RESUMO
The objective of this observational, multicenter study was to evaluate the association of body mass index (BMI) with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. A total of 339 patients (197 females, 142 males) diagnosed with non-cystic fibrosis bronchiectasis by high-resolution computed tomography were classified into four groups: underweight (BMI<18.5 kg/m2), normal weight (18.5≤BMI<25.0 kg/m2), overweight (25.0≤BMI<30.0 kg/m2), and obese (BMI≥30.0 kg/m2). Clinical variables expressing disease severity were recorded, and acute exacerbations, hospitalizations, and survival rates were estimated during the follow-up period. The mean BMI was 21.90 kg/m2. The underweight group comprised 28.61% of all patients. BMI was negatively correlated with acute exacerbations, C-reactive protein, erythrocyte sedimentation rate, radiographic extent of bronchiectasis, and chronic colonization by P. aeruginosa and positively correlated with pulmonary function indices. BMI was a significant predictor of hospitalization risk independent of relevant covariates. The 1-, 2-, 3-, and 4-year cumulative survival rates were 94%, 86%, 81%, and 73%, respectively. Survival rates decreased with decreasing BMI (χ2=35.16, P<0.001). The arterial carbon dioxide partial pressure, inspiratory capacity, age, BMI, and predicted percentage of forced expiratory volume in 1 s independently predicted survival in the Cox proportional hazard model. In conclusion, an underweight status was highly prevalent among patients with non-cystic fibrosis bronchiectasis. Patients with a lower BMI were prone to developing more acute exacerbations, worse pulmonary function, amplified systemic inflammation, and chronic colonization by P. aeruginosa. BMI was a major determinant of hospitalization and death risks. BMI should be considered in the routine assessment of patients with non-cystic fibrosis bronchiectasis.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Índice de Massa Corporal , Bronquiectasia/fisiopatologia , Bronquiectasia/mortalidade , Prognóstico , Índice de Gravidade de Doença , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
To evaluate the access to drugs for hypertension and diabetes and the direct cost of buying them among users of the Family Health Strategy (FHS) in the state of Pernambuco, Brazil. Population-based, cross-sectional study of a systematic random sample of 785 patients with hypertension and 823 patients with diabetes mellitus who were registered in 208 randomly selected FHS teams in 35 municipalities of the state of Pernambuco. The selected municipalities were classified into three levels with probability proportional to municipality size (LS, large-sized; MS, medium-sized; SS, small-sized). To verify differences between the cities, we used the χ2 test. Pharmacological treatment was used by 91.2% patients with hypertension whereas 85.6% patients with diabetes mellitus used oral antidiabetic drugs (OADs), and 15.4% used insulin. The FHS team itself provided antihypertensive medications to 69.0% patients with hypertension, OADs to 75.0% patients with diabetes mellitus, and insulin treatment to 65.4%. The 36.9% patients with hypertension and 29.8% with diabetes mellitus that had to buy all or part of their medications reported median monthly cost of R$ 18.30, R$ 14.00, and R$ 27.61 for antihypertensive drugs, OADs, and insulin, respectively. It is necessary to increase efforts to ensure access to these drugs in the primary health care network.
Avaliar o acesso a medicamentos para hipertensão e diabetes e o gasto direto relacionado à aquisição destes insumos entre os usuários da Estratégia Saúde da Família (ESF), no estado de Pernambuco. Estudo transversal, de base populacional, numa amostra aleatória sistemática de 785 pacientes hipertensos e 823 diabéticos cadastrados em 208 equipes da ESF sorteadas em 35 municípios do estado de Pernambuco. Os municípios selecionados foram classificados em três estratos com probabilidade proporcional ao tamanho do município (GP: grande porte; MP: médio porte; PP: pequeno porte). A fim de verificar diferenças entre os municípios, foi utilizado o teste χ2. Dos 785 hipertensos, 91,2% referiram o uso de anti-hipertensivos e dos 823 diabéticos, 85,6% utilizavam antidiabéticos orais (ADO), e 15,4%, insulina. Os anti-hipertensivos eram fornecidos pelas equipes da ESF para 69,0% dos hipertensos, os ADO, para 75,0% dos diabéticos, e a insulina e insumos, para 65,4%. Os hipertensos (36,9%) e os diabéticos (29,8%) que precisavam comprar os medicamentos referiram um gasto mediano mensal de R$ 18,30, R$ 14,00 e R$ 27,61 para anti-hipertensivos, ADO e insulina, respectivamente. É necessário ampliar os esforços para assegurar o acesso aos medicamentos na rede de atenção primária de saúde.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Pneumopatias/cirurgia , Transplante de Pulmão , Fatores Etários , Bronquiectasia/mortalidade , Bronquiectasia/cirurgia , Irã (Geográfico) , Estimativa de Kaplan-Meier , Pneumopatias/mortalidade , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Análise Multivariada , Fibrose Pulmonar/mortalidade , Fibrose Pulmonar/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Doadores de Tecidos , Resultado do TratamentoRESUMO
Recent advancements in the fields of antibiotic therapy, vaccination and general health have decreased the number of surgical interventions for the treatment of bronchiectasis. On the other hand, improvements made in the field of lung surgery prompt some physicians and patients to pursue surgical treatment. We assessed the results of surgical treatment of bronchiectasis and compared them with the results of medical treatment during the same period of time. The study population consisted of all patients who had referred to Masih Daneshvari Hospital and were admitted for treatment of bronchiectasis during a period of seven and a half years [March 1999 to September 2006]. In this descriptive study, surgical or non-surgical treatment was adopted according to the usual indications for the treatment of bronchiectasis. Response to treatment was evaluated by referring to the patient's medical records and out-patient visits. The results were categorized into the following categories: Sputum production and other major signs completely disappeared. Satisfactory: Signs and symptoms did not totally disappear, but the patient was satisfied with the treatment results. Poor: No significant change was seen after the treatment. Technique of surgery was postero-lateral thoracotomy under one lung ventilation and lobar or segmental resections. Medical treatment consisted of physiotherapy, antibiotic administration and vaccination against influenza and pneumococcus. Statistical analysis was performed using Access and SPSS software. Fisher exact and chi square tests were used for qualitative comparison of the results. The mean duration of follow- up was 35.9 months [range 1-96 months]. Eighty-three patients were studied [48 females, 35 males, mean age 37.8 years, range: 8-71 years]; 40 patients underwent surgery while 43 underwent medical treatment. The results of surgery were good in 16[55.2%], satisfactory in 10 [34.5%] and poor in 2 [6.9%] patients. The results of medical treatment were good in 4 [13.8%], satisfactory in 11[37.9%], and poor in 13 [44.8%] patients. Good results were significantly more [P=0.002] and poor results were significantly less [P=0.002] after surgical treatment. In each group, one death occurred during the treatment course. Fourteen patients in the medical group and 11 patients in the surgical group were lost during the follow-up period. When indicated, surgical therapy offers advantages over medical therapy in the treatment of bronchiectasis