Comparative analyses of thoracic radiographs and bronchoalveolar lavage of dogs and cats with chronic bronchial diseases / Análise comparativa da radiografia torácica e do lavado broncoalveolar em cães e gatos com doença bronquial crônica

There is a high incidence of bronchitis and asthma cases in veterinary medicine. Thoracic radiographs and bronchoalveolar lavage (BAL) are commonly performed for definitive diagnosis in dogs and cats with suspected bronchitis and asthma. It is believed that a combination of diagnostic tools is the best choice to achieve a diagnosis. The aim of this study was to evaluate the efficacy of thoracic radiographs and BAL in the diagnosis of chronic bronchial disease (CBD) in dogs and cats and whether there is any specific radiographic finding that could influence the indication for bronchoalveolar lavage. It was performed a cross-sectional, prospective, observational study including forty client-owned dogs and cats with lower respiratory tract signs and positive radiographic opacities that were evaluated with BAL followed by cytology and culture. The radiographic results compared with BAL culture showed a sensitivity of 38%, specificity of 95% and accuracy of 65% in detecting patients with pneumonia associated with chronic bronchial disease. Thoracic radiographs were effective in diagnosing 65% of the patients, radiographs plus BAL cytology diagnosed 75% of patients and the combination of radiographs, BAL cytology and culture diagnosed 95% of the patients with chronic bronchial disease. In conclusion, the combination of radiographic examination with BAL followed by cytological and microbiological analyses increases diagnostic success in CBD.(AU)

Existe uma alta incidência de casos de bronquite e asma em medicina veterinária. Radiografia torácica e lavado broncoalveolar (LBA) são geralmente realizados para o diagnóstico definitivo em cães e gatos com suspeita de bronquite e asma. Acredita-se que uma combinação de ferramentas diagnósticas é a melhor escolha para se obter um diagnóstico. O objetivo deste estudo foi avaliar a eficácia de radiografias torácicas e do LBA no diagnóstico da doença brônquica crônica (DBC) em cães e gatos e tentar determinar se há algum qualquer achado radiográfico específico que possa influenciar a indicação de lavado broncoalveolar. Foi realizado um estudo prospectivo, observacional, incluindo quarenta cães e gatos com sinais clínicos de trato respiratório inferior e aumento de opacidade radiográfica torácica, os quais foram avaliados com LBA seguido de citologia e cultura bacteriana. Os resultados radiográficos em comparação com a cultura bacteriana do LBA mostraram uma sensibilidade de 38%, especificidade de 95% e acurácia de 65% na detecção de pacientes com pneumonia associada à doença brônquica crônica. As radiografias torácicas foram eficazes em diagnosticar 65% dos pacientes, radiografia mais LBA seguido de citologia diagnosticaram 75% dos pacientes e a combinação de radiografias, LBA seguido de citologia e cultura bacteriana diagnosticaram 95% dos pacientes com doença brônquica crónica. Em conclusão, a combinação de exame radiográfico torácico e LBA seguido de análise citológica e microbiológica aumenta o sucesso diagnóstico na DBC.(AU)

Comparative analyses of thoracic radiographs and bronchoalveolar lavage of dogs and cats with chronic bronchial diseases / Análise comparativa da radiografia torácica e do lavado broncoalveolar em cães e gatos com doença bronquial crônica

There is a high incidence of bronchitis and asthma cases in veterinary medicine. Thoracic radiographs and bronchoalveolar lavage (BAL) are commonly performed for definitive diagnosis in dogs and cats with suspected bronchitis and asthma. It is believed that a combination of diagnostic tools is the best choice to achieve a diagnosis. The aim of this study was to evaluate the efficacy of thoracic radiographs and BAL in the diagnosis of chronic bronchial disease (CBD) in dogs and cats and whether there is any specific radiographic finding that could influence the indication for bronchoalveolar lavage. It was performed a cross-sectional, prospective, observational study including forty client-owned dogs and cats with lower respiratory tract signs and positive radiographic opacities that were evaluated with BAL followed by cytology and culture. The radiographic results compared with BAL culture showed a sensitivity of 38%, specificity of 95% and accuracy of 65% in detecting patients with pneumonia associated with chronic bronchial disease. Thoracic radiographs were effective in diagnosing 65% of the patients, radiographs plus BAL cytology diagnosed 75% of patients and the combination of radiographs, BAL cytology and culture diagnosed 95% of the patients with chronic bronchial disease. In conclusion, the combination of radiographic examination with BAL followed by cytological and microbiological analyses increases diagnostic success in CBD.

