Overprescription of short-acting ß2 agonists: reflections from the SABINA study in Brazil.

OBJECTIVE: To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. METHODS: This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. RESULTS: Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. CONCLUSIONS: Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease.

Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil / Prescrição excessiva de β2-agonistas de curta duração: reflexões a partir do estudo SABINA no Brasil

ABSTRACT Objective: To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. Methods: This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. Results: Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. Conclusions: Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.

RESUMO Objetivo: Avaliar os padrões de prescrição de short-acting b2 agonists (SABAs, b2-agonistas de curta duração) e outros medicamentos para asma em pacientes tratados por especialistas e participantes do estudo SABA use IN Asthma (SABINA) no Brasil. Métodos: Trata-se de um estudo transversal observacional realizado em cinco locais em diferentes regiões do Brasil. Os desfechos primários foram registrar as prescrições de SABAs e obter dados a respeito da compra de SABAs sem receita médica na farmácia. Resultados: Foram analisados dados a respeito de 218 pacientes com asma. Dos 218 pacientes, 80,3% receberam prescrição de SABA além da terapia de manutenção, com uma média de 11,2 frascos de SABA nos 12 meses anteriores. Destes, 71,4% receberam prescrição de ≥ 3 frascos e 42,2% receberam prescrição de ≥ 10 frascos. Nenhum dos pacientes recebeu prescrição de monoterapia com SABA. Do total de pacientes, 14,2% relataram que compraram SABAs sem receita médica na farmácia. Destes, 48,4% compraram ≥ 3 frascos de SABA. Foram prescritas doses fixas combinadas de corticosteroide inalatório e b2-agonista de longa duração para 95,0% dos pacientes. No ano anterior à visita do estudo, 45,0% dos pacientes receberam pelo menos um ciclo de tratamento de curta duração com corticosteroide oral. A asma estava bem controlada em 43,1% dos pacientes, parcialmente controlada em 34,9% e não controlada em 22,0%. Os pacientes relataram uma média de 1,1 exacerbações graves da asma, sendo que 49,1% apresentaram uma ou mais exacerbações graves. Conclusões: A prescrição excessiva e a compra de SABAs sem receita médica são comuns no Brasil e possivelmente levam à necessidade de uso de corticosteroides orais. A comunidade de profissionais de saúde deve colaborar para implantar recomendações baseadas em evidências e promover a educação em saúde para melhorar o manejo da asma no Brasil.

Processo de construção de um ventilador pulmonar mecânico para situação de pandemia da covid-19 / Construction process of a mechanical lung ventilator for a covid-19 pandemic situation

Em dezembro de 2019 o mundo foi surpreendido pela pandemia da COVID-19, que, devido à alta transmissibilidade, rapidamente se espalhou pelo planeta, causando milhares de vítimas. Durante a pandemia muitas vidas foram ceifadas, houve superlotação hospitalar e esgotamento dos recursos. Objetivo: Descrever o processo de construção e equivalência de um ventilador pulmonar mecânico, durante a situação de pandemia. Materiais e Métodos: No processo seguiram-se as recomendações da Associação Brasileira de Normas Técnicas (ABNT), Agência Nacional de Vigilância Sanitária (ANVISA) e Associação de Medicina Intensiva Brasileira (AMIB). Foram utilizados materiais encontrados no mercado brasileiro, dispensando importações para agilizar a construção, a fim de suprir demandas locais. O equipamento foi desenvolvido no Laboratório de Mecânica Aplicada da Universidade Federal de Goiás (UFG) em proposição feita pela Escola de Engenharia Elétrica, Mecânica e de Computação da UFG. O Ensaio pré-clínico foi realizado em suínos in vivo, instrumentados e ventilados mecanicamente no Centro Cirúrgico do Hospital Veterinário da UFG, após aprovação da Comissão de Ética no Uso de Animais (CEUA/UFG), sob o número de protocolo: 049/20. Foram analisados indicadores respiratórios e hemodinâmicos de forma comparativa, utilizando o protótipo de ventilação mecânica versus ventilador pulmonar já consagrado no mercado. Ambos os ventiladores foram igualmente programados. Resultados: O processo de elaboração, construção e funcionamento do protótipo seguiu recomendações da ABNT e mostrou-se seguro, medido pelos indicadores respiratórios e hemodinâmicos. As variáveis analisadas, em sua grande maioria apresentaram comportamento semelhante entre os ventiladores, independentemente do animal ventilado. Durante o ensaio pré-clínico não houve instabilidade hemodinâmica incontrolável. Conclusões: A construção e utilização do protótipo de ventilação pulmonar mecânica deve ser considerada uma alternativa para situações de pandemia, desde que a construção do equipamento cumpra os requisitos mínimos exigidos pela ABNT

