Jornal Brasileiro De Pneumologia最新文献

Venous thromboembolism (VTE) is the third most common acute cardiovascular syndrome after acute myocardial infarction and stroke. In recent years, there has been an increase in the incidence of VTE, related to population aging and common comorbidities in the elderly, including chronic cardiorespiratory disease and cancer. On the other hand, disease-related mortality, particularly for pulmonary embolism (PE), shows a decreasing trend, which can be explained by improvements in diagnostic imaging, advances in available therapies, and greater adherence to patient management protocols. The guidelines presented here provide recommendations for the pharmacological treatment of PE in Brazil, on the basis of scientific evidence and with a focus on common practical issues. Six Patient, Intervention, Comparison, and Outcome questions were developed by a group of experts on the topic. Systematic reviews of randomized clinical trials were conducted for each question, with meta-analyses being performed when possible. The level of evidence and strength of recommendation were defined in accordance with the Grading of Recommendations Assessment, Development, and Evaluation approach. With these guidelines, we expect to provide relevant, up-to-date information on the pharmacological treatment of PE.

Objective: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis, which was recognized by the World Health Organization (WHO) as a global epidemic in 1993. TB is the leading infectious disease associated with silicosis, with studies showing an increased risk when compared to healthy individuals. We conducted an association study to evaluate the influence of polymorphisms in the ACE, FAM13A, FAS, FASLG, IL1RN, NOS2, TGFB1, and TNF genes on TB susceptibility.

Methods: Nine polymorphisms were genotyped using Polymerase Chain Reaction (PCR) in a sample of 143 patients with silicosis in Rio de Janeiro (RJ), Brazil.

Results: Seventy (49%) patients had a confirmed prior diagnosis of TB, of whom 25 (35.7%) had simple silicosis and 45 (64.3%) had complicated silicosis. The TG genotype of rs2609255 in FAM13A showed a protective effect against TB (OR=0.46; 95% CI: 0.22-0.98; p=0.040) compared to the GG genotype, and also when compared to the two combined homozygous genotypes (TT+GG) (OR=0.43; 95% CI: 0.20-0.90; p=0.024). Logistic regression analysis, including independent clinical variables, confirmed the protective effect of the TG genotype.

Conclusion: This study suggests that the rs2609255 polymorphism in FAM13A may play a role in TB risk among patients with silicosis. Given the limited research on genetic polymorphisms and TB susceptibility in silicosis patients, further studies are needed to validate these findings.

Objective: To assess nicotine product use among incoming students at public and private universities in Brazil.

Methods: This was a multicenter cross-sectional study including a convenience sample of incoming university students (≥ 18 years of age). Current use of conventional cigarettes, electronic cigarettes, and other nicotine products, as well as indicators of dependence and knowledge of the consequences of active use of or passive exposure to nicotine products were investigated with the use of a 38-item questionnaire. Descriptive statistics were used to analyze the data.

Results: A total of 863 students completed the questionnaire. Of those, most (61%) were female, and most (76.6%) identified themselves as White. In addition, most (86%) were in the 18- to 24-year age bracket, and most (88.6%) attended a public university. In the past 30 days, 20.7% reported using electronic cigarettes, 23.2% reported using conventional cigarettes, and more than 50% reported using other nicotine products. More than 80% agreed that electronic cigarettes are harmful to health and are as damaging as other types of smoking. Over half of the respondents reported using the product shortly after waking up, and, paradoxically, 81% stated that they would quit whenever they wanted. Passive exposure was reported by 21.6%, occurring at home (in 33.6%), in other indoor environments (in 41.7%), and in open environments (in 87.5%).

Conclusions: Experimentation and current use of nicotine products are high among incoming students at public and private universities in Brazil. Passive exposure to nicotine products is commonplace. Advanced communication tools are needed, particularly to emphasize the dangers of nicotine dependence. Being a legal drug, nicotine is often perceived as harmless, reinforcing the misconception that it can be used without consequences.

Objective: To investigate the level of agreement between the GINA questionnaire and the Asthma Control Test (ACT) in children and adolescents with asthma, as well as to compare the clinical, laboratory, and spirometric characteristics of patients with controlled and uncontrolled asthma as assessed by the two questionnaires.

Methods: Children and adolescents with asthma had their level of asthma control cross-sectionally assessed by the GINA questionnaire and the ACT, the Childhood ACT (C-ACT) being used for the children in the sample. The participating patients also underwent spirometry, clinical assessment (for passive smoking, asthma severity, medication use, and type of inhaler device used), and laboratory measurements of vitamin D levels, blood eosinophils, and total IgE.

Results: A total of 76 patients were assessed. Of those, 62% were male, and the mean age was 10 [9-12] years. In addition, 42% and 20% were classified as having uncontrolled asthma by the GINA questionnaire and the C-ACT/ACT, respectively. There was moderate agreement between the two questionnaires regarding identification of controlled and uncontrolled asthma (k = 0.505; p < 0,0001). The patients classified as having uncontrolled asthma by the GINA questionnaire had worse results in terms of daily inhaled corticosteroid dose, asthma severity, passive smoking, and spirometric parameters (FVC, FEV1, and FEF25-75%). However, there was no significant difference between patients classified as having controlled or uncontrolled asthma by the C-ACT/ACT.

Conclusions: In children and adolescents with asthma, the level of agreement between the GINA questionnaire and the C-ACT/ACT appears to be moderate. The GINA questionnaire appears to have a stronger association with functional parameters, indicating better clinical assessment with less underreporting of uncontrolled asthma.

Objective: Depression and anxiety have been documented in people with cystic fibrosis (CF), jeopardizing treatment adherence. To date, no studies have assessed the prevalence of psychosocial issues in adolescents with CF in Brazil. We sought to assess the prevalence of depression and anxiety in adolescents with CF in Brazil, as well as the impact of depression and anxiety on treatment adherence.

Methods: This was a multicenter, prospective, observational, longitudinal study conducted between 2017 and 2019 at 14 CF referral centers in Brazil. We used standardized tools such as the nine-item Patient Health Questionnaire (for depression), the seven-item Generalized Anxiety Disorder scale (for anxiety), and the eight-item Morisky Medication Adherence Scale (for treatment adherence) in order to collect data on 218 CF patients at two different time points.

Results: The prevalence of depression was 19.1% at time point 1 and 15.4% at time point 2. The prevalence of anxiety was 19.1% at time point 1 and 18.0% at time point 2. Depression and anxiety were significantly higher in female patients and lower in those who underwent home physiotherapy or had psychological support. Significant correlations were found between depression and anxiety at both time points, the associations being strongest at time point 1 (r = 0.68; p < 0.001). Most (66.7%) of the study participants reported low adherence to treatment, and the remainder reported either average adherence (in 28%) or high adherence (in 5.3%). Depression and anxiety showed inverse correlations with treatment adherence.

Conclusions: The prevalence of depression and anxiety in adolescents with CF in Brazil appears to be similar to that reported in other countries, being higher in females and lower in those undergoing home physiotherapy or receiving psychological care. Depression and anxiety appear to correlate with lower treatment adherence. Treating psychosocial issues may effectively improve rates of treatment adherence in adolescents with CF.