Predominance of the SARS-CoV-2 Lineage P.1 and Its Sublineage P.1.2 in Patients from the Metropolitan Region of Porto Alegre, Southern Brazil in March 2021.

Almost a year after the COVID-19 pandemic had begun, new lineages (B.1.1.7, B.1.351, P.1, and B.1.617.2) associated with enhanced transmissibility, immunity evasion, and mortality were identified in the United Kingdom, South Africa, and Brazil. The previous most prevalent lineages in the state of Rio Grande do Sul (RS, Southern Brazil), B.1.1.28 and B.1.1.33, were rapidly replaced by P.1 and P.2, two B.1.1.28-derived lineages harboring the E484K mutation. To perform a genomic characterization from the metropolitan region of Porto Alegre, we sequenced viral samples to: (i) identify the prevalence of SARS-CoV-2 lineages in the region, the state, and bordering countries/regions; (ii) characterize the mutation spectra; (iii) hypothesize viral dispersal routes by using phylogenetic and phylogeographic approaches. We found that 96.4% of the samples belonged to the P.1 lineage and approximately 20% of them were assigned as the novel P.1.2, a P.1-derived sublineage harboring signature substitutions recently described in other Brazilian states and foreign countries. Moreover, sequences from this study were allocated in distinct branches of the P.1 phylogeny, suggesting multiple introductions in RS and placing this state as a potential diffusion core of P.1-derived clades and the emergence of P.1.2. It is uncertain whether the emergence of P.1.2 and other P.1 clades is related to clinical or epidemiological consequences. However, the clear signs of molecular diversity from the recently introduced P.1 warrant further genomic surveillance.

Avaliação do Sono em um Grupo de Policiais Militares de Elite / Evaluación del Sueño en un Grupo de Policías Militares de Élite / Sleep Assessment in a Group of Elite Military Police Officers

Resumo Objetivo Estudar os distúrbios do sono em um Grupo de Policiais Militares de Elite. Método Estudo transversal, que avaliou 22 policiais militares de elite da Brigada Militar, o que corresponde a totalidade do efetivo operacional do grupo estudado. Resultados Os principais achados deste estudo foram quatro. Primeiro, observou-se uma elevada prevalência de distúrbios do sono (100% apresentaram algum distúrbio ou queixa relacionada ao sono) e de má qualidade de sono (63,6%) entre esses policiais. Segundo, observou-se uma elevada prevalência (27,3%) de síndrome da apneia obstrutiva do sono entre os policiais estudados sendo que estes apresentaram maior sonolência diurna. Terceiro, dentre os policiais que apresentaram algum acidente de trabalho constatou-se uma maior prevalência de sonolência diurna, de má qualidade do sono e de síndrome da apneia obstrutiva do sono. Quarto, policiais com má qualidade de sono apresentaram piores escores de qualidade de vida. Conclusão Considerando-se a elevada prevalência de distúrbios do sono entre os policiais militares e as diversas consequências advindas de um sono de má qualidade, sugere-se a inclusão de questões relacionadas ao sono, de questionários de triagem para distúrbios do sono e dependendo do caso, do exame de polissonografia, dentro da inspeção bienal de saúde dos Policiais Militares de Elite.

Resumen Objetivo Estudiar los disturbios del sueño en un Grupo de Policías Militares de Élite. Método Estudio transversal evaluando a 22 policías militares de élite de la Brigada Militar, que constituyen la totalidad de efectivos operativos del grupo estudiado. Resultados El estudio arrojó cuatro hallazgos principales. Primero, se observó elevada prevalencia de disturbios del sueño (100% presentó algún disturbio o queja relativa al sueño) y de mala calidad del sueño (63,6%) entre estos policías. Segundo, se observó elevada prevalencia (27,3%) de síndrome de apnea obstructiva del sueño entre los policías estudiados, presentando los mismos mayor somnolencia diurna.. Tercero, entre los policías que refirieron algún accidente de trabajo, se constató mayor prevalencia de somnolencia diurna, de mala calidad del sueño y de síndrome de apnea obstructiva del sueño. Cuarto, los policías con mala calidad del sueño muestran peores puntajes de calidad de vida. Conclusión Considerando la elevada prevalencia de disturbios del sueño entre los policías militares y las diversas consecuencias devenidas del sueño de mala calidad, se sugiere incluir preguntas relacionadas al sueño, de preguntas de triaje para disturbios del sueño y, dependiendo del caso, de una polisomnografía en la revisión bianual de salud de los Policías Militares de Élite.

