Argemiro D'Oliveira Júnior

Avaliação do questionário de controle da asma validado para uso no Brasil

OBJETIVO: Avaliar se a versao em lingua portuguesa do Asthma Control Questionnaire (ACQ, Questionario de Controle da Asma) e um instrumento valido para medir o controle da asma em pacientes adultos ambulatoriais no Brasil. METODOS: Foram avaliados 278 pacientes ambulatoriais com diagnostico de asma. Todos os pacientes, durante a primeira visita, responderam ao questionario, foram submetidos a espirometria e avaliados clinicamente por um medico para a caracterizacao do controle da doenca. Foram analisadas as versoes do questionario com 5, 6 e 7 questoes, utilizando dois escores distintos (0,75 e 1,50) como pontos de corte. RESULTADOS: Dos 278 pacientes, 77 (27,7%) tinham asma intermitente, 39 (14,0%) asma persistente leve, 40 (14,4%) asma persistente moderada e 122 (43,9%) asma persistente grave. A sensibilidade do questionario para identificar asma nao-controlada variou de 77% a 99% e a especificidade variou de 36% a 84%. O valor preditivo positivo variou de 73% a 90%, e o valor preditivo negativo variou de 67% a 95%. A razao de verossimilhanca positiva variou de 1,55 a 4,81, e a razao de verossimilhanca negativa variou de 0,03 a 0,27. Nas versoes do ACQ com 5 e 6 questoes, o coeficiente de correlacao intraclasse foi de 0,92, e estas versoes foram responsivas a mudancas no quadro clinico dos pacientes. CONCLUSOES: O ACQ, nas suas tres versoes, teve boa capacidade de discriminar individuos com asma nao-controlada daqueles com asma controlada. As versoes com 5 e 6 questoes apresentaram tambem boa reprodutibilidade e responsividade. Trata-se, portanto, de um instrumento valido para avaliacao do controle da asma em pacientes adultos ambulatoriais no Brasil.

Validação do Teste de Controle da Asma em português para uso no Brasil

OBJECTIVE To develop and validate a Portuguese-language version of the Asthma Control Test (ACT) for use in Brazil. METHODS The study comprised 290 asthma outpatients over 12 years of age. The patients completed the ACT questionnaire and had an appointment with a pulmonologist in order to assess asthma control in two visits. In the first visit, the patients also underwent spirometry. The second visit took place at least four weeks later. RESULTS We found that a cut-off score of 18 points-to differentiate between subjects with controlled asthma and those with uncontrolled asthma-had a sensitivity of 93%, a specificity of 74%, a negative predictive value of 86% and a positive predictive value of 85%. The positive and negative likelihood ratios were 3.58 and 0.09, respectively. The questionnaire has an outstanding capacity to differentiate uncontrolled asthma from controlled asthma, with an area under the ROC curve of 0.904. The patients whose symptoms remained stable between the two visits had similar scores, demonstrating good test-retest reproducibility, with an intraclass correlation coefficient of 0.93. The patients whose symptoms improved in the second visit had significantly higher scores, demonstrating good responsiveness of the questionnaire in the identification of changes in disease control. CONCLUSIONS The Portuguese-language version of the ACT showed good test-retest reproducibility and was capable of discriminating the levels of asthma control and detecting changes in asthma control in a population of patients with a low level of education and low family income at a public health facility in Brazil.

