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BACKGROUND/OBJECTIVE The aim of this study was to explore the associations between nailfold videocapillaroscopy (NVC) and pulmonary function tests (PFTs) in systemic sclerosis (SSc) patients. METHODS This was a longitudinal study with follow-up of unselected Brazilian SSc patients. Baseline clinical examination, serological workup, high-resolution chest tomography, and NVC were performed. Pulmonary function test was performed at baseline and after 24 months. Pulmonary function test worsening over time was defined as either a ΔFVC decline ≥10% or a ΔFVC decline ≥5% and

To identify the risk factors associated with all-cause mortality in patients with noncystic fibrosis bronchiectasis (NCFB). This prospective cohort study included 120 adult patients with NCFB, who were regularly treated at a specialized outpatient clinic of a university hospital between January 2017 and June 2020. All patients were diagnosed using high-resolution computed tomography. Demographic and clinical data, pulmonary function tests, and the Euro-quality-of-life 5-domain 3-level questionnaire were analyzed. The factors associated with death were determined using the Cox proportional hazards model. The all-cause mortality rate at 41 months was 10.8%. Adjusted multivariate analysis showed that the main contributing predictors for mortality were female sex, smoking, diabetes, chronic obstructive pulmonary disease, emergency visits, use of antibiotics due to exacerbation, secretion color change, exacerbation, predicted forced expiratory volume in 1 second, predicted forced vital capacity, lack of respiratory physiotherapy, absence of vaccination against pneumococci, and mobility domain. Multiple factors contribute to unfavorable outcomes in patients with NCFB, and early recognition of these factors may improve care management.

BACKGROUND: Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry. METHODS: In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4–20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated. RESULTS: On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H(2)O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0–8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063). CONCLUSIONS: In COVID-19 survivors, IOS detected changes even when spirometry was normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry.

Introduction Small airways are not evaluated with traditional pulmonary function tests. The aim of this study was to evaluate the small airways in patients with chronic obstructive pulmonary disease (COPD) with a nitrogen washout test and to verify whether there is a difference between patients with COPD due to smoking and those with COPD due to alpha-1 antitrypsin mutation. Methods Sixteen patients with mutation in the SERPINA1 gene and 45 patients with no mutation were included in this cross-sectional study. All pulmonary function tests, including the single breath nitrogen washout test, were performed for all patients and alpha-1 antitrypsin dosage was assessed with immunonephelometry. Results A comparison of patients with COPD due to smoking and those with COPD due to smoking and mutation revealed a significant difference in closure volume (%), which was the poorest in the mutation group. In the group with COPD and mutation, there was an inverse correlation between smoking and closure volume (%). We also verified that similar to forced expiratory volume in the first second (FEV1), the phase III slope (%) and ΔN2 750-1250 mL (%) could be used to differentiate the severity of airflow limitation. Conclusion Our results suggest that both variables, phase III slope and the ΔN2 750-1250 mL (%), could be related to COPD severity. Therefore, alterations at the distribution of the location of the emphysema could alter the results of closer volume and that the nitrogen washout test is more sensitive when compared to traditional pulmonary function test in evaluating COPD patients.

Purpose To evaluate ultrasound signs of coronavirus disease‐19 (COVID‐19) pneumonia in symptomatic healthcare professionals and to correlate those changes with clinical findings. Methods All patients underwent real‐time polymerase chain reaction (RT‐PCR), lung ultrasound (LUS) and clinical evaluation on the same day. In each of the 12 areas evaluated in the LUS, the LUS signs were scored to generate the aeration score. Results A total of 409 participants had positive PCR, with a median age of 41 (35‐51) years. All participants had clinical symptoms, with cough in 84.1%, fever in 69.7%, and dyspnea in 36.2% of cases. In the LUS, 72.6% of participants had B‐lines >2, 36.2% had coalescent B‐lines, and 8.06% had subpleural consolidations. The median aeration score was 3 (2‐7). The aeration score differed significantly regarding the presence of cough (P = .002), fever (P = .001), and dyspnea (P

SUMMARY OBJECTIVE: The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol – 5 Dimensions – 3 Levels (EQ-5D-3L) questionnaire. METHODS: A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients’ quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed. RESULTS: Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011). CONCLUSION: Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.

Objective: To evaluate the cellularity, and albumin and interleukin (IL)-1 levels in induced sputum (IS), and to determine respiratory function parameters in patients with type 2 diabetes mellitus (DM2). Design: A cross-section study in type 2 diabetes mellitus. Participants: Patients with type 2 diabetes mellitus and healthy people. Methods: Patients in both groups had normal chest x-ray findings. Exclusion criteria for both groups were: the presence of current pulmonary disease or sequelae, smoking, respiratory atopy, or respiratory infection in the past 3 months. The study consisted of two sub-studies. In sub-study 1 (SS1), measurements of pulmonary volume and flow, and diffusion capacity for carbon monoxide (DLCO) were performed. In sub-study 2 (SS2), analysis of cellularity, albumin, and IL-1 in IS was performed. Results: In all, 60 patients (45 women, 75%) with DM2 with a mean age of 59.52 years (SD, 9.03) were included in SS1. The DM2 group included 8 patients with airway obstruction (13.33%) without reversibility with bronchodilators, and 9 with restrictive disease (15.00 %) (p = 0.026). The DLCO was reduced in 17 patients (28.33%) in the DM2 group. In the control group, all individuals had values within the reference intervals. Lymphocytosis was found in the IS of patients with DM2 (p = 0.028). The levels of sputum albumin showed no statistical difference between the two groups. Conclusion: Our findings indicate the presence of pulmonary impairment in DM2, characterized by changes in the respiratory function and a lymphocytosis in IS. Keywords: Diabetes mellitus type 2; Induced sputum; Lymphocytes.

