Nontuberculous mycobacterial infection as a cause of difficult-to-control asthma: a case-control study.

BACKGROUND: Symptomatic disease due to nontuberculous mycobacteria (NTM) is known to occur commonly in the presence of structural lung disease, but is not described in association with asthma. METHODS: This was a case-control study nested in a cohort. We identified 22 patients with difficult asthma referred to a tertiary academic referral center and subsequently found to have infection with NTM. We matched each case with two control subjects (next two consecutive patients referred for asthma management). RESULTS: It took on average 2.1 years from the onset of new or worsening symptoms to NTM diagnosis. The most common symptoms were worsening cough (77%), sputum production (40.9%), and frequent exacerbations (31.8%). Mycobacterium avium complex accounted for 63.6% of the infections, Mycobacterium xenopi the balance. Case subjects were older (59.8 ± 8.9 vs 42.6 ± 18 years; P < .001) and had more severe airflow obstruction (FEV(1), 57% [40%-74%] vs 89.5% [80%-98%]; P < .001). There was no difference between case and control subjects in the proportion using inhaled corticosteroids (ICS) or the average daily dose at the time of presentation, but case subjects had used ICS for a longer period (17 [6.2-20] vs 4 [0.75-6.0] years; P=.002). Six subjects with NTM were being treated with daily oral steroids, whereas none of the control subjects was. Of the 22 cases, 10 were treated with antibiotics for NTM, seven demonstrating clinical improvement or resolution of the presenting symptoms. CONCLUSIONS: NTM infection can be associated with asthma and should be considered in difficult-to-treat disease, especially in older individuals with more severe airflow obstruction and greater exposure to inhaled or systemic corticosteroids.

Bariatric surgery in the treatment of obstructive sleep apnea in morbidly obese patients.

BACKGROUND: Weight loss has been shown effective in the treatment of the obstructive sleep apnea-hypopnea syndrome. Regrettably, many obese patients are unable to achieve sustained and useful weight loss by dietary means. Recently, bariatric surgery has emerged as an alternative to treat obesity and many of its comorbidities, although its role for sleep apnea treatment is still not defined. OBJECTIVES: To evaluate the impact of bariatric surgery on obstructive sleep apnea in morbidly obese patients. METHODS: In this cohort study, polysomnography, Epworth Sleepiness Scale questionnaire and clinical assessment were performed in 12 of 13 morbidly obese patients with moderate to severe obstructive sleep apnea treated with bariatric surgery through Roux-en-Y gastric bypass procedure after a minimum of 18 months post surgery. RESULTS: The mean (+/-SD) loss of excess body weight was 70.5 +/- 24%. The mean level obtained in the Epworth Scale was 4.8. There was a significant reduction in the apnea-hypopnea index, from a median of 46.5 (range: 33-140) to 16 (range: 0.9-87) events per hour (p < 0.05), an improvement in mean oxygen saturation from 85.7 +/- 5.1 to 94.5 +/- 3.6% (p < 0.05) and in minimum oxygen saturation from 64.7 +/- 13.4 to 78.7 +/- 13.7% (p < 0.05). The magnitude of the weight loss and the improvements in mean and minimum oxygen saturation were positively correlated, (r = 0.76; p

A controlled trial of nortriptyline, sustained-release bupropion and placebo for smoking cessation: preliminary results.

PURPOSE AND METHODS: Cognitive behavior therapy (CBT) constitutes the basis of smoking cessation programs. Quitting rates are usually increased by the concomitant use of CBT and pharmacotherapy. There are studies showing the efficacy of bupropion and nortriptyline compared to placebo, but there is just one published comparison between these drugs, unfortunately with low power to detect significant differences. This study was designed to compare the efficacy of bupropion, nortriptyline and placebo in a group of smokers who also received intensive counseling therapy. We conducted a double blind, double-dummy, placebo-controlled trial for smoking cessation that lasted 9 weeks. Patients were randomized to receive nortriptyline 75 mg/day (52 subjects), bupropion 300 mg/day (53 subjects) or placebo (51 subjects). All smokers also received the same intensive cognitive behavior therapy. The target day for quitting smoking was usually day 10. Intensive counseling was provided at baseline, weekly during treatment, and at 10, 13, 16, 20 and 26 weeks. Abstinence was defined as continuous when the subject was not smoking since the target-quitting day (self-report) and had an expired carbon monoxide concentration of 10 ppm or less. RESULTS: The sustained abstinence rates at 6 months were 21.6% in the placebo group, 30.8% in the nortriptyline group (p = 0.40), and 41.5% in the bupropion group (p = 0.05). The odds ratio was not statistically different for smokers using nortriptyline or bupropion (OR 1.60; 95% CI 0.66-3.86; p = 0.35). The most common adverse events were dry mouth and drowsiness in the nortriptyline group and dry mouth and insomnia in the bupropion group. CONCLUSIONS: Treatment with CBT + bupropion resulted in a better 6-month rate of smoking cessation compared to CBT+nortriptyline or CBT + placebo. Abstinence rate in the nortriptyline group was not statistically different from patients in the bupropion or placebo group.

Selective surfactant prophylaxis in preterm infants born at < or =31 weeks' gestation using the stable microbubble test in gastric aspirates.

OBJECTIVE: To evaluate the stable microbubble test (SMT) ability to select candidates for surfactant prophylaxis for respiratory distress syndrome (RDS). STUDY DESIGN: We followed patients treated according to a new routine for surfactant prophylaxis based on the SMT to determine timing of the initial dose of surfactant, proportion of infants using surfactant, and the predictive value of the SMT. Gastric secretions were collected after birth. Newborns with < 25 microbubbles (MB)/mm(2) received prophylactic surfactant. Surfactant was given only after confirmation of RDS (rescue therapy) to newborns with > or =25 MB/mm(2). RESULTS: Fifty-four (55%) had a low MB count and received prophylactic surfactant. Three out of 44 infants with a high MB count required rescue therapy (negative predictive value 93%; CI:81.3-98.6%). The median interval and interquartile range between surfactant administration and birth in the prophylaxis group was 20 (17-27) minutes. Surfactant was used in 23 of 28 (82%) infants born at < 28 weeks of gestation and in 34 of 70 (49%) infants between 28 and 31 weeks. CONCLUSIONS: The SMT may be useful to determine surfactant prophylaxis (< 30 min after birth). This approach may reduce costs and the number of unnecessary interventions.

Histiocitose de células de Langerhans: rápida resolução após cessação do tabagismo

Descreve-se um caso de histiocitose pulmonar de células de Langerhans com relação estreita entre cessação do tabagismo e melhora radiológica. A tomografia computadorizada de alta resolução revelava múltiplos nódulos pequenos localizados em lobos superiores e campos médios de ambos os pulmões. O exame microscópico dessas lesões mostrava infiltração histiocitária, que se corava fortemente pela proteína S100. Apesar de a remissão espontânea poder ser uma possível explicação para essa evolução, este relato de caso mostra um rápido desaparecimento das lesões após o abandono do tabagismo.

Is there a gender difference in non-small cell lung cancer survival?

BACKGROUND: A possible association had previously been noted between gender and prognosis in non-small cell lung cancer (NSCLC), with a better survival rate for women. OBJECTIVE: The purpose of the current study was to further clarify the role of gender as a possible prognostic factor in NSCLC. METHODS: This retrospective cohort study examined the survival of NSCLC patients who underwent surgical curative treatment at the Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil, between January 1, 1990, and December 31, 2000. Data were analyzed using Kaplan-Meier survival curves. In addition, a Cox proportional hazards regression model was used to adjust for potential confounding factors. RESULTS: In the period studied, lung resections were performed in 253 patients with NSCLC, of whom 114 had stage I tumors. Four patients were excluded because of death in the immediate postoperative period, and 1 committed suicide. The 5-year survival rate was 85.5% for women and 46.4% for men (P<0.0001). The median overall survival time was 44.7 months (interquartile range [IQR(25%-75%)], 17.4-72.3 months) and was longer in women than in men: 63.9 months (IQR(25%5%), 35.2-98.7 months) versus 32.3 months (IQR(25%-75%), 11.8-61.5 months), respectively (P<0.0001). Gender effect was still present after adjustment by Cox regression for several factors (age, smoking habits, hemoglobin, forced expiratory volume in 1 second, tumor size, tumor-node-metastasis stage, histology, postoperative complications, and surgery type). The adjusted hazard ratio in women was 0.23 (95% CI, 0.09-0.59; (P<0.0001) when compared with men. CONCLUSION: This study confirms previous findings that women live longer than men after surgery for stage I NSCLC. This effect persisted after adjusting for several factors. These results highlight the fact that analyses of long-term survival of NSCLC patients, usually generalized to men and women as a whole, may be an inadequate extrapolation. These results question whether analyses of long-term survival, which commonly group men and women together, provide an adequate prognosis of survival rates in women with NSCLC.

Avaliação da PCR no diagnóstico de infecção pneumocócicas em amostras clínicas de escarro / Evaluation of PCR in the diagnosis of pneumococcal infections in clinical sputum samples

O objetivo deste artigo é avaliar o rendimento diagnóstico da Reação em Cadeia da Polimerase (PCR) em infecções respiratórias pelo Streptococcus pneumoniae em amostras de escarro. Foram analisadas 100 amostras de escarro de pacientes com infecção respiratória através dos métodos bacteriológicos convencionais (coloração de Gram e cultura) e da PCR para detecção do gene lytA do S. pneumoniae. Como grupo controle, swabs de orofaringe de 40 indivíduos saudáveis foram coletados e também submetidos à PCR. A identificação do pneumococo pelos métodos tradicionais ocorreu em 14 casos (14%). A PCR detectou 13 casos e mais 9 casos adicionais (22%). No grupo controle, a PCR deu resultados positivos em apenas 2 casos (5%), o que foi significativamente menos comum em comparação com os pacientes infectados (p < 0,05). Nossos achados demostram que a PCR aumenta o rendimento diagnóstico obtido pela coloração de Gram e a cultura e potencialmente pode ser usada para testar amostras clínicas de escarro.

Pico de fluxo expiratório em escoares de Porto Alegre, RS: proposta para valores de referência / Peak expiratory flow in schoolchildren of Porto Alegre, RS: reference values

O estudo apresenta tabelas contendo valores relativos ao pico de fluxo expiratório (PFE) obtidos com o medidor miniWright em 1037 escolares saudáveis com idades entre 10 e 18 anos oriundos da rede pública estadual, localizada em uma área restrita e näo poluida da cidade de Porto Alegre. As equaçöes de regressäo calculadas foram, para o sexo feminino: 2,75 x altura + 2,34 x Idade - 80,12 e, para o sexo masculino: 3,,5 x Altura + 11,96 x Idade - 312,87