Preditores da adesão ao tratamento em pacientes com asma grave atendidos em um centro de referência na Bahia

Objective: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. Methods: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. Results: Of the 160 patients. 158 completed the study. Adherence rate was 83.8%. Of the 158 patients, 112 (70.9%) were considered adherent (cut-off point: 80% of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. Conclusions: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center

T Cell Response of Asymptomatic Leishmania chagasi Infected Subjects to Recombinant Leishmania Antigens

In areas of Leishmania chagasi transmission the ability to control leishmania infection is associated with IFN-gamma production. In visceral leishmaniasis down-regulation of T cell responses is mediated by interleukin-10 (IL-10). In this study we evaluated the lymphoproliferative response, IFN-gamma and IL-10 production on lymphocyte cultures stimulated with recombinant leishmania antigens in subjects with asymptomatic L. chagasi infection. There was a statistically significant difference in the lymphoproliferative response of the subjects with asymptomatic infection as compared to patients with visceral leishmaniasis and healthy subjects with respect to crude antigens (p<0.01), gp-63 (p<0.05) and hsp-70 (p<0. 01), as well as between asymptomatic L. chagasi infected subjects and patients with visceral leishmaniasis with respect to the response to all antigens tested. The IFN-gamma production observed in the group with asymptomatic infection with all the three recombinant antigens tested was higher (p<0.01) than that observed in patients with visceral leishmaniasis and in healthy subjects. Furthermore, in individuals with asymptomatic infection, IL-10 levels in cultures stimulated with recombinant antigens were very low. This study shows that lymphocytes from individuals with asymptomatic L. chagasi infection are able to recognize recombinant leishmania antigens with production of a cytokine that is associated with leishmania killing.

Avaliação de atopia em portadores de DPOC

OBJECTIVE: To determine the prevalence of atopy and to evaluate clinical, laboratory, and radiological profiles in patients with COPD. METHODS: This was a cross-sectional study involving outpatients with stable COPD (defined by the clinical history and a post-bronchodilator FEV1/FVC < 70% of the predicted value). The patients completed a questionnaire regarding clinical characteristics and atopy, after which they underwent nasal lavage cytology, skin prick testing, chest X-rays, arterial blood gas analyses, and determination of total serum IgE. RESULTS: Of the 149 subjects studied, 53 (35.6%), 49 (32.8%), and 88 (59.1%) presented with nasal eosinophilia, a positive skin prick test result, and symptoms of allergic rhinitis, respectively. Correspondence analysis confirmed these findings, showing two distinct patterns of disease expression: atopy in patients with COPD that was less severe; and no evidence of atopy in those with COPD that was more severe (reduced FEV1 and hyperinflation). There was a statistically significant association between nasal eosinophilia and a positive bronchodilator response. CONCLUSIONS: Using simple and reproducible methods, we were able to show that there is a high frequency of atopy in patients with COPD. Monitoring inflammation in the upper airways can be a useful tool for evaluating respiratory diseases in the elderly and in those with concomitant asthma and COPD, a clinical entity not yet fully understood.OBJETIVO: Determinar a prevalencia de atopia e avaliar o perfil clinico, laboratorial e radiologico de pacientes com DPOC. METODOS: Estudo de corte transversal com pacientes ambulatoriais portadores de DPOC estavel (definida pela historia clinica e relacao VEF1/CVF < 70% do previsto apos broncodilatador). Os pacientes responderam um questionario clinico e de atopia e foram submetidos a citologia de lavado nasal, teste cutâneo de alergia, radiografia de torax, hemogasometria arterial e dosagem de IgE total. RESULTADOS: Dos 149 individuos avaliados, 53 (35,6%), 49 (32,8%) e 88 (59,1%), respectivamente, apresentavam eosinofilia no lavado nasal, teste cutâneo positivo e sintomas de rinite alergica. A analise de correspondencia confirmou esses achados, evidenciando dois perfis distintos de doenca: a presenca de atopia em pacientes com estagios mais leves de DPOC, e a ausencia de caracteristicas de atopia em pacientes com aspectos de doenca mais grave (VEF1 reduzido e hiperinsuflacao). Houve uma associacao estatisticamente significante entre eosinofilia no lavado nasal e prova farmacodinâmica positiva. CONCLUSOES: Este estudo identificou uma alta frequencia de atopia em pacientes com DPOC, utilizando ferramentas simples e reprodutiveis. A monitorizacao inflamatoria de vias aereas parece ser uma ferramenta util para avaliar as doencas respiratorias em idosos, assim como em pacientes com sobreposicao de asma e DPOC, entidade clinica ainda pouco compreendida.