The 6-minute walking test (6MWT) is a submaximal testused as a clinical indicator of functional capacity in patientswith pulmonary disease. However, is has not been definedwhether the parameters obtained in the 6MWT are similarin two groups of interstitial lung diseases (ILD), systemic sclerosis(SSc) and idiopathic pulmonary fibrosis (IPF), and whatare the differences when compared to patients with chronicobstructive pulmonary disease (COPD). This is a comparativecross-sectional study of 6MWT data, with the inclusion of 32patients with SSc, 32 with IPF and 50 with COPD. All patientsunderwent the 6MWT and a respiratory function test. Patientswith ILD did not present significant differences when comparedwith each other. However, when compared to patientswith COPD, the ILD group showed greater distance walked(ILD = 404.6 ± 1.09m, COPD = 352.4 ± 10.80m; p = 0.0033) andpredicted percentage above 100% (ILD = 113.5 ± 3.72%, COPD= 84.36 ± 4.81%; p

Sarcoidosis is a multi-systemic granulomatous disease. Affected individuals can show spontaneous healing, develop remission with drug treatment within 2 years, or become chronically ill. Our main goal was to identify features that are related to prognosis. The study consisted of 101 patients, recruited at a single center, who were already diagnosed with sarcoidosis at the start of the study or were diagnosed within 48 months. Ninety individuals were followed-up for at least 24 months and were classified according to clinical outcome status (COS 1 to 9). Those with COS 1–4 and COS 5–9 were classified as having favorable and unfavorable outcomes, respectively. Unconditional logistic regression analyses were conducted to define which variables were associated with sarcoidosis outcomes. Subsequently, we established a scoring system to help predict the likelihood of a favorable or unfavorable outcome. Of our patients, 48% developed a chronic form of the disease (COS 5–9). Three clinical features were predictive of prognosis in sarcoidosis. We built a score-based model where the absence of rheumatological markers (1 point), normal pulmonary functions (2 points), and the presence of early respiratory symptoms manifestations (2 points) were associated with a favorable prognosis. We predicted that a patient with a score of 5 had an 86% (95% confidence interval [CI] 74%–98%) probability of having a favorable prognosis, while those with scores of 4, 3, 2, 1, and 0 had probabilities of 72% (95% CI 59–85%), 52% (95% CI 40–63%), 31% (95% CI 17–44%), 15% (95% CI 2–28%), and 7% (95% CI 0–16%) of having a favorable prognosis, respectively. Thus, our easy-to-compute algorithm can help to predict prognosis of sarcoidosis patients, facilitating their management.

AimsThis study aimed to identify the symptoms associated with early stage SARS-CoV-2 (COVID-19) infections in healthcare professionals (HCP) using both clinical and laboratory data.MethodsA total of 1,297 patients, admitted between March 18 and April 8, 2020, were stratified according to their risk of developing COVID-19 using their responses to a questionnaire designed to evaluate symptoms and risk conditions.ResultsAnosmia/hyposmia (p ConclusionsThe significant clinical features for COVID-19 were identified as anosmia, fever, chills, and body pain. Elevated CRP, leukocytes under 5,400 x 109/L, and relative monocytosis (>9%) were common among patients with a confirmed COVID-19 diagnosis. These variables may help, in the absence of RT-PCR tests, to identify possible COVID-19 infections during pandemic outbreaks.SummaryFrom March 19 to April 8 2020, 1,297 patients attended the Polyclinic Piquet Carneiro for COVID-19 detection. Healthcare professional data was analyzed, significant clinical features were anosmia, fever, chills and body pain. Elevated CRP, leukopenia and monocytosis were common in COVID-19.

OBJECTIVES: The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests. METHODS: This cross-sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B-lines, coalescent B-lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%. RESULTS: Regarding LUS signs, more than 2 B-lines, coalescent B-lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy-paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B-lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001). CONCLUSIONS: Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.

Background Combined pulmonary fibrosis and emphysema (CPFE) is an entity characterized by the presence of emphysema in upper lobes and fibrosis in lower lobes. Due to the presence of the two diseases concomitantly, it may be difficult to diagnose. This study aims at a better understanding of this entity and proposes biological markers (functional and biochemical) that help in this characterization. Methods A prospective, observational, cross-sectional study was carried out at a reference center. Pulmonary function tests (spirometry, CO-diffusion capacity, plethysmography and single-maneuver nitrogen washout test - SBWN 2 ) and biochemical markers (periostin, mucin-16, PDGF-BB and TGF-β 1 ) were measured in groups of patients: idiopathic pulmonary fibrosis, CPFE and chronic obstructive pulmonary disease (COPD). Results Variables derived from SBWN 2 - closing volume (CV) / vital capacity (VC) (%) and closing capacity (CC) / total lung capacity (TLC) (%) - were found to be higher in the CPFE group compared to the Idiopathic pulmonary fibrosis (IPF) group (CV/VC%: 0.25 (0.12 – 11.01) and 13.05 (0.21 – 20.73); p = 0.005; CC/TLC%: 30.1 (22.4 – 37.47) and 33.69 (32.05 – 41.98); p = 0.03, respectively). Periostin was higher in the CPFE group than in the other groups [CPFE: 66.74 (45.21 – 90.5), IPF: 43.81 (31.97 – 56.18), COPD: 40.08 (20.66 – 50.81); p = 0.0002], and mucin-16 was higher in the IPF group than in the CPFE group [CPFE: 13.59 (4.16 – 28.16); IPF: 71.94 (40.46 - 164); COPD: 25.85 (9.27 – 30.29); p = 0.02]. Conclusions Findings show that CPFE presents different functional and biochemical characteristics than IPF, including higher CV/VC%, CC/TLC% and periostin, whereas mucin-16 was higher in the IPF.

To verify whether or not heart rate is maintained below the calculated submaximal level in healthy, sedentary subjects when they perform the 6-minute step test (6MST) and the 6-minute walking test (6MWT), and to compare the maximal heart rate achieved by the subjects at the end of each test.Observational, cross-sectional study.One tertiary centre.Two hundred and fifty-three participants from a pool of 330 healthy and sedentary subjects between 20 and 80 years of age.Both the 6MWT and the 6MST were performed in accordance with the American Thoracic Society's statement. Dyspnoea, blood pressure, oxygen saturation and heart rate were measured before and after each test.Mean heart rate immediately after the 6MST was significantly higher than mean heart rate immediately after the 6MWT {125 [standard deviation (SD) 19] vs 111 (SD 17) beats/minute; mean difference 13 (95% confidence interval of the difference 10 to 16); P0.001}. Moreover, mean heart rate during (3minutes after commencement) the 6MST [118 (SD 18) beats/minute] was statistically higher than mean heart rate at the end of the 6MWT [111 (SD 18) beats/minute; P0.001]. None of the subjects achieved the calculated submaximal heart rate.The 6MST and 6MWT are safe and produce submaximal effort in healthy participants. However, they are not interchangeable, and the 6MST requires more energy than the 6MWT.

