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BACKGROUND: Acute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke. The advent of multi‐detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardiopulmonary reserve, classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncology patients). Traditionally, all PEs are anticoagulated in a similar manner independent of their location, or number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by a possible unnecessary use of anticoagulants. Patients with isolated SSPE, or incidental PE, may have a more benign clinical presentation compared to those with proximal PEs. However, the clinical significance in patients, and their prognosis, needs to be studied to evaluate whether anticoagulation therapy is required. This is the second update of the Cochrane systematic review published in 2014. OBJECTIVES: To assess the effectiveness and safety of anticoagulation therapy versus control in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 26 November 2019. We also undertook reference checking to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials of anticoagulation therapy versus control in patients with SSPE or incidental SSPE. DATA COLLECTION AND ANALYSIS: Two review authors inspected all citations identified to ensure reliable assessment. If relevant studies were identified, we planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: We did not identify any studies that met the inclusion criteria. AUTHORS' CONCLUSIONS: There is no evidence from randomised controlled trials to assess the effectiveness and safety of anticoagulation therapy versus control in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE. Well‐conducted research is required before informed practice decisions can be made.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:57Z No. of bitstreams: 1 S1806-37132011000200006.pdf: 224940 bytes, checksum: 08ee0e40f8d4ea76e24214dba24beb49 (MD5) Made available in DSpace on 2013-08-22T18:43:57Z (GMT). No. of bitstreams: 1 S1806-37132011000200006.pdf: 224940 bytes, checksum: 08ee0e40f8d4ea76e24214dba24beb49 (MD5) Previous issue date: 2011-04-01 Made available in DSpace on 2013-09-30T18:17:54Z (GMT). No. of bitstreams: 2 S1806-37132011000200006.pdf: 224940 bytes, checksum: 08ee0e40f8d4ea76e24214dba24beb49 (MD5) S1806-37132011000200006.pdf.txt: 33651 bytes, checksum: a2f5f6ac3a65d5d4d66a07297f2a717a (MD5) Previous issue date: 2011-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:44Z No. of bitstreams: 2 S1806-37132011000200006.pdf: 224940 bytes, checksum: 08ee0e40f8d4ea76e24214dba24beb49 (MD5) S1806-37132011000200006.pdf.txt: 33651 bytes, checksum: a2f5f6ac3a65d5d4d66a07297f2a717a (MD5) Made available in DSpace on 2014-05-20T13:33:44Z (GMT). No. of bitstreams: 2 S1806-37132011000200006.pdf: 224940 bytes, checksum: 08ee0e40f8d4ea76e24214dba24beb49 (MD5) S1806-37132011000200006.pdf.txt: 33651 bytes, checksum: a2f5f6ac3a65d5d4d66a07297f2a717a (MD5) Previous issue date: 2011-04-01 OBJETIVO: Estudar os padrões clínicos, radiológicos e histopatológicos da biópsia transbrônquica (BTB) utilizados para a confirmação diagnóstica em pacientes com suspeita clinica de doença pulmonar intersticial (DPI) atendidos em um hospital universitário de nível terciário. MÉTODOS: Os prontuários, laudos radiológicos e de biópsias transbrônquicas de todos os pacientes com suspeita de DPI submetidos a BTB entre janeiro de 1999 e dezembro de 2006 no Hospital das Clínicas de Botucatu, localizado na cidade de Botucatu (SP), foram revisados. RESULTADOS: Foram incluídos no estudo 56 pacientes. Desses, 11 (19,6%) apresentaram o diagnóstico definitivo de fibrose pulmonar idiopática (FPI), que foi significativamente maior nos casos nos quais DPI era uma possibilidade diagnóstica em comparação com aqueles nos quais DPI era a principal suspeita (p = 0,011), demonstrando a contribuição da BTB para a definição diagnóstica dessas doenças. O exame histopatológico dessas biópsias revelou que 27,3% dos pacientes com FPI apresentavam o padrão de pneumonia organizante, o que pode sugerir doença mais avançada. O padrão histológico indeterminado foi o mais frequente, refletindo a característica periférica da FPI. Entretanto, o padrão fibrose apresentou alta especificidade e alto valor preditivo negativo. Para os padrões sugestivos de FPI em TC, a curva ROC indicou que a melhor relação entre sensibilidade e especificidade ocorreu com a presença de cinco alterações radiológicas, sendo o aspecto de favo de mel fortemente sugestivo de FPI (p = 0,01). CONCLUSÕES: Nas DPIs, a TC de tórax deve ser sempre realizada e a BTB usada em situações individualizadas, conforme a suspeita e distribuição das lesões. OBJECTIVE: To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital. METHODS: We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil. RESULTS: The study included 56 patients. of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01). CONCLUSIONS: For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Patologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Doenças Tropicais e Diagnóstico por Imagem Universidade de São Paulo Faculdade de Medicina Departamento de Patologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Clínica Médica Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Patologia Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Doenças Tropicais e Diagnóstico por Imagem Universidade Estadual Paulista Faculdade de Medicina de Botucatu Departamento de Clínica Médica

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:43:57Z No. of bitstreams: 1 S1806-37132010000100010.pdf: 537395 bytes, checksum: 53c0224402be60132807a8f71ee52953 (MD5) Made available in DSpace on 2013-08-22T18:43:57Z (GMT). No. of bitstreams: 1 S1806-37132010000100010.pdf: 537395 bytes, checksum: 53c0224402be60132807a8f71ee52953 (MD5) Previous issue date: 2010-02-01 Made available in DSpace on 2013-09-30T19:31:54Z (GMT). No. of bitstreams: 2 S1806-37132010000100010.pdf: 537395 bytes, checksum: 53c0224402be60132807a8f71ee52953 (MD5) S1806-37132010000100010.pdf.txt: 33800 bytes, checksum: aaeb36bc8a97e3b55c600df00ee90668 (MD5) Previous issue date: 2010-02-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:57Z No. of bitstreams: 2 S1806-37132010000100010.pdf: 537395 bytes, checksum: 53c0224402be60132807a8f71ee52953 (MD5) S1806-37132010000100010.pdf.txt: 33800 bytes, checksum: aaeb36bc8a97e3b55c600df00ee90668 (MD5) Made available in DSpace on 2014-05-20T13:32:57Z (GMT). No. of bitstreams: 2 S1806-37132010000100010.pdf: 537395 bytes, checksum: 53c0224402be60132807a8f71ee52953 (MD5) S1806-37132010000100010.pdf.txt: 33800 bytes, checksum: aaeb36bc8a97e3b55c600df00ee90668 (MD5) Previous issue date: 2010-02-01 OBJETIVO: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. MÉTODOS: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. RESULTADOS: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29%, e essa foi a causa mortis de 22,6% dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95%: 1,26-2,95; p = 0,02) e acometimento pulmonar bilateral (OR = 3,23; IC95%: 1,26-8,30; p = 0,01). Não houve associações significativas entre as variáveis e pneumonia aspirativa fatal. CONCLUSÕES: em nossa amostra, a pneumonia nosocomial teve prevalência elevada e foi responsável por quase 25% das mortes. A mortalidade é favorecida por alterações estruturais tabágicas e pneumonia bilateral. Esses achados corroboram os resultados de diversos estudos clínicos sobre pneumonia nosocomial. OBJECTIVE: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. METHODS: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. RESULTS: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. CONCLUSIONS: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Universidade Estadual Paulista Faculdade de Medicina de Botucatu

