic criterion for COPD. However, 126 individuals (87.5 percent) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8 percent) and showed better lung function with greater FEV1 (86.8 ± 20.8 vs 68.5 ± 23.6 percent predicted) and FVC (106.6 ± 22.4 vs 92.0 ± 24.1 percent predicted). Among the COPD patients, only 57.3 percent were advised to stop smoking and 30.6 percent received the influenza vaccine. In addition, 82.3 percent did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.
Subject(s)
Female , Humans , Male , Middle Aged , Health Surveys , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , Brazil/epidemiology , Interviews as Topic , Pulmonary Disease, Chronic Obstructive/epidemiology , Risk Factors , Spirometry , Surveys and Questionnaires , Urban PopulationABSTRACT
Os autores descrevem, de maneira objetiva, os recentes avancos obtidos no terreno das manifestacoes neuromusculares presentes nas afeccoes endocrinas, quer em seus aspectos etiopatogenicos e fisiopatologicos, quer em relacao ao quadro clinico e as medidas terapeuticas preconizadas. Ressaltam finalmente, que o perfeito reconhecimento do conjunto de sinais e sintomas neurologicos e musculares permitira o correto diagnostico de endocrinopatia e possibilitara a formulacao do esquema terapeutico necessario a recuperacao adequada do paciente
Subject(s)
Humans , Endocrine System Diseases , Neuromuscular DiseasesABSTRACT
Sao relatados dois casos de mielopatia transversa subaguda associada a tumores malignos. O primeiro paciente apresentava neoplasia de celulas reticulares histiocitarias e o segundo, carcinoma renal.Os autores fazem revisao dos casos similares descritos na literatura. As alteracoes anatomo-patologicas medulares encontradas foram semelhantes as descritas nos relatos previos, sendo que no primeiro caso havia tambem intenso infiltrado inflamatorio perivascular e a presenca de astrocitos bizarros. Tais alteracoes encontradas sugerem ser esta afeccao de natureza viral
Subject(s)
Middle Aged , Humans , Male , Spinal Cord Diseases , Kidney Neoplasms , Lymphatic Diseases , Spinal Cord NeoplasmsABSTRACT
Foram feitos estudos neuropatologicos em dois casos de pacientes que apresentaram encefalopatia mioclonica pos-anoxica (sindrome de Lance-Adams). O encefalo mostrou lesoes neuronais difusas, comprometendo principalmente o cortice, talamo e estruturas sub-talamicas, desde lesoes discretas caracterizadas pela presenca de vacuolos intracitoplasmaticos (primeira alteracao vista na anoxia) ate neuronios totalmente degenerados, notando-se varios neuronios com lesoes classicas de isquemia. A presenca de material de inclusao anfofilica discretamente PAS positiva observado no citoplasma neuronal foi diferente das inclusoes verificadas nos casos de epilepsia mioclonica com corpusculos de Lafora.Nao conseguimos identificar a constituicao destas inclusoes, apesar de serem feitos diferentes metodos de coloracao. Nao encontramos tambem, na literatura, referencia a tal tipo de inclusao. Foram tambem encontradas alteracoes vasculares, consistindo de vasos proliferados com celulas endoteliais tumefeitas. Tais celulas apresentaram-se com disposicao anarquica, provavelmente devidas a anoxia isquemica.A diferenca dos achados anatomopatologicos, entre os casos 1 e 2,sao provavelmente decorrentes do mecanismo diverso da instalacao da anoxia
Subject(s)
Hypoxia, Brain , Myoclonus , NeuronsSubject(s)
Child, Preschool , Child , Adolescent , Adult , Humans , Male , Female , Anticonvulsants , Epilepsies, PartialABSTRACT
Apos situarem essa especialidade dentro da oftalmologia geral, os autores destacam que e na infortunistica que encontram a maioria das causas de problemas oculares. Acrescentam que no Brasil inexistem referencias de lesoes oculares nos ambientes de trabalho. Porem pesquisas externas confirmam que os acidentes oculares ocupacionais ocupam significativa parcela no computo geral de acidentes. A par dessa constatacao, ressaltam a importancia de se continuar estimulando a prevencao de acidentes