Pleural tuberculosis (PlTB), a common form of extrapulmonary TB, remains a challenge in the diagnosis among many causes of pleural effusion. We recently reported that the combinatorial analysis of interferon gamma (IFN-γ), IFN-γ-inducible protein 10 (IP-10), and adenosine deaminase (ADA) from the pleural microenvironment was useful to distinguish pleural effusion caused by TB (microbiologically confirmed or not) among other etiologies. In this cross-sectional cohort study, a set of inflammatory mediators was quantified in blood and pleural fluid (PF) from exudative pleural effusion cases, including PlTB (n = 27) and non-PlTB (nTB) (n = 25) patients. The levels of interleukin-2 (IL-2), IL-4, IL-6, IL-10, IL-17A, IFN-γ, tumor necrosis factor (TNF), IP-10, transforming growth factor β1 (TGF-β), and ADA were determined using cytometric bead assay, enzyme-linked immunosorbent assay (ELISA), or biochemical tests. IFN-γ, IP-10, TNF, TGF-β, and ADA quantified in PF showed significantly higher concentrations in PlTB patients than in nTB patients. When blood and PF were compared, significantly higher concentrations of IL-6 and IL-10 in PF were identified in both groups. TGF-β, solely, showed significantly increased levels in PF and blood from PlTB patients when both clinical specimens were compared to those from nTB patients. Principal-component analysis (PCA) revealed a T helper type 1 (Th1) pattern attributed mainly to higher levels of IP-10, IFN-γ, TGF-β, and TNF in the pleural cavity, which was distinct between PlTB and nTB. In conclusion, our findings showed a predominantly cellular immune response in PF from TB cases, rather than other causes of exudative effusion commonly considered in the differential diagnosis of PlTB.

Chronic obstructive pulmonary disease (COPD) is a chronic disease related to various systemic manifestations including dyspnea, exercise intolerance and peripheral muscular dysfunction, with a direct impact on functional capacity. Objectives: To describe a whole body vibration exercises (WBVE) protocol to verify the clinical benefits, and the potential of exacerbation of the disease. Methods: Individuals diagnosed with COPD, aged ≥ 40 years, will be randomly distributed into 4 groups: control group (CG) who will not undergo WBVE, with their normal daily routine; group who will be exposed to WBVE in the sitting position in an auxiliary chair once a week (GS1) and twice a week (GS2); and WBVE group twice a week in the standing position with knee flexion (GP2). The protocol will last 6 weeks, each session will have 5 sets of 1 min vibration with 1 min rest, frequency 25 Hz and peak-to-peak displacement 2.5 mm. Muscle strength and function will be assessed through manual dynamometry and surface electromyography and dyspnea using the Modified Borg Scale (MBS) and the Medical Research Council (MRC) Scale. Discussion: WBVE, due to the various effects already described, seem to be a promising exercise modality for individuals with COPD, potentially being used as an instrument for pulmonary rehabilitation. Previous result showed that the WBVE program can improve the physical performance , the neuromuscular function and the quality of life of individuals with COPD, without the exacerbation of the disease.

ResumoA esclerose sistêmica (ES) é uma doença autoimune crônica de alta morbimortalidade. Ainda que a ciclofosfamida seja eficaz, para casos graves e refratários há demanda para novos tratamentos. A terapia biológica com depleção de células B com rituximabe (RTX) demonstrou eficácia para tal demanda em estudos abertos.ObjetivoAvaliar retrospectivamente todos os pacientes que fizeram uso do RTX para tratamento de ES em nosso centro.Pacientes e métodosForam avaliados retrospectivamente todos os prontuários de pacientes com ES que fizeram uso de RTX para tratamento da ES de janeiro de 2009 a janeiro de 2015. Dados de acometimento sistêmico, cutâneo, pulmonar e laboratoriais antes e seis meses após a primeira infusão de RTX foram coletados.ResultadosDez pacientes receberam o tratamento no período de estudo e foram incluídos na presente série de casos. Todos os pacientes tinham a forma difusa da doença. Cinco pacientes tinham formas iniciais (tempo de doença menor ou igual a quatro anos) e rapidamente progressiva da doença e cinco receberam o RTX em fases tardias da doença. Houve estabilização do quadro pulmonar em ambos os grupos de pacientes e redução no escore cutâneo nos pacientes com formas iniciais da doença.DiscussãoSimilar ao encontrado em estudos prévios, o RTX foi eficaz no tratamento de formas iniciais e rapidamente progressivas da ES. Verificamos também benefício em pacientes com longa duração da doença.AbstractSystemic sclerosis (SSc) is a chronic autoimmune disease with a high morbidity and mortality. Although cyclophosphamide is effective for severe and refractory cases, there is demand for new treatments. The biological treatment with B‐cell depletion with rituximab (RTX) has demonstrated efficacy for this demand in open‐label studies.ObjectiveThis study was conducted with the aim to retrospectively evaluate all patients who used RTX for the treatment of SSc in our center.Patients and methodsWe retrospectively evaluated medical records of all patients with SSc who used RTX to treat this disease from January 2009 to January 2015. Systemic, cutaneous, and pulmonary involvement data and laboratory results before and six months after the first infusion of RTX were collected.ResultsTen patients received treatment during the study period and were included in this series. All patients had a diffuse form of the disease. Five patients suffered from an early (duration of disease shorter or equal to four years), rapidly progressive disease, and another five received RTX at late stages of the disease. In both groups of patients, stabilization of the pulmonary picture was observed, with a fall in the skin score in those patients with early forms of the disease.DiscussionSimilar to findings in previous studies, RTX was effective in treating early and rapidly progressive forms of SSc. We also found that patients with long‐term illness may benefit from the treatment.

Activity/remission differentiation is a great challenge in the follow-up and treatment of sarcoidosis patients. Angiotensin-converting enzyme (ACE) and high sensitivity C-reactive protein (hs-CRP) were proposed as sarcoidosis biomarkers. More recently, chitotriosidase (CHITO) has been described as a better alternative. This study has the aim to evaluate the association of CHITO activity, ACE, hs-CRP or a combination of these biomarkers and to construct a clinical algorithm to differentiate between sarcoidosis activity/remission status. Forty-six patients with either active sarcoidosis or sarcoidosis in remission and 21 healthy individuals were included. ACE, hs-CRP, and CHITO were evaluated in serum samples. Comparisons of the laboratory variable means among groups were performed by linear models. The cutoff points of the biomarkers for activity/remission differentiation were calculated using the Youden’s index. Biomarker cutoff points and decision tree classifier (DTC) performance were estimated by their leave-one-out cross-validation (LOOCV) accuracy (Acc), sensitivity (Se), and specificity (Sp). A 55% mean Se and a 100% mean Sp were found for CHITO, while an 88% Se and a 47% Sp were found for ACE, and a 66% Se and a 68% Sp for hs-CRP cutoff points for activity/remission differentiation. The DTC algorithm with CHITO, hs-CRP, and ACE information had an LOOCV mean Acc of 82%, Se of 78%, and Sp of 89% for sarcoidosis activity/remission differentiation. The algorithm involving CHITO, hs-CRP, and ACE could be a suitable strategy for differentiation between sarcoidosis activity/remission status.

Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic disease related to various systemic manifestations including dyspnea, exercise intolerance and peripheral muscular dysfunction, with a direct impact on functional capacity. Objectives: To verify if whole body vibration exercises (WBVE) can be used as exercise modality in individuals with COPD without leading to exacerbation of the disease, with several clinical benefits. Methods: Individuals diagnosed with COPD, aged ≥ 40 years, will be randomly distributed into 4 groups: control group (CG) who will not undergo WBVE, with their normal daily routine, group who will be exposed to WBVE in the sitting position in an auxiliary chair once a week (GS1) and twice a week (GS2) and WBVE group twice a week in the standing position with knee flexion (GP2). The protocol will last 6 weeks, each session will have 5 sets of 1 min vibration with 1 min rest, frequency 25 Hz and peak-to-peak displacement 2.5 mm. Muscle strength and function will be assessed through manual dynamometry and surface electromyography and dyspnea using the Modified Borg Scale (MBS) and the Medical Research Council (MRC) Scale. Discussion: WBVE, due to the various effects already described, seem to be a promising exercise modality for individuals with COPD, potentially being used as an instrument for pulmonary rehabilitation. Conclusions: The results of this study may provide evidence to justify a WBVE program to the improvement on the physical performance and on neuromuscular function of individuals with COPD.Keywords: COPD; Whole-body vibration exercise; Muscular function; Pulmonary rehabilitation.

BACKGROUND: Pulmonary rehabilitation programs improve exercise capacity and quality of life in patients with COPD. Domiciliary strategies to maintain these benefits have been proposed. OBJECTIVE: This study aimed to determine whether a rehabilitation manual would facilitate the maintenance of the benefits acquired during out-patient pulmonary rehabilitation. METHODS: Fifty subjects with stable COPD were included (26 women and 24 men). All the subjects were evaluated during screening and after 12 wk of out-patient rehabilitation, and then were randomly divided into 2 groups, with one group that received the rehabilitation manual for home use (manual group) and the other group only received verbal recommendations (control group). At this point, the 2 groups were similar. After 12 wk at home, both groups were evaluated a third time. All evaluations included a 6-min walk test (6MWT), 6-min step test, COPD Assessment Test, and measurement of dyspnea by using the modified Medical Research Council dyspnea scale. RESULTS: When comparing the results of the 6MWT and 6-min step test done at out-patient discharge and after 12 wk at home, the manual group presented no differences (6MWT, 0 ± 25 m; 6-min step test, 1 ± 32 steps), whereas the control subjects lost part of the gain obtained during rehabilitation (6MWT −46 ± 36 m; 6-min step test −39 ± 33 steps). There was a significant difference between the groups (P CONCLUSIONS: The use of a simple, well-illustrated manual facilitated the maintenance of the benefits acquired in out-patient pulmonary rehabilitation over a period of 3 months after study termination.

Thoracentesis is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid from the pleural space or to determine the cause of the pleural effusion. The aim of this protocol is to spread to the cientific community the standard procedures to perform thoracentesis and pleural biopsy at HUPE / UERJ.

Background Pleural tuberculosis (PlTB) is the most common extrapulmonary manifestation of this infectious disease which still presents high mortality rates worldwide. Conventional diagnostic tests for PlTB register multiple limitations, including the lack of sensitivity of microbiological methods on pleural specimens and the need of invasive procedures such as pleural biopsy performance. In this scenario, the search for biological markers on pleural fluid (PF) has been the target of several studies as a strategy to overcome the limitations of PlTB diagnosis. This study aims to evaluate the use either isolated or in combination with adenosine deaminase (ADA), interferon-gamma (IFN-γ), interferon-gamma inducible protein of 10-kD (IP-10) levels on PF in order to guide an accurate anti-TB treatment in microbiologically non-confirmed cases. Methods and findings Eighty patients presenting pleural effusion under investigation were enrolled in a cross-sectional study conducted at Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil. Peripheral blood (PB) and PF samples collected from all patients were applied to the commercial IFN-γ release assay, QuantiFERON-TB Gold In-Tube, and samples were analyzed for IFN-γ and IP-10 by immunoassays. ADA activity was determined on PF by the colorimetric method. Based on microbiological and histological criteria, patients were categorized as follow: confirmed PlTB (n = 16), non-confirmed PlTB (n = 17) and non-PlTB (n = 47). The Mycobacterium tuberculosis antigen-specific production of IFN-γ and IP-10 on PB or PF did not show significant differences. However, the basal levels of these biomarkers, as well as the ADA activity on PF, were significantly increased in confirmed PlTB in comparison to non-PlTB group. Receiver operating characteristics curves were performed and the best cut-off points of these three biomarkers were estimated. Their either isolated or combined performances (sensitivity [Se], specificity [Sp], positive predictive value [PPV], negative predictive value [NPV] and accuracy [Acc]) were determined and applied to Venn's diagrams among the groups. Based on the confirmed PlTB cases, IFN-γ showed the best performance of them at a cut-off point of 2.33 IU/mL (Se = 93.8% and Sp = 97.9%) followed by ADA at a cut-off of 25.80 IU/L (Se = 100% and Sp = 84.8%) and IP-10 (Cut-point = 4,361.90 pg/mL, Se = 75% and Sp = 82.6%). IFN-γ plus ADA (cut-point: 25.80 IU/L) represent the most accurate biomarker combination (98.4%), showing Se = 93.7%, Sp = 100%, PPV = 100% and NPV = 97.9%. When this analysis was applied in non-confirmed PlTB, 15/17 (88.2%) presented at least two positive biomarkers in combination. Conclusion IFN-γ, IP-10, and ADA in PlTB effusions are significantly higher than in non-PlTB cases. IFN-γ is an excellent rule-in and rule-out test compared to IP-10 and ADA. The combination of IFN-γ and ADA, in a reviewed cut-off point, showed to be particularly useful to clinicians as their positive results combined prompts immediate treatment for TB while both negative results suggest further investigation.

Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.