Pulmonary Division Botucatu Medical School Universidade Estadual Paulista (UNESP), Botucatu, SP 18618-970

To identify potential prognostic factors for pulmonary thromboembolism (PTE), establishing a mathematical model to predict the risk for fatal PTE and nonfatal PTE.The reports on 4,813 consecutive autopsies performed from 1979 to 1998 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the 512 patients found with macroscopically and/or microscopically documented PTE, data on demographics, underlying diseases, and probable PTE site of origin were gathered and studied by multiple logistic regression. Thereafter, the "jackknife" method, a statistical cross-validation technique that uses the original study patients to validate a clinical prediction rule, was performed.The autopsy rate was 50.2%, and PTE prevalence was 10.6%. In 212 cases, PTE was the main cause of death (fatal PTE). The independent variables selected by the regression significance criteria that were more likely to be associated with fatal PTE were age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00 to 1.03), trauma (OR, 8.5; 95% CI, 2.20 to 32.81), right-sided cardiac thrombi (OR, 1.96; 95% CI, 1.02 to 3.77), pelvic vein thrombi (OR, 3.46; 95% CI, 1.19 to 10.05); those most likely to be associated with nonfatal PTE were systemic arterial hypertension (OR, 0.51; 95% CI, 0.33 to 0.80), pneumonia (OR, 0.46; 95% CI, 0.30 to 0.71), and sepsis (OR, 0.16; 95% CI, 0.06 to 0.40). The results obtained from the application of the equation in the 512 cases studied using logistic regression analysis suggest the range in which logit p0.336 favors the occurrence of fatal PTE, logit p- 1.142 favors nonfatal PTE, and logit P with intermediate values is not conclusive. The cross-validation prediction misclassification rate was 25.6%, meaning that the prediction equation correctly classified the majority of the cases (74.4%).Although the usefulness of this method in everyday medical practice needs to be confirmed by a prospective study, for the time being our results suggest that concerning prevention, diagnosis, and treatment of PTE, strict attention should be given to those patients presenting the variables that are significant in the logistic regression model.

Made available in DSpace on 2021-07-14T10:43:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2002-07. Added 1 bitstream(s) on 2021-07-14T11:36:49Z : No. of bitstreams: 1 S0102-35862002000400009.pdf: 114089 bytes, checksum: 3eb1f5b4612eecd1038762e54998b9c5 (MD5) A síndrome aguda do tórax (SAT) acomete portadores de anemia falciforme e é responsável por cerca de 25% dos óbitos. Relata-se o caso de um homem pardo de 45 anos, alcoolista crônico, sem nenhum antecedente de falcização, com quadro de pneumonia-símile havia sete dias. A radiografia simples do tórax mostrou infiltrado heterogêneo bilateral, com áreas de consolidação e broncograma aéreo e derrame pleural à esquerda. Outros exames laboratoriais revelaram anemia, leucocitose com desvio à esquerda e hipoxemia. Tratado com cefoxitina e amicacina, o paciente evoluiu rapidamente para insuficiência respiratória aguda e morreu 14 horas após a internação. Na necropsia, no exame dos pulmões observaram-se intensa congestão, hemorragia intra-alveolar, dano alveolar difuso e hemácias com morfologia falciforme. O caráter rápido, progressivo e freqüentemente mimetizado por outras doenças torna a SAT um evento dramático e de diagnóstico precoce difícil, sendo, entretanto, obrigatória tê-la sempre em mente, especialmente em um país com grande população da raça negra como o Brasil. Acute chest syndrome is an affection, specially in young adults, of sickle cell disease and is responsible for 25% of the deaths. The authors report the case of an alcoholic 45-year-old mulatto man, without any previous manifestation of sickle cell disease, who presented with a pneumonia-like clinical picture with seven days of duration. The chest X-ray revealed bilateral lung infiltrates and spots of consolidation with air bronchograms, and left pleural effusion. The patient also had anemia and leukocytosis with neutrophilia. Treated with cefoxitin and amicacin, the patient developed acute respiratory insufficiency and died 14 hours after hospitalization. The necropsy showed lungs with intense congestion, intra-alveolar hemorrhage, diffuse alveolar damage, and sickle red blood cells. The progressive, fast, and severe character of the acute chest syndrome, which is frequently mimicked by other illnesses, makes the disease a dramatic and severe event of difficult earlier diagnosis. Therefore, in countries like Brazil, with a large black population, the physicians must always be aware of this possibility. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu Universidade Estadual Paulista, Faculdade de Medicina de Botucatu

Background Pulmonary embolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people per year. Outpatient treatment instead of traditional inpatient treatment in selected non-high-risk patients with acute PE might provide several advantages, such as reduction of hospitalizations, substantial cost saving and an improvement in health-related quality of life. Objectives To compare the efficacy and safety of outpatient versus inpatient treatment for acute PE for the outcomes of all-cause and PE-related mortality; bleeding; and adverse events such as hemodynamic instability, recurrence of PE and patients' satisfaction. Search methods The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched October 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 9). The TSC also searched clinical trials databases. The review authors searched LILACS (last searched November 2014). Selection criteria Randomized controlled trials of outpatient versus inpatient treatment in people diagnosed with acute PE. Data collection and analysis Two review authors selected relevant trials, assessed methodological quality, and extracted and analyzed data. Main results We included one study, involving 339 participants. We ranked the quality of the evidence as low because of the small number of events with imprecision in the confidential interval (CI), the small sample size and it was not possible to verify publication bias. For all outcomes, the CIs were wide and included clinically significant treatment effects in both directions: short-term mortality (30 days) (RR 0.33, 95% CI 0.01 to 7.98, P = 0.49), long-term mortality (90 days) (RR 0.98, 95% CI 0.06 to 15.58, P = 0.99), major bleeding at 14 days (RR 4.91, 95% CI 0.24 to 101.57, P = 0.30) and 90 days (RR 6.88, 95% CI 0.36 to 134.14, P = 0.20), recurrent PE within 90 days (RR 2.95, 95% CI 0.12 to 71.85, P = 0.51) and participant satisfaction (RR 0.97, 95% CI 0.92 to 1.03, P = 0.30). PE-related mortality, minor bleeding, and adverse course such as hemodynamic instability and compliance were not assessed by the single included study. Authors' conclusions Current low quality evidence from one published randomized controlled trial did not provide sufficient evidence to assess the efficacy and safety of outpatient versus inpatient treatment for acute PE in overall mortality, bleeding and recurrence of PE adequately. Further well-conducted research is required before informed practice decisions can be made.