Abstract Objective Study sleep disorders in a Group of Elite Military Police Officers. Method Cross-sectional study in which 22 elite military police officers from the Brigada Militar were assessed, corresponding to the total operational headcount of the group studied. Results There were four main findings in this study. First, a high prevalence of sleep disorders was observed (100% presented some sleep-related disorder or complaint) and bad sleep quality (63.6%) among these officers. Second, a high prevalence (27.3%) of obstructive sleep apnea syndrome was observed among the police officers studied, who presented greater daytime sleepiness. Third, among the police officers who presented some occupational accident, a higher prevalence of daytime sleepiness, bad sleep quality and obstructive sleep apnea syndrome was found. Fourth, officers with a bad quality of sleep presented worse quality of life scores. Conclusion Considering the high prevalence of sleep disorders among military police officers and the different consequences resulting from a bad quality of sleep, sleep-related questions, questionnaires to screen for sleep disorders and, depending on the case, polysomnography should be included in the routine health evaluation of Elite Military Police Officers.

Pulmonary hypertension as estimated by Doppler echocardiography in adolescent and adult patients with cystic fibrosis and their relationship with clinical, lung function and sleep findings.

BACKGROUND: In cystic fibrosis (CF) patients, end stage of pulmonary disease is characterized by pulmonary hypertension (PH), hypoxemia, decrease in exercise tolerance, and sleep quality. OBJECTIVE: To evaluate the association between clinical, lung function, sleep quality, and polysomnographic variables with PH in CF patients aged 16 years or older. METHODS: In a cross-sectional study, 51 clinically stable CF patients underwent a clinical evaluation, an overnight polysomnography and answered sleep questionnaires (Pittsburgh Sleep Quality Index and Epworth sleepiness scale). Also, CF patients had their pulmonary function, 6-minute walk test (6MWT) and echocardiography assessed. RESULTS: Fifty-one CF patients participated in the study; 47% were female. The mean age was 25.1 ± 8.8 years. Pulmonary artery systolic pressure (PASP) was greater than 35 mm Hg in 11 (27.5%) patients. Variables associated with PASP>35 mm Hg in univariate analysis were Shwachman-Kulczycki clinical score, forced expiratory volume in 1 second % of predicted, Pseudomonas aeruginosa in sputum culture, at-rest peripheral capillary oxygen saturation (SpO2 ), SpO2 at end of 6MWT and time of oxygen desaturation <90% during sleep. These variables were included in the binary logistic regression. The independent variable associated with the PASP > 35 mm Hg was at-rest SpO2 (OR = 10.8, CI 95% 1.7-67.3, P = .011). The cuttoff SpO2 < 94% had the sensitivity = 7/11 = 64%, specificity = 40/40 = 100%, positive predicted values = 7/7 = 100% and negative predicted values = 40/44 = 91% to the diagnosis of PH. CONCLUSION: the present study showed a high rate of PH in adolescent and adult CF patients. At-rest SpO2 was associated with PH.

Relationship Between Clinical Variables and Health-Related Quality of Life in Young Adult Subjects With Cystic Fibrosis.

BACKGROUND: Health-related quality of life (HRQOL) has received much attention in patients with cystic fibrosis (CF). The goal of this study was to evaluate the association between clinical, lung function, sleep quality, and polysomnographic variables with 2 HRQOL questionnaires, the shorter-version World Health Organization Quality of Life (WHOQOL-BREF) and Cystic Fibrosis Quality of Life (CFQOL) questionnaires, in adult subjects with CF. METHODS: In a cross-sectional study, 51 subjects underwent clinical evaluation and overnight polysomnography and answered WHOQOL-BREF, CFQOL, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale questionnaires. In addition, pulmonary function tests, 6-min walk tests, and echocardiography were performed. RESULTS: For WHOQOL-BREF scores, the sleep quality index was associated with the physical domain; the percent-of-predicted 6-min walk distance (6MWD) and sleepiness scale were associated with the psychological domain; the percent-of-predicted FEV1 and sleep quality index were associated with the social relationship domain; and the sleep quality index was associated with the environment domain. For CFQOL scores, age at diagnosis, clinical score, and sleep quality index were associated with the physical functioning domain; the percent-of-predicted 6MWD and pulmonary arterial systolic pressure were associated with the role domain; sex and sleep quality index were associated with the vitality domain; the apnea-hypopnea index was associated with the emotional functioning domain; sex and body mass index (BMI) were associated with the body image domain; the percent-of-predicted 6MWD and sleep quality index were associated with the health perception domain; age, sex, BMI, and arousal index were associated with the weight domain; age, sex, percent-of-predicted FEV1, percent-of-predicted 6MWD, and pulmonary arterial systolic pressure were associated with the respiratory symptom domain; and the clinical score was associated with the digestive symptom domain. CONCLUSIONS: The sleep quality index score, 6MWD, sleepiness scale score, and FEV1 were predictors of WHOQOL-BREF scores. Age at diagnosis, clinical score, sleep quality score, 6MWD, sex, apnea-hypopnea index, BMI, current age, arousal index, FEV1, and pulmonary arterial systolic pressure were predictors of CFQOL scores.