A doenca pulmonar obstrutiva cronica (DPOC) e uma patologia caracterizada pela obstrucao progressiva do fluxo aereo, parcialmente ou nao totalmente reversivel, causando prejuizos funcionais. Associado a tais limitacoes ha tambem a disfuncao muscular periferica. Existem evidencias de que alteracoes musculoesqueleticas relacionadas a inatividade fisica repercutem negativamente no prognostico dos pacientes com DPOC. Dessa forma, o fortalecimento muscular nestes individuos proporciona, alem do aumento da forca muscular, melhora da capacidade funcional e da qualidade de vida. O presente estudo e uma revisao sistematica que tem como objetivo identificar os aparelhos utilizados para treinamento de forca muscular e a eficacia dos programas de reabilitacao pulmonar (PRP) em pacientes com DPOC. Para tanto, foi realizada uma busca sistematica nas bases de dados Scielo, Pubmed, Medline e Tripdatabase, com artigos publicados no periodo de 2005 a 2016. Foram selecionados 24 estudos e descritos os tipos de equipamentos utilizados para o treino de forca e os resultados dos programas de reabilitacao. Foi constatado que os equipamentos de musculacao sao os mais utilizados para este fim, porem opcoes mais viaveis e mais versateis produzem os mesmos resultados, alem disso, em todos os estudos, os PRP produziram resultados significativos. Descritores: Doenca pulmonar obstrutiva cronica (DPOC); Reabilitacao pulmonar; Fortalecimento muscular; Disfuncao muscular periferica; Aparelhos para treinamento muscular; Alta intensidade.

Introducao: A frequencia cardiaca (FC) pode ser utilizada como resposta ao esforco maximo e submaximo durante o exercicio. A observacao do retorno da frequencia cardiaca apos o esforco denota informacao prognostica relevante. Ha poucos estudos sobre o tempo de recuperacao da FC apos o teste de caminhada de seis minutos (TC6M). Objetivo: Analisar a FC apos um minuto do TC6M dos individuos saudaveis comparando a FC na sua condicao basal e final apos o teste. Metodologia: Foram avaliados 52 homens e 52 mulheres com idade entre 20-80 anos. Foi analisada e comparada a FC inicial, final e um minuto apos o TC6M. Resultados: FC inicial media foi 77 ± 16 bpm (homens 73 ± 16 bpm; mulheres 82 ± 16 bpm). FC final media foi 111 ± 17 bpm, homens e mulheres apresentaram 107 ± 12 e 115 ± 21 bpm, respectivamente (p < 0,0001). A FC media aferida um minuto apos o TC6M foi 86 ± 13 bpm, sendo que os homens apresentaram 85 ± 14 bpm e as mulheres, 88 ± 12 bpm (p < 0,0001). Conclusao: A frequencia cardiaca de individuos saudaveis medida 1 minuto apos o TC6M se aproxima da FC inicial. Embora nao tenha alcancado os niveis basais, essa rapida recuperacao sugere que nao seja necessario esperar 30 minutos para a realizacao do segundo teste em individuos saudaveis. Descritores: Frequencia cardiaca; Teste de caminhada em seis minutos; Esforco.

OBJECTIVE: To compare the absolute serum von Willebrand factor (vWF) levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. METHODS: The study included 57 subjects, in three groups: COPD (n = 36); smoker (n = 12); and control (n = 9). During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2) was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. RESULTS: Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001) and 1,865 ± 592 pg/mL (p < 0.01). Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05), as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05). In all three groups, there was a negative correlation between FEV1 (% of predicted) and relative serum vWF activity (r2 = −0.13; p = 0.009). CONCLUSIONS: Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients. OBJETIVO: Comparar os níveis séricos absolutos e a atividade sérica em percentual do fator de von Willebrand (FvW) em pacientes com DPOC clinicamente estáveis, tabagistas sem obstrução das vias aéreas e em indivíduos saudáveis que nunca fumaram. MÉTODOS: Foram incluídos no estudo 57 indivíduos, em três grupos: DPOC (n = 36), tabagista (n = 12) e controle (n = 9). Todos os participantes realizaram radiografia do tórax, espirometria e exame de sangue durante a fase de seleção. Os níveis séricos absolutos e a atividade sérica em percentual do FvW foram obtidos por turbidimetria e ELISA, respectivamente. A escala Medical Research Council modificada foi utilizada para classificar pacientes como sintomáticos ou assintomáticos/pouco sintomáticos no grupo DPOC (ponto de corte = 2). RESULTADOS: Os níveis absolutos do FvW no grupo controle foram significativamente menores que os nos grupos tabagista e DPOC: 989 ± 436 pg/mL vs. 2.220 ± 746 pg/mL (p < 0,001) e 1.865 ± 592 pg/mL (p < 0,01). Os valores em percentual de atividade do FvW no grupo DPOC foram significativamente maiores que no grupo tabagista (136,7 ± 46,0% vs. 92,8 ± 34,0%; p < 0,05), assim como foram significativamente maiores no subgrupo DPOC sintomático que no subgrupo DPOC assintomático/pouco sintomático (154 ± 48% vs. 119 ± 8%; p < 0,05). Houve uma correlação negativa entre o VEF1 (% do previsto) e os níveis em percentual de atividade do FvW nos três grupos (r2 = −0,13; p = 0,009). CONCLUSÕES: Nossos resultados sugerem que aumentos nos níveis de FvW e de sua atividade contribuem para a manutenção da inflamação sistêmica e o aumento do risco cardiovascular em pacientes com DPOC.

Introduction: Diagnostic approaches to patients with a pleural effusion must be precise because many procedures depend on the nature of the fluid in the effusion. To date, no biochemical test is considered an appropriate alternative to Light’s criteria. This study compared the absolute pleural cholesterol (PC) level and the pleural cholesterol/serum cholesterol (PC/SC) ratio with Light’s criteria to determine exudative pleural effusions. Materials and Methodology: This study was a case series of 100 consecutive patients with pleural effusions. The clinical parameters that were used to diagnosis an exudative effusion included the cholesterol level, a pleural cholesterol level ≥ 50 mg/dL, a pleural/serum ratio ≥ 0.4, and Light’s criteria. The sensitivity, specificity, and positive and negative predictive values of each test for the diagnosis of an exudative effusion were assessed. Results: A total of 79 patients were definitively diagnosed with an exudative effusion and were included in the trial and analyzed. The mean PC level in the exudates was 90.39 mg/dL. The PC levels demonstrated a sensitivity of 97.22%, a specificity of 85.71%, a positive predictive value of 98.59% and a negative predictive value of 75%. The PC/SC ratio demonstrated a sensitivity of 81.48%, a specificity of 57.14%, a positive predictive value of 93.61% and a negative predictive value of 28.57%. Conclusion: The pleural cholesterol dosage level and the pleural/serum cholesterol ratio can be utilized as unique biomarkers to identify an exudative effusion and replace Light’s criteria.

