Cyro Teixeira da Silva Junior

Dosagem de proteínas totais e desidrogenase lática para o diagnóstico de transudatos e exsudatos pleurais: redefinindo o critério clássico com uma nova abordagem estatística

OBJECTIVE To propose a new classification criterion for the differentiation between pleural exudates and transudates-quantifying total proteins in pleural fluid (TP-PF) and lactate dehydrogenase in pleural fluid (LDH-PF) exclusively-as well as to compare this new criterion with the classical criterion in terms of diagnostic yield. METHODS This was an observational, cross-sectional study with a within-subject design, comprising 181 patients with pleural effusion treated at two university hospitals in the state of Rio de Janeiro, Brazil, between 2003 and 2006. The diagnostic parameters included in the classical criterion were identified, as were those included in the new criterion. RESULTS Of the 181 patients, 152 and 29 were diagnosed with pleural exudates and pleural transudates, respectively. For the classical criterion, the sensitivity, specificity, and accuracy for the diagnosis of pleural exudates were, respectively, 99.8%, 68.6%, and 94.5%, whereas the corresponding values for the diagnosis of pleural transudates were 76.1%, 90.1%, and 87.6%. For the new criterion (cut-off points set at 3.4 g/dL for TP-PF and 328.0 U/L for LDH-PF), the sensitivity, specificity, and accuracy for the diagnosis of exudates were, respectively, 99.4%, 72.6%, and 99.2%, whereas the corresponding values for the diagnosis of transudates were 98.5%, 83.4%, and 90.0%. The accuracy of the new criterion for the diagnosis of pleural exudates was significantly greater than was that of the classical criterion (p = 0.0022). CONCLUSIONS The diagnostic yield was comparable between the two criteria studied. Therefore, the new classification criterion can be used in daily practice.

Aspectos pulmonares na deficiência de alfa-1-antitripsina

Alpha-1-antitrypsin deficiency is an autosomal hereditary disorder and the large majority of individuals with severe deficiency are protease inhibitor type ZZ. The disease occurs predominantly in white persons of European origin and its frequency in Europe and North America is comparable to that of cystic fibrosis (1 in 2000 to 1 in 7000). Persons with this deficiency may have no clinical manifestations, but the most prevalent clinical disorder associated, also pointed as the most frequent cause of disability and death, is chronic obstructive pulmonary disease. In those individuals, tobacco smoking is the major risk. The condition appears to be widely underdiagnosed, based on studies. Several strategies have been explored in the treatment of this deficiency. REV PORT PNEUMOL 2004; X (2): 145-154

Avaliação do coeficiente de variação da idade dos pacientes com síndroma de derrame pleural no Hospital Universitário António Pedro, cidade de Niterói, estado do Rio de Janeiro, Brasil

Pleural effusion is a frequent syndrome in Brazil. Tuberculosis is the most prevalent (P) cause. The coeficient of variation (CV) is a useful single measure of variability. The objective of the present work was to evaluate the coeficient of variation in pleural effusion, having as variable the age. 215 patients had appeared after diagnostic physician and for image of syndrome of pleural effusions. Diagnostic thoracentesis, tests on pleural fluid and others invasise surgical procedures to the approach to a patient with pleural effusion. Tuberculosis (P = 56.0%; CV = 39,7%), adenocarcinoma (P = 11.0%; CV = 25.1%), transudates (P = 12.0%; CV = 19.6%), lymphomas (P = 2.0%; CV = 34.6%), systemic lupus erythematosus (P = 2.0%; CV = 38.7%), empyema pleural not tuberculosis (P = 5.0%; CV = 42.2%), pulmonary infarction (P = 4.0 %; CV = 30.1%) and parapneumonic (P = 4.0 %; CV = 38.9%) are the causes more prevalent. The analysis on the date showed that the coefficient of variation of age in pleural effusions was high and very high. The values of the coeficient of variation translate a high degree of dispersion of the age of the patients in each cause of pleural effusion. REV PORT PNEUMOL 2003; IX (5): 389-393

