Avaliação do perfil nutricional em pacientes portadores de fibrose cística de acordo com faixa etária / Evaluation of nutritional status in patients with cystic fibrosis according to age group

RESUMO Objetivo: Avaliar o perfil nutricional da população atendida em centro de referência em fibrose cística. Métodos: Estudo transversal incluindo pacientes com fibrose cística de um centro pediátrico de referência de São Paulo, em 2014. Todos os sujeitos que concordaram em participar do estudo foram incluídos. Foi aplicado um questionário sobre hábitos alimentares (recordatório de 24 horas) e características socioeconômicas. Dados antropométricos (comparados com referencial da Organização Mundial da Saúde de 2006 e 2007) e função pulmonar foram coletados do prontuário. Os integrantes da pesquisa foram estratificados em faixas etárias para análise estatística. Resultados: Dos 101 pacientes incluídos no estudo, 59,4% eram masculinos, sendo a maioria caucasiana (86,4%), com mediana de idade de 10 anos. A maioria dos pacientes (n=77, 75%) foi classificada como eutrófica, mas valores menores de escore Z de índice de massa corpórea (IMC) foram observados em escolares e adolescentes. A proporção de pacientes com peso abaixo do esperado foi de 10% (n=2) na faixa etária pré-escolar e de 35% (n=6) em escolares. O consumo alimentar mostrou-se adequado, e somente dois suplementos (triglicérides de cadeia média e suplemento em pó completo) tiveram utilização ligada à adequação da ingesta de macronutrientes. Características socioeconômicas não apresentaram associação com o estado nutricional ou com o consumo nutricional. Valores de função pulmonar não apontaram diferença significante em adolescentes nem em indivíduos com pior estado nutricional no grupo estudado. Conclusões: A maioria dos pacientes apresentou estado nutricional e consumo alimentar adequados, indicando bom manejo das ações nutricionais. Novos estudos com foco em pré-escolares devem ser realizados para avaliar se é possível reduzir o risco nutricional de pacientes com fibrose cística em idades posteriores.

ABSTRACT Objective: To evaluate the nutritional profile of the population assisted at a reference center for cystic fibrosis treatment. Methods: Cross-sectional study including patients with cystic fibrosis assisted at a pediatric reference center in São Paulo, Brazil, in 2014. All patients attending regular visits who agreed to participate in the study were included. A questionnaire on dietary habits (24-hour diet recall) and socioeconomic characteristics was applied. Anthropometric data (compared with the reference from the World Health Organization, 2006 and 2007) and pulmonary function data were collected from medical records. Patients were stratified into age groups for statistical analysis. Results: A total of 101 patients were included in the study (59.4% male, 86.4% Caucasian), with median age of 10 years old. Most patients (n=77; 75%) were classified as eutrophic, but lower values of body mass index (BMI) Z scores were observed in schoolchildren and adolescents. The proportion of underweight patients was 10% (n=2) among preschoolers and 35% (n=6) of the school age group. Dietary intake was adequate, and the use of only two supplements (medium chain triglycerides and complete powdered supplement) was associated with adequacy of macronutrient intake. The socioeconomic characteristics did not show any statistical association with the nutritional state or nutritional consumption. Lung function was not significantly different between neither adolescents nor individuals with worse nutritional status in this sample. Conclusions: Most of the patients presented adequate nutritional status and adequate consumption of calories and macronutrients, indicating appropriate nutritional management. New studies focusing on preschool children should be performed to assess if it is possible to reduce the nutritional risk of patients with cystic fibrosis at older ages.

Poluição atmosférica e função pulmonar em asmáticos: associação e interação gene-ambiente / Air pollution and pulmonary function in asthmatics: gene-environment interaction and association

Os poluentes do ar induzem o aumento de componentes inflamatórios no pulmão e redução da função pulmonar. A variabilidade na resposta pulmonar à exposição à poluição atmosférica tem sido associada a polimorfismos em genes envolvidos nas respostas inflamatórias e imunológicas à inalação destes poluentes. O objetivo deste estudo foi investigar a associação entre poluição atmosférica e a função pulmonar em crianças e adolescentes asmáticos e a potencial modificação de efeito dos polimorfismos em genes antioxidantes e inflamatórios. Trata-se de um estudo epidemiológico transversal, com 112 crianças e adolescentes asmáticos, de 6 a 14 anos de idade, no período de novembro de 2015 a dezembro de 2016, residentes no município do Rio de Janeiro. Foram coletadas células da mucosa bucal para pesquisa dos polimorfismos dos genes Glutationa S Transferase M1 (GSTM1), Glutationa S Transferase T1 (GSTT1) e Glutationa S Transferase P1 (GSTP1) e Fator de necrose tumoral A (TNF-A). As variáveis desfecho foram volume expiratório forçado no 1º segundo (VEF1), capacidade vital forçada (CVF), fluxo expiratório forçado entre 25% e 75% da CVF (FEF25-75%) e pico de fluxo expiratório (PFE). Os polimorfismos foram genotipados pela técnica de reação em cadeia da polimerase (PCR), utilizando sondas Taqman®. Modelos Lineares Generalizados foram usados e a relação entre o PM10 e O3 e o VEF1, CVF, FEF25-75% e PFE foi estimada pelo método Modelo Polinomial de Defasagem Distribuída (PDLM). A modificação de efeito dos polimorfismos genéticos foi avaliada pela inclusão dos genótipos e dos poluentes no modelo de trabalho. O aumento de 10 µg/m³ de PM10 foi associado com declínio do VEF1 no dia corrente, no primeiro dia de defasagem e no acumulado de 5 dias. Nos demais indicadores, uma associação negativa foi verificada apenas no acumulado de 5 dias. Com o incremento de 10 µg/m³ de O3, uma associação negativa foi evidenciada no quarto e quinto dia de defasagem para o VEF1 e CVF, e no quinto dia de defasagem para FEF25-75 e PFE. Em indivíduos que possuem o alelo variante do TNF-308, foi observado uma associação negativa entre PM10 e o VEF1 no dia corrente (-11,23; IC95%: -19,23, -2,45), no primeiro dia de defasagem (-5,6; IC95%: -10,16, -0,8) e no acumulado de 5 dias (-9,37; IC95%: -13,75, -4,76). A interação foi observada para o GSTT1 nulo no VEF1 no dia corrente (-11,49; IC95%; -16,26, -6,45), no primeiro dia de defasagem (-6,23; IC95%: -8,81, -3,57) e no acumulado de 5 dias (-10,88; IC95%: -13,34, -8,35) e na CVF, no dia corrente (-7,94; IC95%; -11,91, -3,8), no primeiro dia de defasagem (-4,38; IC95%: -6,48, -2,23) e no acumulado de 5 dias (-7,99; IC95%: -10,01, -5,93). ). Os indivíduos com genótipo nulo GSTM1/GSTT1 combinado apresentaram uma associação negativa significativa, no incremento de 10 µg/m³ de PM10 e VEF1 e na CVF. Estes resultados evidenciaram a associação negativa entre poluentes do ar e a função pulmonar e modificação de efeito dos polimorfismos nos genes inflamatórios e antioxidantes na associação dos poluentes atmosféricos e função pulmonar