Increasing prevalence of sedentary behavior (SB) combined with low levels of physical activity (PA) in children and adolescents has become a growing public health concern. Therefore, this study aimed to identify the daily behavioral pattern of adolescents and examine the isotemporal substitution effects of SB with light-intensity PA (LIPA) or moderate-to-vigorous PA (MVPA) on cardiometabolic markers. In this cross-sectional study, the daily behavioral pattern of Brazilian male adolescents was objectively measured for 7 days. Vector magnitude activity counts were used to estimate SB, LIPA, and MVPA with cut-points specifically validated for youth. The isotemporal substitution model was used to assess the effects of replacing different SB bouts (5, 10, 30, and 60 min) with LIPA or MVPA on cardiometabolic markers [body mass index, waist circumference, body fat percentage (BF%), total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, low-density lipoprotein cholesterol, triglyceride (TG), glucose, insulin, homeostatic model assessment of insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-S), beta cell function (HOMA2-β), systolic-blood pressure (SBP), diastolic-blood pressure, and cardiometabolic risk score]. Male adolescents (n = 84; age, 16.7 ± 0.9 years) wore the GT3X+ for 6.7 ± 0.6 days, during 15.2 ± 2.3 h, and spent 72.9% of the time in SB, 17.3% in LIPA, and 9.8% in MVPA. SB replacement with LIPA was associated with increased HDL-C, TG, HOMA2-IR, and HOMA2-S and decreased SBP. In contrast, SB replacement with MVPA was associated with decreased BF%. Therefore, our findings suggest that replacing SB with LIPA showed positive results on HDL-C, HOMA2-S and SBP, while replacing SB with MVPA was associated with only one obesity indicator (BF%). Moreover, participants met the daily MVPA recommendations, but they still had a daily behavioral pattern with high SB. In this context, LIPAs can be considered an effective alternative to reduce SB and improve the health indicators of this population.

This study aimed to assess the effects of isotemporal replacement of sitting time (SIT) with standing (STA) on cardiometabolic biomarkers. In this cross-sectional study, male adolescents wore the GT3X+ activity monitor for 7 days to measure the SIT and STA. Moderate-to-vigorous physical activity (MVPA) was estimated by a youth-specific cut-off point. An isotemporal substitution approach was used to examine the effects of replacing different periods of SIT (15, 30, 60, and 120 min) with STA on cardiometabolic biomarkers [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), non-HDL-c, low-density lipoprotein cholesterol (LDL-c), triglycerides (TG), glucose, insulin, HOMA2-&beta, HOMA2-S, and HOMA2-IR]. Analysis of covariance (ANCOVA) with a post-hoc Bonferroni test was used to compare the adjusted means between the four subgroups that were clustered according to SIT and STA amount. Adolescents (n = 84, age, 16.7 &plusmn, 0.9 years) wore GT3X+ for 15.2 &plusmn, 2.3 h, for 6.7 &plusmn, 0.6 days. Isotemporal substitution of SIT with STA was associated with TC, non-HDL-c, LDL-c, and TG. ANCOVA results showed a statistically significant difference for TC, non-HDL-c, and LDL-c. These findings showed that for male adolescents, sitting less and standing more may be an effective alternative to reduce cardiometabolic biomarker levels related to lipid metabolism, regardless of MVPA.

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Hereditary etiology has been proposed as a cause of the sarcoidosis, and some Human Leucocyte Antigen (HLA) alleles have been related to the diagnosis or severity of the disease. Lofgren’s syndrome has been linked to patients with the DRB1*03 allele, and non-resolving disease has been associated with the DRB1*07, DRB1*14 and DRB1*15 alleles. However, the results observed in Caucasian patients are not reproducible in other populations, such as in Japanese individuals. The aim of this study is to examine the HLA alleles in Brazilian patients with sarcoidosis confirmed by biopsy. Sixty-three patients were included in the study, and the HLA alleles were compared with 126 control individuals. HLA-A, -B, -C, -DRB1 and -DQB1 genes were typed using a Luminex Multi-analyte profiling system (One Lambda, Inc. Canoga Park, CA). Among sarcoidosis patients, the HLA A*23, A*80, B*08, B*41, DQB1*05 and DRB1*14 antigens tended to be more common than in the controls, whereas the B*44, B*45, B*51, B*58, DRB1*15 and DRB1*16 alleles were more frequently found in control subjects than in the sarcoidosis patients. However, after Bonferroni correction, only the HLA-DRB1*14 allele was found to be significantly different between sarcoidosis patients and controls (pC = 0.0047, OR = 11.69, CI = 2.47–55.22). This allele was more frequent in mestizos and black patients. The presence of an HLA-DRB1*14 allele might determine the risk of sarcoidosis in Brazilian individuals, especially in mestizos and black patients.

Embora seja uma condição clínica rara, a síndrome hemofagocítica é associada com alta mortalidade e o número de casos descritos na literatura vem aumentando progressivamente. O diagnóstico de síndrome hemofagocítica depende da presença de hemofagocitose. A sarcoidose é uma doença de alta prevalência cujo curso e prognóstico podem correlacionar-se com a apresentação clínica inicial e a extensão da doença. Relatamos o caso de um paciente com sarcoidose de longa duração que apresentava febre intermitente e fadiga. O diagnóstico de síndrome hemofagocítica foi realizado por aspirado de medula óssea, e o tratamento específico foi ineficaz. Trata-se do terceiro caso de síndrome hemofagocítica relacionada a sarcoidose na literatura mundial e o primeiro na literatura latino-americana. Os três casos tiveram desfecho desfavorável.

OBJETIVO: Estimar o custo do diagnóstico e tratamento da asma. MÉTODOS: Foi utilizada a perspectiva da sociedade. Foram incluídos por 12 meses em 2011–2012, sequencialmente, 117 indivíduos maiores de cinco anos de idade, em tratamento por asma nos Serviços de Pneumologia e Alergia-Imunologia da Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro. Todos realizaram duas entrevistas com seis meses de intervalo para coleta de dados, cobrindo 12 meses. As unidades de custos foram identificadas e valoradas de acordo com métodos definidos. Foi feita análise de sensibilidade e foram aplicados métodos estatísticos com nível de significância de 5% para comparações de custos entre subgrupos. RESULTADOS: Cento e oito pacientes completaram o estudo, 73,8% eram mulheres. Mediana de idade foi de 49,5 anos. Rinite esteve presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade. A renda familiar média foi de R$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES: Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença.

