Original Article

Are maximum respiratory pressures predictors of sarcopenia in the elderly?

Pressões respiratórias máximas são preditores de sarcopenia em idosos?

Rhaine Borges Santos Pedreira1, Marcos Henrique Fernandes1, Thaís Alves Brito1, Paloma Andrade Pinheiro1, Raildo da Silva Coqueiro1, José Ailton Oliveira Carneiro1

J Bras Pneumol.2022;48(1):e20210335

Comparisons among parameters of maximal respiratory pressures in healthy subjects

Comparação entre parâmetros de pressões respiratórias máximas em indivíduos saudáveis

Cristina Martins Coelho, Rosa Maria de Carvalho, David Sérgio Adães Gouvêa, José Marques Novo Júnior

J Bras Pneumol.2012;38(5):605-613

Letters to the Editor

New reference values for maximal respiratory pressures in the Brazilian population: Corrections

Novos valores de referência para pressões respiratórias máximas na população brasileira: Correções

Dirceu Costa, Helena Amaral Gonçalves, Luciana Peraro de Lima, Daniela Ike,Karina Maria Cancelliero, Maria Imaculada de Lima Montebelo

J Bras Pneumol.2010;36(5):667-

Original Article

New reference values for maximal respiratory pressures in the Brazilian population

Novos valores de referência para pressões respiratórias máximas na população brasileira

Dirceu Costa, Helena Amaral Gonçalves, Luciana Peraro de Lima, Daniela Ike, Karina Maria Cancelliero, Maria Imaculada de Lima Montebelo

J Bras Pneumol.2010;36(3):

Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia

Comparação da acurácia de preditores de mortalidade na pneumonia associada à ventilação mecânica

Renato Seligman, Beatriz Graeff Santos Seligman, Paulo José Zimermann Teixeira

J Bras Pneumol.2011;37(4):495-503

Comparing peak and sustained values of maximal respiratory pressures in healthy subjects and chronic pulmonary disease patients

Comparação entre os valores de pico e sustentados das pressões respiratórias máximas em indivíduos saudáveis e pacientes portadores de pneumopatia crônica

J Bras Pneumol.2003;29(4):208-212

Mortality due to respiratory diseases in the elderly after influenza vaccination campaigns in theFederal District, Brazil, 1996-2009

Mortalidade por doenças respiratórias em idosos após campanhas vacinais contrainfluenza no Distrito Federal, Brasil, 1996-2009

Francisca Magalhães Scoralick, Luciana Paganini Piazzolla, Liana Laura Pires, Cleudsom Neri,Wladimir Kummer de Paula

J Bras Pneumol.2013;39(2):198-204

Letters to the Editor

Influence of a heat and moisture exchanger with a microbiological filter on measurements of maximal respiratory pressures and vital capacity in patients with COPD

Influência do trocador de calor e umidade com filtro microbiológico nas medidas de pressões respiratórias máximas e capacidade vital em pacientes com DPOC

Jeanette Janaina Jaber Lucato1,a, Renata Cléia Claudino Barbosa1,b, Patricia Salerno de Almeida Picanço1,c, Thiago Marraccini Nogueira da Cunha2,d, Renato Fraga Righetti3,e

J Bras Pneumol.2020;46(1):e20190054

Tuberculosis in elderly patients in the city of Cali, Colombia: a hospital-based cohort study

Tuberculose em pacientes idosos na cidade de Cali, na Colômbia: um estudo de coorte de base hospitalar

Jose Fernando García-Goez1,2, Juan Diego Vélez1,2, Barbara Lucía Mora3, Luis Gabriel Parra-Lara2,3, Jessica Pino-Escobar3, Joan Artur Caylà4, Jose M. Miro5

J Bras Pneumol.2020;46(5):e20200072

Original Article

Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU

Prevalência, desfechos e preditores de infecções nosocomiais do trato respiratório inferior multirresistentes em pacientes em uma UTI

Ana Beatriz Souza de Oliveira1, Guilherme Hirassawa Sacillotto2, Manuela Francisco Balthazar Neves2, Andressa Hellen Nora da Silva2, Tamiris Adriane Moimaz3, Joelma Villafanha Gandolfi3, Mara Correa Lelles Nogueira3, Suzana Margareth Lobo3

J Bras Pneumol.2023;49(1):e20220235

Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrug-resistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay = 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes.

Keywords: Drug resistance, multiple; Healthcare-associated pneumonia; Pneumonia, ventilator-associated; Cross infection; Intensive care units.

