Publications

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    ABSTRACT: PURPOSE: Questions remain about the polysomnographic findings and the predictors for sleep desaturation in cystic fibrosis (CF) patients. Our study aimed to evaluate sleep parameters in a sample of adult CF patients comparing them with healthy controls and to determine the best predictors of sleep desaturation in CF patients with awake resting peripheral oxygen saturation (SpO(2)) ≥90%. METHODS: In a cross-sectional study, with data collected prospectively, 51 clinically stable adult CF patients (mean age 25.1 ± 6.7 years) and 25 age-matched controls underwent an overnight polysomnography and answered sleep questionnaires. CF patients had their pulmonary function, 6-min walk test, and echocardiography assessed. RESULTS: CF patients and control subjects had similar sleep architecture. However, CF patients had impaired subjective sleep quality and a higher arousal index than controls. The apnea-hypopnea index was similar in both groups, and only two CF patients (3.9%) fulfilled the criteria for obstructive sleep apnea syndrome. Sleep desaturation was more common in CF patients (29.4% vs 0%; p < 0.001). In a logistic regression model, we observed that awake resting SpO(2) was the single best variable associated with sleep desaturation in CF population (p < 0.001). The awake SpO(2) <94% had a sensitivity, specificity, positive and negative predictive value for sleep desaturation of, respectively, 93.3%, 100%, 100%, and 97.3%. CONCLUSIONS: CF patients had a worse subjective sleep quality and small changes in sleep architecture. In nonhypoxic, adult CF patients, sleep desaturation is common, is not associated with obstructive sleep events, and can be accurately predicted by awake resting SpO(2) <94%.
    Sleep And Breathing 09/2011; · 2.26 Impact Factor
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    ABSTRACT: To determine the diagnostic sensitivity of bacteriological analyses in induced sputum (IS) for the diagnosis of pulmonary tuberculosis (TB) and to identify the clinical characteristics associated with the confirmed diagnosis, as well as to determine the diagnostic yield of bronchoscopy carried out when IS tests negative for AFB in smear microscopy. A retrospective, cross-sectional study of patients suspected of having active pulmonary TB and referred to our clinic for sputum induction. We consecutively reviewed the laboratory data of all patients submitted to sputum induction between June of 2003 and January of 2006, as well as their electronic medical records. In addition, the results of the bacteriological analysis of bronchoscopic specimens collected from the patients whose AFB tests were negative in IS were reviewed. Of the 417 patients included in the study, 83 (19.9%) presented IS samples that tested positive for TB (smear microscopy or culture). In the logistic regression analysis, radiological findings of cavitation (OR = 3.8; 95% CI: 1.9-7.6) and of miliary infiltrate (OR = 3.7; 95% CI: 1.6-8.6) showed the strongest association with the diagnosis of pulmonary TB. In 134 patients, bronchoscopy was carried out after negative AFB results in IS and added 25 (64.1%) confirmed diagnoses of pulmonary TB. In our clinical practice, the frequency of confirmed diagnosis of pulmonary TB using IS (19.9%) was lower than that previously reported in controlled trials. Cavitation and miliary infiltrate increase the diagnostic probability of pulmonary TB using IS. The use of bronchoscopy when IS tests negative for AFB significantly increases sensitivity in the diagnosis of pulmonary TB.
    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 11/2009; 35(11):1092-9.
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    Paulo de Tarso Roth Dalcin, Christiano Perin
    Revista Da Associacao Medica Brasileira - REV ASSOC MED BRAS. 01/2009; 55(1).
  • Sleep Medicine - SLEEP MED. 01/2009; 10.
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    Paulo de Tarso Roth Dalcin, Christiano Perin
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    ABSTRACT: Asthma is a disease with high prevalence in our country and worldwide. Although new therapeutic approaches have been developed recently, there seems to be a global increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that management of acute asthma in the emergency room entails crucial decisions that could determine the clinical outcome. In this review, the authors focus on assessment and treatment of patients with acute asthma and outline an appropriate management strategy. Diagnosis, severity assessment, treatment, complications, decision about where additional treatment will take place and orientations on discharge from the emergency will be considered. It is expected that these recommendations will help physicians to make the appropriate decisions about care of acute asthma in the emergency room.
