Sleep findings and predictors of sleep desaturation in adult cystic fibrosis patients.

PURPOSE: Questions remain about the polysomnographic findings and the predictors for sleep desaturation in cystic fibrosis (CF) patients. Our study aimed to evaluate sleep parameters in a sample of adult CF patients comparing them with healthy controls and to determine the best predictors of sleep desaturation in CF patients with awake resting peripheral oxygen saturation (SpO(2)) ≥90%. METHODS: In a cross-sectional study, with data collected prospectively, 51 clinically stable adult CF patients (mean age 25.1 ± 6.7 years) and 25 age-matched controls underwent an overnight polysomnography and answered sleep questionnaires. CF patients had their pulmonary function, 6-min walk test, and echocardiography assessed. RESULTS: CF patients and control subjects had similar sleep architecture. However, CF patients had impaired subjective sleep quality and a higher arousal index than controls. The apnea-hypopnea index was similar in both groups, and only two CF patients (3.9%) fulfilled the criteria for obstructive sleep apnea syndrome. Sleep desaturation was more common in CF patients (29.4% vs 0%; p < 0.001). In a logistic regression model, we observed that awake resting SpO(2) was the single best variable associated with sleep desaturation in CF population (p < 0.001). The awake SpO(2) <94% had a sensitivity, specificity, positive and negative predictive value for sleep desaturation of, respectively, 93.3%, 100%, 100%, and 97.3%. CONCLUSIONS: CF patients had a worse subjective sleep quality and small changes in sleep architecture. In nonhypoxic, adult CF patients, sleep desaturation is common, is not associated with obstructive sleep events, and can be accurately predicted by awake resting SpO(2) <94%.

Transbronchoscopic pulmonary emphysema treatment: 1-month to 24-month endoscopic follow-up.

OBJECTIVE: Describe the results of a 1- to 24-month follow-up of individuals undergoing transbronchoscopic placement of one-way valves. DESIGN: Longitudinal, noncomparative study. SETTING: University hospital. PATIENTS: Nineteen heterogeneous emphysema patients. MEASUREMENTS AND RESULTS: Pulmonary function testing, imaging examination, and videobronchoscopy were performed at 1, 3, 6, 12, and 24 months after the insertion of one-way valves. Mean age was 67.63 +/- 8.71 years, mean body mass index (BMI) was 24.02 +/- 2.65, and mean exposure to smoking was 65.32 +/- 27.46 pack-years (+/- SD). Baseline BODE index (BMI, degree of airflow obstruction and dyspnea, exercise capacity as measured by the 6-min walk test [6MWT]) was 7 to 10 in 10 patients (estimated 4-year mortality, 80%) and 5 to 6 in 9 patients (estimated 4-year mortality, 40%). Sixty-four valves were inserted. There was no procedure-related mortality. Nonsustained atelectasis was observed within 48 h in 2 of 12 patients with right upper lobe occlusion. Fifty-six bronchoscopic examinations were performed in 24 months. Granulomas not requiring treatment were the main complication. Mucus clogging the valve, mainly at 1 month, was easily cleaned. Eighteen patients completed the 1- and 3-month follow-ups, 14 patients completed the 6-month follow-up, 11 patients completed the 12-month follow-up, and 5 patients completed the 24-month follow-up. Improvement was observed in the 6MWT after 1 month (p = 0.028) and in the BODE index at 3 months (p = 0.002). FEV1 or FVC improvement > or = 12% or > or = 150 mL was observed, respectively, in 4 of 18 patients and 8 of 18 patients at 1 month, 4 of 18 patients and 7 of 18 patients at 3 months, and in 3 of 14 patients and 5 of 14 patients at 6 months. After 24 months, one of five patients and three of five patients, respectively, retained an FEV1 and FVC change > or = 12% or > or = 150 mL. Significant improvement (decrease > or = 4%) in the St. George Respiratory Questionnaire was observed at 3 months and 6 months in three of four domains. CONCLUSION: Endobronchial valves are safe, but the criteria to measure improvement and to select patients should be refined. Atelectasis should be reconsidered as primary treatment goal.

Community-acquired pneumonia by Legionella pneumophila serogroups 1-6 in Brazil.

A prospective cohort study of adult patients hospitalized due to community-acquired pneumonia was carried out for 1 year in a Brazilian university general hospital to detect the incidence of community-acquired pneumonia by Legionella pneumophila serogroups 1-6. During a whole year, a total of 645 consecutive patients who were hospitalized due to a initial presumptive diagnosis of respiratory disease by ICD-10 (J00-J99), excluding upper respiratory diseases, were screened to detect the patients with community-acquired pneumonia. Fifty-nine consecutive patients hospitalized due to community-acquired pneumonia between July 19, 2000 and July 18, 2001, were included in the study. They had determinations of serum antibodies to L. pneumophila serogroups 1-6 by indirect immunofluorescence antibody test at the Infectious Diseases Laboratory of University of Louisville (KY, USA) and urinary antigen tests for L. pneumophila serogroup 1. Three patients had community-acquired pneumonia by L. pneumophila serogroups 1-6, two patients being diagnosed by seroconversion and positive urinary antigen tests; the other had negative serologies but strongly positive urinary antigen test. The incidence of community-acquired pneumonia by L. pneumophila serogroups 1-6 in our hospital was 5.1%.

