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ABSTRACT Objective: Silicosis is a pneumoconiosis characterized by fibrosis of the lung parenchyma caused by inhalation of silica particles. Genetic factors might play a role in the severity silicosis. We sought to evaluate the influence of polymorphisms in the ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1, and TNF genes on the severity of silicosis. Methods: Nine polymorphisms were genotyped by PCR in a sample of 143 patients with silicosis in the state of Rio de Janeiro, Brazil. Results: Fifty-seven patients (40%) were classified as having simple silicosis and 86 (60%) were classified as having complicated silicosis. The TT genotype of rs1800469 in the TGFB1 gene showed a protective effect for complicated silicosis (OR = 0.35; 95% CI, 0.14-0.92; p = 0.028) when compared with the other two genotypes (CC+CT). The polymorphic T allele of rs763110 in the FASLG gene (OR = 0.56; 95% CI, 0.31-0.99; p = 0.047), as well as a dominant model for the T allele (TT+CT: OR = 0.37; 95% CI, 0.15-0.96; p = 0.037), also showed a protective effect. When patients with simple silicosis despite having been exposed to silica for a longer time (> 44,229 hours) were compared with patients with complicated silicosis despite having been exposed to silica for a shorter time, the T allele of rs763110 in the FASLG gene (OR = 0.20; 95% CI, 0.08-0.48; p < 0.0001), as well as dominant and recessive models (OR = 0.06; 95% CI, 0.00-0.49; p = 0.01 and OR = 0.22; 95% CI, 0.06-0.77; p = 0.014, respectively), showed a protective effect against the severity of silicosis. Conclusions: It appears that rs1800469 polymorphisms in the TGFB1 gene and rs763110 polymorphisms in the FASLG gene are involved in the severity of silicosis. Given the lack of studies relating genetic polymorphisms to the severity of silicosis, these results should be replicated in other populations.
RESUMO Objetivo: A silicose é uma pneumoconiose caracterizada por fibrose do parênquima pulmonar causada por inalação de partículas de sílica. Fatores genéticos podem desempenhar um papel na gravidade da silicose. Nosso objetivo foi avaliar a influência de polimorfismos dos genes ACE, FAS, FASLG, NOS2, IL1RN, FAM13A, TGFB1 e TNF na gravidade da silicose. Métodos: Nove polimorfismos foram genotipados por meio de PCR em uma amostra composta por 143 pacientes com silicose no estado do Rio de Janeiro, Brasil. Resultados: A silicose foi classificada em simples em 57 (40%) dos pacientes e em complicada, em 86 (60%). O genótipo TT do polimorfismo rs1800469 do gene TGFB1 teve efeito protetor contra a silicose complicada (OR = 0,35; IC95%: 0,14-0,92; p = 0,028) em comparação com os outros dois genótipos (CC+CT). O alelo T polimórfico do polimorfismo rs763110 do gene FASLG (OR = 0,56; IC95%: 0,31-0,99; p = 0,047) e um modelo dominante do alelo T (TT+CT: OR = 0,37; IC95%: 0,15-0,96; p = 0,037) também tiveram efeito protetor. Quando se compararam os pacientes que tinham silicose simples com um tempo maior de exposição à sílica (> 44.229 horas) àqueles que tinham silicose complicada com um tempo menor de exposição à sílica, o alelo T do polimorfismo rs763110 do gene FASLG (OR = 0,20; IC95%: 0,08-0,48; p < 0,0001) e modelos dominantes e recessivos (OR = 0,06; IC95%: 0,00-0,49; p = 0,01 e OR = 0,22; IC95%: 0,06-0,77; p = 0,014, respectivamente) tiveram efeito protetor contra a gravidade da silicose. Conclusões: Polimorfismos rs1800469 do gene TGFB1 e polimorfismos rs763110 do gene FASLG parecem estar envolvidos na gravidade da silicose. Como há poucos estudos que tenham estabelecido relações entre polimorfismos genéticos e a gravidade da silicose, esses resultados devem ser replicados em outras populações.
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SUMMARY OBJECTIVE: This study aims to analyze the risk factors for in-hospital mortality in a cohort of patients admitted to a newly adapted intensive care unit in a public hospital in Rio de Janeiro. METHODS: This was an observational, retrospective, and descriptive study. Data were obtained from electronic medical records. Coronavirus disease 2019 (COVID-19) was diagnosed by detecting viral ribonucleic acid using reverse transcription polymerase chain reaction. Factors associated with the risk/protection from death were determined using the odds ratio and adjusted odds ratio. RESULTS: Fifty-one patients were admitted to the hospital. The median age of the patients was 63 years, 60% were male patients, and 54% were white patients. Sixty-seven percent of the patients were diagnosed with COVID-19. Sepsis at admission increased the chance of in-hospital death by 21 times (adjusted odds ratio=21.06 [0.79-555.2]; p=0.06). The strongest risk factor for death was the development of septic shock during hospitalization (adjusted odds ratio=98.56 [2.75-352.5]; p=0.01), and one in four patients had multidrug-resistant bacteria. Mechanical ventilation, vasopressors, neuromuscular blockers, and sedatives were also the risk factors for in-hospital mortality. The in-hospital mortality rate was 41%, and the mortality rate of patients on mechanical ventilation was 60%. The diagnosis of COVID-19 was not statistically related to the adverse outcomes. CONCLUSIONS: In this cohort, the strongest risk factor for in-hospital death was the development of nosocomial septic shock. Healthcare-associated infections have a significant impact on mortality rates. Therefore, to have a better outcome, it is important to consider not only the availability of beds but also the way healthcare is delivered.