Existe uma alta incidência de casos de bronquite e asma em medicina veterinária. Radiografia torácica e lavado broncoalveolar (LBA) são geralmente realizados para o diagnóstico definitivo em cães e gatos com suspeita de bronquite e asma. Acredita-se que uma combinação de ferramentas diagnósticas é a melhor escolha para se obter um diagnóstico. O objetivo deste estudo foi avaliar a eficácia de radiografias torácicas e do LBA no diagnóstico da doença brônquica crônica (DBC) em cães e gatos e tentar determinar se há algum qualquer achado radiográfico específico que possa influenciar a indicação de lavado broncoalveolar. Foi realizado um estudo prospectivo, observacional, incluindo quarenta cães e gatos com sinais clínicos de trato respiratório inferior e aumento de opacidade radiográfica torácica, os quais foram avaliados com LBA seguido de citologia e cultura bacteriana. Os resultados radiográficos em comparação com a cultura bacteriana do LBA mostraram uma sensibilidade de 38%, especificidade de 95% e acurácia de 65% na detecção de pacientes com pneumonia associada à doença brônquica crônica. As radiografias torácicas foram eficazes em diagnosticar 65% dos pacientes, radiografia mais LBA seguido de citologia diagnosticaram 75% dos pacientes e a combinação de radiografias, LBA seguido de citologia e cultura bacteriana diagnosticaram 95% dos pacientes com doença brônquica crónica. Em conclusão, a combinação de exame radiográfico torácico e LBA seguido de análise citológica e microbiológica aumenta o sucesso diagnóstico na DBC.

Rastreio de patologia respiratória em crianças em idade escolar com o uso de espirometria portátil / Respiratory disease screening in school-aged children using portable spirometry

OBJETIVOS: Avaliar a prevalência de doença respiratória em crianças em idade escolar e determinar o valor da espirometria de campo. MÉTODOS: Avaliaram-se 313 alunos do primeiro e quarto ano de quatro escolas de Lisboa. Aplicou-se questionário respiratório auto-preenchido, e efetuou-se espirometria. Realizou-se análise descritiva e bivariada seguida de análise de regressão logística múltipla. RESULTADOS: Trinta e cinco por cento das crianças tiveram pelo menos um episódio de sibilância (18 por cento > 2 episódios), e 4 por cento tiveram diagnóstico de asma. Sibilância foi mais frequente com história familiar de atopia (OR ajustado = 2,7, IC95 por cento 1,4-5,1), tabagismo na gravidez, infecção respiratória baixa (IRB) (OR ajustado = 2,8; IC95 por cento 1,2-6,2), bronquiolite (OR ajustado = 3,3; IC95 por cento 1,3-8,2) e alergia a aeroalérgenos (OR ajustado = 3,2; IC95 por cento 1,4-7,2). Asma foi mais frequente com história de IRB (OR ajustado = 14,6; IC95 por cento 1,7-122,9) e alergia a aeroalérgenos (OR ajustado = 8,2; IC95 por cento 2,0-34,2). Cento e sessenta e nove (54 por cento) valores espirométricos preencheram critérios de aceitabilidade. O grupo com sibilância tinha em média valores de escore z inferiores para volume expiratório forçado no primeiro segundo (VEF1), razão entre VEF1 e capacidade vital forçada (CVF) (VEF1/CVF) e fluxo expiratório forçado entre 25 e 75 por cento (FEF25-75) (p < 0,05), além de maior percentagem de crianças com valores anormais para VEF1, VEF1/CVF e FEF25-75 (FEF25-75, p < 0,05). CONCLUSÕES: Este estudo piloto revelou frequência elevada de sintomatologia respiratória obstrutiva em escolares em Lisboa. Verificou-se boa correlação entre o questionário e os valores espirométricos. A baixa prevalência de asma leva-nos a especular que este diagnóstico esteja subestimado nesta população.

OBJECTIVES: To assess the prevalence of respiratory disease in school-aged children and to determine the value of field spirometry. METHODS: Data on 313 1st and 4th graders from four public schools in Lisbon were analyzed. A respiratory self-answered questionnaire and standard spirometry were performed. Descriptive and bivariate analysis was followed by multiple logistic regression. RESULTS: Thirty-five percent of the children presented at least one episode of wheezing (18 percent > 2 episodes), and 4 percent had asthma. Wheezing was more frequent with family history of atopy (adjusted OR = 2.7; 95 percentCI 1.4-5.1), maternal smoking during pregnancy, lower respiratory tract infection (LRTI) (adjusted OR = 2.8; 95 percentCI 1.2-6.2), bronchiolitis (adjusted OR = 3.3; 95 percentCI 1.3-8.2), and allergy to aeroallergens (adjusted OR = 3.2; 95 percentCI 1.4-7.2). Asthma was more frequent with previous history of LRTI (adjusted OR = 14.6; 95 percentCI 1.7-122.9) and allergy to aeroallergens (adjusted OR = 8.2; 95 percentCI 2.0-34.2). Fifty-five percent of spirometry measurements met the acceptability criteria of the American Thoracic Society and of the European Respiratory Society. Wheezers presented mean lower z scores for forced expiratory volume in 1 second (FEV1), ratio between FEV1 and forced vital capacity (FVC) (FEV1/FVC), and forced expiratory flow between 25 and 75 percent (FEF25-75) (p < 0.05), as well as higher percentage of abnormal FEV1, FEV1/FVC and FEF25-75 (FEF25-75, p < 0.05). CONCLUSIONS: This pilot study showed a high prevalence of obstructive airway symptoms in school-aged children in Lisbon. Symptoms assessed by the questionnaire showed good correlation with spirometric values. The small prevalence of asthma leads us to speculate that asthma is under-diagnosed in this population.