Sleep findings and predictors of sleep desaturation in adult cystic fibrosis patients.

PURPOSE: Questions remain about the polysomnographic findings and the predictors for sleep desaturation in cystic fibrosis (CF) patients. Our study aimed to evaluate sleep parameters in a sample of adult CF patients comparing them with healthy controls and to determine the best predictors of sleep desaturation in CF patients with awake resting peripheral oxygen saturation (SpO(2)) ≥90%. METHODS: In a cross-sectional study, with data collected prospectively, 51 clinically stable adult CF patients (mean age 25.1 ± 6.7 years) and 25 age-matched controls underwent an overnight polysomnography and answered sleep questionnaires. CF patients had their pulmonary function, 6-min walk test, and echocardiography assessed. RESULTS: CF patients and control subjects had similar sleep architecture. However, CF patients had impaired subjective sleep quality and a higher arousal index than controls. The apnea-hypopnea index was similar in both groups, and only two CF patients (3.9%) fulfilled the criteria for obstructive sleep apnea syndrome. Sleep desaturation was more common in CF patients (29.4% vs 0%; p < 0.001). In a logistic regression model, we observed that awake resting SpO(2) was the single best variable associated with sleep desaturation in CF population (p < 0.001). The awake SpO(2) <94% had a sensitivity, specificity, positive and negative predictive value for sleep desaturation of, respectively, 93.3%, 100%, 100%, and 97.3%. CONCLUSIONS: CF patients had a worse subjective sleep quality and small changes in sleep architecture. In nonhypoxic, adult CF patients, sleep desaturation is common, is not associated with obstructive sleep events, and can be accurately predicted by awake resting SpO(2) <94%.

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital.

OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.

Bacteriological analysis of induced sputum for the diagnosis of pulmonary tuberculosis in the clinical practice of a general tertiary hospital / Análise bacteriológica do escarro induzido para o diagnóstico de tuberculose pulmonar na prática clínica de um hospital geral terciário

OBJECTIVE: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. METHODS: A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. RESULTS: Of the 417 patients included in the study, 83 (19.9 percent) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95 percent CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95 percent CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1 percent) confirmed diagnoses of pulmonary TB. CONCLUSIONS: In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9 percent) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.

OBJETIVO: Verificar a sensibilidade diagnóstica da análise bacteriológica do escarro induzido (EI) para o diagnóstico de tuberculose (TB) pulmonar e identificar as variáveis clínicas associadas com o diagnóstico confirmado. Além disso, avaliar o rendimento diagnóstico da broncoscopia realizada se a pesquisa de BAAR for negativa no EI. MÉTODOS: Estudo transversal e retrospectivo de pacientes com suspeita de TB pulmonar ativa, encaminhados ao serviço para a indução de escarro. Foram revisados consecutivamente os registros laboratoriais de todos os pacientes submetidos à indução de escarro entre junho de 2003 e janeiro de 2006, assim como o prontuário eletrônico de cada caso. Também foram revisados os resultados bacteriológicos das amostras broncoscópicas coletadas dos pacientes cujos resultados de BAAR em EI foram negativos. RESULTADOS: Dos 417 pacientes estudados, 83 (19,9 por cento) tiveram resultados positivos (BAAR e/ou cultura) no EI. Na análise de regressão logística, os achados radiológicos de cavitação pulmonar (OR = 3,8; IC95 por cento: 1,9-7,6) e de infiltrado de padrão miliar (OR = 3,7; IC95 por cento: 1,6-8,6) associaram-se mais significativamente com o diagnóstico de TB pulmonar. A broncoscopia foi realizada, após resultado de BAAR negativo no EI, em 134 pacientes e acrescentou 25 (64,1 por cento) diagnósticos confirmados de TB pulmonar. CONCLUSÕES: Na prática clínica, a frequência de diagnósticos confirmados de TB pulmonar por EI (19,9 por cento) foi menor do que aquela previamente relatada em ensaios controlados. Cavitação e infiltrado miliar aumentam a probabilidade diagnóstica de TB pulmonar no EI. O uso de broncoscopia quando EI é negativo para BAAR melhora significativamente a sensibilidade para o diagnóstico de TB.