Background Thyroperoxidase is the major antigen of the thyroid microsomal antibodies (TMA) detected in autoimmune thyroid diseases. Its amino acid sequence has 44% homology with myeloperoxidase (MPO), an enzyme present in the primary granules of neutrophils and one of the major antineutrophil cytoplasmic antibodies (ANCA) antigens. The objective of the present study was to investigate the presence of cross-reactivity to MPO of TMA. Methods We studied sera from 51 patients with autoimmune thyroid diseases, all of them TMA-positive. The presence of ANCA was investigated by indirect immunofluorescence and by capture enzyme-linked immunosorbent assay. Results ANCA were positive in 3.9% of the TMA-positive sera and none of them reacted with MPO. In contrast, the ANCA-positive sera revealed antielastase activity. None of the ANCA-positive cases presented clinical signs of vasculitis. However, these 2 patients had been on prolonged treatment with propylthiouracil. Conclusions We conclude that there is no cross-reactivity to MPO of TMA in patients with autoimmune thyroid diseases, possibly because of difference in the spatial configuration of the immunodominant region. The presence of ANCA in patients with autoimmune thyroid diseases without evidence of vasculitis might result from propylthiouracil-induced polyclonal activation.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:26:54Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:31:44Z : No. of bitstreams: 1 2-s2.0-84864510746.pdf: 274160 bytes, checksum: dcd3b5e90752c938a89d8fa48f8c7362 (MD5) Made available in DSpace on 2014-05-27T11:26:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-08-08 Background: The pathogenesis of pulmonary hypertension (PH) in hemodialysis is still unclear. The aim of thisstudy was to identify the risk factors associated with the presence of PH in chronic hemodialysis patients and toverify whether these factors might explain the highest mortality among them.Methods: We conducted a retrospective study of hemodialysis patients who started treatment from August 2001to October 2007 and were followed up until April 2011 in a Brazilian referral medical school. According to theresults of echocardiography examination, patients were allocated in two groups: those with PH and those withoutPH. Clinical parameters, site and type of vascular access, bioimpedance, and laboratorial findings were comparedbetween the groups and a logistic regression model was elaborated. Actuarial survival curves were constructed andhazard risk to death was evaluated by Cox regression analysis.Results: PH > 35 mmHg was found in 23 (30.6%) of the 75 patients studied. The groups differed in extracellularwater, ventricular thickness, left atrium diameter, and ventricular filling. In a univariate analysis, extracellular waterwas associated with PH (relative risk = 1.194; 95% CI of 1.006 1.416; p = 0.042); nevertheless, in a multiple model,only left atrium enlargement was independently associated with PH (relative risk =1.172; 95% CI of 1.010 1.359;p = 0.036). PH (hazard risk = 3.008; 95% CI of 1.285 7.043; p = 0.011) and age (hazard risk of 1.034 per year of age;95% CI of 1.000 7.068; p = 0.047) were significantly associated with mortality in a multiple Cox regression analysis.However, when albumin was taken in account the only statistically significant association was between albuminlevel and mortality (hazard risk = 0.342 per g/dL; 95% CI of 0.119 0.984; p = 0.047) while the presence of PH lost itsstatistical significance (p = 0.184). Mortality was higher in patients with PH (47.8% vs 25%) who also had astatistically worse survival after the sixth year of follow up.Conclusions: PH in hemodialysis patients is associated with parameters of volume overload that sheds light on itspathophysiology. Mortality is higher in hemodialysis patients with PH and the low albumin level can explain thisassociation.© 2012 Greenfield et al.; licensee BioMed Central Ltd. Division of Pulmonology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Pulmonology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Nephrology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP Division of Cardiology Botucatu School of Medicine State University of São Paulo UNESP, Botucatu, SP

Made available in DSpace on 2013-08-28T14:07:43Z (GMT). No. of bitstreams: 1 WOS000314109000001.pdf: 238891 bytes, checksum: 0f609b6f86362938f61544d9e022bd7e (MD5) Made available in DSpace on 2013-09-30T18:24:07Z (GMT). No. of bitstreams: 2 WOS000314109000001.pdf: 238891 bytes, checksum: 0f609b6f86362938f61544d9e022bd7e (MD5) WOS000314109000001.pdf.txt: 33780 bytes, checksum: 85fad1a958ac0383307c3c580e863b61 (MD5) Previous issue date: 2012-07-19 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:26Z No. of bitstreams: 2 WOS000314109000001.pdf: 238891 bytes, checksum: 0f609b6f86362938f61544d9e022bd7e (MD5) WOS000314109000001.pdf.txt: 33780 bytes, checksum: 85fad1a958ac0383307c3c580e863b61 (MD5) Made available in DSpace on 2014-05-20T13:38:26Z (GMT). No. of bitstreams: 2 WOS000314109000001.pdf: 238891 bytes, checksum: 0f609b6f86362938f61544d9e022bd7e (MD5) WOS000314109000001.pdf.txt: 33780 bytes, checksum: 85fad1a958ac0383307c3c580e863b61 (MD5) Previous issue date: 2012-07-19 Background: Prescribing is a complex and challenging task that must be part of a logical deductive process based on accurate and objective information and not an automated action, without critical thinking or a response to commercial pressure. The objectives of this study were 1) develop and implement a discipline based on the WHO's Guide to Good Prescribing; 2) evaluate the course acceptance by students; 3) assess the impact that the Rational Use of Medicines (RUM) knowledge had on the students habits of prescribing medication in the University Hospital.Methods: In 2003, the RUM principal, based in the WHO's Guide to Good Prescribing, was included in the official curriculum of the Botucatu School of Medicine, Brazil, to be taught over a total of 24 hours to students in the 4th year. We analyzed the students' feedback forms about content and teaching methodology filled out immediately after the end of the discipline from 2003 to 2010. In 2010, the use of RUM by past students in their medical practice was assessed through a qualitative approach by a questionnaire with closed-ended rank scaling questions distributed at random and a single semistructured interview for content analysis.Results: The discipline teaches future prescribers to use a logical deductive process, based on accurate and objective information, to adopt strict criteria (efficacy, safety, convenience and cost) on selecting drugs and to write a complete prescription. At the end of it, most students considered the discipline very good due to the opportunity to reflect on different actions involved in the prescribing process and liked the teaching methodology. However, former students report that although they are aware of the RUM concepts they cannot regularly use this knowledge in their daily practice because they are not stimulated or even allowed to do so by neither older residents nor senior medical staff.Conclusions: This discipline is useful to teach RUM to medical students who become aware of the importance of this subject, but the assimilation of the RUM principles in the institution seems to be a long-term process which requires the involvement of a greater number of the academic members. Univ Estadual Paulista, UNESP, Botucatu Sch Med, Dept Publ Hlth, BR-18618970 Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Sch Med, Dept Internal Med, BR-18618970 Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Sch Med, Dept Publ Hlth, BR-18618970 Botucatu, SP, Brazil Univ Estadual Paulista, UNESP, Botucatu Sch Med, Dept Internal Med, BR-18618970 Botucatu, SP, Brazil