Escala de Epwoth y cuestionario de Stop Bang como predictores del síndrome de apneas hipopneas obstructivas del sueño / Epworth Sleepiness Scale and Stop Bang questionnaire as predictors for the obstructive sleep apnea syndrome / Escala de Epworth e questionário PARAR BANG como preditores de hipopnéias apneia obstrutiva do sono. Síndrome do sono

Introducción: El SAHOS (Síndrome de Apneas e Hipopneas Obstructivas del Sueño) surge de apneas e hipopneas que generan una hipoxia intermitente. La polisomnografía es el gold standard para su diagnóstico. La Escala de Somnolencia de Epworth (ESS) identifica pacientes con somnolencia diurna. El cuestionario Stop Bang reconoce pacientes con riesgo de SAHOS. El objetivo es describir la sensibilidad y especificidad de la ESS y Stop Bang para el diagnóstico de SAHOS realizado con polisomnografía. Métodos: 125 pacientes completaron la ESS, Stop Bang y realizaron una polisomnografía de noche completa. Se confeccionaron dos grupos: pacientes con IAH < 15, y pacientes con IAH ≥ 15. Se calcularon sensibilidad, especificidad, razón de probabilidades (OR) y curvas ROC para el diagnóstico de SAHOS de la ESS y el Stop Bang. Resultados: La prevalencia del grupo IAH ‹ 15 fue de 36%, y del grupo IAH ≥ 15 fue de 64%. Para la ESS, 71 pacientes presentaron somnolencia diurna, 49,3% con un IAH < 15 y 50,7% con un IAH ≥ 15. Especificidad 77,78%, sensibilidad 55%, área bajo la curva ROC 0,6553. Para el cuestionario Stop Bang, 110 pacientes presentaron alto riesgo para SAHOS, 30% con un IAH < 15 y 70% con IAH ≥ 15. Especificidad 26,67%, sensibilidad 96,25%, área bajo la curva ROC 0,7671. Se enfrentaron ambos cuestionarios y calcularon sus OR: ESS, OR=1,1014 (p=0,038); Stop Bang, OR=8,099 (p=0,002). Conclusiones: La sensibilidad de ESS es baja y su área bajo la curva ROC poco significativa. La gran sensibilidad del cuestionario Stop Bang junto con su área bajo la curva ROC, lo convierten en una herramienta de importancia para realizar screening de SAHOS.

Introduction: osa (obstructive sleep apnea) arises from apneas and hypopneas that cause intermittent hypoxia. Polysomnography is the gold standard for its diagnosis. The Epworth Sleepiness Scale (ESS) measures daytime sleepiness. The Stop Bang Questionnaire (SBQ) recognizes patients at risk of OSA. Objectives: describe the sensitivity and specificity of the ESS and SBQ for the diagnosis of OSA accomplished by polysomnography. Methods: 125 adult patients completed the ESS, SBQ and a full night polysomnography. Patients were grouped into two: those with AHI < 15 and those with AHI ≥ 15. Sensibility, specificity, odds ratio (OR) and ROC curves were determined for the ESS and SBQ. Results: The group with AHI ≥ 15 prevailed (64%). 71 patients (56.8%) showed an abnormal ESS´s score; 49.3% showed an AHI < 15 and 50.7% AHI ≥ 15. The specificity was 77.78% and sensitivity 55%. The area under the ROC curve was 0.6553. Regarding the SBQ, 110 patients were within the high risk group; 30% corresponded to an AHI < 15 and 70% AHI ≥ 15. The specificity was 26.67% and sensitivity 96.25%. The area under the ROC curve was 0.7671. The OR for the ESS was 1.1014 (p=0.038) and SBQ, OR = 8.099 (p=0.002). Conclusion: The sensitivity of the ESS is low and the area under the ROC curve insubstantial. The SBQ shows high sensitivity and a remarkable area under the ROC curve, which turn it into an important tool for screening OSA.