In December 2019, the world was surprised by the COVID-19 pandemic, which, due to its high transmissibility, quickly spread across the planet, causing thousands of victims. During the pandemic, many lives were lost, there was hospital overcrowding and an exhaustion of resources. Objective: To describe the construction process and equivalence of a mechanical lung ventilator, during the pandemic situation. Materials and Methods: The process followed the recommendations of the Brazilian Association of Technical Standards (ABNT), the National Health Surveillance Agency (ANVISA) and the Brazilian Intensive Care Medicine Association (AMIB). Materials found on the Brazilian market were used, eliminating imports to speed up construction, in order to meet local demands. The equipment was developed at the Applied Mechanics Laboratory at the Federal University of Goiás (UFG) on a proposal made by the School of Electrical, Mechanical and Computer Engineering at UFG. The pre-clinical trial was carried out in pigs in vivo, instrumented and mechanically ventilated in the Surgical Center of the UFG Veterinary Hospital, after approval by the Ethics Committee on the Use of Animals (CEUA/UFG), under protocol number: 049/20. Respiratory and hemodynamic indicators were analyzed in a comparative way, using the prototype of mechanical ventilation versus pulmonary ventilator already established on the market. Both ventilators were programmed equally. Results: The process of elaboration, construction and operation of the prototype followed ABNT recommendations and proved to be safe, measured by respiratory and hemodynamic indicators. The vast majority of the variables analyzed showed similar behavior between ventilators, regardless of the ventilated animal. During the preclinical trial there was no uncontrollable hemodynamic instability. Conclusions: The construction and use of the mechanical lung ventilation prototype should be considered an alternative for pandemic situations, as long as the construction of the equipment meets the minimum requirements required by ABNT

Assessment of attitudes related to humanization of assistance by medical students / Avaliação de atitudes relacionadas ao atendimento humanizado pelos estudantes de Medicina

Abstract: Introduction: Typical medical care has been characterized by professional and disease-centered attitudes, with little concern for focusing on the patient's psychosocial context and expectations. However, the medical care that seeks to more globally encompass the patient's perspective has shown to bring greater benefits. Objective: To evaluate the attitudes of medical students regarding the physician-patient relationship. Methods: This is a cross-sectional study that evaluated the attitudes of students in the 4th semester of the medical course in relation to patient care based on the application of the Patient-Practitioner Orientation Scale and a questionnaire with sociodemographic and curricular characteristics. Data were analyzed using the Statistical Package for Social Science (SPSS) software and the Mann-Whitney test, Kruskal-Wallis test with Dunn's post hoc, and Chi-square test. Results: A total of 83 medical students participated in the study, with a prevalence of female students (74.7%), and those who declared a family income of less than US$ 2,140 (43.0%), as well as those who professed the Catholic religion (53.0%). The majority of students (85.5%) had attitudes centered on the physician and the disease (mean PPOS scores <4.57), with scores in the caring domain higher than those in the sharing domain. The variables gender, family income, student financial aid, and religion showed a positive association (p≤0.05) with PPOS scores related to patient-centered attitudes. There were no statistically significant associations of PPOS scores with the variables age group, city of origin, undergraduate research activities, extracurricular internships, artistic activities, personal and family history of serious illness, and parental level of schooling. Conclusion: The present study showed that the assessed medical students had attitudes centered on the physician and on the disease, with mean PPOS scores below the range related to attitudes of humanized medicine.