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:00Z No. of bitstreams: 1 S0482-50042011000600002.pdf: 644406 bytes, checksum: a7c48bfe4b2007d404508cba39659ff1 (MD5) Made available in DSpace on 2013-08-22T19:03:00Z (GMT). No. of bitstreams: 1 S0482-50042011000600002.pdf: 644406 bytes, checksum: a7c48bfe4b2007d404508cba39659ff1 (MD5) Previous issue date: 2011-12-01 Made available in DSpace on 2013-09-30T20:04:21Z (GMT). No. of bitstreams: 2 S0482-50042011000600002.pdf: 644406 bytes, checksum: a7c48bfe4b2007d404508cba39659ff1 (MD5) S0482-50042011000600002.pdf.txt: 29523 bytes, checksum: 558a815c93577838c98ead591965dae9 (MD5) Previous issue date: 2011-12-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:16:32Z No. of bitstreams: 2 S0482-50042011000600002.pdf: 644406 bytes, checksum: a7c48bfe4b2007d404508cba39659ff1 (MD5) S0482-50042011000600002.pdf.txt: 29523 bytes, checksum: 558a815c93577838c98ead591965dae9 (MD5) Made available in DSpace on 2014-05-20T15:16:32Z (GMT). No. of bitstreams: 2 S0482-50042011000600002.pdf: 644406 bytes, checksum: a7c48bfe4b2007d404508cba39659ff1 (MD5) S0482-50042011000600002.pdf.txt: 29523 bytes, checksum: 558a815c93577838c98ead591965dae9 (MD5) Previous issue date: 2011-12-01 OBJETIVO: Avaliar a qualidade de vida e sua associação com a atividade física nos diferentes contextos da vida diária de pacientes com osteoartrite (OA) encaminhados pelas unidades básicas de saúde para um serviço universitário. MÉTODOS: Estudo transversal, série de casos, em que a atividade física foi avaliada pelo International Physical Activity Questionnaire (IPAQ) e a qualidade de vida foi avaliada pelos questionários Medical Outcomes Study 36 Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Index (WOMAC) e Australian/Canadian Osteoarthritis Hand Index (AUSCAN). Para verificação da intensidade da dor, utilizou-se também a Escala Visual Analógica (EVA). RESULTADOS: Foram incluídos 100 pacientes (92 mulheres e oito homens), com média de idade de 59,9 ± 9,4 anos. As articulações mais comprometidas foram joelhos e mãos. Dez pacientes tinham comprometimento de uma única articulação, 69 de duas, oito de três e 13 de quatro. O IPAQ demonstrou que 70 pacientes eram ativos ou muito ativos e 30 eram insuficientemente ativos ou sedentários. A atividade física associou-se positivamente aos domínios do SF-36, que avaliam a saúde física (capacidade funcional, aspectos físicos, dor, estado geral da saúde). Houve associação entre atividade física e qualidade de vida quando avaliada pelo WOMAC, e quanto mais intensa a dor, pior a qualidade de vida. CONCLUSÃO: Nessa população, a maioria dos pacientes apresenta piora dos aspectos físicos da qualidade de vida, mas mantém as atividades físicas cotidianas. OBJECTIVE: To evaluate the quality of life and its association with daily physical activity in different contexts of life in osteoarthritis patients referred from Basic Health Care Units to a university-affiliated service. METHODS: This is a crosssectional, case series study in which physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ), and quality of life was assessed by the Medical Outcomes Study 36 Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Index (WOMAC), and Australian/Canadian Osteoarthritis Hand Index (AUSCAN). To evaluate pain intensity, a Visual Analogue Scale (VAS) was also used. RESULTS: One hundred patients (92 women and eight men; mean age 59.9 ± 9.4 years) were included. The most affected joints were the knees and hands. Ten patients had only a single joint affected, 69 patients had two, eight patients had three, and 13 patients had four joints affected. The IPAQ showed that 70 patients were active or very active, while 30 were insufficiently active or sedentary. Physical activity was positively associated with the SF-36 domains that assess physical health (physical functioning, physical role, pain, general health perceptions). There was an association between physical activity and quality of life assessed by WOMAC, and the more severe the pain, the worse the quality of life. CONCLUSION: In most patients in this population, the physical aspects of the quality of life are worse, but they maintain their daily physical activities. Universidade Federal do Amazonas Instituto de Saúde e Biotecnologia UNESP Faculdade de Medicina de Botucatu Departamento de Clínica Médica UNESP Faculdade de Medicina de Botucatu UNESP Faculdade de Medicina de Botucatu Departamento de Clínica Médica UNESP Faculdade de Medicina de Botucatu