[Management of acute asthma in adults in the emergency room: current evidence]. / Manejo da asma aguda em adultos na sala de emergência: evidências atuais.

Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency room.

Manejo da asma aguda em adultos na sala de emergência: evidências atuais: [revisão] / Management of acute asthma in adults in the emergency room: current evidence: [review]

Asma é uma doença com uma alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver um aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda se constituem em uma emergência médica muito comum. As evidências têm demonstrado que o manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão, enfocaremos a avaliação e o tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. Serão consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento, avaliação das complicações, decisão sobre onde se realizará o tratamento adicional e orientações por ocasião da alta da emergência. Espera-se que estas recomendações contribuam para que o médico clínico tome as decisões apropriadas durante o manejo da asma aguda na sala de emergência.

Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency room.

Diagnóstico e tratamento das bronquiectasias: uma atualização / Diagnosis and treatment of bronchiectasis: an update

O termo bronquiectasia refere-se à dilatação anormal e irreversível dos brônquios. Atualmente, nos países desenvolvidos, onde a maior parte das bronquiectasias é atribuída a doenças sistêmicas, como a fibrose cística e as imunodeficiências primárias, têm-se observado uma diminuição progressiva da incidência dessa doença. Entretanto, em países em desenvolvimento, com menores recursos de saúde, as bronquiectasias pós-infecciosas continuam sendo um importante e freqüente problema de saúde pública. A tomografia computadorizada de alta resolução melhorou a eficácia diagnóstica nas bronquiectasias permitindo o diagnóstico mais precoce dessa entidade. A base do tratamento das bronquiectasias inclui tratar a causa específica quando possível, administrar antibióticos para tratamento da exacerbação e para supressão da carga microbiana, reduzir a excessiva resposta inflamatória, promover a higiene brônquica, controlar a hemorragia brônquica e remover cirurgicamente segmentos ou lobos extremamente danificados que possam se constituir em focos de infecção ou sangramento. Esta revisão aborda aspectos relevantes da patogênese, etiologia e diagnóstico das bronquiectasias e realiza uma atualização da terapêutica disponível

The bronchiectasis are abnormal and irreversible dilated bronchi. Nowadays, in industrialized countries, where most of the bronchiectasis is attributed to systemic illnesses, such as cystic fibrosis and the primary immunodeficiencies, the observation is that there has been a progressive decrease in the incidence of this disease. Nevertheless, in developing countries, with less health resources, the postinfectious bronchiectasis remains a relevant and frequent public health condition. High-resolution computed tomography (HRCT) has improved the diagnostic accuracy of bronchiectasis, allowing diagnosis in earlier stages. The foundations of bronchiectasis’ therapy includes the treatment of the specific cause when possible, the administration of antibiotics for acute exacerbation’s treatment and for suppression of the microbial load, reduction of the excessive inflammatory response, promotion of bronchial hygiene, control of bronchial hemorrhage, and surgical removal of extremely damaged segments or lobes that may be a nidus for infection or bleeding. This review discusses relevant aspects of pathogenesis, etiology and diagnosis of the bronchiectasis and makes an update of available therapy

Eficácia do formoterol na reversão imediata do broncoespasmo / Efficacy of inhaled formoterol in reversing bronchoconstriction