Introdução: sahos (síndrome da apneia e hipopneia obstrutiva do sono) surge de apnéias e hipopnéias que geram hipóxia intermitente. A polissonografia (PSG) é o gold standard para o diagnóstico. A Escala de Sonolência de Epworth (ESS) identifica pacientes com sonolência diurna. O questionário Stop bang reconhece pacientes em risco de doenca de SAHOS. O objetivo de este trabalho é descrever a sensibilidade e especificidade da ESS e do questionario Stop Bang para diagnóstico de SAHOS feito coma PSG. Métodos: 125 pacientes completaram a ess, o stop bang efisseram uma psg con oximetria de noite completa. Dividiram-se os pacientes em dois grupos: com IAH < 15 e 50,7% com um IAH ≥ 15. A especificidade foi de 77,78%, a sensibilidade de 55%, e a área abaixo da curva ROC 0,6553. Enquanto ao questionário stop bang, 110 pacientes apresentaram alto risco de SAHOS, 30% com um IAH < 15 e 70% com IAH ≥ 15. Especificidade de 26,67%, 96,25% de sensibilidade, e 0,7671 da área abaixo da curva. Se comparam ambos questionários e foi calculada sua OR: ESS, OR = 1,1014 (p = 0,038); Stop Bang, OR = 8,099 (p = 0,002). Conclusões: a sensibilidade ess é baixa e a área baixo da curva roc insignificante. A alta sensibilidade do questionário Stop Bang junto com a área baixo da curva ROC o tornam uma ferramenta muito importante para o sreening de esta doença.

Effect of Airflow Limitation on Acute Exacerbations in Patients with Destroyed Lungs by Tuberculosis

History of treatment for tuberculosis (TB) is a risk factor for obstructive lung disease. However, it has been unclear whether the clinical characteristics of patients with destroyed lung by TB differ according to the presence or absence of airflow limitation. The objective of the study was to evaluate differences in acute exacerbations and forced expiratory volume in 1 second (FEV1) decline in patients with destroyed lung by TB according to the presence or absence of airflow limitation. We performed a retrospective cohort study and enrolled patients with destroyed lung by TB. The presence of airflow limitation was defined as FEV1/forced vital capacity (FVC) < 0.7. One hundred and fifty-nine patients were enrolled, and 128 (80.5%) had airflow limitation. The proportion of patients who experienced acute exacerbation was higher in patients with airflow limitation compared to those without (89.1 vs. 67.7%, respectively; P = 0.009). The rate of acute exacerbation was higher in patients with airflow limitation (IRR, 1.19; 95% CI, 1.11-1.27). Low body mass index (X vs. X + 1; HR, 0.944; 95% CI, 0.895-0.996) in addition to airflow limitation (HR, 1.634; 95% CI, 1.012-2.638), was an independent risk factor for acute exacerbation. The annual decline of FEV1 was 2 mL in patients with airflow limitation and 36 mL in those without (P < 0.001). In conclusion, the presence of airflow limitation is an independent risk factor for acute exacerbation in patients with the destroyed lung by TB.

Botulism as a food poisoning: what is it?

Botulism is a rare but potentially life-threatening neuroparalytic syndrome resulting from the action of a neurotoxin elaborated by the microorganism Clostridium botulinum. This disease has a lengthy history; the first investigation of botulism occurred in the 1820s with a case report on hundreds of patients with [sausage poisoning] in a southern German town. Several decades later in Belgium, the association was demonstrated between a neu-romuscular paralysis and ham infected by a spore forming bacillus that was isolated from the ham. The organism was named Bacillus botulinus after the Latin word for sausage, botulus

Effects of an outpatient education program in patients with uncontrolled asthma / Efeitos de um programa educativo ambulatorial em pacientes com asma não controlada

OBJECTIVE: To evaluate the effects of an outpatient education program in patients with uncontrolled asthma. METHODS: This was an uncontrolled study evaluating an educational intervention and involving patients with uncontrolled asthma ≥ 14 years of age. The participants completed a questionnaire designed to assess the level of asthma control, the inhalation technique, and quality of life. All of the patients underwent pulmonary function testing, after which they participated in an education program consisting of one 45-min face-to-face session, followed by phone interviews at two, four, and eight weeks. The participants were reevaluated after three months. RESULTS: Sixty-three patients completed the study. There was a significant improvement in the level of asthma control (p < 0.001). Of the 63 patients, 28 (44.4%) and 6 (9.5%) were classified as having partially controlled asthma and controlled asthma, respectively. The mean FEV1 was 63.0 ± 20.0% and 68.5 ± 21.2% of the predicted value prior to and after the educational intervention, respectively (p = 0.002), and all of the quality of life scores improved (p < 0.05 for all). The same was true for the proportion of patients prior to and after the educational intervention using the proper inhalation technique when using metered dose inhalers (15.4% vs. 46.2%; p = 0.02) and dry powder inhalers (21.3% vs. 76.6%; p < 0.001). The logistic regression analysis revealed that an incorrect inhalation technique identified during the first evaluation was independently associated with a favorable response to the educational intervention. CONCLUSIONS: This study suggests that an outpatient education program for asthma patients improves the level of asthma control, lung function parameters, and quality of life. An incorrect inhalation technique identified during the first evaluation was predictive ...