Resumo: Introdução: O atendimento médico usual tem sido caracterizado por atitudes centradas no profissional e na doença, pouco se preocupando em focar o contexto psicossocial e as expectativas do paciente. Entretanto, o atendimento médico que procura abranger mais globalmente a perspectiva do paciente tem se mostrado mais eficiente ao promover maiores benefícios. Objetivo: Este estudo teve como objetivo avaliar as atitudes de estudantes de Medicina a respeito da relação médico-paciente. Método: Trata-se de um estudo transversal que avaliou as atitudes de acadêmicos do quarto período de Medicina em relação à atenção aos pacientes a partir da aplicação da Escala de Orientação Médico-Paciente (EOMP) e de questionário com características sociodemográficas e curriculares. Os dados foram analisados no software Statistical Package for Social Science (SPSS), e utilizaram-se o teste de Mann-Whitney, o teste de Kruskall-Wallis com post hoc de Dunn e o teste de qui-quadrado. Resultado: Participaram do estudo 83 estudantes de Medicina, com prevalência maior de alunos do sexo feminino (74,7%) e que declararam renda familiar inferior a dez salários mínimos (43,0%), bem como a religião católica (53,0%). A maioria dos acadêmicos (85,5%) apresentou atitudes centradas no médico e na doença (média de escores da EOMP < 4,57), com escores do domínio cuidar superiores aos do domínio compartilhar. As variáveis sexo, renda familiar, bolsa de auxílio financeiro estudantil e religião apresentaram associação positiva (p ≤ 0,05) com os escores da EOMP relacionados às atitudes centradas no paciente. Não foram observadas associações estatisticamente significativas dos escores da EOMP entre as variáveis faixa etária, cidade de procedência, realização de atividades de iniciação científica, estágios extracurriculares, atividades artísticas, antecedentes pessoais e familiares de doença grave, e escolaridade dos pais. Conclusão: O presente estudo demonstrou que os acadêmicos de Medicina avaliados apresentaram atitudes centradas no médico e na doença, com média de escores da EOMP abaixo do intervalo relacionado às atitudes da medicina humanizada.

Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease / Recomendações da Sociedade Brasileira de Pneumologia e Tisiologia para o manejo da doença pulmonar pós-tuberculose

ABSTRACT Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

RESUMO Historicamente, todos os esforços contra a tuberculose concentraram-se no diagnóstico rápido e no tratamento efetivo para quebrar a cadeia de transmissão do Mycobacterium tuberculosis. No entanto, nos últimos anos, têm sido encontradas mais e mais evidências sobre as dramáticas consequências da condição definida como doença pulmonar pós-tuberculose (DPPT). Aproximadamente um terço dos pacientes que sobrevivem à tuberculose pulmonar enfrenta morbidades consideráveis e persistentes, incluindo comprometimento respiratório, desafios psicossociais e redução da qualidade de vida relacionada à saúde após o término do tratamento. Diante da importante carga global e local da tuberculose, bem como da carga estimada da DPPT, considerou-se urgente o desenvolvimento de um documento de consenso por uma sociedade científica brasileira - a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - para a prevenção e manejo dessa condição, a fim de alocar recursos de forma adequada para e nos serviços de tuberculose e servir de guia para os profissionais de saúde. Uma equipe de onze pneumologistas e um metodologista foi criada pela SBPT para revisar as evidências atuais sobre a DPPT e desenvolver recomendações adaptadas ao contexto brasileiro. O painel de especialistas selecionou os temas com base nas evidências atuais e diretrizes internacionais. Durante a primeira fase, três membros do painel redigiram as recomendações, que foram divididas em três seções: definição e prevalência de DPPT, avaliação da DPPT e manejo da DPPT. Na segunda fase, todos os membros do painel analisaram, discutiram e revisaram as recomendações até chegar a um consenso. O documento foi aprovado formalmente pela SBPT em sessão especial organizada durante o Congresso Anual da SBPT de 2023.

Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study.

OBJECTIVE: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. METHODS: This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. RESULTS: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of ≤ 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). CONCLUSIONS: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing.

Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

Efficacy and Safety of BCG Revaccination With M. bovis BCG Moscow to Prevent COVID-19 Infection in Health Care Workers: A Randomized Phase II Clinical Trial.