OBJETIVO: Avaliar efetividade e rapidez de ação do formoterol liberado através de inalador para pó seco na reversão de broncoespasmo induzido pela metacolina. MÉTODOS: Avaliaram-se prospectivamente 84 pacientes com queda do volume expiratório forçado no primeiro segundo 20 por cento após inalação de metacolina. Todos estavam sob investigação de sintomas respiratórios de etiologia não definida. Foram randomizados 41 pacientes para receber 200 mcg de fenoterol spray e 43 para receber 12 mcg de formoterol sob a forma de inalador de pó seco para reversão imediata do broncoespasmo. Avaliaram-se a queda no volume expiratório forçado no primeiro segundo inicial, dose provocadora de queda de 20 por cento do volume expiratório forçado no primeiro segundo inicial, e volume expiratório forçado no primeiro segundo após cinco e dez minutos da administração dos fármacos. RESULTADOS: Não houve diferença significativa entre os grupos em relação ao sexo, idade, peso, altura, dose provocadora de queda de 20 por cento do volume expiratório forçado no primeiro segundo, volume expiratório forçado no primeiro segundo inicial e pós-metacolina. A melhora do volume expiratório forçado no primeiro segundo após uso do broncodilatador foi de 34 por cento (cinco minutos) e 50,1 por cento (dez minutos) no primeiro grupo, e 46,5 por cento (cinco minutos) e 53,2 por cento (dez minutos) no segundo. CONCLUSÃO: O efeito broncodilatador do formoterol após cinco e dez minutos da indução de broncoespasmo pela metacolina foi similar ao do fenoterol. O formoterol, além de ser um broncodilatador de longa duração, tem também rápido início de ação, sugerindo que possa ser empregado como medicação de resgate nas crises de broncoespasmo.

OBJECTIVE: To evaluate the effectiveness and onset of action of formoterol delivered by dry-powder inhaler in reversing methacholine-induced bronchoconstriction. METHODS: Patients presenting a drop in forced expiratory volume in one second > 20 percent after methacholine inhalation were included. A total of 84 patients were evaluated. All of the participating patients presented respiratory symptoms of unknown origin, which were being investigated. The patients were randomized to receive 200 æg of spray fenoterol (n = 41) or 12 æg of dry-powder inhaler formoterol (n = 43), both administered in order to achieve immediate reversal of methacholine-induced bronchoconstriction. We evaluated the decrease in forced expiratory volume in one second (in relation to the baseline value) after methacholine challenge and the dose of methacholine required to provoke a drop of 20 percent in forced expiratory volume in one second, as well as the increase in forced expiratory volume in one second (in relation to the baseline value) at five and ten minutes after bronchodilator use. RESULTS: There were no significant differences related to gender, age, weight, height or dose of methacholine required to provoke a drop of 20 percent in forced expiratory volume in one second. Nor were there any significant differences in terms of baseline or post-methacholine forced expiratory volume in one second. In the fenoterol group, the mean postbronchodilator increase in forced expiratory volume in one second increase was 34 percent (at five minutes) and 50.1 percent (at ten minutes), compared with 46.5 percent (at five minutes) and 53.2 percent (at ten minutes) in the formoterol group. CONCLUSION: The bronchodilator effect of formoterol at five and ten minutes after methacholine-induced bronchoconstriction was similar to that of fenoterol. Despite being a long-acting bronchodilator, formoterol also has a rapid onset of action, which suggests that it could be employed ...

Epidemiologia e perfil de sensibilidade dos germes isolados de hemoculturas de pacientes hematológicos com neutropenia febril / Epidemiology and sensitivity profile of germs isolated in blood cultures of hematological patients with febrile neutropenia

A neutropenia febril(NF) é uma complicação muito freqüente nos pacientes com neoplasias hematológicas submetidos à quimioterapia. Determinar a prevalência e a sensibilidade aos antimicrobianos dos germes isolados de hemoculturas(HMC) de pacientes hematológicos com NF internados no HCPA. Foram analisadas, retrospectivamente, todas as HMC solicitadas para pacientes com NF(contagem total de neutrófilos<500/uL) internados na Unidade de Hematologia do HCPA entre fev/2003 e fev/2005. Considerou-se febre uma temperatura axilar>38,5oC ou duas medidas>38oC em 24 horas. Comparou-se o perfil de sensibilidade das infecções em pacientes com NF em relação às demais unidades de internação clínica do hospital. Foram solicitadas no período em estudo 2389 hemoculturas para 178 pacientes. Destas, 719 (30,1 por cento) foram positivas sendo que este percentual subiu para 38,7 por cento quando consideradas apenas as hemoculturas coletas sem a vigência de antibiótico. A análise dos germes isolados revelou que a maioria das infecções foi causada por Bacilos Gram-negativos(53,8 por cento) seguido pelos Cocos Gram-positivos(31,2 por cento). Os microrganismos isolados com maior freqüência foram: E. coli(14,6 por cento), S. aureus(13,8 por cento), K. pneumoniae(12,2 por cento), Streptococcus sp.(8,5 por cento), Pseudomonas sp. (7,9 por cento), Staphylococcus coagulase-negativo (7,3 por cento). A sensibilidade dos Bacilos Gram-negativos aos diferentes antimicrobianos foi: Cefepime(63 por cento), Amicacina(65 por cento), Ciprofloxacin(63 por cento), Piperacilina/Tazobactam(71 por cento), Ceftazidima(63 por cento), Meropenem(97 por cento). A sensibilidade dos Cocos Gram-positivos foi: Oxacilina(30 por cento), Levofloxacin(38 por cento), Vancomicina(100 por cento). Comparativamente ao perfil de sensibilidade das unidades de internação clínica adulta não-hematológicas constatou-se diferença estatisticamente significante(p<0,05) entre a sensibilidade dos Bacilos Gram-negativos ao Cefepime...