OBJETIVO: Avaliar os efeitos de um programa educativo ambulatorial em pacientes com asma não controlada. MÉTODOS: Estudo não controlado, avaliando uma intervenção educacional e envolvendo pacientes com idade ≥ 14 anos com asma não controlada. Os participantes responderam a um questionário para avaliar o grau de controle da asma, a qualidade de vida e a técnica inalatória e foram submetidos a testes de função pulmonar. A seguir, participaram do programa educativo, que consistia de uma sessão inicial de 45 min e de entrevistas telefônicas em duas, quatro e oito semanas. Os participantes foram reavaliados após três meses. RESULTADOS: Completaram o estudo 63 pacientes. Houve melhora significativa no grau de controle da asma (p < 0,001). Dos 63 pacientes, 28 (44,4%) e 6 (9,5%) passaram a apresentar asma parcialmente controlada e controlada, respectivamente. Antes e depois a intervenção educacional, a média de VEF1 foi, respectivamente, 63,0 ± 20,0% do previsto e 68,5 ± 21,2% do previsto (p = 0,002), e todos os escores de qualidade de vida melhoraram (p < 0,05 para todos). O mesmo ocorreu com a proporção de pacientes com técnica inalatória adequada no uso de inalador pressurizado (15,4% vs. 46,2%; p = 0,02) e de dispositivo de pó (21,3% vs. 76,6%; p < 0,001). A análise de regressão logística identificou que a técnica inalatória incorreta na primeira avaliação estava independentemente associada com a resposta favorável à intervenção educativa. CONCLUSÕES: Este estudo sugere que um programa educativo ambulatorial resultou em uma melhora no grau de controle da asma, na função pulmonar e na qualidade de vida. A técnica inalatória incorreta na avaliação ...

Asthma is inversely associated with Helicobacter pylori status

The increase in asthma rates has been linked epidemiologically to the rapid disappearance of Helicobacter pylori, a bacterial pathogen that persistently colonizes the human stomach. Recent evidence indicates that, H. pylori may have protective effects on allergic diseases. The aim of this study was to explore the relationship between asthma and H. pylori infection in a population with high prevalence of H. pyloriinfection. One hundred and seventeen asthma cases were eligible for the study in addition to 86 non asthma cases as control. Pre and post - bronchodilator spirometry, assay of Total serum immunoglobulin E [IgE] by enzyme immunoassay technique [ELISA] and [14]C Urea Breath Test [UBT] were done. Out of 41 asthmatic cases with positive H. pylori were 22 patients had mild asthma, 14 had moderate asthma, and 5 only had severe asthma with statistically significant difference between them. The mean serum level of Total IgE was significantly higher [190.04 +/- 111.9] in patients group than control group [94.13 +/- 46.49] with p-value 0.000, while the mean UBT was significantly lower [325.85 +/- 261.35] in patients group than control group [1068.67 +/- 680.7] with p-value 0.000. AS regard pulmonary function tests [FEV1 and FVC], there was statistically significant difference between positive H. pylori asthmatic and negative H. pylori asthmatic. We demonstrate an inverse association between H. pylori and asthma in a population with a high prevalence of H. pylori

Study the relationship of erythropoietin and chronic obstructive pulomonary disease

It has long been known that COPD causes polycythemia secondary to erythrocytosis caused by hypoxia present in advanced cases of COPD. However, it was shown in several studies that some COPD patients had anemia rather than erythrocytosis. Revealing the changes which occur in erythropoiesis in response to COPD was the aim of the current study. 41 COPD patients of different groups according to the inclusion and exclusion criteria and ten healthy control subjects age and sex matched were enrolled in the study. For all, history taking and full Clinical exam were performed, also ABGs, PFT [spirometry], routine labs [CBC, liver and renal function] and determination of EPO should be performed on human serum by ELISA. Showed that the erythropoietin level was 15.24 +/- 2.6 in stage 1, 22.61 +/- 5.68 in stage 2, 33.59 +/- 4, in stage 3, then 17.9 +/- 3.3 in stage 4. Also the total percentage of anemia in COPD patients was 46.3% [19/41], in comparison to 51.3% [21/41] non anemic and 2.4% [1/41] polycythemic. And that the percentage of anemia was 27.3% in stage 1, followed by 38.0% in stage 2, 100% in stage 3 then dropped to 58.33% in stage 4 with emergence of polycythemia in 8.33% of cases. Although COPD was thought to cause polycythemia, the current study showed that almost half of patients have anemia, and polycythemia occurred only in the advanced stages. It also appeared that response to erythropoietin in COPD is probably blunted especially with increased severity of the condition. This might be considered as a contributing factor in the development of anemia in COPD which is considered as anemia of chronic disease

Pulomanry involvement in asymptomatic Systemic Lupus Erythematosus patients with antiphospholipid syndrome multislice CT angiography and pulomnary involvement in asymptomatic SLE patients with APS

To detect the pulmonary involvement in asymptomatic secondary APS patients by pulmonary function tests [PFTs] and chest multislice HRCT angiography. Comparing the pulmonary findings to those of asymptomatic SLE patients without APS was considered. Thirty-four SLE patients with APS and another 34 SLE patients without APS and with a negative ACL test were included as control. All patients were asymptomatic for any pulmonary manifestations. Plain chest X-ray, HRCT angiography and PFTs were performed for all patients in an attempt to assess the pulmonary vasculature and lung parenchyma. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index [SLEDAI] while assessment of organ damage was made using the Systemic Lupus International Collaborating Clinics/ACR [SLICC/ACR] index. There were abnormal pulmonary CT findings in 11 [32.35%] of the asymptomatic secondary APS patients with an obvious association to lupus anticoagulants. However, plain X-ray showed basal atelectasis and/or elevation of the copulae in four patients. Pulmonary abnormalities included a high frequency of pulmonary artery aneurysms [20.59%] thrombosis, basal atelectasis, embolism, bronchiectasis, pleural effusion and thickening. The SLEDAI and SLICC were significantly higher in APS patients. More SLE patients without APS were receiving hydroxychloroquine which suggests a protective role on the thromboembolic events occurring in APS. Multislice HRCT pulmonary angiography, with its multiplanar capability, vascular reconstruction and high quality, is useful in demonstrating the entire thoracic spectrum in asymptomatic APS patients. Particular concern about the medications used in APS could prevent the risk of developing noticeable thromboembolic events