OBJETIVO: Contribuir para o melhor conhecimento da atividade de pesquisa em Pneumologia no Brasil. MÉTODOS: Estudo retrospectivo observacional dos resumos publicados nos Anais dos Congressos Brasileiros de Pneumologia e Tisiologia de 1986 a 2004, para descrição quantitativa da distribuição geográfica e do tipo das instituições de origem dos resumos, dos tipos de estudos e dos temas abordados. RESULTADOS: Foram publicados 6.467 resumos, sendo 3.870 originários de instituições do Sudeste, 1.309 do Sul, 783 do Nordeste, 267 do Centro-Oeste e 84 do Norte. Houve 94 resumos provenientes de instituições estrangeiras, em especial portuguesas (56,3%) e norte-americanas (13,8%). A maioria dos trabalhos (5.825) foi realizada em instituições públicas brasileiras. Quanto aos tipos de estudos, foram observados 4.234 estudos clínicos, 1.994 relatos de caso e 239 estudos experimentais, com elevação progressiva acentuada do número de estudos clínicos e de relatos de caso no período. No cômputo geral, tuberculose e outras doenças infecciosas foram os temas mais freqüentes (25,2%), seguidos por oncologia (11,6%), doenças pulmonares intersticiais (8,8%) e cirurgia torácica (8,5%). Entretanto, houve grandes variações no número de resumos sobre cada tema no decorrer do período. CONCLUSÃO: As instituições públicas brasileiras são as principais responsáveis pela atividade de pesquisa em Pneumologia no Brasil, a qual está concentrada na Região Sudeste. Um terço desta atividade é representada por relatos de caso e, embora haja grande variação de assuntos abordados, as doenças com elevada prevalência no país, como tuberculose e outras infecções pulmonares, são os temas mais freqüentes. OBJECTIVE: To increase the knowledge base regarding pulmonology research in Brazil. METHODS: A retrospective, observational study of the abstracts published in the Annals of the Brazilian Pulmonology and Phthisiology Conferences held from 1986 to 2004, quantifying the institutions of origin by geographic distribution and type, as well as categorizing the abstracts by study design and topic. RESULTS: A total of 6467 abstracts were published. The institutions of origin were located, variously, in the Southeast (3870 abstracts), South (1309), Northeast (783), Central-West (267) and North (84). There were 94 abstracts originating from foreign institutions, especially from institutions in Portugal (56.3%) and the United States (13.8%). Most of the studies (5825) were conducted in public Brazilian institutions. There were 4234 clinical studies, 1994 case reports and 239 original research articles. A marked, progressive increase was observed in the number of clinical studies and case reports during the period evaluated. Overall, the most common themes were tuberculosis and other infections diseases (25.2%), following by oncology (11.6%), interstitial lung diseases (8.8%) and thoracic surgery (8.5%). Nevertheless, the number of abstracts on each topic varied widely from year to year. CONCLUSION: Public Brazilian institutions are the principal sources of pulmonology research in Brazil. Such research activity is concentrated in the southeastern part of the country. Case reports account for one-third of this activity. Although there was great variability in the subjects addressed, diseases that are highly prevalent in Brazil, such as tuberculosis and other infections diseases, were the most common topics.

To increase the knowledge base regarding pulmonology research in Brazil.A retrospective, observational study of the abstracts published in the Annals of the Brazilian Pulmonology and Phthisiology Conferences held from 1986 to 2004, quantifying the institutions of origin by geographic distribution and type, as well as categorizing the abstracts by study design and topic.A total of 6467 abstracts were published. The institutions of origin were located, variously, in the Southeast (3870 abstracts), South (1309), Northeast (783), Central-West (267) and North (84). There were 94 abstracts originating from foreign institutions, especially from institutions in Portugal (56.3%) and the United States (13.8%). Most of the studies (5825) were conducted in public Brazilian institutions. There were 4234 clinical studies, 1994 case reports and 239 original research articles. A marked, progressive increase was observed in the number of clinical studies and case reports during the period evaluated. Overall, the most common themes were tuberculosis and other infections diseases (25.2%), following by oncology (11.6%), interstitial lung diseases (8.8%) and thoracic surgery (8.5%). Nevertheless, the number of abstracts on each topic varied widely from year to year.Public Brazilian institutions are the principal sources of pulmonology research in Brazil. Such research activity is concentrated in the southeastern part of the country. Case reports account for one-third of this activity. Although there was great variability in the subjects addressed, diseases that are highly prevalent in Brazil, such as tuberculosis and other infections diseases, were the most common topics.

Made available in DSpace on 2021-07-14T10:50:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-07. Added 1 bitstream(s) on 2021-07-14T11:39:18Z : No. of bitstreams: 1 S1806-37132005000700003.pdf: 24489 bytes, checksum: 8528174d1a009a65cd8d1d1b37c1099f (MD5) A vasculite necrosante foi descrita em 1866 e seu espectro é muito amplo, uma vez que acomete vasos arteriais e venosos de todos os calibres e de vários órgãos, apresenta diversos tipos de infiltrados inflamatórios, tem um significante número de manifestações clínicas e pode ter ou não fatores desencadeantes identificáveis. A sempre controversa classificação das vasculites mudou radicalmente com a descoberta dos anticorpos anticitoplasma de neutrófilos em 1982, contemplando atualmente a doença de Goodpasture, as vasculites associadas aos anticorpos anticitoplasma de neutrófilos, as vasculites por imunocomplexos e outros tipos de vasculites. As evidências de que os anticorpos anticitoplasma de neutrófilos estão envolvidos na patogênese destas lesões trouxeram avanços consideráveis para o seu diagnóstico e tratamento. Granulomatose de Wegener, doença de Churg-Strauss e poliangeíte microscópica, todas vasculites associadas aos anticorpos anticitoplasma de neutrófilos, são as vasculites sistêmicas que mais acometem os pulmões. Suas manifestações clínicas comuns são tosse, hemorragia alveolar difusa ou asma de difícil controle. Na arterite de Takayasu, na doença de Behçet, na púrpura de Henoch-Schönlein e nas vasculites associadas às doenças do colágeno o acometimento pulmonar é mais raro. Em todos os casos há evidências de serem processos de origem imunológica e com base neste princípio são propostas as abordagens terapêuticas. Necrotizing vasculitis was first described in 1866. The condition encompasses a wide spectrum of symptoms, affecting arterial blood vessels of various calibers and in various organs. In addition, it is associated with many types of inflammatory infiltrate, and presents a significant number of clinical manifestations. The causative factor or factors may or may not be identifiable. The eternally controversial classification of the various forms of vasculitis changed radically after the discovery of antineutrophil cytoplasmic antibodies in 1982, and current classifications include Goodpasture's syndrome, forms of vasculitis related to antineutrophil cytoplasmic antibodies, forms caused by immune complexes and other forms. The evidence that antineutrophil cytoplasmic antibodies are involved in the pathogenesis of such conditions led to considerable advances in the diagnosis and treatment of vasculitis. Wegener's granulomatosis, Churg-Strauss syndrome and microscopic polyangiitis, all forms of vasculitis that have been associated with antineutrophil cytoplasmic antibodies, are the systemic forms that most affect the lungs. The most common presentation of such forms is characterized by cough, diffuse alveolar hemorrhage or difficult-to-control asthma. In Takayasu's arteritis, Behçet's disease and Henoch-Schönlein purpura, as well as in forms of vasculitis related to collagen diseases, pulmonary involvement is less common. In all forms of vasculitis, there is evidence that immune system processes are involved. It is based on this knowledge that new therapeutic approaches are proposed. Universidade Estadual Paulista Universidade Estadual Paulista