The Bacillus Calmette-Guérin (BCG) vaccine, which is widely used to protect children against tuberculosis, can also improve immune response against viral infections. This unicentric, randomized-controlled clinical trial assessed the efficacy and safety of revaccination with BCG Moscow in reducing the positivity and symptoms of COVID-19 in health care workers (HCWs) during the COVID-19 pandemic. HCWs who had negative COVID-19 IgM and IgG and who dedicated at least eight hours per week in facilities that attended to individuals suspected of having COVID-19 were included in the study and were followed for 7, 15, 30, 60, and 180 days by telemedicine. The HCWs were randomly allocated to a revaccinated with BCG group, which received the BCG vaccine, or an unvaccinated group. Revaccination with BCG Moscow was found to be safe, and its efficacy ranged from 30.0% (95.0%CI -78.0 to 72.0%) to 31.0% (95.0%CI -74.0 to 74.0%). Mycobacterium bovis BCG Moscow did not induce NK cell activation at 15-20 days post-revaccination. As hypothesized, revaccination with BCG Moscow was associated with a lower incidence of COVID-19 positivity, though the results did not reach statistical significance. Further studies should be carried out to assess whether revaccination with BCG is able to protect HCWs against COVID-19. The protocol of this clinical trial was registered on August 5th, 2020, at REBEC (Registro Brasileiro de Ensaios Clínicos, RBR-4kjqtg - ensaiosclinicos.gov.br/rg/RBR-4kjqtg/1) and the WHO (# U1111-1256-3892). The clinical trial protocol was approved by the Comissão Nacional de ética de pesquisa- CONEP (CAAE 31783720.0.0000.5078).

Dyspnoea at the end of life: instrument development and validation-the CONFORTO Strategy.

OBJECTIVE: To describe the construction and validation of the algorithm for Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid (CONFORTO), an instrument to guide health professionals in managing dyspnoea in patients with an advance stage of the disease at the end-of-life. METHODS: The study was carried out in three stages: (1) literature review and construction of CONFORTO; (2) semantic validation; (3) application of the CONFORTO Strategy to health professionals as a test (before video lessons) and post-test (20 days after watching video lessons) methodology. The scores obtained in the pretest and post-test were compared using the Wilcoxon test. RESULTS: Seventy-four professionals from different internal medicine and intensive care units participated in the study. The CONFORTO Strategy involved eight acronym-forming items: Criteria for inclusion; Objective of dyspnoea; Notification of patient/family/health professionals; Facial air flow; Oxygen; Relaxion and breathing; Treating causes of dyspnoea and Opioid. The post-test indicated a significant increase in the score for the following items: facial air flow (p=0.016); oxygen (p=0.002); relaxation and breathing (p=0.002) and treating the causes of dyspnoea (p=0.011). The increase in score occurred after the training sessions with video lessons. CONCLUSION: The CONFORTO Strategy proved valid and reliable for managing dyspnoea in patients with an advanced stage of the disease at the end-of-life. Because the instrument is easy-to-use, it can be used by the entire health team at any assistance-providing location, and can, thus, contribute to improving dyspnoea management for these patients.

Índices de internações, de mortalidade e de custos associados à doença pulmonar obstrutiva crônica (DPOC) no Distrito Federal após mudança do Protocolo Estadual de 2018 ­ Dados do mundo real / Hospitalization, mortality rates and costs associated with chronic obstructive pulmonary disease (COPD) in Distrito Federal, Brazil, before and after the change in 2018 state COPD protocol version ­ Real-world data