Effect of Aspergillus fumigatus sensitization and colonization on lung function and airways inflammation in asthma

The sensitization and exposure to fungal allergens have been reported to be associated with asthma. The importance of Aspergillus fumigatus [AF] sensitization and colonization of the airways in patients with asthma is unclear. To clarify the effect of sensitization and airways colonization of AF on lung function and airways inflammation in asthma. We studied 66 patients with asthma. Patients were classified into two groups according to AF sensitization: [1] AF-sensitized [immediate cutaneous reactivity >3 mm]; and [2] AFnonsensitized. A positive sputum culture for AF confirmed airways colonization by AF. Routine spirometry was performed for all patients. Airways inflammation was assessed by sputum differential inflammatory cell count. Asthma duration was significantly longer in AF-sensitized asthmatics. Significantly higher rates of positive AF-culture were detected in sputum from AF-sensitized asthmatics [63%] in comparison to AF-nonsensitized asthmatics [31%]. FEV1 and FEV1/FVC were more reduced in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum neutrophils count was significantly higher in AF-sensitized asthmatics in comparison to AF-nonsensitized asthmatics. Sputum eosinophils did not differ between AF-sensitized and AF-nonsensitized asthma groups, concordant with peripheral blood eosinophils, which did not differ significantly between groups. Multilinear regression analysis predicting FEV1% showed that AF sensitization and sputum neutrophil count were the most important predictors of FEV1 [p= 0.016 for both], followed by positive sputum culture for AF and sputum eosinophil count [p= 0.024 and 0.046 respectively]. [p = 0.105]. AF detection in sputum is associated with AF-sensitization, neutrophilic airway inflammation, and reduced lung function. This supports the concept that development of fixed airflow obstruction in asthma is consequent upon the damaging effects of airway colonization with AF

Study of 2-min walk test and 15-step exercise oximetry test in the assessment of exercise tolerance in Egyptian patients with chronic obstructive pulmonary diseass

The present study was conducted to study the 2-min walk test and 15-step exercise oximetry test in determination of exercise tolerance in Egyptian patients with chronic obstructive pulmonary disease. Sixty male patients with COPD were included in this study who were divided into three groups [mild, moderate and severe]. All of the patients were subjected cardio pulmonary exercise test using ramp protocol, 6 min walk test, 2-min walk test and 15 step exercise oximetry test. In this study we found significant difference between mild, moderate and severe groups as regards VO2% predicted, distance walked during 6-MWT, distance walked during 2-MWT, and saturation difference% and exercise time/s during 15-step exercise oximetry test [p value <0.05].We found also significant correlation between 2-MWT and 6-MWT and VO2 in the mild, moderate and severe groups. [r = 0.9 and 0.85, respectively for the mild, r = 0.52 and 0.48, respectively for the moderate and r = 0.94 and 0.45, respectively for the severe p <0.05 for all]. We did not find such correlation between exercise time in 15-step exercise oximetry test and both 6-MWT and VO2 in the three groups. [r = -0.066 and -0.067, respectively for the mild, r = -0.08 and -0.07, respectively for the moderate and r = -0.07 and -0.021, respectively for the severe, P > 0.05 for all]. Also there was non-significant correlation between saturation difference in 15-step exercise oximetry test and both 6-MWT and VO2 in the three groups[r = -0.371 and -0.378, respectively for the mild, r = -0.086 and -0.061, respectively for the moderate and r = -0.051 and -0.013, respectively for the severe p > 0.05 for all]. The study shows that the 2MWT is a valid test for the assessment of exercise capacity in patients with COPD. It is practical, simple, and well-tolerated by patients with severe COPD

Bronchiectasis in COPD patients

COPD and brochiectasis are characterized by fixed airway obstruction and chronic cough. The finding of bronchiectasis on HRCT scan in the patient with COPD may indicate the presence of more advanced airway dysfunction, frequent exacerbation and bacterial colonization. The aim of this study to evaluate the incidence of bronchiectasis on high resolution computed tomography [HRCT] scanning in patients with moderate and severe COPD, and to relate this with the presence of lower airway bacterial colonization, exacerbation frequency, severity. This study was carried out on 69 patients diagnosed with COPD. All cases were subjected to through history taking, lung function test, sputum culture, HRCT scan of the chest to diagnose bronchiectasis, All the test were performed in a stable phase. 69 COPD patients, 32 patients had moderate COPD, 37 patients had severe COPD, 33 patients [47, 8%] presented with brochiectasis, [31.3%] of the patients with moderate COPD and 62.2% of the patients with severe COPD with statistically significant difference, the more severe functional impairment [FEV1