Made available in DSpace on 2021-07-14T10:43:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2002-11. Added 1 bitstream(s) on 2021-07-14T11:36:49Z : No. of bitstreams: 1 S0102-35862002000600003.pdf: 159633 bytes, checksum: 12b4bf1d593cd24783b00c916c2ca92e (MD5) Introdução: A maioria dos estudos experimentais sobre a toxicidade pulmonar induzida por amiodarona tem sido realizada em ratos machos da linhagem Fischer-344. Objetivos: Investigar o efeito da amiodarona sobre o peso corpóreo e sobre determinantes morfológicos e citopatológicos do pulmão em outras linhagens de ratos de ambos os sexos. Métodos: Grupos de ratos machos e de fêmeas das linhagens Wistar, Wistar-Kyoto (WKY) e espontaneamente hipertenso (SHR) receberam, por gavagem, durante quatro semanas, 175mg/kg/dia de amiodarona em suspensão salina. Os grupos controles receberam apenas salina. Foram estudados ganho de peso corpóreo, celularidade total e diferencial do lavado broncoalveolar (LBA) e histopatologia dos pulmões. Resultados: Mortalidade pela amiodarona foi observada nos ratos WKY tratados, sendo maior em machos. Animais SHR tratados de ambos os sexos apresentaram o menor ganho de peso entre as linhagens estudadas. Ratos machos Wistar e SHR tratados apresentaram maior ganho de peso do que as fêmeas das suas respectivas linhagens. O LBA de ratos SHR tratados de ambos os sexos era hemorrágico. A celularidade do LBA foi maior em machos tratados (WKY > Wistar > SHR). Entretanto, nos machos e fêmeas WKY a contagem diferencial mostrou o menor percentual de macrófagos e o maior de neutrófilos entre as três linhagens. Macrófagos do LBA de ratos Wistar tratados apresentavam fosfolipidose, enquanto a maioria dos macrófagos de ratos SHR tratados eram normais. No exame anatomopatológico dos pulmões, não houve diferenças entre os sexos e não foi observada pneumonite. Em ratos Wistar o exame foi caracterizado pela acentuada quantidade de macrófagos espumosos intra-alveolares, em ratos WKY, por inúmeros abscessos intraparenquimatosos e em ratos SHR, pela hemorragia alveolar. Conclusões: 1) a amiodarona induz em ratos Wistar maior quantidade de macrófagos espumosos do que nas linhagens WKY e SHR, embora no modelo utilizado eles não desenvolvam pneumonite; 2) a amiodarona tem maior efeito sobre os determinantes morfológicos e citopatológicos do pulmão em animais do sexo masculino. Introduction: Most of the experimental studies on amiodarone-induced pulmonary toxicity have been performed in male Fischer-344 rats. Objective: To investigate the effect of amiodarone on body weight and on lung morphological and cytopathologic parameters in both genders of other rat strains. Methods: Groups of male and female Wistar, Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats received, 175 mg/kg/day of amiodarone suspended in saline by gavage for four weeks. Controls received saline alone. Body weight gain, total cellularity, and differential of the bronchoalveolar lavage (BAL) and lung histopathology were studied. Results: Mortality due to amiodarone was observed in treated WKY rats, mostly in males. Treated male and female SHR animals had less body weight gain among all strains studied. Male Wistar and SHR treated rats presented more body weight gain than females of the respective strains. BAL of treated SHR rats were hemorrhagic. BAL cellularity was higher in treated males (WKY > Wistar > SHR). In WKY males and females, however, the differential count showed a lesser percent of macrophages and higher of neutrophils than in the other strains. BAL macrophages of treated Wistar rats presented phospholipidosis, whereas most macrophages of treated SHR rats were normal. In lung anatomicopathologic examination, no difference was found related to gender and no pneumonitis was observed. In Wistar rats, the examination was characterized by a marked quantity of intra-alveolar foamy macrophages, numerous intraparenchymal abscesses were found in WKY rats, and alveolar hemorrhage was present in SHR rats. Conclusions: 1) amiodarone induces more foamy macrophages in Wistar rats than in the WKY and SHR strains, although they do not develop pneumonitis in the model used; 2) amiodarone has greater effect on lung morphological and cytopathologic parameters of male rats. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu Universidade Federal do Triângulo Mineiro, Disciplina de Pneumologia Universidade Estadual Paulista, Faculdade de Medicina de Botucatu

Patients injected systemically with recombinant human interleukin-2 (rhIL-2) for treatment of solid tumor develop a vascular leak syndrome (VLS), characterized mainly by pulmonary edema whose pathogenesis is unknown. We have examined the structure of pulmonary vessels in mice with severe VLS induced by systemic injections of rhIL-2 and recombinant human interferon-alpha-A/D (rhIFN-alpha), which has a synergistic effect with IL-2. The pulmonary edema was associated with lesions of venous and capillary endothelia, alveolar basement membrane, and type I epithelial cells. These changes were more severe and diffuse than those seen in mice systemically injected with rhIL-2 alone, and in beige mice (deficient in NK cells and certain enzymes of polymorphonuclear leukocytes) injected with rhIL-2 and rhIFN-alpha. The endothelial lesions were comparable to those seen when leukocytes activated by cytokines react with activated endothelial cells in vitro, or at the site of injection of cytokines in vivo. The observations are in agreement with the interpretation that the severe lesions occurring in mice systemically injected with rhIL-2 with rhIFN-alpha result from the interaction of leukocytes with the endothelium. The results confirm the validity of previous studies performed in vitro or in animals injected intradermally with cytokines and extend their significance.

Univ Estadual Paulista Julio Mesquita Filho, Botucatu Med Sch, Dept Internal Med, BR-18618000 Botucatu, SP, Brazil

Parasites of the genus Mammomonogamus may occasionally affect the human respiratory tract, causing human syngamosis. We describe two cases of chronic unproductive cough caused by Mammomonogamus laryngeus that occurred in the state of Sao Paulo, Brazil. Some aspects related to human parasitism, diagnostic approach, and treatment are discussed.