Efficacy of inhaled formoterol in reversing bronchoconstriction.

OBJECTIVE: To evaluate the effectiveness and onset of action of formoterol delivered by dry-powder inhaler in reversing methacholine-induced bronchoconstriction. METHODS: Patients presenting a drop in forced expiratory volume in one second > 20% after methacholine inhalation were included. A total of 84 patients were evaluated. All of the participating patients presented respiratory symptoms of unknown origin, which were being investigated. The patients were randomized to receive 200 microg of spray fenoterol (n = 41) or 12 microg of dry-powder inhaler formoterol (n = 43), both administered in order to achieve immediate reversal of methacholine-induced bronchoconstriction. We evaluated the decrease in forced expiratory volume in one second (in relation to the baseline value) after methacholine challenge and the dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second, as well as the increase in forced expiratory volume in one second (in relation to the baseline value) at five and ten minutes after bronchodilator use. RESULTS: There were no significant differences related to gender, age, weight, height or dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second. Nor were there any significant differences in terms of baseline or post-methacholine forced expiratory volume in one second. In the fenoterol group, the mean postbronchodilator increase in forced expiratory volume in one second increase was 34% (at five minutes) and 50.1% (at ten minutes), compared with 46.5% (at five minutes) and 53.2% (at ten minutes) in the formoterol group. CONCLUSION: The bronchodilator effect of formoterol at five and ten minutes after methacholine-induced bronchoconstriction was similar to that of fenoterol. Despite being a long-acting bronchodilator, formoterol also has a rapid onset of action, which suggests that it could be employed as a relief medication in cases of bronchoconstriction occurring during asthma attacks.

Efeito do salbutamol liberado através de inalador de pó seco sobre o broncoespasmo induzido por metacolina / Effects of salbutamol delivered by dry-powder inhaler on methacholine-induced bronchoconstriction

INTRODUÇAO: Os beta2-agonistas de curta duração sob a forma de nebulímetro pressurizado são os fármacos utilizados rotineiramente na reversão do broncoespasmo induzido pela metacolina. A administração desses fármacos na forma de pó seco, liberados por inaladores de pó seco pode ser uma alternativa eficaz. OBJETIVO: Avaliar a efetividade e rapidez de ação do salbutamol liberado através de inalador de pó seco pulvinal (Butovent®) na reversão do broncoespasmo induzido por metacolina, comparando-o com o salbutamol liberado por nebulímetro pressurizado. MÉTODO: Foram avaliados prospectivamente 60 pacientes sucessivos com broncoespasmo induzido por metacolina, cuja queda do volume expiratório forçado no primeiro segundo (VEF1) foi de, no mínimo, 20 por cento. Foram randomizados 30 pacientes para receber 200 mcg de salbutamol liberado por nebulímetro pressurizado e 30 pacientes para receber 200 mcg de salbutamol através de inalador de pó seco (pulvinal), na etapa final do teste de broncoprovocação, com o objetivo de reverter o broncoespasmo induzido pela metacolina. Foram avaliados os VEF1 obtidos 1 minuto e 5 minutos após a administração do broncodilatador. RESULTADOS: Os grupos foram pareados por sexo, idade, peso, altura, dose provocativa causadora de queda de 20 por cento no VEF1 (primeiro grupo: 1,3 mg ; segundo grupo: 1,19 mg; p = 0,79) e VEF1 pós-metacolina (primeiro grupo: 2,03 l; segundo grupo: 1,99 l; p = 0,87), sem diferença significativa entre eles. O incremento médio do VEF1 foi de 16,2 por cento (1 minuto) e 22,2 por cento (5 minutos) no primeiro grupo e de 17 por cento (1 minuto) e 23,6 por cento (5 minutos) no segundo grupo, não havendo diferença estatística entre eles (p = 0,8). CONCLUSÕES: Os beta2-agonistas administrados através de inalador de pó seco (pulvinal) apresentam a mesma eficácia broncodilatadora e rapidez de ação que no tradicional método por nebulímetro pressurizado.