Brain-stem auditory evoked responses in COPD patients

COPD is a multi-system disorder. It appears to be associated with the presence of systemic inflammatory markers as C reactive protein. The present study aimed to evaluate the brain-stem auditory evoked potentials [BAEP] abnormalities in stable COPD patient and its correlation with high sensitivity C reactive protein [hs-CRP] as a part of multi-system disorder. This case control study was carried out at Mansoura University Hospital Egypt from October 2009 to February 2010. The study comprised 40 stable COPD patients and 15 healthy controls with no risk that may lead to neuropathy. All the patients and controls were subjected to the following: I-Thorough history taking and clinical examination. II-Pulmonary function tests including: 1-Spirometry 2-Body plethsymography 3-Arterial blood gases analysis. III- Record of brain-stem auditory evoked potentials [BAEP] including: latencies of waves I, II, III, IV and V together with interpeak latencies [IPLs] of I-III, I-V and III-V and amplitudes of waves I-Ia and V-Va. IV - Measurement of serum high sensitivity C reactive protein [hs-CRP] by ELISA technique. V - Statistical analysis. The level of hs-CRP reactive protein in COPD was significantly elevated and correlated with spirometric, blood gases parameters and GOLD stage. The BAEP latencies of waves I, II, III, IV and V, together with interpeak latencies and amplitudes of waves I-Ia and V-Va measured on both ears were significantly different in COPD patients than controls. The prevalence of brain-stem auditory evoked potentials abnormalities was higher among very severe group of COPD. Most of BAEP wave latencies together with interpeak latencies and wave amplitudes on both ears were significantly correlated with the spirometric and blood gases parameters. The level of hs-CRP was correlated significantly with abnormalities of BAEP variables. This study showed significant subclinical BAEP abnormalities in studied stable COPD male patients. This indicates conductive defect of auditory nerve, cochlea and even hearing pathway in the brain as a part of systemic inflammation. Theses BAEP abnormalities were significantly correlated with GOLD classification, hs-CRP and PaO[2]

role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers

Impulse oscillometry provides useful clinical information that prominently includes functional assessment of small, peripheral airway behavior beyond that available from commonly used pulmonary function tests [PFT]. The aim of this study was to assess the role of impulse oscillometry in assessment of airway obstruction in smokers and ex-smokers. Sixty subjects divided into three groups [asymptomatic smokers, ex-smokers and non smoker healthy subjects as a controls] all were assessed by spirometry and IOS. Based on the IOS results in smokers, there was 17 negative cases and only 3 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 33% as it was able to detect one diseased case from a total of three cases .In ex-smokers, there was 13 negative cases and only 7 diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was only 42.8% as it was able to detect 3 diseased case from a total of 7 cases. In controls, there was 18 negative cases and two diseased cases, the calculated Specificity of spirometry [ability to detect negative cases as negative] 100%, while its sensitivity [ability to detect diseased cases as diseased] was 50% as it was able to detect 1 diseased case from a total of 2 cases. IOS is an effective, easy to perform, and a non invasive method for the assessment of airway obstruction in obstructive pulmonary disorders. Although, there is no significant difference between impulse oscillometry and spirometry parameters in early detection of airway obstruction in smokers and ex-smokers groups

Effects of thoracic epidural anesthesia on pulmonary venous admixture and oxygenation with isoflurane or propofol anesthesia during one lung ventilation

Thoracic epidural anesthesia [TEA] with local anesthetics during OLV is increasingly being combined with general anesthesia [GA] in our clinical practice for thoracic surgery. A combination of TEA with GA might maximize the benefits of each form of anesthesia. Furthermore, epidural anesthesia and postoperative epidural analgesia may improve outcome in high-risk patients. The present study was designed to compare the effects of thoracic epidural anesthesia on oxygenation and pulmonary venous admixture [Qs/Qt], when combined with isoflurane or propofol anesthesia, during one lung ventilation and to compare also between the effects of propofol with isoflurane on oxygenation and pulmonary venous admixture [Qs/Qt], during one lung ventilation. This study was carried out on 60 patients, [ASA classification I-II-III] in Tanta University Hospitals, scheduled for thoracotomies for pulmonary resections in the lateral decubitus position and one-lung ventilation. The patients were randomized into one of four groups, 15 patients in each group: Group I: propofol group [TIVA group], Group II: propofol combined with thoracic epidural anesthesia [TIVA-TEA group], Group III: isoflurane group [ISO group] and Group IV: isoflurane combined with thoracic epidural. The trachea was intubated with a doublelumen tube and its position was confirmed with auscultation. Anesthesia was maintained with propofol at continuous infusion in [Group I and Group II], and with isoflurane in [Group III and Group IV] and with increments of fentanyl and vecuronium. PaO[2], PaCO[2], SaO[2], PvO[2], SvO[2] and Hb, as well as the hemodynamic variables [HR and MAP] were measured. A right atrial blood sample was used to calculate the pulmonary venous admixture [Qs/Qt]. In epidural groups [Group II and Group IV] a 10-ml bolus of a solution of bupivacaine 0.1%+ 0.1 mg/ml morphine in saline was administered at least 30 min before the induction, followed by a 7 ml/h infusion of the same solution during the operation. In the other two groups [Group III and Group IV], no medication was applied via the epidural catheter in the preoperative and the intraoperative period. After preoxygenation, anesthesia was induced with fentanyl 3 microg/kg and propofol 2 mg/kg; tracheal intubation was facilitated with vecuronium 0.1 mg/kg. As regards PaO[2], it was significantly higher in Group I and Group II [propofol groups] than Group III and Group IV [isoflurane], in contrary, no significant effect of TEA [between Group I and Group II] nor between [Group III and Group IV] on PaO[2]. However; PaO[2] significantly decreased during OLV in all groups. As regards Qs/Qt, it was significantly lower in Group I and Group II [propofol groups] than Group III and Group IV [isoflurane], in contrary, no significant effect of TEA [between GI and GII] nor between [GIII and GIV] on Qs/Qt. However; Qs/ Qt significantly increased during OLV in all groups. The administration of thoracic epidural anesthesia, either combined with propofol or isoflurane, was not associated with a relevant impairment of oxygenation during OLV. Therefore Pre-emptive analgesia via an epidural thoracic catheter can be used safely as a standard in lung surgery, decreasing the anesthesia requirements when combined with GA, maximizing the benefits of each form of anesthesia and improving the outcome in patients with cardiopulmonary diseases, hence it was found that it has no effect on oxygenation during OLV, and it is associated with stable hemodynamics