O sequestro pulmonar é uma rara anomalia congênita, caracterizada por tecido pulmonar embrionário não funcionante, perfazendo 0,15-6,40% de todas as malformações pulmonares congênitas. Essa anomalia envolve o parênquima e a vascularização pulmonar, sendo classificado como intralobar ou extralobar. Neste relato, descrevemos o caso de um paciente de 56 anos com hemoptise e imagem hipotransparente retrocardíaca em base de hemitórax esquerdo na radiografia de tórax. Após a realização de TC com contraste endovenoso, foi evidenciada a presença de sequestro pulmonar. O paciente foi submetido à cirurgia para a retirada do tecido anômalo, que foi realizada com sucesso. Apresentou boa evolução pós-operatória e recebeu alta com acompanhamento ambulatorial.

Relatamos o caso de um paciente de 56 anos submetido a transplante pulmonar unilateral esquerdo em decorrência de fibrose pulmonar idiopática (FPI). No pós-operatório imediato, sob intensa imunossupressão, houve progressão rápida da FPI no pulmão nativo direito, confirmada pela biópsia pulmonar videotoracoscópica, necessitando de ventilação mecânica durante 104 dias até a realização de outro transplante pulmonar à direita. Obteve alta hospitalar após o 26º dia do segundo pós-operatório.

Background. Appropriate management, including pulmonary rehabilitation, associated with correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients can contribute to improving clinical conditions of these patients. Physical activity is recommended for COPD patients. Whole-body vibration (WBV) is a modality of physical activity. Putting together the biological effects and safe use of WBV, it may be a potentially feasible intervention to add to pulmonary rehabilitation. The purpose of this investigation was to systematically review studies regarding the effects of WBV, as a component of the pulmonary rehabilitation, in patients with COPD.Results. A total of six publications met inclusion for review. There was evidence to support the beneficial use of WBV to improve functional performance of the lower limbs and quality of life. However, the appropriateness of and descriptors of WBV methods were poorly described.Conclusions. The results of this review support the use of WBV as a component of pulmonary rehabilitation to assist management of patients with COPD. However, future research should examine the dose-response curve and optimal dosing regimen of WBV according to standard reporting recommendations for people with COPD. Such an approach will allow comparison among studies and the potential of meta-analysis of randomized controlled trials.

O câncer de pulmao e uma doenca agressiva e seu diagnostico precoce direciona seu tratamento para uma maior chance de cura. Dados gerais da literatura apontam que uma minoria de pacientes (cerca de 30%), portadores de carcinoma nao pequenas celulas, limitadas ao pulmao, beneficiam-se do tratamento cirurgico curativo. Desta forma todo esforco para um diagnostico precoce deve ser realizado. O objetivo deste artigo de atualizacao e abordar o tema proposto de uma forma geral, ressaltando as informacoes mais relevantes para profissionais da area de saude. Exames cada vez mais sofisticados podem ser utilizados na pratica medica, assim como tecnicas cirurgicas mais evoluidas e inovacoes de quimioterapia/radioterapia complementam o avanco para uma maior sobrevida. Descritores: Neoplasias pulmonares; Oncologia; Diagnostico; Estadiamento de neoplasias; Terapia combinada; Cirurgia toracica videoassistida. Revista HUPE, Rio de Janeiro, 2015;14(Supl. 1):87-96 doi: 10.12957/rhupe.2015.17933

The relationship between asthma and obesity is well established, although the pathophysiological mechanisms linking both diseases remain unknown. Adiponectin is a hormone secreted by adipose cells, plays a role in the modulation of inflammation and may be the key linking these two types of inflammation. We conducted a cross-sectional study with asthma with different body mass indices (BMI); the patients were classified as eutrophic, overweight, or obese. We assessed disease control using the GINA consensus, and the levels of adiponectin, C-reactive protein (CRP) and interleukin 33 (IL-33) in each of the patients. We evaluated 75 of the 96 patients eligible for the study, including 25 in each BMI group. The CRP levels were significantly higher in the obese patients compared with both the eutrophic (p = 0.01) and the overweight (p = 0.03) patients. The mean adiponectin level was 21.82 ± 9.93 mg/L for the eutrophic asthmatics, which is a level that was significantly higher than in the overweight (15.31 ± 6.27 mg/L, p = 0.0140) and the obese (16.69 ± 11.45 mg/L, p = 0.0287) patients. The patients with higher adiponectin levels exhibited smaller FEV1 (p = 0.02) and lower FVC (p = 0.003). The IL-33 levels were not different between the groups. Adiponectin does not protect against the development of inflammation in the setting of asthma and may in fact exacerbate the disease via its anti-TH1 inflammatory effects, allowing for increased TH2 differentiation and a more severe allergic response.

OBJETIVO: Analisar de forma retrospectiva fragmentos de biópsias pulmonares que receberam o diagnóstico de pneumonia intersticial crônica idiopática, à luz da classificação da American Thoracic Society e European Respiratory Society, de 2000. MÉTODOS: A partir da revisão de 252 fragmentos de biópsias pulmonares a céu aberto de pacientes com doença intersticial pulmonar, no período de 1977 a 1999, 39 casos de doença pulmonar intersticial idiopática foram selecionados e reavaliados por dois patologistas, segundo a classificação da American Thoracic Society e European Respiratory Society, de 2000. RESULTADOS: Vinte e oito dos 39 diagnósticos foram mantidos (71,8%). Uma nova entidade patológica, a pneumonia intersticial não específica, foi incluída na reclassificação e houve superposição de padrões em seis casos. Mantiveram o mesmo diagnóstico 28 casos, 4 casos apresentaram associação entre fibrose pulmonar idiopática e organização pneumônica criptogênica, 1 entre organização pneumônica criptogênica e pneumonia intersticial não específica, e 1 entre pneumonia intersticial descamativa e pneumonia intersticial não específica. Todos os casos de fibrose pulmonar idiopática foram confirmados, embora 3 deles estivessem associados a organização pneumônica criptogênica. Os diagnósticos anteriores foram quase todos mantidos na revisão dos espécimes (p > 0,05). CONCLUSÃO: A classificação das doenças pulmonares intersticiais da American Thoracic Society e European Respiratory Society é uma ferramenta útil aos patologistas que lidam com biópsias pulmonares.

Chronic obstructive pulmonary disease is an inflammatory disease. Together with oxidant stimuli, which directly affect lung structures, macrophages, neutrophils and CD8+ lymphocytes actively participate in the pathogenesis of the disease and promote biochemical reactions that result in progressive alteration of the upper airways and irreversible lung remodeling. The release of substances promoted by inflammatory cell recruitment and by oxidative stress lead to a temporary imbalance in the pulmonary defense mechanisms. Understanding the long-term maintenance of this imbalance is key to understanding the current physiopathology of the disease. The present study explores the cellular and molecular alterations seen in chronic obstructive pulmonary disease.