    Revista da Associação Médica Brasileira 12/2008; 55(1):82-8. · 0.77 Impact Factor
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    ABSTRACT: To evaluate the effectiveness and onset of action of formoterol delivered by dry-powder inhaler in reversing methacholine-induced bronchoconstriction. Patients presenting a drop in forced expiratory volume in one second > 20% after methacholine inhalation were included. A total of 84 patients were evaluated. All of the participating patients presented respiratory symptoms of unknown origin, which were being investigated. The patients were randomized to receive 200 microg of spray fenoterol (n = 41) or 12 microg of dry-powder inhaler formoterol (n = 43), both administered in order to achieve immediate reversal of methacholine-induced bronchoconstriction. We evaluated the decrease in forced expiratory volume in one second (in relation to the baseline value) after methacholine challenge and the dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second, as well as the increase in forced expiratory volume in one second (in relation to the baseline value) at five and ten minutes after bronchodilator use. There were no significant differences related to gender, age, weight, height or dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second. Nor were there any significant differences in terms of baseline or post-methacholine forced expiratory volume in one second. In the fenoterol group, the mean postbronchodilator increase in forced expiratory volume in one second increase was 34% (at five minutes) and 50.1% (at ten minutes), compared with 46.5% (at five minutes) and 53.2% (at ten minutes) in the formoterol group. The bronchodilator effect of formoterol at five and ten minutes after methacholine-induced bronchoconstriction was similar to that of fenoterol. Despite being a long-acting bronchodilator, formoterol also has a rapid onset of action, which suggests that it could be employed as a relief medication in cases of bronchoconstriction occurring during asthma attacks.
    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 06/2006; 32(3):202-6.
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    Jornal Brasileiro De Pneumologia - J BRAS PNEUMOL. 01/2006; 32(3).
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    ABSTRACT: INTRODUÇÃO: Os b2-agonistas de curta duração sob a forma de nebulímetro pressurizado são os fármacos utilizados rotineiramente na reversão do broncoespasmo induzido pela metacolina. A administração desses fármacos na forma de pó seco, liberados por inaladores de pó seco pode ser uma alternativa eficaz. OBJETIVO: Avaliar a efetividade e rapidez de ação do salbutamol liberado através de inalador de pó seco pulvinal (Butoventâ) na reversão do broncoespasmo induzido por metacolina, comparando-o com o salbutamol liberado por nebulímetro pressurizado. MÉTODO: Foram avaliados prospectivamente 60 pacientes sucessivos com broncoespasmo induzido por metacolina, cuja queda do volume expiratório forçado no primeiro segundo (VEF1) foi de, no mínimo, 20%. Foram randomizados 30 pacientes para receber 200 mcg de salbutamol liberado por nebulímetro pressurizado e 30 pacientes para receber 200 mcg de salbutamol através de inalador de pó seco (pulvinal), na etapa final do teste de broncoprovocação, com o objetivo de reverter o broncoespasmo induzido pela metacolina. Foram avaliados os VEF1 obtidos 1 minuto e 5 minutos após a administração do broncodilatador. RESULTADOS: Os grupos foram pareados por sexo, idade, peso, altura, dose provocativa causadora de queda de 20% no VEF1 (primeiro grupo: 1,3 mg ; segundo grupo: 1,19 mg; p = 0,79) e VEF1 pós-metacolina (primeiro grupo: 2,03 l; segundo grupo: 1,99 l; p = 0,87), sem diferença significativa entre eles. O incremento médio do VEF1 foi de 16,2% (1 minuto) e 22,2% (5 minutos) no primeiro grupo e de 17% (1 minuto) e 23,6% (5 minutos) no segundo grupo, não havendo diferença estatística entre eles (p = 0,8). CONCLUSÕES: Os b2-agonistas administrados através de inalador de pó seco (pulvinal) apresentam a mesma eficácia broncodilatadora e rapidez de ação que no tradicional método por nebulímetro pressurizado.
    Jornal Brasileiro de Pneumologia 06/2004; 30(3):195-200.
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    Jornal Brasileiro De Pneumologia - J BRAS PNEUMOL. 01/2004; 30(3).