Análise de covariância: uma aplicação a dados de função pulmonar, ajustados por idade / Analysis of covariance: application to pulmonary function data, adjusted for age

Introdução: Em diversas situações estamos interessados em comparar médias entre dois ou mais grupos. A relação entre estas variáveis pode ser influenciada por uma terceira variável. Esta última é conhecida como covariável e deve ser incluída na análise estatística. Quando essa variável é quantitativa utiliza-se Análise de Covariância (ANCOVA). No contexto da fibrose cística (FC), o volume expiratório forçado no primeiro segundo (VEF1) é uma medida de função pulmonar conhecida por desempenhar importante papel na monitorização de pacientes. Estudos mostram que mulheres com FC apresentaram valores mais baixos de VEF1. Entretanto, a influência da idade também deve ser considerada. Objetivo: Apresentar a aplicabilidade da ANCOVA, suas suposições e a interpretação de seus resultados, através de um exemplo envolvendo a relação entre VEF1 e gênero, considerando a idade dos pacientes como covariável. Métodos: Foram utilizados dados obtidos por simulação, considerando VEF1 com distribuição normal (média=86; DP=21). ANCOVA foi utilizada para avaliar diferença média de VEF1 entre homens e mulheres, ajustada por idade.Resultados: Foram analisados dados de 64 pacientes, idade média de 12 anos (DP=2,5) e VEF1 médio de 85,9 (DP=20,73). Na avaliação inicial do VEF1, as mulheres apresentaram, em média, valores significativamente maiores do que os homens (P=0,021). Entretanto, após o ajuste por idade, esta relação deixou de ser significativa (P=0,100). Conclusão: Esses dados ilustram a influência de uma covariável na relação entre um fator em estudo e o desfecho. Verificou-se a partir da ANCOVA, que o efeito aparente de gênero no VEF1 desaparece com o ajuste para idade do paciente.

Background: In several situations there is an interest in comparing means between two or more groups. The relationship between these variables may be influenced by a third variable, known as covariate, which should be included in the statistical analysis. When the covariate is a quantitative variable, analysis of covariance (ANCOVA) should be used. In the context of cystic fibrosis (CF), forced expiratory volume in 1 second (FEV1) is a measure of pulmonary function known to play an important role in patient monitoring. Studies have shown that women with CF have lower FEV1. However, the influence of age should also be considered. Aim: To demonstrate the applicability of ANCOVA, with assumptions and interpretation of results, using an example involving the relationship between FEV1 and gender, considering patient age as a covariate. Methods: Data were obtained by simulation, considering FEV1 as normally distributed (mean=86; SD=21). ANCOVA was used to assess mean differences in FEV1 between men and women, adjusted for age. Results: Data from 64 patients [mean age: 12 years (SD=2.5)] were analyzed, and mean FEV1 was 85.9 (SD=20.73). At baseline, women had average FEV1 values significantly higher than men (P=0.021). However, after adjusting for age, this relationship was no longer significant (P=0.100). Conclusion: These data illustrate the influence that a covariate may have on the relationship between factors under study and the outcome of interest. ANCOVA revealed that the apparent effect of gender on FEV1 disappears after adjustment for patient age.

Pulmonary arterial hypertension: literature review

Pulmonary arterial hypertension [PAH] is a fatal disease as it results in a very bad damage to the pulmonary vasculature which progress gradually to cause right ventricular failure. In idiopathic PAH there is hypertrophy and hyperplasia of the pulmonary arteries which eventually obliterate the vessel, and in more advanced stages thrombosis The classification of PAH has undergone several revisions, the latest was during the 4[th] World Symposium held in 2008, few modifications were adopted concerning Group 1 and Group 4. Many pathways are involved in the abnormal proliferation and contraction of the smooth muscle cells of the pulmonary arteries in patients with PAH. Three of these pathways are important: endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclin derivatives. The aim of medical treatment is to dilate the pulmonary vasculature and reverse the abnormal remodeling characteristic of pulmonary vascular disease. The practical difficulties encountered in treating children influence management and include their age, level of understanding, size, and in some, and the presence of other anomalies.Monitoring patients are normally monitored through commonly available tests such as pulse oxymetery, arterial blood gas tests, CXR, serial ECG's, serial echocardiograms, and spirometry or more advanced lung function tests. The prognosis of pulmonary hypertension varies in between different diagnostic groups. In general, the prognosis is poor with no definitive cure for it. Patients whose disease progresses and is unresponsive to medical treatments either undergo transplantation or die of progressive right-sided heart failure. Certain types of pulmonary venous hypertension has poorer prognosis especially in pediatric patients. Although the disease is * fatal, trials to get more effective treatments are being held in many centers, and great efforts should be done to clarify the complete patho-physiological process

prevalence of gastro esophageal reflux disease [GERD] in copd patients and its effect on the number of exacerbations in dnmi

This study included 25 COPD inpatients in chest, ICU and internal medicine departments in Damanhur National medical Institute., 10 of them with moderate COPD and 15 of them with severe COPD [by gold 2007][1]. 21 were males and 4 were females [active or passive smokers]. The aim of the work was to study the prevalence of GERD in COPD patients and its effect on the number of exacerbations of COPD. Both groups were subjected to history taking, full clinical examination, full laboratory investigations, Chest radiography, spirometry, arterial blood gases and upper GIT endoscopy and biopsy. Results revealed that the prevalence of GERD in COPD patients by endoscopy was 36% in the moderate group, 64% in the severe group. By biopsy being more prevalent in the severe group of COPD 86.6% compared to70% in moderate COPD. GERD severity increases as the degree of COPD increases. GERD increases with increase in the smoking [pack/year] both in moderate, in the severe group. Moreover, there was increase in the frequency of exacerbations of COPD in GERD patients both in moderate and severe groups. This study revealed that the frequency of exacerbation was higher among GERD cases with statistically significant difference in between both group From this study we conclude that GERD is common in COPD patients being more among severe COPD. Also GERD increase the number of exacerbations of COPD