Respiratory disease screening in school-aged children using portable spirometry.

OBJECTIVES: To assess the prevalence of respiratory disease in school-aged children and to determine the value of field spirometry. METHODS: Data on 313 1st and 4th graders from four public schools in Lisbon were analyzed. A respiratory self-answered questionnaire and standard spirometry were performed. Descriptive and bivariate analysis was followed by multiple logistic regression. RESULTS: Thirty-five percent of the children presented at least one episode of wheezing (18% ≥ 2 episodes), and 4% had asthma. Wheezing was more frequent with family history of atopy (adjusted OR = 2.7; 95%CI 1.4-5.1), maternal smoking during pregnancy, lower respiratory tract infection (LRTI) (adjusted OR = 2.8; 95%CI 1.2-6.2), bronchiolitis (adjusted OR = 3.3; 95%CI 1.3-8.2), and allergy to aeroallergens (adjusted OR = 3.2; 95%CI 1.4-7.2). Asthma was more frequent with previous history of LRTI (adjusted OR = 14.6; 95%CI 1.7-122.9) and allergy to aeroallergens (adjusted OR = 8.2; 95%CI 2.0-34.2). Fifty-five percent of spirometry measurements met the acceptability criteria of the American Thoracic Society and of the European Respiratory Society. Wheezers presented mean lower z scores for forced expiratory volume in 1 second (FEV1), ratio between FEV1 and forced vital capacity (FVC) (FEV1/FVC), and forced expiratory flow between 25 and 75% (FEF25-75) (p < 0.05), as well as higher percentage of abnormal FEV1, FEV1/FVC and FEF25-75/ (FEF25-75, p < 0.05). CONCLUSIONS: This pilot study showed a high prevalence of obstructive airway symptoms in school-aged children in Lisbon. Symptoms assessed by the questionnaire showed good correlation with spirometric values. The small prevalence of asthma leads us to speculate that asthma is under-diagnosed in this population.

Tratamento cirúrgico de crianças com pneumonia necrosante / Surgical treatment of children with necrotizing pneumonia

OBJETIVO: Descrever os resultados do tratamento cirúrgico de crianças com pneumonia necrosante. MÉTODOS: Análise retrospectiva dos prontuários de 20 crianças diagnosticadas com pneumonia necrosante e submetidas ao tratamento cirúrgico nos serviços de cirurgia torácica de dois hospitais na cidade de Manaus (AM) entre março de 1997 e setembro de 2008. Dados referentes a idade, sexo, agente etiológico, motivos da indicação cirúrgica, tipo de ressecção cirúrgica realizada e complicações pós-operatórias foram compilados. RESULTADOS: Dos 20 pacientes analisados, 12 (60 por cento) eram do sexo feminino. A média de idade dos pacientes foi de 30 meses. Os agentes etiológicos mais encontrados foram Staphylococcus aureus, em 5 pacientes (25 por cento), e Klebsiella sp., em 2 (10 por cento). Os motivos de indicação cirúrgica foram sepse, em 16 pacientes (80 por cento), e fístula broncopleural, em 4 (20 por cento). Os tipos de procedimentos cirúrgicos realizados foram lobectomia, em 12 pacientes (60 por cento), segmentectomia, em 7 (35 por cento), e bilobectomia, em 1 (5 por cento). Além desses procedimentos, 8 pacientes (40 por cento) foram submetidos à descorticação pulmonar. As complicações pós-operatórias foram as seguintes: fístula broncopleural, em 4 pacientes (20 por cento); empiema, em 1 (5 por cento); pneumatocele, em 1 (5 por cento); e flebite em membro superior esquerdo, em 1 (5 por cento). Quatro pacientes (20 por cento) morreram. CONCLUSÕES: Pacientes com evidências de necrose pulmonar devem ser considerados para a ressecção cirúrgica, que está indicada em casos graves de sepse, fístula broncopleural de alto débito ou insuficiência respiratória aguda que não respondem ao tratamento clínico.