Expressão hormonal e metabólica dos carcinomas broncogénicos

RESUMO No presente artigo de revisao os autores abordam um tema nao levado em consideracao pela maioria dos clinicos e pneumologistas, que sao as manifestacoes endocrino-metabolicas do carcinoma broncogenico. As principais manifestacoes encontradas na literatura sao as sindromas para neoplasicas (sindroma de secrecao inapropriada da hormona antidiuretica, alteracoes no metabolismo do calcio, sindroma carcinoide e de Cushing). A osteoartropatia hipertrofica tambem e revista. REV PORT PNEUMOL 2003; IX (2): 109-115

Manifestações endócrino-metabólicas na tuberculose

RESUMO No presente artigo de revisao os autores abordam um tema nao levado em consideracao pela maioria dos clinicos e pneumologistas, que sao as manifestacoes endocrino-metabolicas da tuberculose. As principais manifestacoes encon tradas na literatura sao: insuficiencia adrenal, sindroma de secrecao inapropriada da hormona antidiuretica, alteracoes no metabolismo do calcio, hipopituitarismo, tireoidopatias, alteracoes pancreaticas, manifestacoes da tuberculose nos diabeticos e as alteracoes metabolicas produzidas pelos tuberculostaticos. Chama a atencao na discussao realizada a quantidade de informacoes sobre as alteracoes no metabolismo do calcio. REV PORT PNEUMOL 2003; IX (4): 353-358

Influence of a scientific initiation programme on scientific output of professors on a medical course in Brazil

BACKGROUND Scientific Initiation Programmes (SIP) are now considered increasingly important in medical courses, and are now being introduced in many medical courses. The School of Medicine at Universidade Federal Fluminense pioneered on optional SIP in 1995. This study aims to compare scientific output of professors who engaged in SIP disciplines (SIP group) with that of professors who did not (non-SIP group). METHODS Data on the scientific output of both groups was collected from a period that began 4 years before and ended 4 years after the SIPs inception. The average number of papers published or presented in me di cal meetings in both groups was compared. RESULTS The scientific output of the SIP group was larger than that of the non SIP group (p = 0.0017), except for M.Sc. professors (p = 0.8362). This result did not change when the scientific production of Ph.D. professors was analysed according to the periods before (p = 0.0003) and after (p = 0.0001) SIPs inception. Scientific output of M.Sc. professors of both group were similar in both periods, i.e., before (p = 1.0) and after (p = 0.67) SIPs inception. When scientific output in the periods before and after SIPs inception is compared, it was found that it increased in both groups, SIP (p = 0.0001) and non SIP (p = 0.0086) alike. CONCLUSIONS After the inception of SIP, all professors had an increase in their scientific output; however, this occurred independently of their engagement in SIP disciplines.

Factores preditivos de risco para surgimento de segundo tumor maligno primário no pulmão em 104 casos

Objectives: The objective of our study was to identify the risks factors for the de development of a second pulmonary primary cancer. Methods: It was a primary, observational, multicentric and retrospective study with 104 patients from the Cancer National Institute and the Antonio Pedro Universitary Hospital, in Rio de Janeiro, Brazil. Results: The sites of primary tumors were: head and neck(56.7%); with laryngeal carcinoma (42.4%); lungs (15.5%); bladder (8.6%); uterine cervix (7.6%); stomach (4.8%); others (6.8%). Male patients represented 84.6%. Average age 56.7 ± 10.7 years, with a coefficient of variation 18.8%.Among the patients 91.4% were smokers and 92.0% were alcohol consumers. Multiple logistic regression model: site of primary tumor (OR:8.22; CI 95% - 2.21 to 30.56; p = 0,0017); specific histologic of primary cancer (OR:0.21; IC 95%: 0.04 to 0.99; p = 0.0498); sex (OR: 0.25; CI 95%: 0.03 to 1.81; p = 0.1711); age (OR: 0.98; CI 95%: 0.92 to 1.04; p = 0.6318); smoking (OR: 2.80; CI 95%: 0.44 to 17.55; p = 0.2711) and alcohol consumption (OR:0.76; CIIC 95%: 0.19 to 2.95; p = 0.6964). Asjusted model: odds ratio of the site of the primary tumor was 4.14,; CI 95%; from 1.36 and 12.78 and p = 0.0123 (p < 0.05). Accuracy or the model: 82. 69%. Conclusion: In this study teh site of the primary tumor was the only predictor of risk for the second pulmonary primary cancer. REV PORT PNEUMOL 2004; X (4): 297-303