Objetivo: Avaliar os índices de hospitalização, mortalidade e custos associados à doença pulmonar obstrutiva crônica (DPOC) após mudança do Protocolo de Atenção à Saúde da Secretaria do Distrito Federal (SES-DF) em 2018 por um medicamento da mesma classe terapêutica, porém em dispositivo inalatório diferente. Métodos: Foi realizado um estudo observacional, transversal, em uma coorte de pacientes adultos internados em dois períodos específicos: gosto/2017 a julho/2018 (MAT 1 ­ vigência do Protocolo antigo) e agosto/2018 a julho/2019 (MAT 2 ­ vigência do novo Protocolo). Foram avaliados pacientes internados com diagnóstico principal de DPOC de acordo com a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde Versão 10 (CID-10) estabelecida pelo protocolo de atenção à saúde e registrada no Datasus. Os desfechos avaliados foram número de internações, mortalidade e custos totais associados à internação por DPOC. Resultados: Após análise dos dados relacionados à DPOC, a comparação entre MAT 1 (agosto/2017 a julho/2018) e MAT 2 (agosto/2018 a julho/2019) resultou no aumento na ocorrência de importantes desfechos: +131,3% no número de internações com passagens em unidade de terapia intensiva (UTI) (n = 16 no MAT 1 vs. n = 37 no MAT 2, p < 0,01), +101,0% na frequência de internações com passagem em UTI sobre o total de internações (2,4% no MAT 1 vs. 4,8% no MAT 2, p = 0,01), +566,7% nos óbitos de pacientes internados em UTI (n = 3 no MAT 1 vs. n = 20 no MAT 2, p < 0,01) e +52,9% nos custos totais de internação (R$ 828.761 no MAT 1 vs. R$ 1.267.318 no MAT 2, p = 0,03). Conclusão: Durante os períodos analisados, houve aumento no uso de UTI, na mortalidade em UTI e nos custos totais relacionados à DPOC. A atualização do protocolo alterou tanto o dispositivo inalatório (névoa suave para pó seco) quanto a molécula (tiotrópio para glicopirrônio) e poderia ser um dos fatores responsáveis por esses desfechos, no entanto as limitações desta análise observacional não podem determinar um impacto causal da mudança do protocolo, pois outras variáveis também podem ter levado às diferenças descritas.

Objective: Evaluate the rates of hospitalization, mortality and costs associated with chronic obstructive pulmonary disease (COPD) before and after the change in COPD Treatment Protocol of State Health Secretariat of Distrito Federal (SES-DF). Methods: An observational, cross-sectional study was conducted in a cohort of hospitalized adult patients in two specific periods: August/2017 to July/2018 (MAT 1 ­ old version of Protocol in place) and August/2018 to July/2019 (MAT 2 - after the new Protocol version). Hospitalized patients with COPD as primary diagnosis according to International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) established by COPD Treatment Protocol and registered in DATASUS database were evaluated. The outcomes assessed were the number of hospitalizations, mortality and total costs ssociated with COPD hospitalizations. Results: After analyzing the data related to COPD, the comparison between MAT 1 (August/2017 to July/2018) and MAT 2 (August/2018 to July/2019) periods resulted in an increase in the occurrence of relevant outcomes: +131.3% in the number of hospitalizations with intensive care unit (ICU) admissions (n = 16 in MAT 1 vs. n = 37 in MAT 2, p < 0.01), +101.0% in the frequency of hospitalizations with ICU admissions over total number of hospitalizations (2.4% in MAT 1 vs. 4.8% in MAT 2, p = 0.01), +566.7% in deaths of patients admitted in ICU (n = 3 in MAT 1 vs. n = 20 in MAT 2, p < 0.01), +52.9% in total costs associated with COPD hospitalizations (R$ 828,761 in MAT 1 vs. R$ 1,267,318 in MAT 2, p = 0.03). Conclusion: During the analyzed periods, an increase in ICU usage, mortality in ICU and total costs related to COPD was observed. The update in the protocol switched the inhaler device (from soft mist to dry powder) and also the molecule (tiotropium to glycopyrronium) and could be potentially one of the factors responsible for these endpoints, however the limitations of this observational analysis cannot determine a causal impact of the protocol change as other variables could also have led to the differences described.