OBJECTIVE: To describe the results of the surgical treatment of children with necrotizing pneumonia. METHODS: A retrospective analysis of the medical charts of 20 children diagnosed with necrotizing pneumonia and submitted to surgical treatment between March of 1997 and September of 2008 in the thoracic surgery departments of two hospitals in the city of Manaus, Brazil. We compiled data regarding age, gender, etiologic agent, indications for surgery, type of surgical resection performed, and postoperative complications. RESULTS: The mean age of the patients was 30 months. Of the 20 patients studied, 12 (60 percent) were female. The most common etiologic agents were Staphylococcus aureus, in 5 patients (25 percent), and Klebsiella sp., in 2 (10 percent). The indications for surgery were sepsis, in 16 patients (80 percent), and bronchopleural fistula, in 4 (20 percent). The types of surgical procedures performed were lobectomy, in 12 patients (60 percent), segmentectomy, in 7 (35 percent), and bilobectomy, in 1 (5 percent). There were 8 patients (40 percent) who also underwent decortication. The postoperative complications were as follows: bronchopleural fistula, in 4 patients (20 percent); empyema, in 1 (5 percent); pneumatocele, in 1 (5 percent); and phlebitis of the left arm, in 1 (5 percent). Four (20 percent) of the patients died. CONCLUSIONS: Surgical resection should be considered in patients with evidence of pulmonary necrosis. Resection is indicated in cases of severe sepsis, high output bronchopleural fistula, or acute respiratory failure that are refractory to clinical treatment.

[Respiratory symptoms in charcoal production workers in the cities of Lindolfo Collor, Ivoti and Presidente Lucena, Brazil]. / Sintomas respiratórios em trabalhadores de carvoarias nos municípios de Lindolfo Collor, Ivoti e Presidente Lucena, RS.

OBJECTIVE: To determine the prevalence of respiratory symptoms and smoking, as well as pulmonary function parameters among charcoal production workers in three cities in southern Brazil. METHODS: This was an observational study including 67 individuals. Data were obtained by means of interviews and spirometry. RESULTS: Of the 67 workers, 50 (75.0%) were male; mean age, 46.52 +/- 13.25 years; mean BMI, 25.7 +/- 3.85 kg/m(2); FEV1, 3.24 +/- 0.82 L (93.2 +/- 16.0% of predicted); FVC, 4.02 +/- 0.92 L (95.5 +/- 14.3% of predicted); and FEV1/FVC, 80.31 +/- 9.82. The most common upper airway symptoms were sneezing and nasal secretion-in 24 workers (35.82%)-whereas the most common lower airway symptom was cough-in 15 (22.38%).Of the 67 workers, 21 (31.34%) were smokers. In comparison with the nonsmokers, the smokers more often presented with cough (OR = 5.00; p = 0.01), nasal obstruction (OR = 3.50; p = 0.03), nasal itching (OR = 8.80; p = 0.01) and wheezing (OR = 10.0; p = 0.03), as well as presenting with lower FEV1 values (2.93 +/- 0.80 vs. 3.38 +/- 0.80 L; p = 0.04). We detected occupational rhinitis in 14 workers (20.85%), asthma in 4 (5.97%) and COPD in 4 (5.97%). CONCLUSIONS: Respiratory symptoms and airflow reduction were more common in the smoking workers. Controlling the progression of the pyrolysis did not increase the prevalence of respiratory symptoms in the charcoal production workers studied.

Sintomas respiratórios em trabalhadores de carvoarias nos municípios de Lindolfo Collor, Ivoti e Presidente Lucena, RS / Respiratory symptoms in charcoal production workers in the cities of Lindolfo Collor, Ivoti and Presidente Lucena, Brazil

OBJETIVO: Determinar a ocorrência de sintomas respiratórios e tabagismo, assim como parâmetros de função pulmonar, em trabalhadores da produção de carvão vegetal em três municípios do sul do Brasil. MÉTODOS: Estudo do tipo observacional com 67 indivíduos, no qual os dados foram obtidos através de entrevistas e espirometria. RESULTADOS: Do total de 67 trabalhadores, 50 (75,0 por cento) eram homens; média de idade = 46,52 ± 13,25 anos; média de IMC = 25,7 ± 3,85 kg/m²; VEF1 = 3,24 ± 0,82 L (93,2 ± 16,0 por cento do previsto); CVF = 4,02 ± 0,92 L (95,5 ± 14,3 por cento do previsto); e VEF1/CVF = 80,31 ± 9,82. Os sintomas de vias aéreas superiores mais frequentes foram espirros e secreção nasal, em 24 trabalhadores (35,82 por cento), enquanto o das vias aéreas inferiores foi tosse, em 15 (22,38 por cento). Dos 67 trabalhadores, 21 (31,34 por cento) eram tabagistas. Os tabagistas apresentaram mais tosse (OR = 5,00; p = 0,01), obstrução nasal (OR = 3,50; p = 0,03), prurido nasal (OR = 8,80; p = 0,01) e sibilância (OR = 10,0; p = 0,03), assim como menor VEF1 (2,93 ± 0,80 L vs. 3,38 ± 0,80 L; p = 0,04) que os não tabagistas. Rinite ocupacional foi detectada em 14 trabalhadores (20,85 por cento), asma brônquica em 4 (5,97 por cento) e DPOC em 4 (5,97 por cento). CONCLUSÕES: A ocorrência dos sintomas respiratórios e a redução do fluxo aéreo foram maiores nos trabalhadores tabagistas. O controle da pirólise não aumentou a ocorrência de sintomas respiratórios nos trabalhadores de carvoarias.