Oxidative parameters and mortality in sepsis induced by cecal ligation and perforation.

OBJECTIVE: This study assessed parameters of free radical damage to biomolecules, mitochondrial superoxide production, superoxide dismutase, and catalase activities and their relationship to sepsis mortality. DESIGN AND SETTING: Prospective animal study in a university laboratory for experimental. SUBJECTS: 140 male Wistar rats. INTERVENTIONS: The animals were randomly divided into three groups: sham-operated (n=20), cecal ligation and perforation resuscitated with normal saline (n=40), and cecal ligation and perforation with normal saline plus antibiotics (n=40). MEASUREMENTS AND RESULTS: Blood samples were collected from all animals 3, 12, and 24 h after CLP through a jugular catheter inserted before CLP. Rats were evaluated during 5 days after the intervention. Nonsurvivor animals were grouped according to the duration between sepsis induction and death, and oxidative parameters were compared to survivors and sham-operated. Lipid peroxidation, protein carbonyls, and superoxide dismutase were significantly increased in nonsurvivor septic rats and were predictive of mortality. We demonstrated that there is a different modulation of superoxide dismutase and catalase in nonsurvivors during the course of septic response. There was a marked increase in superoxide dismutase activity without a proportional increase in catalase activity in nonsurvivors. CONCLUSIONS: This is the first report of plasma superoxide dismutase as an earlier marker of mortality. Ours results might help to clarify an important aspect of oxidative response to sepsis, i.e., an increase in superoxide dismutase activity without a proportional increase in catalase activity

Heliox versus oxygen for nebulized aerosol therapy in children with lower airway obstruction.

OBJECTIVE: To compare the distribution of an inhaled labeled radioaerosol (diethilenotriaminopenthacetate labeled with technetium-99m) when either oxygen or heliox was used as a gas vehicle of nebulization. DESIGN: Randomized, double-blind, controlled study. SETTING: Nuclear medicine imagining department of tertiary university-affiliated hospital. PATIENTS: Twenty children (5-15 yrs old) with confirmed diagnosis of chronic lower airway obstruction and referred for a ventilatory scintigraphy study. INTERVENTION: Patients were randomized to use either the heliox mixture (helium/oxygen, 80:20) or oxygen during the scintigraphy study. The maximal cumulative irradiation absorbed by the lungs and the slope of the curve of the cumulative irradiation incorporated into the lungs over the time were used to compare the groups. Student's t -test, one-way analysis of variance, chi-square test, and Fisher's exact test were used to compare the groups. MEASUREMENTS AND MAIN RESULTS: Ten patients were allocated to each group with no differences in demographic data, main diagnosis, and pulmonary function tests. Ninety-five percent of the particles produced by both gases had a diameter <2.4 micro. The heliox group showed a higher slope of the irradiation incorporated curve (p <.05) than the oxygen group. When broken down into groups, these changes were more significant in those patients classified by the pulmonary function tests as having severe lower airway obstruction. They showed higher cumulative lung irradiation (p =.045) and better slope of the irradiation incorporated curve (p =.017) when heliox rather than oxygen was used as a vehicle for the diethilenotriaminopenthacetate labeled with technetium-99m. Nevertheless, in those patients with mild lower airway obstruction, heliox did not show any advantage over oxygen in the distribution the radioaerosol into the lungs. CONCLUSION: Related to its physical properties, heliox gas seems to have a strong and pronounced effect when used in patients with severe lower airway obstruction. However, in the absence of severe lower airway obstruction, there is no advantage to using heliox instead of oxygen as a vehicle of nebulization.

[Concentrations of interleukin-2 in the nasopharyngeal secretion of children with acute respiratory syncytial virus bronchiolitis]. / Concentrações de interleucina-2 na secreção nasofaríngea de crianças com bronquiolite viral aguda pelo vírus respiratório sincicial.

