Use of fractional exhaled nitric oxide as a potential predictor of bronchodilator response.

Nitric oxide (NO) is an important product of eosinophilic metabolism, and its increase is associated with bronchial remodeling and airway hyperresponsiveness. Fractional exhaled NO (FENO) in the expired air of patients with suspected or diagnosed asthma has been used as a marker for eosinophilic inflammation. This cohort study included asthmatic patients classified under steps 3, 4, or 5 of the global strategy for asthma management and prevention. In the morning of the same day, all patients underwent blood collection for eosinophil counts, followed by FENO measurement and spirometry. We considered 2 groups based on the bronchodilation (BD) response on spirometry (>10% of FVC or FEV1): positive (BD+) and negative (BD-). Differences between the 2 groups were analyzed for demographic features, FENO values, and predictive correlations between FENO and BD. Both groups of patients showed an increase in the eosinophil count (BD+, P = .03; BD-, P = .04) and FENO values (P = .015 for both) with an increase in the asthma severity from step 3 to step 5 of the global strategy for asthma management and prevention. The correlations of FENO and eosinophils as well as FENO values and BD + were 0.127 (95% confidence interval,-0.269 to -0.486) and 0.696 (95% confidence interval, 0.246-0.899; P = .007), respectively. Measuring FENO levels may be useful for identifying patients with BD+.

Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID-19 Pneumonia.

OBJECTIVES: The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests. METHODS: This cross-sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B-lines, coalescent B-lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%. RESULTS: Regarding LUS signs, more than 2 B-lines, coalescent B-lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy-paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B-lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001). CONCLUSIONS: Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.

Vigilância pós-comercialização do pelargonium sidoides no tratamento das tonsilofaringites comunitárias agudas de origem presumidamente viral / Post-marketing surveillance of perlagonium sidoides for treatment of presumably viral acute community acquired tonsillopharyngitis

Este é um estudo observacional, prospectivo, aberto, de vigilância epidemiológica em crianças, adolescentes e adultos atendidos em consultórios e ambulatórios por todo o Brasil, com o objetivo de comprovar a segurança e efetividade do Pelargonium sidoides (Umckan®) no tratamento das tonsilofaringites agudas presumidamente virais em pacientes pediátricos e adultos na população brasileira. Após a obtenção de um termo de consentimento livre e esclarecido e verificação de critérios de inclusão e exclusão, foram avaliados 1.667 pacientes em relação ao perfil de segurança, efetividade e tolerância dos pacientes em uso clínico cotidiano do Pelargonium sidoides (Umckan®). Apenas 22 pacientes (1,4%) apresentaram eventos adversos, principalmente diarréia (cinco pacientes), exantema (três pacientes) e epigastralgia (dois pacientes). Além destes foram observados: amolecimento das fezes, urticária, epistaxe, equimose subocular, cefaléia, hiperemia com descamação em regiões de face e tronco, eructações, petéquias, hipermenorréia, edema labial (após três dias de uso), mal-estar e náuseas. Em relação à efetividade, todos os sinais e sintomas observados tiveram uma redução estatística e clinicamente signi- ficativa ao longo de sete dias de observação. Pelargonium sidoides (Umckan®) demonstrou boa ou muito boa tolerabilidade, tanto por parte dos pacientes (93%) como por parte da observação dos médicos (96,4%). Neste primeiro estudo brasileiro, Pelargonium sidoides (Umckan®) confirmou seu excelente perfil de segurança e eficácia.

Síndrome de Lõffler / Lõffler’s syndrome

Síndrome de Lõffler é uma pneumonia eosinofílica, caracterizada por infiltrados pulmonares migratórios associados, geralmente, com um aumento do número de eosinófilos no sangue e escarro. Apresentamos um caso de síndrome de Lõffler causada por Strongyloides stercoralis, em um homem de 37 anos de idade. Em virtude da prevalência elevada da estrongiloidíase em nosso país, os autores enfatizam a importância do seu diagnóstico.