Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype. / Influência da reabilitação pulmonar no paciente com Doença Pulmonar Obstrutiva Crônica fenótipo exacerbador.

Objective To verify if there are differences in Chronic Obstructive Pulmonary Disease (COPD) patient exacerbator and non-exacerbator phenotypes undergoing a Pulmonary Rehabilitation Program (PRP). Methods A real life retrospective study included outpatients with COPD from public primary care who completed a 12-weeks PRP, three times a week. All were assessed before and after PRP using the six-minute walk test (6MWT), the modified Medical Research Council (mMRC) dyspnea index, quality of life and Body-mass Index, airflow Obstruction, Dyspnea and Exercise (BODE index). Results A total of 151 patients were analyzed and mean age was 65.0 ± 8.1 years and mean Forced Expiratory Volume (FEV) 1% of predicted was 39.8 ± 15.9. The predominant gender was male (66.9%). Of these patients 31 (20.5%) were exacerbator phenotype There was a significant improvement in the mean distance in the 6MWT in both groups, with the largest change observed in the exacerbator group [mΔ (95% CI): 84.9 (57.1-112.6) vs. 48.6 (37-60.2) p= 0.018]. Significant reduction in dyspnea on the mMRC scale occurred in both groups, with the highest intensity in the exacerbator group [mΔ (95% CI): - 0.8 (-1.11 to 0.51) vs. -1.6 (-2.20 to -1.13) p = 0.006]. Improvement in the BODE index occurred in both groups, but the mean variation was also significantly greater in the exacerbator group [mΔ (95% CI): -1.44 (-2.17 to -0.70) p= 0.045]. Conclusion Patients with COPD exacerbator phenotype had a greater magnitude of response to PRP (36 meters) when compared to non-exacerbator phenotype regardless the severity of airflow obstruction, also showing improvement in prognosis measured by the BODE index.

Influência da reabilitação pulmonar no paciente com Doença Pulmonar Obstrutiva Crônica fenótipo exacerbador / Influence of pulmonary rehabilitation in patients with Chronic Obstructive Pulmonary Disease exacerbator phenotype

RESUMO Objetivo Verificar se existem diferenças em pacientes com doença pulmonar obstrutiva crônica (DPOC) fenótipos exacerbador e não exacerbador submetidos a um programa de reabilitação pulmonar (PRP). Métodos Estudo retrospectivo de vida real que incluiu pacientes com DPOC da rede pública de atendimento ambulatorial em nível de atenção primária, que completaram o PRP, com duração de 12 semanas, três vezes por semana. Todos foram avaliados antes e depois do PRP, por meio do teste de caminhada dos seis minutos (TC6min), índice de dispneia (mMRC), qualidade de vida e índice BODE. Resultados Dos 151 pacientes analisados, a média de idade foi 65,0 ± 8,1 anos e a média VEF1% do predito foi de 39,8 ± 15,9. O gênero predominante foi o masculino (66,9%). Desses pacientes, 31 (20,5%) eram fenótipo exacerbador. Houve melhora significativa na média da distância percorrida no TC6min em ambos os grupos, sendo a maior mudança observada no grupo exacerbador [mΔ(IC95%): 84,9 (57,1-112,6) vs. 48,6 (37-60,2); p = 0,018]. Redução significativa da dispneia pela escala mMRC ocorreu em ambos os grupos, sendo de maior intensidade no grupo exacerbador [mΔ(IC95%): -0,8 (-1,11 a 0,51) vs. -1,6 (-2,20 a -1,13); p = 0,006]. Melhora no índice BODE ocorreu em ambos os grupos, mas a variação média também foi significativamente maior no grupo exacerbador [mΔ(IC95%): -1,44 (-2,17 a -0,70); p = 0,045]. Conclusão Os pacientes com DPOC fenótipo exacerbador apresentaram maior magnitude de resposta ao PRP (36 metros) quando comparados ao não exacerbador, independentemente da gravidade da obstrução do fluxo aéreo, impactando a melhora no prognóstico medido pelo índice BODE.

ABSTRACT Objective To verify if there are differences in Chronic Obstructive Pulmonary Disease (COPD) patient exacerbator and non-exacerbator phenotypes undergoing a Pulmonary Rehabilitation Program (PRP). Methods A real life retrospective study included outpatients with COPD from public primary care who completed a 12-weeks PRP, three times a week. All were assessed before and after PRP using the six-minute walk test (6MWT), the modified Medical Research Council (mMRC) dyspnea index, quality of life and Body-mass Index, airflow Obstruction, Dyspnea and Exercise (BODE index). Results A total of 151 patients were analyzed and mean age was 65.0 ± 8.1 years and mean Forced Expiratory Volume (FEV) 1% of predicted was 39.8 ± 15.9. The predominant gender was male (66.9%). Of these patients 31 (20.5%) were exacerbator phenotype There was a significant improvement in the mean distance in the 6MWT in both groups, with the largest change observed in the exacerbator group [mΔ (95% CI): 84.9 (57.1-112.6) vs. 48.6 (37-60.2) p= 0.018]. Significant reduction in dyspnea on the mMRC scale occurred in both groups, with the highest intensity in the exacerbator group [mΔ (95% CI): - 0.8 (-1.11 to 0.51) vs. -1.6 (-2.20 to -1.13) p = 0.006]. Improvement in the BODE index occurred in both groups, but the mean variation was also significantly greater in the exacerbator group [mΔ (95% CI): -1.44 (-2.17 to -0.70) p= 0.045]. Conclusion Patients with COPD exacerbator phenotype had a greater magnitude of response to PRP (36 meters) when compared to non-exacerbator phenotype regardless the severity of airflow obstruction, also showing improvement in prognosis measured by the BODE index.

[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.

Remoção cirúrgica de toro palatino para confecção de prótese total convencional: indicações de diferentes incisões / Surgical removal of torus palatinus for confection of dental prosthesis: indications of different incisons

O toro palatino é uma alteração de desenvolvimento comum, sendo geralmente indicada sua remoção quando ocorre trauma sobre a lesão ou quando interfere na confecção de próteses dentárias. Os autores relatam dois casos de remoção de toro palatino para confecção de prótese total e discutem os diferentes tipos de incisões que podem ser utilizados na técnica.