OBJECTIVE: To determine the prevalence of respiratory symptoms and smoking, as well as pulmonary function parameters among charcoal production workers in three cities in southern Brazil. METHODS: This was an observational study including 67 individuals. Data were obtained by means of interviews and spirometry. RESULTS: Of the 67 workers, 50 (75.0 percent) were male; mean age, 46.52 ± 13.25 years; mean BMI, 25.7 ± 3.85 kg/m²; FEV1, 3.24 ± 0.82 L (93.2 ± 16.0 percent of predicted); FVC, 4.02 ± 0.92 L (95.5 ± 14.3 percent of predicted); and FEV1/FVC, 80.31 ± 9.82. The most common upper airway symptoms were sneezing and nasal secretion-in 24 workers (35.82 percent)-whereas the most common lower airway symptom was cough-in 15 (22.38 percent).Of the 67 workers, 21 (31.34 percent) were smokers. In comparison with the nonsmokers, the smokers more often presented with cough (OR = 5.00; p = 0.01), nasal obstruction (OR = 3.50; p = 0.03), nasal itching (OR = 8.80; p = 0.01) and wheezing (OR = 10.0; p = 0.03), as well as presenting with lower FEV1 values (2.93 ± 0.80 vs. 3.38 ± 0.80 L; p = 0.04). We detected occupational rhinitis in 14 workers (20.85 percent), asthma in 4 (5.97 percent) and COPD in 4 (5.97 percent). CONCLUSIONS: Respiratory symptoms and airflow reduction were more common in the smoking workers. Controlling the progression of the pyrolysis did not increase the prevalence of respiratory symptoms in the charcoal production workers studied.

Early and late infections in lung transplantation patients.

UNLABELLED: Infections are an important cause of morbidity and mortality among transplanted patients. Their pathophysiology is associated with anatomic factors, immunosuppression, and pretransplant viral exposure. The aim of this investigation was to characterize infections following lung transplantation. We retrospectively analyzed the charts of 51 lung transplant recipients, who were transplanted between 1999 and 2008. Infections were classified according to their origin, etiology, occurrence time, and risk factors. The patient mean age was 55 years (range 13-71), 65% were male, and pulmonary fibrosis was the lung disease etiology in 59% of cases. Seventy-one episodes of infection were reported in the 51 patients, including (75%) during the first year after transplantation and 30 within the first 3 months (42%). Between the 4th and 11th months the number of infections decreased to 23 (32%), and afterwards there were 18 additional cases. The original site of infection was pulmonary in 43 episodes (60%), and the etiology was bacterial in 34 (48%), with Pseudomonas in 12 instances (35% of bacterial infections). Viruses were involved in 25 episodes, especially cytomegalovirus (CMV) in seronegative patients. The nine infections of fungal etiology (13%) were all caused by Aspergillus and always associated with either an acute rejection episode or suture damage. Three cases of tuberculosis were diagnosed, including two in the late post-transplant period. Three patients died of early infections. CONCLUSIONS: The critical period for infections in lung transplantation patients is the first 3 months, especially for those of bacterial etiology. CMV diseases were more common in seronegative patients and fungal infections in airway injury cases.

Surgical treatment of children with necrotizing pneumonia.

OBJECTIVE: To describe the results of the surgical treatment of children with necrotizing pneumonia. METHODS: A retrospective analysis of the medical charts of 20 children diagnosed with necrotizing pneumonia and submitted to surgical treatment between March of 1997 and September of 2008 in the thoracic surgery departments of two hospitals in the city of Manaus, Brazil. We compiled data regarding age, gender, etiologic agent, indications for surgery, type of surgical resection performed, and postoperative complications. RESULTS: The mean age of the patients was 30 months. Of the 20 patients studied, 12 (60%) were female. The most common etiologic agents were Staphylococcus aureus, in 5 patients (25%), and Klebsiella sp., in 2 (10%). The indications for surgery were sepsis, in 16 patients (80%), and bronchopleural fistula, in 4 (20%). The types of surgical procedures performed were lobectomy, in 12 patients (60%), segmentectomy, in 7 (35%), and bilobectomy, in 1 (5%). There were 8 patients (40%) who also underwent decortication. The postoperative complications were as follows: bronchopleural fistula, in 4 patients (20%); empyema, in 1 (5%); pneumatocele, in 1 (5%); and phlebitis of the left arm, in 1 (5%). Four (20%) of the patients died. CONCLUSIONS: Surgical resection should be considered in patients with evidence of pulmonary necrosis. Resection is indicated in cases of severe sepsis, high output bronchopleural fistula, or acute respiratory failure that are refractory to clinical treatment.

Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria.