Validation of measuring pi using ct and a comparison with whole spine and lumbosacral x-rays / Validação da medição daip usando tc e comparação com radiografias da coluna total e lombossacral / Validación de la medición de ip con tc y comparación con radiografías de la columna vertebral total y lumbosacra

ABSTRACT Objective: The objective of this study is to describe a new, extremely simple method for measuring pelvic incidence (PI) using computed tomography (CT) and to compare those measurements with measurements derived from whole spine and lumbosacral X-rays in a Brazilian population. Methods: Patients who had whole spine and lumbosacral X-rays and whole abdomen, pelvis, or lumbar spine CT performed within a period of less than three months were selected. Image overlay was used to measure PI from the CT. The PI was calculated by two independent examiners, and the PI for each exam was calculated twice, with an interval of two months between the assessments. The intra- and interexaminer reliability and reproducibility were evaluatedusing the intraclass correlation coefficient (ICC) and the repeatability coefficient, considering a 95% confidence interval. Results: Fifty-five patients of both sexes with a mean age of 58.7 years (±19) were analyzed. The mean PI angles in the analyses of both examiners at both evaluations were 54.85° (±13.73) for the whole spine X-ray, 54.06° (±11.67) for the lumbosacral spine X-ray, and 49.96° (±9.85) for the CT. There was good intra- and interexaminer reliability and reproducibility. There was also high concordancewith the whole spine and lumbosacral X-rays. Conclusion: CT is a reliable and reproducible alternative for measuring PI. Level of Evidence III; Prospective comparative.

RESUMO: Objetivo: O objetivo deste estudo é descrever um novo método extremamente simples para medir a incidência pélvica (IP) usando tomografia computadorizada (TC) e comparar essas medidas com as medidas derivadas de radiografias de coluna totale lombossacral em uma população brasileira. Métodos: Foram selecionados pacientes que realizaram radiografias de coluna totale lombossacral e tomografia computadorizada de abdome, pelve ou coluna lombar em intervalo inferior a três meses.A sobreposição de imagens foi usada para medir a IP na TC.AIP foi calculada por dois examinadores independentes e aIP de cada exame foi calculada duas vezes, com intervalo de dois meses entre as avaliações. A confiabilidade e a reprodutibilidade intra e interexaminadores foram avaliadas por meio do coeficiente de correlação intraclasse (ICC) e do coeficiente de repetibilidade, considerando um intervalo de confiança de 95%. Resultados: Foram analisados 55 pacientes de ambos os sexos com média de idade de 58,7 anos (±19). Os ângulos IP médios na análise de ambos os examinadores em ambas as avaliações foram de 54,85° (±13,73) na radiografia de coluna total, 54,06° (±11,67) na radiografia de coluna lombossacral e 49,96° (±9,85) na TC. Houve boa confiabilidade e reprodutibilidade intra e interexaminadores. A concordância também foi alta nasradiografias da coluna total e lombossacral. Conclusões: A TC é uma alternativa confiável e reprodutível para mensuração da IP Nível de evidência III; Estudo prospectivo comparativo.

RESUMEN: Objetivo: El objetivo de este estudio es describir un método nuevo y extremadamente simple para medir la incidencia pélvica (IP) mediante tomografía computarizada (TC) y comparar esas medidas con las derivadas de radiografías de columna vertebral total y lumbosacra en una población brasileña. Métodos: Se seleccionaron pacientes a los que se les realizaron radiografías de columna vertebraltotal, lumbosacra y TC de abdomen, pelvis o columna lumbar con un intervalo inferior a tres meses. Se utilizó la superposición de imágenes para medir laIP en la TC. LaIPfue calculada por dos examinadores independientes, y en cada examen se calculó dos veces, con un intervalo de dos meses entre las evaluaciones. La confiabilidad y reproducibilidad intra e interexaminadores fueron evaluadas mediante el coeficiente de correlación intraclase (CCI) y el coeficiente de repetibilidad, considerando un intervalo de confianza del 95%. Resultados: Se analizaron 55 pacientes de ambos sexos con una edad media de 58,7 años (±19). Los ángulos medios deIP en el análisis de ambos examinadores en ambas evaluaciones fueron de 54,85° (±13,73) en la radiografía de la columna vertebral total, de 54,06° (±11,67) en la radiografía de columna lumbosacra y de 49,96° (±9,85) en la TC. Hubo buena confiabilidad y reproducibilidad intra e interexaminadores. La concordancia también fue alta enlas radiografías de columna vertebral total y lumbosacra. Conclusiones: La TC es una alternativa confiable y reproducible para medir laIP. Nivel de Evidencia III; Estudio prospectivo comparativo.