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    ABSTRACT: To identify and quantify the fungal spores in the atmospheric air of Porto Alegre and to assess sensitization to these allergens in atopic individuals suffering from rhinitis and asthma. A total of 52 samples were obtained using a Rotorod Sampler from April 2000 through March 20001. Allergy skin tests with anemophilous fungus allergens as well as fluorimmunoenzymatic tests were performed in 39 atopic individuals with rhinitis and asthma in order to detect the incidence of respiratory allergies caused by these airborne fungi. In the 3773 fungal spores detected in this study, there was a prevalence of ascosporos (50.49%), Cladosporium (17.86%), Aspergillus/Penicillium (15.03%), basidiosporos (3.84%), rusts (3.82%), and Helminthosporium (2.49%), as well as a lesser frequency of Botrytis (1.22%), Alternaria (1.19%), smuts (0.90%), Curvularia (0.87%), Nigrospora (0.61%), and Fusarium (0.08%). Sixty spores (1.59%) detected here could not be identified by the systematic key used. Among the atopic individuals tested, 15.38% were found to be sensitized by these anemophilous fungi allergens. The occurrence of a great number of fungal spores emphasizes the importance of studying anemophilous fungi locally, since they are responsible for 15.38% of allergic sensitization in atopic individuals with asthma and rhinitis.
    Revista da Associação Médica Brasileira 01/2003; 49(3):270-3. · 0.77 Impact Factor
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    01/2003;
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    ABSTRACT: Epidemiologic data on idiopathic pulmonary fibrosis are relatively scarce, and its real incidence and prevalence are unknown. Recent studies suggest that mortality due to idiopathic pulmonary fibrosis is rising in developed countries. OBJECTIVE: To describe mortality caused by idiopathic pulmonary fibrosis in the State of Rio Grande do Sul (RS), Brazil, from 1970 to 2000, analyzing its trend and comparing it with that from other countries. METHOD: Prevalence study, using data from the Brazilian Institute of Geography and Statistics (IBGE), analyzing death certificates in which idiopathic pulmonary fibrosis was stated as the ultimate cause of death. RESULTS: Annual mortality rate adjusted to the population was 0.22/100,000 people in the 1970?s, 0.3/100,000 people in the 1980?s, and 0.48/100,000 people in the 1990?s. Total mortality raised 36% from 1970 to 1980, and 73% from 1980 to 1990. The mortality rate adjusted to the population raised 36% and 60% during the same periods. The rise in both total and adjusted mortality from IPF was statistically significant (p < 0.05). The mean mortality rate per 100,000 inhabitants between 1996 and 1998, however, was 0.683, corresponding to a 70% increase when compared to the previous three-year period, which was 0.4 (p = 0.0002), probably reflecting coding practices. CONCLUSION: There was a significant increase in IPF mortality in RS from 1970 to 2000, partly due to changes in coding practices. This increase is in conformity with observations in other countries, although mortality rates in RS are considerably lower.
    Jornal de Pneumologia. 01/2003;
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    ABSTRACT: OBJETIVOS: Identificar e caracterizar a freqüência e a concentração de esporos de fungos anemófilos em Porto Alegre. Determinar a prevalência de sensibilização a estes fungos em indivíduos atópicos. MÉTODOS: Em 52 amostras colhidas no equipamento Rotorod Sampler®, foram quantificados 3773 esporos de fungos no período de um ano (abril de 2000 a março de 2001). Em 39 pacientes atópicos com rinite e ou asma foram realizados testes cutâneos com alérgenos de fungos anemófilos e o teste fluorimunoenzimático para verificar a incidência de manifestações alérgicas provocadas por tais fungos. RESULTADOS: Em 3773 esporos de fungos encontrados foram identificados 674 (17,86%) de Cladosporium sp, 567 (15,03%) do grupo Aspergillus/Penicillium, 144 (3,82%) de rusts, 94 (2,49%) de Helminthosporium sp, 46 (1,22%) de Botrytis sp, 45 (1,19%) de Alternaria sp, 34 (0,90%) de smuts, 33 (0,87%) de Curvularia sp, 23 (0,61%) de Nigrospora sp e 3 (0,08%) de Fusarium sp. Também foram encontrados 1905 (50,49%) de ascosporos e 145 (3,84%) de basidiosporos. Não foram possíveis de serem identificados 60 (1,59%) dos esporos observados. Nos 39 testes cutâneos e sorológicos realizados, resultaram em 15,38% de indivíduos atópicos sensibilizados por alérgenos de fungos em Porto Alegre. CONCLUSÕES: A ocorrência de grande número de esporos de fungos no ar em nossa cidade enfatiza a importância deste estudo sobre os fungos anemófilos, sendo eles responsáveis por 15,38% das sensibilizações alérgicas em indivíduos atópicos com manifestações de asma e ou rinite.