Revista HUPE, Rio de Janeiro, 2013;12(Supl 1):61-73 doi:10.12957/rhupe.2013.7084 Pulmonary arterial hypertension (PAH) is a rare disease characterized by a progressive increase in pulmonary vascular resistance, leading to right heart failure and premature death. Over the last decades, a better understanding of the pathogenesis of PAH has led to the approval of several targeted therapies that confer improvements in patients’ clinical and haemodynamic status, quality of life and survival. The clinical manifestations are non-specific but progressive, with the majority of patients presenting with worsening dyspnea, the most common symptom, that has usually been attributed to other cardiorespiratory disorders. As a consequence, diagnostic delay is usual, with 75% of patients reporting New York Heart Association functional class (NYHA-FC) III or IV symptoms by the time the diagnosis is established. Brazil has until March 2013 indexed in the database PUBMED 52 articles on this topic since the early twentieth century. In fact, the disease was forgotten until the early 1990s, when it was found that their frequency was greater than previously thought and that it could be approached together or separately, in cases of idiopathic etiology, improving quality of life and increasing survival in years. In Brazil, despite advances in therapeutic and diagnostic approach, there are few reference centers for diagnosis and treatment, which hinders the capillarization of knowledge. This review presents the current scenario of the diagnosis of PAH and its broad perspective for treatment. Keywords: Pulmonary arterial hypertension; Therapy ; Review.

A doenca pulmonar obstrutiva cronica (DPOC) e uma enfermidade respiratoria prevenivel e tratavel, caracterizada pela limitacao ao fluxo aereo. O tratamento tem avancado recentemente com novos medicamentos introduzidos, questionamentos sobre a insercao dos corticosteroides inalaveis e sobre as futuras associacoes de broncodilatadores. Os sintomas mais angustiantes para os pacientes que tem DPOC sao dispneia, intolerância ao exercicio, e incapacidade progressiva para participar de atividades do dia a dia. Estas manifestacoes clinicas da DPOC, resultam em ma qualidade de vida do paciente. Tal como acontece com muitas outras doencas cronicas, uma abordagem multimodal da DPOC e abordada em varios artigos e diretrizes baseadas em evidencias. Os principaiso bjetivos do manejo da DPOC e focar no alivio dos sintomas, melhorando o estado de saude, elevando a prevencao do declinio da funcao pulmonar e a melhora do desempenho do exercicio, evitando as exacerbacoes, e diminuindo a mortalidade. Alem disso, estes objectivos deverao ser atingidos com o minimo de efeitos secundarios do tratamento. Terapias tradicionais da DPOC tem centrado no controle dos sintomas com o objetivo de evitar a obstrucao ao de fluxo de ar reduzida e o declinio da funcao pulmonar. Medicamentos atuais usados para a DPOC pode reduzir ou abolir os sintomas, o numero e agravidade das exacerbacoes, e pode melhorar a capacidade ao exercicio. A farmacoterapia atual visa a melhora dos sintomas, a maior tolerância ao exercicio e reducao das exacerbacoes. A prevencao da progressao da doenca e a reducao da mortalidade sao os objetivos finais de tal terapia. Todos os pacientes sintomaticos que tem DPOC devem receber intervencao farmacologica. Revista HUPE, Rio de Janeiro, 2013:12(2)71-7 doi: 10.12957/rhupe.2013.8489

Chronic obstructive pulmonary disease is on the rise in the contemporary World. It is a preventable disease and rarely attributed to genetic deficiency. Several factors are responsible for this increased incidence, such as active and passive smoking, environmental pollution and occupational and delay of implementation of effective public policies for its prevention. The prevalence in the World varies greatly from 0.2% to 37%, this wide range is explained in part by cultural characteristics of countries that emitting international epidemiological reports, methods used to establish the diagnosis and classification of COPD. The prevalence and incidence has being higher in men, especially in the elderly above 75 years of age. Mortality has also increased in the last 30 to 40 years, 3-111 deaths per 100,000 populations. In Brazil, in 2011, the National Cancer Institute reported that 15.1% of the population of 190,732,694 million people in Brazil is smokers and about 15% of this population could develop the COPD. Thus, in absolute numbers, 4.32 million people have COPD Brazilian, only related to smoking. COPD is the fourth leading cause of death in the United States, representing 5% of all deaths, with an increase of 8% of the total number of deaths from 116,494 to 126,005 in the period from 2000 to 2005. If the analysis is extended from 1980 to 2000, the percentage of mortality was increased in 67%. This chapter aims to demonstrate the importance of the epidemic, which is characterized by late onset and deterioration of lung function very slow, but that may be controllable by harsher measures of tobacco control in Brazil.

Chronic obstructive pulmonary disease (COPD) is a slowly progressive condition characterized by airflow limitation, which is largely irreversible. Cigarette smoking is the main etiologic factor in this condition, far outweighing any other risk factors. The pathogenesis of COPD therefore is strongly linked to the effects of cigarette smoke on the lungs. The extent of smoking history and the severity of airflow limitation are generally related, but with huge individual variation. The pathogenesis of COPD encompasses a number of injurious processes, including an abnormal inflammatory response in the lungs to inhaled particles and gases. Other processes, such as failure to resolve inflammation, abnormal cell repair, apoptosis, abnormal cellular maintenance programs, extracellular matrix destruction (protease/antiprotease imbalance), and oxidative stress (oxidant/antioxidant imbalance) have also a role. The subsequent chronic inflammatory responses lead to mucus hypersecretion, airway remodeling, and alveolar destruction. This article provides an update on the cellular and molecular mechanisms of these processes in the pathogenesis. COPD is an inflammatory disease with active participation of macrophages, neutrophils, and CD8 lymphocytes, associated to oxidant stimulus which directly injures lung structure. These biochemistry reactions progressively develop alterations in small airways and take a new model of non‑reversible pulmonary structural. Substances liberated by recruited cells and by oxidants stress brought temporary imbalance of pulmonary defense mechanism. This long time imbalance is one of the tools to up to date pathophysiology. The authors describe the relationship among structure, cells and biochemistry in COPD and its patho-physiological consequences.

A 32-year-old man worked as a subsistence farmer raising pigs and tending his small garden; he also kept cats and dogs. He reported fever, night sweats, weight loss of 10 kg over 3 months, haemoptysis and skin ulcers (figure 1). Radiography and chest CT scan (figure …