Problemas relacionados a medicamentos (PRMs) compreendem erros de medicação (EMs) e reações adversas a medicamentos (RAMs). Este estudo teve por objetivo analisar, classificar, quantificar e intervir nos PRMs ocorridos em pacientes idosos internados. Este estudo prospectivo descritivo de uma série de casos clínicos abrangeu 28 pacientes e 100 prescrições aleatórias a eles destinadas. A identificação dos PRMs se deu por métodos de farmacovigilância ativa e as intervenções farmacêuticas (IFs) foram realizadas diretamente junto à equipe médica. Medicamentos de uso potencialmente inapropriado para idosos foram utilizados por 21,4% dos pacientes; 19% das prescrições possuíam rasuras. Foram encontrados 924 PRMs, sendo 920 EMs e 4 possíveis RAMs, sendo uma delas confirmada. A maioria dos EMs foi classificada como sem prejuízo ao paciente. Foram realizadas 143 IFs em 73 prescrições de 92,9% dos pacientes, sendo a maioria (77,6%) acatada pela equipe médica. Apesar das limitações, demonstrou-se a importância do farmacêutico na investigação, prevenção e solução de PRMs. Drug related problems (DRPs) include medication errors (MEs) and adverse drug reactions (ADRs). The objective of this study was to analyze, classify, quantify and intervene in DRPs occurred in hospitalized elderly patients. This prospective descriptive study of a case series included 28 patients and 100 random prescriptions to them addressed. The identification of DRPs was carry out by methods of active pharmacovigilance and the pharmaceutical interventions (PIs) were performed directly with the medical staff. Drugs potentially inappropriate for the elderly were used by 21.4% of the patients; 19% of the prescriptions had rasures. There were 924 DRPs, with 920 MEs and 4 possible ADRs 4, one of which confirmed. The majority of MEs was classified as \"without harm to the patient\". Were carried out 143 PIs on 73 prescriptions of 92.9% of the patients, being the majority (77.6%) fully embraced by the medical staff. Despite the limitations, it was possible to demonstrate the pharmacist importance in research, prevention and resolution of DRPs.

Objetivos: avaliar o efeito dos padrões ventilatórios reexpansivos associados ao biofeedback respiratório (BFR) sobre a função pulmonar, força muscular respiratória e hábitos em respiradores bucais funcionais. Métodos: foram avaliadas 60 crianças respiradoras bucais funcionais (RBF), divididas em Grupo Experimental e Controle, sendo o Grupo Experimental submetido a 15 sessões de padrões ventilatórios reexpansivos associados ao BFR por meio do biofeedback pletsmovent (MICROHARD® V1.0), o qual proporciona o biofeedback dos movimentos tóraco-abdominais e o Grupo Controle submetido ao mesmo número de sessões realizando apenas o biofeedback. Espirometria, medidas das pressões respiratórias máximas estáticas e questões para avaliação de hábitos, respondidas pelos responsáveis pelas crianças, foram realizadas antes e após a terapia. Teste t de Student para dados pareados e testes não paramétricos, com nível de significância de 5%, foram utilizados para análise. Resultados: Foram observados alterações significativas na capacidade vital forçada (FVC), índice de Tiffeneau (IT), pressão expiratória máxima (PEmáx), pressão inspiratória máxima (PImáx) e nos hábitos avaliados em RBF com o uso do BFR associado aos padrões reexpansivos. Não foram observadas diferenças significantes quando comparados o Grupo Experimental e o Controle. Conclusão: Os resultados permitem concluir que o BFR associado aos padrões reexpansivos melhora a capacidade vital forçada, IT, força da musculatura respiratória e hábitos em RBF, podendo ser, portanto, utilizado como uma das formas de terapia nesses indivíduos Objectives: Assess the effect of re-expansive respiratory patterns associated to respiratory biofeedback (RBF) on pulmonary function, respiratory muscle strength and habits in individuals with functional mouth breathing (FMB). Methods: Sixty children with FMB were divided into experimental and control groups. The experimental group was submitted to 15 sessions of re-expansive respiratory patterns associated to RBF (biofeedback pletsmovent; MICROHARD® V1.0), which provided biofeedback of the thoracic and abdominal movements. The control group was submitted to 15 sessions using biofeedback alone. Spirometry, maximum static respiratory pressure measurements and questions regarding habits (answered by parents/guardians) were carried out before and after therapy. The Student\'s t-test for paired data and non-parametric tests were employed for statistical analysis at a 5% level of significance. Results: Significant changes were found in forced vital capacity, Tiffeneau index scores, maximum expiratory pressure, maximum inspiratory pressure and habits assessed in FMB with the use of RBF associated to the re-expansive patterns. No significant differences were found comparing the experimental and control groups. The results allow the conclusion that RBF associated to re-expansive patterns improves forced vital capacity, Tiffeneau index scores, respiratory muscle strength and habits in FMB and can therefore be used as a form of therapy for such individuals.

Apesar de bem estabelecido em termos morfológicos, a repercussão funcional do envolvimento das pequenas vias aéreas nas pneumopatias intersticiais fibrosantes (PIF) permanece controversa. O presente estudo avaliou de maneira invasiva e não-invasiva (espirometria, volume de fechamento, variação da complacência dinâmica com a freqüência respiratória) a função das pequenas vias aéreas em portadores de PIF, comparando com grupo controle e correlacionando com índices morfométricos de biópsias. Os testes funcionais não diferenciaram portadores da doença dos controles quanto ao acomentimento das pequenas via aéreas e não se correlacionaram com os dados morfométricos Although well known involvement of small airway in fibrosing interstitial lung disease based on morfologic issues, its functional consequences remains controversial. We present an invasive and non-invasive physiologic study for small airway function (pulmonary function tests, closing volume and frequency dependence of dynamic compliance) in patients with lung fibrosis. The physiological data were compared with normal controls and correlated with morfometric measurements from biopsies. Specific small airway function data could not show obstructive pattern when compared with normals, and did not correlate with morofmetric data

