Alice Mânica Müller

Respiratory viral infections and effects of meteorological parameters and air pollution in adults with respiratory symptoms admitted to the emergency room

Respiratory viral infections (RVIs) are the most common causes of respiratory infections. The prevalence of respiratory viruses in adults is underestimated. Meteorological variations and air pollution are likely to play a role in these infections.

Factors associated with delayed diagnosis of tuberculosis in hospitalized patients in a high TB and HIV burden setting: a cross-sectional study

BackgroundThe most essential components of TB control are early diagnosis and adequate treatment. Delay in the diagnosis and treatment of tuberculosis may result in more extensive disease and more complications, increase severity of the disease and is associated with higher risk of mortality. The purpose of this study was to identify factors associated with delayed diagnosis of TB in hospitalized patients.MethodsWe conducted a cross-sectional study in a general, tertiary care, university-affiliated hospital. Adult patients with TB that were hospitalized were identified retrospectively, and risk factors for delayed diagnosis were collected.ResultsThe median delay until diagnosis was 6 days (IQR: 2-12 days). One hundred and sixty six (54.4%) patients were diagnosed ≤ 6 days, and 139 (45.6%) > 6 days after admission. The main factors associated with diagnostic delay (> 6 days) were extra-pulmonary TB and negative sputum smear.ConclusionsAlthough hospitalization permits a rapid management of the patient and favors a faster diagnosis, we found an unacceptable time delay before the diagnosis of pulmonary TB was made. Future studies should focus on attempt to explain the reasons of diagnostic retard in the patients with the characteristics related to delay in this study.

Active Case Finding of Tuberculosis (TB) in an Emergency Room in a Region with High Prevalence of TB in Brazil

Setting Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. Objective To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis. Methods Cross sectional study. All patients ≥18 years seeking care at the ER were screened for respiratory symptoms and those with cough ≥2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acid-fast bacilli smear and culture. Results Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough ≥2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92–0.97; p<0.0001), sputum production (OR 0.18, 95% CI 0.06–0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45–32.93; p<0.0001). Conclusions This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting.

Perfil epidemiológico dos atendimentos de emergência por sintomas respiratórios em um hospital terciário

OBJECTIVE: To evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients, describing the major clinical syndromes diagnosed and the outcomes of the patients. METHODS: A cross-sectional study conducted in the emergency room of a tertiary care university hospital. Between November of 2008 and November of 2009, we reviewed the total number of emergency room visits per day. Children and adults who presented with at least one respiratory symptom were included in the study. The electronic medical records were reviewed, and the major characteristics of the patients were recorded. RESULTS: During the study period, there were 37,059 emergency room visits, of which 11,953 (32.3%) were motivated by respiratory symptoms. The prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children, respectively. In adults, the rates of hospitalization and mortality were 21.2% and 2.7%, respectively, compared with 11.9% and 0.3%, respectively, in children. Among the adults, the time from symptom onset to emergency room visit correlated positively with the need for hospitalization (p < 0.0001), the length of the hospital stay (p < 0.0001), and the mortality rate (p = 0.028). CONCLUSIONS: We found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients. Our results could inform decisions regarding the planning of prevention measures. Further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms.

Interventions to improve adherence to tuberculosis treatment: systematic review and meta-analysis

SETTING One of the most serious problems in tuberculosis (TB) control is non-adherence to treatment. Several strategies have been developed to improve adherence and increase the cure rate. OBJECTIVE To systematically review interventions to improve adherence to anti-tuberculosis treatment. DESIGN We performed a systematic review and meta-analysis of 22 randomised clinical trials (RCTs) to ascertain whether providing directly observed treatment, short-course (DOTS), financial incentives, food incentives and/or patient education/counselling improved adherence to anti-tuberculosis treatment. The primary outcome was cure rate; secondary outcomes were default and mortality rates. Sources used were Medline (accessed via PubMed), Cochrane Central, LILACS (Literatura Latino Americana em Ciências da Saúde, Latin American and Caribbean Health Sciences Literature) and Embase from inception to October 2015. RESULTS A significant increase in cure rates, by 18% with DOTS and by 16% with patient education and counselling, was observed. In addition, the default rate decreased by 49% with DOTS, by 26% with financial incentives and by 13% with patient education and counselling. There was no statistically significant reduction in mortality rates with these interventions. CONCLUSION Use of DOTS and patient education/counselling significantly improved cure rates; DOTS, patient education/counselling and financial incentives led to a reduction in the default rate.

Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão

Introducao: O câncer de pulmao e uma doenca muito prevalente e altamente fatal. O objetivo deste estudo foi avaliar a qualidade de vida (QV) e funcao pulmonar de pacientes com câncer de pulmao do Hospital de Clinicas de Porto Alegre que receberam tratamento cirurgico e/ou quimio-radioterapia. Metodos: Foi realizado um estudo de coorte, prospectivo, observacional incluindo 92 pacientes ambulatoriais/internacoes com diagnostico recente de câncer de pulmao e que ainda nao tinham iniciado tratamento, os quais foram submetidos a uma avaliacao da QV atraves do Medical Outcomes Study 36-item Short-Form Health Survey ( SF-36), alem de espirometria e teste da caminhada de seis minutos, antes de iniciar o tratamento, apos 60 dias e 120 dias do inicio do mesmo. Resultados: Foram analisados 27 pacientes cirurgicos, 60 nao cirurgicos, e 5 que nao realizaram tratamentos especificos. Predominou o tipo adenocarcinoma e o estadio avancado da doenca. Nao houve diferenca na QV entre os tres momentos, mas observou-se um aumento significativo do porcentual de capacidade vital forcada previsto nos primeiros 60 dias no grupo nao cirurgico (p=0,023). Nesse grupo, houve correlacao significativa entre as seguintes variaveis: volume expiratorio forcado (VEF 1 ) e aspectos fisicos (r=0,471), distância e dor (r=0,471), distância e vitalidade (r=0,460). No grupo cirurgico, foi encontrada correlacao entre VEF 1 e capacidade funcional (r=0,600). Sobrevida foi de 50% nos primeiros 160 dias. Conclusoes: Houve correlacao positiva entre VEF 1 e QV em pacientes com câncer de pulmao, tanto cirurgicos quanto nao cirurgicos, e entre distância da caminhada e vitalidade em pacientes nao cirurgicos.