Cirurgia redutora de volume pulmonar: critérios de seleção de pacientes no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ

BACKGROUND: Chronic Obstructive Pulmonary Disease (CPOD) is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS) is an alternative of surgical treatment of emphysema (aside from lung transplantation). OBJECTIVES: The aim of this study was to analyse patient selection criteria for LVRS. METHODS: This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions. RESULTS: Contraindications to surgery included chronic bronchitis (29% or nine patients), forced expiratory volume in one second (FEV 1) more than 80 percent predicted (13% or four patients), negative consent for surgery (10% or three patients), fibrosis pattern, severe depression and bronchiectasis (two patients each one), solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history, current cigarette smoking, diffuse emphysema with alpha-1-antitrypsin deficiency and severe cardiac disease (one patient each). Indication. One selected patient with severe symptoms of emphysema met criteria for LVRS (bilateral superior lobe heterogeneous pattern of emphysema on chest computed tomography and lung perfusion scan). CONCLUSIONS: Chronic bronchitis was the major isolated factor to contraindicate LVRS. Most patients who fit the criteria for the surgery performance refused to undergo the LVRS for fear of the surgery and after pulmonary rehabilitation. The most important criteria for LVRS is bilateral superior lobe heterogeneous pattern of emphysema.

Increased Cytokeratin 19 Fragment Levels Are Positively Correlated with Adenosine Deaminase Activity in Malignant Pleural Effusions from Adenocarcinomas

Adenosine deaminase (ADA) and cytokeratin 19 (CK19) are known pleural biomarkers. Although ADA in humans functions mainly in the immune system, it also appears to be associated with the differentiation of epithelial cells. Keratin filaments are important structural stabilizers of epithelial cells and potent biomarkers in epithelial differentiation. This study aimed to investigate the simultaneous presence of the ADA enzyme and CK19 fragments to assess epithelial differentiation in malignant and benign pleural fluids. Diagnosis of the cause of pleural effusion syndrome was confirmed by means of standard examinations and appropriate surgical procedures. An ADA assay, in which ADA irreversibly catalyzes the conversion of adenosine into inosine, was performed using a commercial kit. The CK19 assay was performed using a CYFRA 21-1 kit, developed to detect quantitative soluble fragments of CK19 using an electrochemiluminescence immunoassay. One hundred nineteen pleural fluid samples were collected from untreated individuals with pleural effusion syndrome due to several causes. ADA levels only correlated with CK19 fragments in adenocarcinomas, with high significance and good correlation (rho = 0.5145, P = 0.0036). However, further studies are required to understand this strong association on epithelial differentiation in metastatic pleural fluids from adenocarcinomas.

Influência de um programa de iniciação científica de graduação no perfil profissional dos médicos recém-formados

INTRODUCTION This paper studies the influence of a Scientific Initiation Programme (SIP) on the professional profile of new doctors from a Brazilian university. AIM AND METHODS Evaluate fifty-two new doctors divided into two groups matched by sex, age and academic performance and differing only in participation in the SIP. Professional and socioeconomic data were collected, including schooling of parents; average income before, during and after the medical course; current professional situation; results of exams for civil servant recruitment; and titles and degrees obtained after graduation. RESULTS Significant differences were found only in civil servant recruitment exam results (p=0.0098) and in income after graduation (p=0.02), which were both higher in the non-SIP group. Only one doctor got a M.Sc. degree after graduation, but many of them in both groups obtained technical titles, and had papers presented at congresses or published. CONCLUSIONS Apparently, taking part in a SIP led to lower income and worse civil servant recruitment exam results. However, this may only reflect a transient phase in a long-term process. New research currently under way will answer this remaining question, now that more time has elapsed since graduation. Rev Port Pneumol 2010; XVI (5): 797-808.