Manifestações clínicas da neurocisticercose na região do semi-árido do nordeste brasileiro

Case sheets of 44 patients with neurocysticercosis, coming from Campina Grande and others cities of Para ba state, examined between 1990 - 2001 were analyzed. The average age (SD +/-) was 20.6 +/- 14.3 years old, of which 54.5% were male. Thirty eight patients (86.2%) came from urban area. The initial symptom was convulsion in 90.9% of the cases and headaches in 9.1%. The epileptical form was present in 63.6% of the cases and the combined form in 22.3%. Computerized tomography of the skull was compatible with neurocysticercosis in 100% of the cases, showing calcification in (59.1%), integral cysts in (18.2%) and in degenerating in (20.4%), isolated or associated. The LCR performed on 29 patients showed alterations in 25 (86.2%) cases, predominating linfomonocitary pleocitose in 100% of the cases and positive immunological reactions in 64.3% of the cases. In conclusion neurocysticercosis is a frequent cause for convulsions in children and young adults in this region, and the ocorrence in urbane and rural areas denote the poor control of the taeniases/cistycercosis complex in this state.

Prognostic value of exercise echocardiography in diabetic patients

BackgroundCoronary artery disease (CAD) is the leading cause of death in diabetic patients. Although exercise echocardiography (EE) is established as a useful method for diagnosis and stratification of risk for CAD in the general population, there are few studies on its value as a prognostic tool in diabetic patients. The purpose of this investigation was to evaluate the value of EE in predicting cardiac events in diabetics.Methods193 diabetic patients, 97 males, 59.8 ± 9.3 yrs (mean ± SD) were submitted to EE between 2001 and 2006 and followed from 7 to 65 months with median of 29 months by phone calls and personal interviews with patients and their primary physician, and reviewing medical records and death certificates. The end points were cardiac events, defined as non-fatal myocardial infarction, late myocardial revascularization and cardiac death. Sudden death without another explanation was considered cardiac death. Survival free of end points was estimated by the Kaplan-Meier method.ResultsTwenty-six cardiac events were registered in 24 individuals during the follow-up. The rates of cardiac events were 20.6 and 7% in patients with positive and negative EE, respectively (p < 0.001). Predictors of cardiac events included sedentary lifestyle, with RR of 2.57 95%CI [1.09 to 6.02] (P = 0.03) and positive EE, with RR 3.63, 95%CI [1.44 to 9.16] (P = 0.01). Patients with positive EE presented higher rates of cardiac events at 12 months (6.8% vs. 2.2%), p = 0.004.ConclusionEE is a useful method to predict cardiac events in diabetic patients with suspected or known CAD.

Exercise stress echocardiography in the identification of coronary artery disease in the elderly with chronotropic incompetence

BACKGROUND Chronotropic incompetence (CTI) is frequent in elderly patients and may limit the role of the exercise test in the identification of coronary artery disease (CAD) in this population. OBJECTIVE To assess the value of CTI in an elderly population in the diagnosis of CAD. METHODS A total of 3,308 patients were studied, 804 were elderly individuals (age > 65 years) who underwent exercise stress echocardiography (ESE). Based on the heart rate (HR) reached during the exercise test, were divided into two groups: G1 150 patients who did not reach 85% of the age-predicted HR, and G2 654 patients who did. The groups were compared to clinical characteristics, segmental left ventricular contractility rate (WMSI) and coronary angiography (CAG). RESULTS Clinical characteristics were similar between the groups. WMSI was higher in G1 than in G2, both at rest (1.09 +/- 0.21 versus 1.04 +/- 0.15) and after exercise (1.15 +/- 0.29 versus 1.08 +/- 0.2) (p < 0.001). Abnormalities in wall contractility were more frequent in G1 than in G2 (55% versus 37%; p < 0.05), thus suggesting that elderly with CTI have a higher frequency of CAD. CAG was performed in 69% ESE positive for myocardial ischemia. In the G1 group, 91% of the ESE were true positive versus 84.5% in G2, that is, presence of obstructive coronary artery disease (> 50%). CONCLUSION CTI is associated with a higher frequency of contractile alterations in the elderly population and adds a positive predictive value to ESE in the identification of patients with obstructive CAD.

