Anticorpos monoclonais no tratamento da asma / Monoclonal antibodies in asthma treatment

Objetivo: Revisar a aplicação dos principais anticorpos monoclonais já utilizados em estudos clínicos de asma, bem como detalhar os que já estão disponíveis para uso clínico. Fontes de dados: Artigos originais indexados nos bancos de dados MEDLINE e LILACS de janeiro de 1975 a dezembro de 2011, nos idiomas português e inglês, e livros-textos selecionados. Síntese dos dados: Os principais anticorpos monoclonais já estudados no tratamento da asma são os antagonistas de algumas citocinas de perfil TH2 (anti-IL-4, Anti-IL-5, Anti-IL-9 e Anti-IL-13) e da IgE (anti-IgE), embora outros anticorpos, como anti-TNF e anti-CD11a, já tenham sido pesquisados.Conclusões: Embora diversos anticorpos monoclonais já tenham sido utilizados na pesquisa clínica em asma, apenas o omalizumabe (anti-IgE) está disponível comercialmente, porque há evidências demonstrando sua eficácia.

Objective: To review the application of the main monoclonal antibodies which have already been used in clinical studies of asthma,as well as detailing those already available for clinical practice. Sources: Original articles indexed in the databases MEDLINE and LILACS January 1975 to December 2010, Languages: Portuguese and English and selected textbooks. Data synthesis: The main monoclonal antibodies which have already been studied for asthma are cytokines TH2 antagonists (anti-IL-4, Anti-IL-5, Anti-IL-9 e Anti-IL-13) and IgE antagonist (anti-IgE), although otherantibodies, as anti-TNF and anti-CD11a, have already been utilized. Conclusions: Despite the fact that many monoclonal antibodies havebeen utilized in asthma clinical research, only omalizumab (anti-IgE) iscommercially available, because many studies have shown its efficacy.

Fatores associados à pneumonia nosocomial em indivíduos hospitalizados / Factors associated with nosocomial pneumonia in hospitalized individuals

OBJETIVO: Identificar os fatores associados à pneumonia nosocomial em hospital público de Feira de Santana, Bahia. MÉTODOS: Este estudo caso-controle foi realizado em 211 indivíduos adultos (46 casos e 165 controles), com idade média de 41 anos, atendidos na Clínica Médica, Clínica Cirúrgica ou na Unidade de Terapia Intensiva Adulta do Hospital Geral Clériston Andrade, em Feira de Santana. Os casos foram constituídos por indivíduos que desenvolveram infecção do trato respiratório (pneumonia nosocomial) após admissão hospitalar. Os controles foram formados por não portadores de pneumonia nosocomial. Informações socioeconómicas, história médica, estilo de vida e hábitos de higiene bucal foram obtidos por meio de entrevistas. Os prontuários foram checados para registro da condição de saúde do indivíduo e diagnóstico de pneumonia. Exame clínico bucal foi realizado por cirurgião-dentista treinado. Na análise bivariada, foi estimado o odds ratio (OR) como medida de associação e seus respectivos intervalos de confiança de 95 por cento (IC 95 por cento) com uso do método de Mantel-Haenzel. RESULTADOS: A frequência de pneumonia nosocomial na amostra foi de 21,8 por cento. A ocorrência de hipertensão e o tempo de internamento foram maiores nos casos do que nos controles (p < 0,05). A falta de uso de fio dental e de enxaguatório bucal foram maiores no grupo controle (p = 0,01). CONCLUSÃO: Os achados apontam a hipertensão, tempo de internamento > 5 dias e ausência do fio dental e enxaguatório bucal como fatores possivelmente associados à pneumonia nosocomial, apontando-os como alvos efetivos de prevenção.

OBJECTIVE: To identify factors associated with nosocomial pneumonia in individuals admitted to apublic hospital in Feira de Santana, Bahia. METHODS: This case control study was carried out in 211 adult individuals (46 cases and 165 controls), of a mean age of 41 years, treated at clinical wards, surgical wards or the adult intensive care unit of Cleriston Andrade General Hospital in Feira de Santana. The cases comprised individuals who developed respiratory tract infections (nosocomial pneumonia) after hospital admission. The controls consisted of patients without nosocomial pneumonia. Information on socioeconomic status, medical history, lifestyle and oral hygiene habits was obtained through interviews. The medical records were checked to verify subjects' health status and the diagnosis opneumonia. A clinical oral examination was performed by a trained dental surgeon. Odds ratio (OR) was estimated in the bivariate analysis as an association measurement, along with the respective 95 percent confidence interval through the Mantel-Haenszel method. RESULTS: The frequency of nosocomial pneumonia in the sample was 21.8 percent. The occurrence of hypertension was higher and hospital stay duration was longer in the cases than in controls (p ≤ 0.05). Lack of dental floss and mouthwash use were higher in the controls (p = 0.01). CONCLUSION: The findings indicate that arterial hypertension, length of hospital stay of five days and lack of dental floss and mouthwash use are factors likely associated with nosocomial pneumonia, suggesting that these factors should be targeted for effective prevention.

Factors associated with nosocomial pneumonia in hospitalized individuals.

OBJECTIVE: To identify factors associated with nosocomial pneumonia in individuals admitted to a public hospital in Feira de Santana, Bahia. METHODS: This case control study was carried out in 211 adult individuals (46 cases and 165 controls), of a mean age of 41 years, treated at clinical wards, surgical wards or the adult intensive care unit of Cleriston Andrade General Hospital in Feira de Santana. The cases comprised individuals who developed respiratory tract infections (nosocomial pneumonia) after hospital admission. The controls consisted of patients without nosocomial pneumonia. Information on socioeconomic status, medical history, lifestyle and oral hygiene habits was obtained through interviews. The medical records were checked to verify subjects' health status and the diagnosis of pneumonia. A clinical oral examination was performed by a trained dental surgeon. Odds ratio (OR) was estimated in the bivariate analysis as an association measurement, along with the respective 95% confidence interval through the Mantel-Haenszel method. RESULTS: The frequency of nosocomial pneumonia in the sample was 21.8%. The occurrence of hypertension was higher and hospital stay duration was longer in the cases than in controls (p ≤ 0.05). Lack of dental floss and mouthwash use were higher in the controls (p = 0.01). CONCLUSION: The findings indicate that arterial hypertension, length of hospital stay of five days and lack of dental floss and mouthwash use are factors likely associated with nosocomial pneumonia, suggesting that these factors should be targeted for effective prevention.