Community-acquired pneumonia in elderly patients: adherence to Brazilian guidelines for the treatment of pneumonia

Pneumonias adquiridas na comunidade em pacientes idosos: aderência ao Consenso Brasileiro sobre Pneumonias

José Roberto de Almeida, Olavo Franco Ferreira Filho

J Bras Pneumol.2004;30(3):229-236

Background: Pneumonia is a common disease with a high mortality rate, being the sixth leading cause of death among elderly people in the USA and the fifth among those in Brazil. Initial treatment of pneumonia is usually empirical since the ethiological agent is identified in only approximately 50% of cases. Therefore, several scientific societies have defined some guidelines for initial antimicrobial therapies. Objectives: This study evaluated adherence to the guidelines set forth by the Consenso Brasileiro sobre Pneumonias (Brazilian Consensus on Pneumonia) for treatment of community-acquired pneumonia in hospitalized elderly patients. Method: Fifty-four patients, aged 60 or over, hospitalized at Londrina University Hospital with community-acquired pneumonia between 2 August 1999 and 2 August 2000 were evaluated. Whether their treatment adhered or did not adhere to guidelines, the patients were compared in terms of 30-day mortality, average time for clinical stabilization, average length of hospital stay, cost of treatment and severity score. Results: The average age was 74.1, and 61.1% of the patients were treated in accordance with the Brazilian guidelines for treatment of community-acquired pneumonia. There were no differences in length of hospital stays, cost of treatment, time to clinical stability and severity score between the two groups (adherent and non-adherent). However, there was a difference in mortality. The rate of mortality was higher in patients with pneumonia severity index (PSI) scores of IV or V who were treated according to the guidelines than in those with the same score whose treatment was non-adherent (p = 0.04). In general, PSI score was related to mortality. The mortality rate among patients with scores of II and III was 9.5%, compared with 30.3% in patients with scores of IV and V. Conclusion: Adherence to the Brazilian guidelines for treatment of community-acquired pneumonia in elderly patients was satisfactory, and there was no difference in results between both groups, except for the higher mortality rate found for patients with higher PSI scores who were treated according to the guidelines. A positive correlation was found between PSI score and mortality.

Keywords: Pneumonia. Health Planning Guidelines. Community-Acquired Infections. Health Services for the Aged.

Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program

Características da tuberculose em idosos no Recife (PE): contribuição para o programa de controle

Zilda do Rego Cavalcanti, Maria de Fátima Pessoa Militão de Albuquerque, Antônio Roberto Leite Campelo, Ricardo Ximenes, Ulisses Montarroyos, Marianne Karel Amaral Verçosa

J Bras Pneumol.2006;32(6):535-543

Objective: To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. Methods: A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. Results: The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. Conclusion: In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.

Keywords: Tuberculosis; Elderly; Case-control; Brazil

Brief Communication

Sublobar resection in the treatment of elderly patients with early-stage non-small cell lung cancer

Ressecção sublobar no tratamento de pacientes idosos com câncer de pulmão não pequenas células em estágio inicial

Margarida Afonso1 , Carlos Branco2 , Tiago Manuel Alfaro1

J Bras Pneumol.2020;46(4):e20190145

Original Article

Who are the patients with tuberculosis who are diagnosed in emergency facilities? An analysis of treatment outcomes in the state of São Paulo, Brazil

Quem são os pacientes com tuberculose diagnosticados no pronto-socorro? Uma análise dos desfechos do tratamento no Estado de São Paulo, Brasil

Otavio Tavares Ranzani1,2,a, Laura Cunha Rodrigues2,b, Eliseu Alves Waldman3,c, Elena Prina1,d, Carlos Roberto Ribeiro Carvalho1,e

J Bras Pneumol.2018;44(2):125-133

Objective: Early tuberculosis diagnosis and treatment are determinants of better outcomes and effective disease control. Although tuberculosis should ideally be managed in a primary care setting, a proportion of patients are diagnosed in emergency facilities (EFs). We sought to describe patient characteristics by place of tuberculosis diagnosis and determine whether the place of diagnosis is associated with treatment outcomes. A secondary objective was to determine whether municipal indicators are associated with the probability of tuberculosis diagnosis in EFs. Methods: We analyzed data from the São Paulo State Tuberculosis Control Program database for the period between January of 2010 and December of 2013. Newly diagnosed patients over 15 years of age with pulmonary, extrapulmonary, or disseminated tuberculosis were included in the study. Multiple logistic regression models adjusted for potential confounders were used in order to evaluate the association between place of diagnosis and treatment outcomes. Results: Of a total of 50,295 patients, 12,696 (25%) were found to have been diagnosed in EFs. In comparison with the patients who had been diagnosed in an outpatient setting, those who had been diagnosed in EFs were younger and more socially vulnerable. Patients diagnosed in EFs were more likely to have unsuccessful treatment outcomes (adjusted OR: 1.54; 95% CI: 1.42-1.66), including loss to follow-up and death. At the municipal level, the probability of tuberculosis diagnosis in EFs was associated with low primary care coverage, inequality, and social vulnerability. In some municipalities, more than 50% of the tuberculosis cases were diagnosed in EFs. Conclusions: In the state of São Paulo, one in every four tuberculosis patients is diagnosed in EFs, a diagnosis of tuberculosis in EFs being associated with poor treatment outcomes. At the municipal level, an EF diagnosis of tuberculosis is associated with structural and socioeconomic indicators, indicating areas for improvement.

Keywords: Tuberculosis/diagnosis; Emergency treatment; Treatment outcome; Delivery of health care.