OBJECTIVE: To assess interleukin-2 concentrations in nasopharyngeal secretion of children (0-24 months) with acute respiratory syncytial virus bronchiolitis, within the first 12 hours of hospital admission, and compare the levels of IL-2 with the severity of the illness. METHODS: Prospective study performed between June and August 1999. The study included 62 patients, previously healthy, hospitalized with acute viral bronchiolitis characterized by recent prodromes of coryza and/or nasal obstruction, which evolved to at least two of the following signs: respiratory dysfunction, tachypnea, wheezing or rales, and detection of respiratory syncytial virus in nasopharyngeal aspirate. The nasopharyngeal specimens were collected within 12 hours of hospital admission. The interleukin-2 levels were obtained by enzyme immunoassay. Severity of illness was assessed through oxygen saturation by pulse oximetry, Modified Clinical Score System, time of supplemental oxygen required, length of hospital stay, and mechanical ventilation. Spearman's correlation and Kruskal-Wallis test were used to compared these variables in relation to the median of interleukin-2. The chi-square test was used for categorical analysis of interleukin-2. RESULTS: The mean age of patients was 2.2 (1.3-4) months. Males comprised 54% of cases. Hemoglobin oxygen saturation by pulse oximetry at hospital admission was below 95% in 66.1% of patients. The mean time of supplemental oxygen use was 4.7 days (+/-3.54). The mean length of hospital stay was 4.25 days (+/-1.76). Mechanical ventilation was used in 4.8% of patients. The values of interleukin-2 in nasopharyngeal aspirates varied from 0 to 40,256 ng/ml with median of 86 ng/ml (4.4 - 457.3). The study showed no statistical difference between levels of IL-2 and severity of illness. CONCLUSIONS: The interleukin-2 levels showed a heterogeneous behavior. We found no association between interleukin-2 levels in nasopharyngeal secretion and respiratory syncytial virus bronchiolitis.

[Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children]. / Concordância no diagnóstico radiológico das infecções respiratórias agudas baixas em crianças.

OBJECTIVE: To evaluate the inter-observer agreement of radiological diagnosis of lower respiratory tract infections in children. METHODS: Chest X-rays from 60 children younger than 5 years of age were evaluated by three physicians: a pediatric radiologist (PR), a pediatric pulmonologist (PP) and an experienced emergency pediatrician (EP). All children had sought an emergency room due to acute respiratory infections with apparent lower respiratory tract involvement. Observers were blinded to the original diagnostic conclusions, but clinical and laboratory data from the initial medical evaluation were provided with each film. Variables were grouped into five categories: a) film quality; b) site of abnormality; c) radiological patterns; d) other radiographic images; e) diagnosis. Inter-observer agreement was assessed using Kappa statistics, accepting prevalence-bias-adjusted values (PABAK). compare the prevalence of breastfeeding and exclusive breastfeeding during the first six months of life among pacifier and non-pacifier users. RESULTS: Kappa values for each of the three observer pairs (RP vs. PP, RP vs. EP, and PP vs. PE) were 0.41, 0.43, and 0.39, respectively. The overall inter-observer agreement was moderate (0.41). Agreement on other variables was as follows: regular for "film quality" (0.30); moderate for "site of abnormality" (0.48); fair for "radiological patterns" (0.29); moderate for "other radiographic images" (0,43); and moderate for "diagnosis" (0.33). The overall intra-observer agreement was "moderate" (0.54), which is below the agreement values reported by other studies on chest X-ray variability. CONCLUSIONS: Inter-observer variability is an intrinsic characteristic of the interpretation of chest X-rays, and the diagnosis of lower respiratory tract infections in children remains a challenge. Most of our results were similar to those previously reported.

Perfused lung volume to thoracic gas volume ratio (perfused lung fraction) in patients with COPD and in controls.

BACKGROUND: The deterioration of the ventilation-to-perfusion distribution in patients with chronic obstructive pulmonary disease (COPD) reflects structural changes affecting both the airways and the blood vessels. These changes result in lung perfusion abnormalities that may be quantified by lung perfusion single photon emission computed tomography (SPECT). OBJECTIVE: To compare the perfused lung fraction (PLF) in patients with airflow obstruction and controls. METHODS: Fourteen patients with COPD and 21 controls underwent spirometry, whole-body plethysmography, and lung perfusion SPECT. PLF was derived from the ratio of perfused lung volume (measured by SPECT) to thoracic gas volume (measured by whole-body plethysmography). RESULTS: In the whole study sample, there were 18 (51%) women and 17 (49%) men, mean age was 46.2 (±20.3) years, range: 18-80 years). In the COPD group, PLF was 0.74 (±0.08), whereas in the control group PLF was 0.99 (±0.18) (P<0.001). PLF correlated directly with forced expiratory volume in 1 s to forced vital capacity (r=0.597, P<0.001). Perfused lung volume was 3.66 (±0.64) l in the COPD group compared with 2.71 (±0.70) l in the control group (P<0.001). CONCLUSION: The fraction of lung volume receiving blood from the pulmonary artery is reduced in patients with COPD. The degree of underperfusion seems to correlate with the degree of airflow limitation.