    Revista da Associação Médica Brasileira. 01/2003;
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    ABSTRACT: Study the epidemiological profile of selective garbage collectors and describe the major muscle lesions and work acidents. Material and techniques this was a transversal study comparing the employees of the two principal companies who collects selective garbaje at Porto Alegre city, symbolized in this study as company A and company B. We applied a questionnaire randomly for 50 workers of the two companies. The mean age was 34 and 22 years old for company A and B respectively. Around sixty six percente of worker at company B have les than 5 years of experience at the job, comparing with the 95% of the employees of the company A who have more than 5 years at the job. The lesions indices are high at the two companies, 90 and 46,% for company A and B, respectively. The most common injuries were in inferior limbs, followed by upper limbs and column. Both the companies lack the do use of protection equipament in their workers, despite the obrigatory use in the work legislation. Medical evaluations are not regular. Both companies have a elevated percentage on injuries at work in general, being inferior limbs the most common ones. They also presented elevated indices of cuts and other small bruises, probably because of the no use of the obrigatory protection equipament.
    Revista Brasileira de Saúde Ocupacional. 12/2002; 28(107-108):19-28.
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    ABSTRACT: Pneumonia eosinofílica crônica é uma entidade clínica rara que se caracteriza por infiltração alveolar e intersticial eosinofílica, de causa desconhecida. Os autores descrevem o caso de uma mulher branca de 49 anos, admitida por dispnéia aos mínimos esforços, de início insidioso e progressivo havia seis meses. Apresentava eosinofilia sérica e no escarro, radiografias de tórax com áreas de infiltração multifocais de distribuição irregular em ambos os pulmões e, na avaliação funcional pulmonar, distúrbio restritivo. O exame histopatológico de tecido pulmonar obtido por biópsia a céu aberto evidenciou pneumonia eosinofílica crônica. Houve marcada melhora clínica, radiológica e funcional após corticoterapia.
    Jornal de Pneumologia 09/2002; 28(5):281-284.
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    ABSTRACT: There is a histologic similarity between nonalcoholic steatohepatitis and alcoholic liver disease and in some cases differential diagnosis may be difficult, since some patients do not report abusive alcohol consumption. Evaluating the usefulness of setting the rate AST/ALT for the differential diagnosis of nonalcoholic steatohepatitis and alcoholic liver disease. Twenty nine obese patients with nonalcoholic steatohepatitis were compared with 28 patients with alcoholic liver disease. The diagnosis of nonalcoholic steatohepatitis was made after exclusion of other causes of liver disease and by histologic findings of, at least, macrovesicular steatosis and hepatocellular necrosis. In patients with nonalcoholic steatohepatitis the medium AST value was 52.3 +/- 21.2 U/L and ALT of 90.1 +/- 37.9 U/L, being the AST/ALT rate lower than 1 in all patients. In patients with alcoholic liver disease the medium AST value was 140 +/- 82.5 U/L and ALT was 50.6 +/- 40.3 U/L. The rate was higher than 1 in all cases and higher than 2 in 24 (85.7%), being statistically significant when compared with patients with nonalcoholic steatohepatitis. The AST/ALT rate seems to be useful in the differential diagnosis of liver diseases, while lower than 1 is highly suggestive of nonalcoholic steatohepatitis.
    Arquivos de Gastroenterologia 03/2002; 39(1):22-6.
  • Rev. bras. reumatol. 01/2002; 42(6):375-380.