Metabolic Syndrome and Military Policemen’s Quality of Life: An Interdisciplinary Comprehensive Approach

Men generally have a lower life expectancy and higher mortality than women in nearly all age groups. Military police, whose main activity in Brazil is the maintenance of public order and the prevention of crimes and transgressions of the laws, is mostly composed of men; it is also a risky and stressful profession generally related to poor quality of life. Considering that risk factors for disease and death from cardiovascular causes—including the multiple risk factor metabolic syndrome—are mostly related to lifestyle and associated with impaired quality of life, this study aims to provide a theoretical basis for other studies about the prevalence of metabolic syndrome among police officers. In a theoretical study, the authors present an interdisciplinary review based on studies on the health and quality of life of men in general and policemen in their specificity; published studies were selected according to the key words: men, health, quality of life, police, metabolic syndrome; they should also have been published in the past 15 years and available in the Scientific Electronic Library Online—SciELO—and in the Public Medline—PubMed. In conclusion, military policemen have a risky profession, whose conditions may contribute to low quality of life, illness, and mortality from cardiovascular causes; these conditions indicate a need for the characterization of metabolic syndrome in this population as an important element for promotion of health. Studying these conditions may contribute to the adoption of comprehensive and continuing care for military policemen’s integral health.

Qualidade dos dados das notificações de hepatites virais por acidentes de trabalho, Brasil

RESUMO: Objetivo: Avaliar a completitude e a consistencia das notificacoes de hepatites virais por acidentes de trabalho no Brasil entre 2007 e 2014. Metodos: Trata-se de um estudo epidemiologico analitico de avaliacao da qualidade dos dados do Sistema de Informacao de Agravos de Notificacao. Os dados foram analisados pelas frequencias absoluta e relativa, variacao percentual proporcional e pelo teste do χ2 linear. Resultados: A maior parte das variaveis obrigatorias e essenciais foi classificada em boa completitude, apesar de crescimento no periodo em estudo. A ocupacao e a forma clinica foram classificadas como regular, com mais de 25,1% dos dados incompletos. A inconsistencia foi considerada alta entre diferentes variaveis, superior a 15,0%, como por exemplo os marcadores sorologicos com os tipos de hepatites virais; e a idade com a ocupacao e data de nascimento. Conclusoes: Conclui-se que se faz necessaria a avaliacao da qualidade dos dados periodicamente, assim como a capacitacao dos profissionais de saude quanto ao preenchimento adequado e completo das notificacoes, o que contribui para atuacao eficiente da vigilância das doencas transmissiveis e melhoria da qualidade de vida da populacao.OBJECTIVE To assess the completeness and consistency of reports describing viral hepatitis caused by work-related accidents in Brazil between 2007 and 2014. METHODS This is an analytical, epidemiological study evaluating the quality of data from the Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação). Data were analyzed using absolute and relative frequencies, proportional percentage variation, and a linear χ2 test. RESULTS The majority of mandatory and essential variables were classified with good completeness, despite growth during the study period. The occupation and clinical form variables were classified as normal when they had less than 25.1% incomplete data. Inconsistency was considered high among different variables above 15.0%, including, for example, serologic markers with the types of viral hepatitis and age with occupation and date of birth. CONCLUSIONS We need to evaluate data quality periodically, in addition to train health professionals on the adequate way to completely fill out reports, because this contributes to the establishment of an efficient surveillance of communicable diseases and improves the populations quality of life.