Introdução: Fungos são alérgenos cuja importância nas doenças alérgicas respiratórias é subestimada por falta de extratos alergênicos adequados para diagnóstico, quer através de testes cutâneos, quer através de dosagem de IgE específica. Botucatu possui características próprias por se localizar numa \"cuesta\" e possuir vegetação variada que cobre grande parte da cidade. A partir das plantas os fungos ganham o ar através da esporulação podendo ser inalados e sensibilizar pacientes com alergias respiratórias. Este trabalho se propõe a estudar quais os fungos mais prevalentes em Botucatu e a taxa de sensibilização dos principais gêneros entre os portadores de asma e rinite procedentes dessa região. Casuística e Métodos: Foi desenvolvido um aparelho caça esporos para a captura dos mesmos em quatro pontos da cidade. Foram feitas cinco coletas/ponto/semana durante um ano para contagem e identificação das UFC (unidades formadoras de colônias). Foram selecionados pacientes de Botucatu e região com asma e rinite, nos quais se aplicou testes de puntura para os principais alérgenos, incluindo onze diferentes fungos. Foram também realizados testes intradérmicos com extratos de fungos nos pacientes cujo teste de puntura ao fungo em questão tenha sido negativo. Resultados: Foram identificados 67 gêneros sendo os mais prevalentes: Cladosporium, Epicoccum, Levedura, Aspergillus, Helminthosporium, Nigrospora, Monilia, Fusarium, Hyalodendrum, Penicillium, Curvularia, Humicola, Alternaria, Trichoderma e Sphaerosporium. Foram selecionados 207 pacientes dos quais 118 (57%) apresentaram pelo menos um teste positivo a fungo. O teste intradérmico foi responsável por 88% do diagnóstico de sensibilização A dosagem de IgE específica mostrou baixa sensibilidade (4%). Os fungos mais sensibilizantes foram: Aspergillus, Neurospora, Candida, Penicillium e Cladosporium. Observou-se maior positividade a fungos no grupo de asma grave, sendo que Aspergillus, Neurospora e Candida foram mais prevalentes nesse grupo. Encontrou-se associação positiva entre pacientes com asma atendidos em Pronto-Socorros durante o ano estudado e o total de UFC nesse período. Conclusões: Os fungos mais prevalentes no planeta são também encontrados em Botucatu, embora haja fungos característicos dessa região; a sensibilização a fungos é expressiva na população estudada e guarda relação com maior gravidade da asma; o teste intradérmico foi o melhor meio diagnóstico para sensibilização a fungos Purpose: Fungi are allergens whose importance has been underestimated due to the absence of reliable extracts for the diagnosis of sensitization in vivo or in vitro. Botucatu has unique characteristics because of its location on a \"cuesta\" and its varied vegetation which cover a large area of the city. The fungi reach the air from the plants through sporulation and they can be inhaled and sensitize patients with allergic diseases. Here we studied the most prevalent fungi in the air of Botucatu and the rate of sensitization to the main fungi genus among patients with asthma and rhinitis. Methods: We developed a spore trap to catch the spores from the air in four points in the city. Five collections were taken weekly during a whole year. Colony forming units (CFU) were counted and the fungi on Petri dishes were classified. Patients with asthma and rhinitis have been selected and submitted to prick tests with the main allergens including eleven different types of fungi. Intradermal tests with fungi extract were also performed in the patients whose prick test to these fungi had been negative. Results: Sixty-seven genus of fungi have been identified and the more prevalent were: Cladosporium, Epicoccum, yeast, Aspergillus, Helminthosporium, Nigrospora, Monilia, Fusarium, Hyalodendrum, Penicillium, Curvularia, Humicola, Alternaria, Trichoderma and Sphaerosporium. Two hundred and seven patients have been selected and 118 (57%) have been at least one positive test to fungus. Intradermal test made the diagnosis in 88% of all diagnostics of sensitization, whereas \"in vitro\" specific IgE had low sensibility (4%). The more sensitizer fungi were: Aspergillus, Neurospora, Candida, Penicillium and Cladosporium. There was a significant correlation between severe asthma and fungi sensitization and the fungi more prevalent in that group of patient were: Aspergillus, Neurospora and Candida. Moreover, there was a positive correlation between the number of asthmatic patients attended in Emergencies and the total of CFU in the study period. Conclusion: We recognize in the air fungi specific to Botucatu although the most prevalent fungi are the same found in other places in the world; the fungi sensitization among patients with allergic respiratory diseases is meaningful and correlated with asthma severity; the intradermal test was the best mean to diagnose fungi sensitization

A hemorragia alveolar é uma síndrome que pode ocorrer como manifestação de uma série de doenças, cada uma com eventos fisiopatológicos diferentes resultando em sangramento pulmonar. A análise histológica detalhada destes pacientes pode auxiliar no entendimento desta síndrome. Neste estudo nós fizemos a revisão e descrição dos achados das lâminas de tecido pulmonar e do prontuário médico de 48 pacientes falecidos por hemorragia alveolar nos anos de 1999 a 2004. A maioria apresentou hemorragia de característica difusa (87,5%), predominantemente alveolar (79,2%), sem sinais de recorrência (79,2%) e com presença de fibrina (81,3%). As outras características avaliadas foram: vasculite (8,3%), trombose intravascular (27,1%),esclerose arterial (31,3%), capilarite (41,7%), acometimento intersticial (35,4%), acometimento venoso (41,7%), presença de sinais de infecção (50%), membrana hialina (25%). Com os registros médicos, classificamos os pacientes nas seguintes síndromes clínicas: congestão pulmonar (29,17%), coagulopatia (25%), sepse (27,08%) e inflamação (18,75%). Após as análises clínica e histológica, fizemos a correlação entre estes dados e encontramos que os pacientes com diagnóstico de congestão apresentaram menor presença de fibrina e de acometimento intersticial e maior presença de sangramento focal. O sangramento por coagulopatia se caracterizou por menor presença de fibrina e ausência de sinais de sangramento recorrente. Os pacientes com infecção clínica, histologicamente apresentaram fibrina e sinais de infecção no tecido pulmonar, já os pacientes com diagnóstico de inflamação se caracterizaram pela presença de fibrina, esclerose arterial e sangramento focal. Concluindo, nosso estudo sugere que alguns padrões histológicos são mais comuns em determinadas síndromes clínicas, e podem ser úteis no diagnóstico causal da hemorragia alveolar Alveolar haemorrhage is a syndrome presented by many diseases each one with its particular physiopathologic mechanism resulting in pulmonary bleeding. The detailed histological analysis of these patients can help understanding this syndrome. In this study we reviewed and described histological findings of lung slides and medical records from patients whose cause of death was alveolar haemorrhage between 1999 and 2004. Most patients presented diffuse (87,5%), mainly alveolar (79,2%) rather than interstitial and recent bleeding with no signs of recurrence (79,2%). We also observed the presence of: fibrin (81,3%), vasculitis (8,3%), intravascular thrombosis (27,1%), arterial sclerosis (31,3%), capillarity (41,7%), interstitial involvement (35,4%), venous involvement (41,7%), signs of infection on lung tissue (50%) and hyaline membrane (25%). Clinically we classified the patients as having one of the following syndromes: pulmonary oedema due to congestive heart failure (CHF- 29,17%), coagulation disorders (25%), sepsis (27,08%) and systemic inflammation (18,75%). After correlating clinical and histological data we found CHF to have lower presence of fibrin and interstitial involvement and a greater presence of focal bleeding. Coagulation disorders were characterized by no signs of recurrent bleeding and a lower presence of fibrin than infection and inflammation. Patients with clinical diagnosis of systemic inflammation had a greater presence of fibrin and arterial sclerosis than other clinical syndrome and patients with clinical diagnosis of sepsis showed presence of signs of infection in lung tissue no matter the clinical site of infection. In conclusion, our study suggests that some histological patterns happens more commonly in determined clinical syndromes and can help diagnosing the cause of bleeding .