[Airborne fungi and sensitization in atopic individuals in Porto Alegre, RS, Brazil]. / Os fungos anemófilos e sensibilização em indivíduos atópicos em Porto Alegre, RS.

OBJECTIVE: To identify and quantify the fungal spores in the atmospheric air of Porto Alegre and to assess sensitization to these allergens in atopic individuals suffering from rhinitis and asthma. METHODS: A total of 52 samples were obtained using a Rotorod Sampler from April 2000 through March 20001. Allergy skin tests with anemophilous fungus allergens as well as fluorimmunoenzymatic tests were performed in 39 atopic individuals with rhinitis and asthma in order to detect the incidence of respiratory allergies caused by these airborne fungi. RESULTS: In the 3773 fungal spores detected in this study, there was a prevalence of ascosporos (50.49%), Cladosporium (17.86%), Aspergillus/Penicillium (15.03%), basidiosporos (3.84%), rusts (3.82%), and Helminthosporium (2.49%), as well as a lesser frequency of Botrytis (1.22%), Alternaria (1.19%), smuts (0.90%), Curvularia (0.87%), Nigrospora (0.61%), and Fusarium (0.08%). Sixty spores (1.59%) detected here could not be identified by the systematic key used. Among the atopic individuals tested, 15.38% were found to be sensitized by these anemophilous fungi allergens. CONCLUSIONS: The occurrence of a great number of fungal spores emphasizes the importance of studying anemophilous fungi locally, since they are responsible for 15.38% of allergic sensitization in atopic individuals with asthma and rhinitis.

Os fungos anemófilos e sensibilizaçäo em indivíduos atópicos em Porto Alegre, RS / Airborne fungi and sensitization in atopic individuals in Porto Alegre, RS, Brazil

OBJETIVOS: Identificar e caracterizar a freqüência e a concentraçäo de esporos de fungos anemófilos em Porto Alegre. Determinar a prevalência de sensibilizaçäo a estes fungos em indivíduos atópicos. MÉTODOS: Em 52 amostras colhidas no equipamento Rotorod Sampler«, foram quantificados 3773 esporos de fungos no período de um ano (abril de 2000 a março de 2001). Em 39 pacientes atópicos com rinite e ou asma foram realizados testes cutâneos com alérgenos de fungos anemófilos e o teste fluorimunoenzimático para verificar a incidência de manifestações alérgicas provocadas por tais fungos. RESULTADOS: Em 3773 esporos de fungos encontrados foram identificados 674 (17,86 por cento) de Cladosporium sp, 567 (15,03 por cento) do grupo Aspergillus/Penicillium, 144 (3,82 por cento) de rusts, 94 (2,49 por cento) de Helminthosporium sp, 46 (1,22 por cento) de Botrytis sp, 45 (1,19 por cento) de Alternaria sp, 34 (0,90 por cento) de smuts, 33 (0,87 por cento) de Curvularia sp, 23 (0,61 por cento) de Nigrospora sp e 3 (0,08 por cento) de Fusarium sp. Também foram encontrados 1905 (50,49 por cento) de ascosporos e 145 (3,84 por cento) de basidiosporos. Näo foram possíveis de serem identificados 60 (1,59 por cento) dos esporos observados. Nos 39 testes cutâneos e sorológicos realizados, resultaram em 15,38 por cento de indivíduos atópicos sensibilizados por alérgenos de fungos em Porto Alegre. CONCLUSÕES: A ocorrência de grande número de esporos de fungos no ar em nossa cidade enfatiza a importância deste estudo sobre os fungos anemófilos, sendo eles responsáveis por 15,38 por cento das sensibilizações alérgicas em indivíduos atópicos com manifestações de asma e ou rinite

Mortality caused by idiopathic pulmonary fibrosis in the State of Rio Grande do Sul (Brazil)