OBJECTIVE: To determine the morbidity and mortality related to respiratory diseases among adults attending a tertiary-care hospital in Nigeria. METHODS: We carried out a retrospective study of 183 adult patients (> 15 years of age), diagnosed with respiratory diseases between November of 2006 and October of 2008 at the Federal Medical Centre in Ido-Ekiti, Nigeria. RESULTS: Of the 183 patients enrolled in the study, 78 (42.6%) were male and 105 (57.4%) were female, the male: female ratio being 1:1.4. Respiratory diseases were predominant in the 25-44 year age bracket (37.2%) and lower socioeconomic class (81.4%). Pulmonary TB was the leading cause of morbidity (in 42.1%), followed by asthma (in 17.5%) and pneumonia (in 15.3%). Lung cancer was uncommon (in only 0.6%). Pulmonary TB was the leading cause of hospitalization for respiratory disease (in 32%). Pulmonary TB, asthma, pneumonia and pleural pathologies were more common in women, whereas COPD was more common in men. The most common comorbidity was HIV infection (in 11.5%). The overall mean length of hospital stay was 14 days. Overall mortality was 8.7%; 50% of the deaths were attributed to pulmonary TB, 25% were attributed to pleural disease, 12.5% were attributed to pneumonia, and 6.25% were attributed to acute exacerbation of COPD. Mortality was higher in women and in the 25-44 year age bracket. CONCLUSIONS: Pulmonary TB, asthma and pneumonia were the leading causes of respiratory disease-related morbidity. Pulmonary TB was the leading cause of respiratory disease-related mortality among the adult Nigerians evaluated. Therefore, these conditions should be given higher priority in patient care. In addition, antiretroviral therapy should be readily accessible and affordable to HIV-infected individuals.

Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria / Morbidade e mortalidade relacionadas a doenças respiratórias em adultos atendidos em um hospital terciário na Nigéria

OBJECTIVE: To determine the morbidity and mortality related to respiratory diseases among adults attending a tertiary-care hospital in Nigeria. METHODS: We carried out a retrospective study of 183 adult patients (> 15 years of age), diagnosed with respiratory diseases between November of 2006 and October of 2008 at the Federal Medical Centre in Ido-Ekiti, Nigeria. RESULTS: Of the 183 patients enrolled in the study, 78 (42.6 percent) were male and 105 (57.4 percent) were female, the male: female ratio being 1:1.4. Respiratory diseases were predominant in the 25-44 year age bracket (37.2 percent) and lower socioeconomic class (81.4 percent). Pulmonary TB was the leading cause of morbidity (in 42.1 percent), followed by asthma (in 17.5 percent) and pneumonia (in 15.3 percent). Lung cancer was uncommon (in only 0.6 percent). Pulmonary TB was the leading cause of hospitalization for respiratory disease (in 32 percent). Pulmonary TB, asthma, pneumonia and pleural pathologies were more common in women, whereas COPD was more common in men. The most common comorbidity was HIV infection (in 11.5 percent). The overall mean length of hospital stay was 14 days. Overall mortality was 8.7 percent; 50 percent of the deaths were attributed to pulmonary TB, 25 percent were attributed to pleural disease, 12.5 percent were attributed to pneumonia, and 6.25 percent were attributed to acute exacerbation of COPD. Mortality was higher in women and in the 25-44 year age bracket. CONCLUSIONS: Pulmonary TB, asthma and pneumonia were the leading causes of respiratory disease-related morbidity. Pulmonary TB was the leading cause of respiratory disease-related mortality among the adult Nigerians evaluated. Therefore, these conditions should be given higher priority in patient care. In addition, antiretroviral therapy should be readily accessible and affordable to HIV-infected individuals.

OBJETIVO: Determinar a morbidade e a mortalidade relacionadas a doenças respiratórias em adultos atendidos em um hospital terciário na Nigéria. MÉTODOS: Estudo retrospectivo com 183 pacientes adultos (> 15 anos) diagnosticados com doenças respiratórias, entre novembro de 2006 e outubro de 2008, no Centro Médico Federal em Ido-Ekiti, Nigéria. RESULTADOS: Dos 183 pacientes estudados, 78 (42,6 por cento) eram do sexo masculino e 105 (57,4 por cento) do sexo feminino (razão entre homens e mulheres: 1:1,4). As doenças respiratórias foram predominantes na faixa etária entre 25 e 44 anos (37,2 por cento) e classe socioeconômica baixa (81,4 por cento). A forma pulmonar da TB foi a principal causa de morbidade (em 42,1 por cento), seguida por asma (em 17,5 por cento) e pneumonia (em 15,3 por cento). O câncer de pulmão foi raro (em somente 0,6 por cento). A TB pulmonar foi a principal causa de hospitalização devido à doença respiratória (em 32 por cento). A forma pulmonar da TB, asma, pneumonia e patologias da pleura foram mais frequentes no sexo feminino, ao passo que a DPOC foi mais frequente no sexo masculino. A comorbidade mais frequente foi a infecção por HIV (em 11,5 por cento). A média do tempo de hospitalização foi de 14 dias. A mortalidade foi 8,7 por cento; 50 por cento das mortes foram atribuídas à TB pulmonar, 25 por cento à doença pleural, 12,5 por cento à pneumonia e 6,25 por cento à exacerbação aguda da DPOC. A mortalidade foi maior em mulheres e na faixa etária de 25 a 44 anos. CONCLUSÕES: TB pulmonar, asma e pneumonia foram as principais causas de morbidade relacionada a doenças pulmonares. A forma pulmonar da TB foi a principal causa de mortalidade relacionada a doenças respiratórias na população adulta nigeriana estudada. Portanto, deve-se dar grande prioridade a essas doenças no atendimento desses pacientes. Além disso, a terapia antirretroviral deve ser de fácil acesso e pouco dispendiosa para indivíduos infectados com HIV.