Análise da função pulmonar de motoboys: o efeito da poluiçãoatmosférica: prevenção, a melhor forma de cuidar / Análisis de la función pulmonar de conductores profesionales de motocicleta y taxistas: el efecto de la contaminación atmosférica: prevención como la mejor manera de cuidar / Analysis of the pulmonary function of motorcycle professional drivers and taxi drivers: the effect of air pollution: prevention as the best way for caring

O presente estudo teve por objetivo analisar e comparar a função pulmonar de motoboys e taxistas da cidade de São Paulo. Para tanto foram avaliados 90 indivíduos divididos em três subgrupos, 30 motoboys (GM), 30 taxistas (GT) e 30 funcionários do setor administrativo, que formaram o grupo controle (GC), todos fizeram prova de função pulmonar, com avaliação de capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1), relação CVF/VEF1 e fluxo expiratório entre 25 e 75 por cento (FEF 25-75 por cento) Dentre os resultados obtidos tem-se que em todas as variáveis de função pulmonar, houve diferenças estatísticas entre os grupos, sendo que o GMapresentou os piores valores. A maior diferença encontrada foi no FEF 25-75 por cento, com médias de valores previstos de 98,8 por cento, 78,7 por cento e 65,4 por cento respectivamente para o GC, GT e GM, p< 0,001. Concluiu-se que o grupo de motoboys apresentou pior função pulmonar, que pode estardiretamente relacionada à intensidade e tempo de exposição aos poluentes.

The present study aims to analyze and to compare the pulmonary function of motorcycle professional drivers and taxi drivers of the city of São Paulo. 90 individuals divided in three sub-groups were evaluated: 30 motorcycle professional drivers (MG), 30 taxidrivers (TG) and 30 staff employees, the control group (CG). All were submitted to a pulmonary function test, with evaluation of forced vital capacity (CVF), forced expiratory volume in the first second (VEF1), relation CVF/VEF1 and expiratory flow from 25 to 75 per cent (FEF 25-75 per cent). Results show differences in all the variables regarding pulmonary function, with statistical differences among the groups. MG subjects presented the worse values. The highest difference was in FEF 25-75 per cent, with averages of 98.8 per cent, 78.7 per cent and 65.4 per cent respectively for CG, TG and MG, p< 0.001. We concluded that the group of motorcycle professional drivers presented a worse pulmonary function, which can be directly related to the intensity and time of exposure to pollutants.

Este estudio pretende analizar y comparar la función pulmonar de conductores profesionales de motocicleta y de los taxistas de la ciudad de São Paulo. Se evaluaron a 90 individuos divididos en tres subgrupos: 30 conductores profesionales de motocicleta (GM), 30 taxistas (GT) y 30 empleados administrativos, el grupo de control (GC). Todos fueron sometidos a una prueba de función pulmonar,con evaluación de la capacidad vital forzada (CVF), el volumen espiratorio forzado en el primer segundo (VEF1), la relación CVF/VEF1 y el flujo espiratorio de 25 hasta 75 por ciento (FEF 25-75 por ciento). Los resultados demuestran diferencias en todas las variables respecto a la función pulmonar, con diferencias estadísticas entre los grupos. Los sujetos del GM presentaron los peores valores. La diferencia más alta fue en FEF 25-75 por ciento, con promedios de 98.8 por ciento, 78.7 por ciento y 65.4 por ciento, respectivamente, para GC, GT y GM, p<0.001. Concluimos que el grupo de conductores profesionales de motocicleta presentó una función pulmonar peor, que se puede relacionar directamente con la intensidad y el tiempo de exposición a agentes contaminadores.

Impact of acute exposure to air pollution on the cardiorespiratory performance of military firemen

The objective of the present study was to determine the impact of acute short-term exposure to air pollution on the cardiorespiratory performance of military fireman living and working in the city of Guarujá, São Paulo, Brazil. Twenty-five healthy non-smoking firemen aged 24 to 45 years had about 1 h of exposure to low and high levels of air pollution. The tests consisted of two phases: phase A, in Bertioga, a town with low levels of air pollution, and phase B, in Cubatão, a polluted town, with a 7-day interval between phases. The volunteers remained in the cities (Bertioga/Cubatão) only for the time required to perform the tests. Cumulative load 10 ± 2 min-long exertion tests were performed on a treadmill, consisting of a 2-min stage at a load of 7 km/h, followed by increasing exertion of 1 km h-1 min-1 until the maximum individual limit. There were statistically significant differences (P < 0.05) in anaerobic threshold (AT) between Cubatão (35.04 ± 4.91 mL kg-1 min-1) and Bertioga (36.98 ± 5.62 mL kg-1 min-1; P = 0.01), in the heart rate at AT (AT HR; Cubatão 152.08 ± 14.86 bpm, Bertioga 157.44 ± 13.64 bpm; P = 0.001), and in percent maximal oxygen consumption at AT (AT percentVO2max; Cubatão 64.56 ± 6.55 percent, Bertioga 67.40 ± 5.35 percent; P = 0.03). However, there were no differences in VO2max, maximal heart rate or velocity at AT (ATvel) observed in firemen between towns. The acute exposure to pollutants in Cubatão, SP, caused a significant reduction in the performance at submaximal levels of physical exertion.