Epidemiologic data on idiopathic pulmonary fibrosis are relatively scarce, and its real incidence and prevalence are unknown. Recent studies suggest that mortality due to idiopathic pulmonary fibrosis is rising in developed countries. OBJECTIVE: To describe mortality caused by idiopathic pulmonary fibrosis in the State of Rio Grande do Sul (RS), Brazil, from 1970 to 2000, analyzing its trend and comparing it with that from other countries. METHOD: Prevalence study, using data from the Brazilian Institute of Geography and Statistics (IBGE), analyzing death certificates in which idiopathic pulmonary fibrosis was stated as the ultimate cause of death. RESULTS: Annual mortality rate adjusted to the population was 0.22/100,000 people in the 1970's, 0.3/100,000 people in the 1980's, and 0.48/100,000 people in the 1990's. Total mortality raised 36 percent from 1970 to 1980, and 73 percent from 1980 to 1990. The mortality rate adjusted to the population raised 36 percent and 60 percent during the same periods. The rise in both total and adjusted mortality from IPF was statistically significant (p < 0.05). The mean mortality rate per 100,000 inhabitants between 1996 and 1998, however, was 0.683, corresponding to a 70 percent increase when compared to the previous three-year period, which was 0.4 (p = 0.0002), probably reflecting coding practices. CONCLUSION: There was a significant increase in IPF mortality in RS from 1970 to 2000, partly due to changes in coding practices. This increase is in conformity with observations in other countries, although mortality rates in RS are considerably lower.

Estudo epidemiologico dos coletores de lixo seletivo / Epidemiologic study of the selective garbage collectors

O artigo aborda epidemiologicamente o perfil dos coletores de lixo seletivo e descreve as lesões musculares e acidentes de trabalho mais freqüentes. Este estudo transversal foi desenvolvido com duas empresas (denominadas como empresa A e empresa B), em Porto Alegre, selecionando-se 50 funcionários aleatoriamente (presentes e aptos nos dias das entrevistas para a pesquisa) e aos quais foi aplicado um questionário. A Média de idade da amostra foi de 34 e 22 anos para a empresa A e B, respectivamente. Cerca de 66% dos funcionários da empresa B trabalham a menos de 5 anos na companhia, ao passo que 95% dos funcionários da empresa A trabalham há mais de 5 anos. O índice de lesões entre as duas empresas é alta 90% e 46,6% para empresas A e B, respectivamente. Lesões são mais comuns nos membros inferiores, seguidas pelas lesões dos membros superiores e da coluna. Ambas as empresas apresentavam deficiência do uso de equipamentos de proteção, sendo estes praticamente ignorados pelos funcionários, embora de uso obrigatório. As avaliações médicas são realizadas esporadicamente, sem acompanhamento regular. Ambas as empresas apresentam altos índices de leões em geral, sendo as lesões de membros inferiores mais comuns. Também são altos os índices de cortes e outros pequenos ferimentos, provavelmente pelo não uso de equipamentos de proteção obrigatórios.

Study the epidemiological profile of selective garbage collectors and describe the major muscle lesions and work acidents. Material and techniques this was a transversal study comparing the employees of the two principal companies who collects selective garbaje at Porto Alegre city, symbolized in this study as company A and company B. We applied a questionnaire randomly for 50 workers of the two companies. The mean age was 34 and 22 years old for company A and B respectively. Around sixty six percente of worker at company B have les than 5 years of experience at the job, comparing with the 95% of the employees of the company A who have more than 5 years at the job. The lesions indices are high at the two companies, 90 and 46,% for company A and B, respectively. The most common injuries were in inferior limbs, followed by upper limbs and column. Both the companies lack the do use of protection equipament in their workers, despite the obrigatory use in the work legislation. Medical evaluations are not regular. Both companies have a elevated percentage on injuries at work in general, being inferior limbs the most common ones. They also presented elevated indices of cuts and other small bruises, probably because of the no use of the obrigatory protection equipament.

Artrite reumatóide e depressão / Rheumatoid arthritis and depression

A depressão é uma doença freqüentemente subdiagnosticada e dificilmente bem manejada em pacientes com artrite reumatóide(AR). É possível verificar que alterações psicopatológicas podem ser decorrentes da AR, ou, pelo menos, de uma estado de dor crônica. Quanto à etiologia, não há base científica consistente que permita afirmar que distúrbios psiquiátricos participem da fisiopatologia dessa doença e vice-versa, sendo necessária a realização de estudos mais criteriosos nesse sentido. Todavia, as repercussões que a depressão pode provocar na qualidade de vida e prognóstico dos pacientes com AR já justificam por si o dever dos clínicos em atentar para o diagnóstico dessa co-morbidade e para o adequado manejo dessa situação. Nesta revisão bibliográfica são abordados fatores etiológicos, diagnóstico e o manejo de pacientes portadores de Ar e transtornos do humor