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    ABSTRACT: Pilocarpine is a cholinergic agonist that increases salivary flow and has been used to treat xerostomia. Oral intake is the most frequent route of administration. Adverse effects are dose-dependent and include sudoresis, facial blushing and increased urinary frequency. The objective of the present study was to evaluate the effects of topical pilocarpine solutions as mouthwashes on salivary flow and their adverse effects on healthy subjects. Forty volunteers received 10 ml 0.5, 1 and 2% pilocarpine solutions or 0.9% saline in a randomized, double-blind, placebo-controlled manner. Salivation was measured before and 45, 60 and 75 min after mouth rinsing for 1 min with 10 ml of saline or pilocarpine solutions. Vital signs were measured and ocular, gastrointestinal and cardiovascular symptoms, anxiety and flushing were estimated using visual analog scales. There was a dose-dependent increase in salivation. Salivation measured after 1 and 2% pilocarpine (1.4 +/- 0.36 and 2.22 +/- 0.42 g, respectively) was significantly (P<0.001) higher than before (0.70 +/- 0.15 and 0.64 +/- 0.1 g), with a plateau between 45 and 75 min. Cardiovascular, visual, gastrointestinal and behavioral symptoms and signs were not changed by topical pilocarpine. Mouth rinsing with pilocarpine solutions at concentrations of 1 to 2% induced a significant objective and subjective dose-dependent increase in salivary flow, similar to the results reported by others studying the effect of oral 5 mg pilocarpine. The present study revealed the efficacy of pilocarpine mouthwash solutions in increasing salivary flow in healthy volunteers, with no adverse effects. Additional studies on patients with xerostomia are needed.
    Brazilian Journal of Medical and Biological Research 01/2002; 35(1):105-10. · 1.14 Impact Factor
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    ABSTRACT: Racional - A esteatohepatite não-alcoólica e a doença hepática alcoólica apresentam similaridade histológica e em algumas situações, o diagnóstico diferencial das mesmas pode ser difícil, pois alguns pacientes não revelam o consumo abusivo de álcool. Objetivo- Avaliar a utilidade da determinação do índice AST/ALT no diagnóstico diferencial da esteatohepatite não-alcoólica e da doença hepática alcoólica. Pacientes e Métodos -Foram estudados 29 pacientes obesos com esteatohepatite não-alcoólica, cujo o diagnóstico foi realizado após exclusão de outras causas de doença hepática e que na biopsia apresentasse, no mínimo, esteatose macrovesicular associada a infiltrado inflamatório lobular e injúria hepatocelular. Como grupo controle, foram estudados 28 pacientes com doença hepática alcoólica. Resultados - Nos pacientes com esteatohepatite não-alcoólica, a média de AST foi de 52,3 ± 21,2 U/L e a de ALT de 90,1 ± 37,9 U/L, sendo o índice AST/ALT menor que 1 em todos os casos. No grupo controle, a média de AST foi de 140 ± 82,5 U/L e a de ALT foi de 50,6 ± 40,3 U/L. O índice AST/ALT foi superior a 1 em todos os pacientes e a 2 em 24 (85,7%), o que foi estatisticamente significativo quando comparado aos pacientes com esteatohepatite não-alcoólica. Conclusão- O índice AST/ALT parece ser útil no diagnóstico diferencial das hepatopatias, sendo que valores inferiores a 1 sugerem fortemente a hipótese de esteatohepatite não-alcoólica.
    Arquivos de Gastroenterologia. 01/2002;
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    ABSTRACT: Knowledge of anemophilous fungi in a given city or region is important for the ecological diagnosis and specific treatment of allergic manifestations induced by inhaled allergens. In order to diagnose the presence of anemophilous fungi, several qualitative and quantitative techniques are used depending on the study place. This study of fungal air spores was performed with a Rotorod Sampler(R), an equipment which samples the air through a plastic rod attached to an electric engine that makes it spin fast enough to collect the particles in the air. The samples were collected once a week during 24 hours using the standard cycle of the manufacturers. A total of 52 samples were obtained from April 2000 through March 2001. The results revealed prevalence of ascosporos (50.49%), Cladosporium (17.86%), Aspergillus/Penicillium (15.03%), basidiosporos (3.84%), rusts (3.82%), and Helminthosporium (2.49%), and a lesser frequency of Botrytis (1.22%), Alternaria (1.19%), smuts (0.90%), Curvularia (0.87%), Nigrospora (0.61%), and Fusarium (0.08%). Also, 1.59% of the spores detected here could not be identified by the systematic key used. More fungal spores were observed during the summer than during the autumn.
    Revista do Instituto de Medicina Tropical de São Paulo 01/2002; 44(5):269-72. · 0.96 Impact Factor

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