Subject(s)
Humans , Male , Cross Infection , COVID-19 , Brazil/epidemiology , Retrospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , Delivery of Health Care , SARS-CoV-2 , Hospitalization , Hospitals, Public , Intensive Care Units , Middle AgedABSTRACT
ABSTRACT Objective: This study aimed to compare the effectiveness of two cognitive behavioral therapy-based smoking cessation interventions initiated during hospitalization and to evaluate the factors related to relapse after discharge. Methods: This was a prospective randomized study involving 90 smokers hospitalized in a university hospital. We collected data related to sociodemographic characteristics, reasons for admission, smoking-related diseases, smoking history, the degree of nicotine dependence (ND), and the level of craving. Patients were divided into two treatment groups: brief intervention (BrInter, n = 45); and intensive intervention with presentation of an educational video (InInterV, n=45). To assess relapse, all patients were assessed by telephone interview in the first, third, and sixth months after discharge. Abstinence was confirmed by measurement of exhaled carbon monoxide (eCO). Results: Of the 90 patients evaluated, 55 (61.1%) were male. The mean age was 51.1 ± 12.2 years. The degree of ND was elevated in 39 (43.4%), and withdrawal symptoms were present in 53 (58.9%). The mean eCO at baseline was 4.8 ± 4.5 ppm. The eCO correlated positively with the degree of ND (r = 0.244; p = 0.02) and negatively with the number of smoke-free days (r = −0.284; p = 0.006). There were no differences between the groups in terms of the variables related to socioeconomic status, smoking history, or hospitalization. Of the 81 patients evaluated at 6 months, 33 (40.7%) remained abstinent (9 and 24 BrInter and InInterV group patients, respectively; p = 0.001), and 48 (59.3%) had relapsed (31 and 17 BrInter and InInterV group patients, respectively; p= 0.001). Moderate or intense craving was a significant independent risk factor for relapse, with a relative risk of 4.0 (95% CI: 1.5-10.7; p < 0.00001). Conclusions: The inclusion of an educational video proved effective in reducing relapse rates. Craving is a significant risk factor for relapse.
RESUMO Objetivo: Comparar a eficácia de duas intervenções de cessação de tabagismo baseadas na terapia cognitivo-comportamental em pacientes internados e avaliar os fatores relacionados à recaída após a alta hospitalar. Métodos: Estudo prospectivo, randomizado, com 90 tabagistas internados em um hospital universitário. Foram coletados dados relacionados a características sociodemográficas, motivo da internação, doenças relacionadas ao tabagismo, carga tabágica, grau de dependência de nicotina (DN) e grau de fissura. Os pacientes foram distribuídos em dois grupos de tratamento: intervenção breve (InB; n = 45) e intervenção intensiva com apresentação de um vídeo educativo (InIV; n = 45). Para avaliar recaídas, todos os pacientes foram entrevistados por contato telefônico no primeiro, terceiro e sexto mês após a alta. A abstinência foi confirmada pela medida de monóxido de carbono no ar expirado (COex). Resultados: Dos 90 pacientes avaliados, 55 (61,1%) eram homens. A média de idade foi de 51,1 ± 12,2 anos. O grau de DN foi elevado em 39 (43,4%), e sintomas de abstinência estavam presentes em 53 (58,9%). A média de COex inicial foi de 4,8 ± 4,5 ppm. O COex se correlacionou positivamente com o grau de DN (r = 0,244; p = 0,02) e negativamente com o número de dias sem fumar (r = −0,284; p = 0,006). Não houve diferenças entre os grupos quanto a variáveis relacionadas com nível socioeconômico, carga tabágica ou internação. Dos 81 pacientes avaliados após 6 meses de segmento, 33 (40,7%) continuaram abstinentes (9 e 24 nos grupos InB e InIV, respectivamente; p = 0,001) e 48 (59,3%) recaíram (31 e 17 nos grupos InB e InIV, respectivamente; p = 0,001). O grau de fissura (moderado ou intenso) foi um fator de risco independente significativo para a recaída, com um risco relativo de 4,0 (IC95%: 1,5-10,7; p < 0,00001). Conclusões: A inclusão de um vídeo educativo provou ser eficaz na redução das taxas de recaída. O grau de fissura foi um fator de risco significativo para a recaída.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Cognitive Behavioral Therapy/methods , Smoking Cessation/methods , Smoking Prevention/methods , Inpatients/psychology , Patient Discharge , Recurrence , Socioeconomic Factors , Substance Withdrawal Syndrome , Time Factors , Logistic Models , Surveys and Questionnaires , Reproducibility of Results , ROC Curve , Smoking Cessation/psychology , Statistics, Nonparametric , Kaplan-Meier Estimate , HospitalizationABSTRACT
Discinesia ciliar primária é uma doença autossômica recessiva, que se caracteriza por infecções de repetição do trato respiratório, otite média, rinossinusite e bronquiectasias, associadas a situs inversus na metade dos casos. Os autores apresentam caso de um paciente do sexo masculino, de 20 anos de idade, com quadro de infecções de repetição e bronquiectasias bilaterais, cujo diagnóstico foi confirmado por biópsia brônquica com auxílio de microscopia eletrônica, que revelou ausência dos braços de dineína nos microtúbulos, prejudicando a função ciliar. O paciente permanece em tratamento clínico.
Primary ciliary dyskinesia is an autosomal recessive disorder characterized by a history of recurrent upper and lower respiratory tract infections with chronic otitis media, bronchitis and rhinosinusitis, associated with situs inversus in 50% of cases. Theautors present a case of a young man with 20 years old with the clinic of recurrent infection and bilateral bronchiectasis. The diagnosis was established by study with electronic microscopy of bronchial musosis, reveled abnormal ciliary ultrastructurein association with abnormal ciliary motility. The patient maintains clinical treatment.