Gravedad de la infección por virus sincicial respiratorio en pacientes con factores de riesgo y sin ellos / Severity of synctitial respiratory virus infection in patients with risk factors and without them

Objetivo. Analizar diferentes variables de gravedad clínica en niños con factores de riesgo y sin ellos para enfermedad respiratoria por virus sincicial respiratorio en nuestro medio. Población, material y métodos. Estudio retrospectivo de cohorte de historias clínicas de pacientes hospitalizados en el Hospital ¶Prof. Dr. Juan P. Garrahan÷, con diagnóstico de infección respiratoria aguda baja por virus sincicial respiratorio entre 1998 y1999. Se consideraron factores de riesgo: recién nacidos pretérmino ≤ 34 semanas, prematuros ≤ 6 meses al momento de la infección, recién nacidos de término ≤ 45 días, enfermedad pulmonar obstructiva crónica, displasia broncopulmonar, fibrosis quística y cardiopatías congénitas. Se dividió a la población en dos grupos: sin riesgo y con riesgo, y se evaluaron distintas variables. Resultados. Se analizaron 461 pacientes. La edad media fue de 6,96 meses (r igual 0,33 a 23,8 y modo 1 m). La relación M/F fue de 1:0,8. Las formas clínicas de presentación más frecuentes fueron bronquiolitis 72,2 por ciento y neumonía 13,9 por ciento. Los pacientes sin riesgo fueron 57,3 por ciento y con riesgo, 42,7 por ciento. Los pacientes con riesgo tuvieron más días de internación (p igual 0,001), de oxigenoterapia (p igual 0,001) y mayor requerimiento de asistencia respiratoria mecánica y durante más días (p igual 0,001). La mortalidad del grupo fue 1,04 por ciento. Conclusión. Los niños con infección por virus sincicial respiratorio con factores de riesgo requirieron mayor tiempo de internación, de oxigenoterapia y tuvieron mayor probabilidad de requerir asistencia respiratoria mecánica. Estos datos determinan en qué pacientes deberían implementarse medidas preventivas y terapéuticas más precoces para mejorar su evolución y pronóstico (AU)

Gravedad de la infección por virus sincicial respiratorio en pacientes con factores de riesgo y sin ellos / Severity of synctitial respiratory virus infection in patients with risk factors and without them

Objetivo. Analizar diferentes variables de gravedad clínica en niños con factores de riesgo y sin ellos para enfermedad respiratoria por virus sincicial respiratorio en nuestro medio. Población, material y métodos. Estudio retrospectivo de cohorte de historias clínicas de pacientes hospitalizados en el Hospital “Prof. Dr. Juan P. Garrahan”, con diagnóstico de infección respiratoria aguda baja por virus sincicial respiratorio entre 1998 y1999. Se consideraron factores de riesgo: recién nacidos pretérmino ≤ 34 semanas, prematuros ≤ 6 meses al momento de la infección, recién nacidos de término ≤ 45 días, enfermedad pulmonar obstructiva crónica, displasia broncopulmonar, fibrosis quística y cardiopatías congénitas. Se dividió a la población en dos grupos: sin riesgo y con riesgo, y se evaluaron distintas variables. Resultados. Se analizaron 461 pacientes. La edad media fue de 6,96 meses (r igual 0,33 a 23,8 y modo 1 m). La relación M/F fue de 1:0,8. Las formas clínicas de presentación más frecuentes fueron bronquiolitis 72,2 por ciento y neumonía 13,9 por ciento. Los pacientes sin riesgo fueron 57,3 por ciento y con riesgo, 42,7 por ciento. Los pacientes con riesgo tuvieron más días de internación (p igual 0,001), de oxigenoterapia (p igual 0,001) y mayor requerimiento de asistencia respiratoria mecánica y durante más días (p igual 0,001). La mortalidad del grupo fue 1,04 por ciento. Conclusión. Los niños con infección por virus sincicial respiratorio con factores de riesgo requirieron mayor tiempo de internación, de oxigenoterapia y tuvieron mayor probabilidad de requerir asistencia respiratoria mecánica. Estos datos determinan en qué pacientes deberían implementarse medidas preventivas y terapéuticas más precoces para mejorar su evolución y pronóstico

Guía de normas técnicas y operativas sobre atención de enfermedades respiratorias del adulto para centros y puestos de salud / Guide of technical and operational standards on care of respiratory diseases of the adult for centers and posts of health

Esta guía está destinada al personal médico de enfermería que trabajan en Centros y Puestos de Salud, sin servicios de radiología. El personal que atiende en estos establecimientos está en contacto habitual con la población y debe responder a la demanda de atención curativa de enfermos que consultan por diferentes afecciones, incluidas las que se manifiestan con síntomas respiratorios

Lung eosinophilic inflammation and airway hyperreactivity are enhanced by murine anaphylactic, but not nonanaphylactic, IgG1 antibodies

Background Chronic airway inflammation is a fundamental feature of bronchial asthma, which is characterized by the accumulation and activation of inflammatory cells, such as mast cells and eosinophils, that are tightly regulated by TH2 cytokines and chemokines. Recently, we demonstrated, in a murine model of asthma with immunosuppressed mice reconstituted with antigen-specific IgE or IgG1 antibodies, that IgE, but not IgG1, participates in potentiation of airway inflammation and induction of airway hyperreactivity (AHR). The IgG1 antibody, however, did not elicit passive cutaneous anaphylactic reactions, which was in contrast to IgE. Objectives Because 2 types of murine IgG1 have been demonstrated with regard to anaphylactic activity, the present experiments were undertaken to determine the role of anaphylactic and nonanaphylactic IgG1 antibodies in the development of antigen-induced eosinophilia and AHR in this model. Methods Dinitrophenyl-conjugated, heat-coagulated hen's egg white was implanted in immunosuppressed mice reconstituted with anaphylactic or nonanaphylactic IgG1. Intratracheal challenge with aggregated dinitrophenyl-ovalbumin was performed on day 14, and lung inflammatory and mechanical parameters were evaluated after 48 hours. Results Our results demonstrated that reconstitution of immunosuppressed mice with anaphylactic IgG1 antibodies in contrast to nonanaphylactic IgG1 antibodies potentiates their ability to have pulmonary eosinophilic inflammation and AHR. IL-5 and eotaxin levels in bronchoalveolar lavage fluid from anaphylactic IgG1-reconstituted mice were also higher than those in nonanaphylactic IgG1-reconstituted mice. Conclusions These results indicate that the anaphylactic property of murine IgG1 molecules is essential for their capacity to enhance lung eosinophilic inflammation and to induce AHR.

Guía de normas técnicas y operativas sobre atención de enfermedades respiratorias del adulto para centros y puestos de salud / Guide of technical and operational standards on care of respiratory diseases of the adult for centers and posts of health

Esta guía está destinada al personal médico de enfermería que trabajan en Centros y Puestos de Salud, sin servicios de radiología. El personal que atiende en estos establecimientos está en contacto habitual con la población y debe responder a la demanda de atención curativa de enfermos que consultan por diferentes afecciones, incluidas las que se manifiestan con síntomas respiratorios

Acute respiratory disorders in the newborn at the Mount Hope Women's Hospital, Trinidad.

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital (MHWH) from January 1 to December 31, 1994. The study also examined the relationships between incidence rate of ARD and maternal and neonatal parameters. Hyaline membrane disease (HMD), transient tachypnoea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent fetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5062 live newborns using standard diagnostic criteria. Overall, 174/5062 neonates were diagnosed with ARD to give an incidence of 3.4% (104 males and 70 females). The most common ARD was PI (39%) followed by HMD (29%). The incidence of ARD in preterm infants was 20.6% (100/486) and 1.1% (48/4363) in term neonates. Hyaline membrane disease occurred mainly in the preterm and low birthweight babies. Transient tachypnoea of the newborn and PI were found in all gestational age groups. Asphyxia was present in 10.9% (19/174) at five minutes of age. It was more common in babies who developed HMD and PFC. Forty-one per cent (71/174) of babies with ARD required assisted ventilation. There were 58/174 (33%) deaths. More than a half of those ventilated died (39/71 or 55%); 2/3 of those with airleaks and all those with intraventricular haemorrhage died. Mortality was significantly associated with asphyxia at both one and five minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs.

Acute respiratory disorders in the newborn at the Mount Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital (MHWH) from January 1 to December 31, 1994. The study also examined the relationships between incidence rate of ARD and maternal and neonatal parameters. Hyaline membrane disease (HMD), transient tachypnoea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent fetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5062 live newborns using standard diagnostic criteria. Overall, 174/5062 neonates were diagnosed with ARD to give an incidence of 3.4 (104 males and 70 females). The most common ARD was PI (39) followed by HMD (29). The incidence of ARD in preterm infants was 20.6 (100/486) and 1.1 (48/4363) in term neonates. Hyaline membrane disease occurred mainly in the preterm and low birthweight babies. Transient tachypnoea of the newborn and PI were found in all gestational age groups. Asphyxia was present in 10.9 (19/174) at five minutes of age. It was more common in babies who developed HMD and PFC. Forty-one per cent (71/174) of babies with ARD required assisted ventilation. There were 58/174 (33) deaths. More than a half of those ventilated died (39/71 or 55); 2/3 of those with airleaks and all those with intraventricular haemorrhage died. Mortality was significantly associated with asphyxia at both one and five minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs