Patients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), mortality, reoperation, tracheostomy, and duration of postoperative hospitalization following elective intra-cranial surgery. The study involved a prospective observational cohort of 317 patients submitted to elective intracranial surgery for tumors, aneurysms and arteriovenous malformation. Preoperative assessment was performed and patients were followed up for the determination of extubation failure and prolonged MV (>48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.

The present cross-sectional, population-based study was designed to evaluate the performance of the FEV1/FEV6 ratio for the detection of airway-obstructed subjects compared to the FEV1/FVC <0.70 fixed ratio test, as well as the lower limit of normality (LLN) for 1000 subjects ³40 years of age in the metropolitan area of São Paulo, SP, Brazil. After the exclusion of 37 (3.7%) spirometries, a total of 963 pre-bronchodilator (BD) and 918 post-BD curves were constructed. The majority of the post-BD curves (93.1%) were of very good quality and achieved grade A (762 curves) or B (93 curves). The FEV1/FEV6 and FEV1/FVC ratios were highly correlated (r² = 0.92, P < 0.000). Two receiver operator characteristic curves were constructed in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction: equal to 70 (area under the curve = 0.98, P < 0.0001) and the LLN (area under the curve = 0.97, P < 0.0001), in the post-BD curves. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The FEV1/FEV6 ratio can be considered to be a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, both using a fixed cut-off point or below the LLN as reference. The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.

Chronic obstructive pulmonary disease (COPD) is a common disease in adults over 40 years of age and has a great social and economic impact. It remains little recognized and undertreated even in developed countries. However, there are no data about its diagnosis and treatment in Brazil. The objectives of the present study were to evaluate the proportion of COPD patients who had never been diagnosed and to determine if the COPD patients who had been identified were receiving appropriate treatment. The Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) was a randomized epidemiological study of adults over 40 years living in five metropolitan areas, including São Paulo. The studied sample was randomly selected from the population after a division of the metropolitan area of São Paulo in clusters according to social characteristics. All subjects answered a standardized questionnaire on respiratory symptoms, history of smoking, previous diagnosis of lung disease, and treatments. All subjects performed spirometry. The criterion for the diagnosis of COPD was defined by a post-bronchodilator FEV1/FVC ratio lower than 0.7. A total of 918 subjects were evaluated and 144 (15.8%) met the diagnostic criterion for COPD. However, 126 individuals (87.5%) had never been diagnosed. This undiagnosed group of COPD patients had a lower proportion of subjects with respiratory symptoms than the previously diagnosed patients (88.9 vs 54.8%) and showed better lung function with greater FEV1 (86.8 ± 20.8 vs 68.5 ± 23.6% predicted) and FVC (106.6 ± 22.4 vs 92.0 ± 24.1% predicted). Among the COPD patients, only 57.3% were advised to stop smoking and 30.6% received the influenza vaccine. In addition, 82.3% did not receive any pharmacological treatment. In conclusion, COPD is underdiagnosed and a large number of COPD patients are not treated appropriately.

Two radioaerosol preparations, TechneScan®-DTPA (99mTc-DTPA, 40 mCi/3 ml; IPEN-CNEN, São Paulo, SP, Brazil) and TechneScan®-DTPA/AEROSOL (99mTc-DTPA/A, 15 mCi/1.5 ml with 0.5 ml ethanol; Mallinckrodt Medical, St. Louis, MO, USA), were compared in pulmonary ventilation studies in terms of total radiocounts and clearance after inhalation. An aerosol with ethanol is supposed to better distribute the radioparticles in the lungs. Twenty normal nonsmoking volunteers (10 men and 10 women), mean age of 23.2 years (range: 20 to 35 years), were studied. Images were obtained immediately and 30, 60 and 90 min after inhalation. Total and regional counts were obtained and the clearance half-lives of both lungs were determined. There was no difference in total counts between the two types of radioaerosol at any time (mean of ~188,000 cpm for male and female subjects at time zero in both aerosols). The highest count was obtained in the middle region of both lungs (P<0.001) with both preparations. The clearance half-life did not differ between aerosols (mean of ~80-88 min for male and female subjects for both aerosols). Small nonsignificant regional differences were observed. No differences between genders or between right and left lung were observed. 99mTc-DTPA/A generated the highest output of radioaerosol. 99mTc-DTPA with alcohol costs approximately five times more than the aerosol without alcohol. The present results show that either kind of aerosol may be adopted routinely for use in pulmonary examinations without affecting diagnosis. We suggest that the amount of 740 mBq (20 mCi) of 99mTc-DTPA in 1.5 ml saline can be used for routine examinations resulting in reduction of costs in pulmonary ventilation studies without diagnostic impairment.

OBJETIVO: O conhecimento da prevalência do tabagismo é necessário para a realização de programas institucionais adequados que visem a diminuição do número de fumantes. O objetivo do trabalho foi verificar a prevalência do tabagismo entre funcionários, docentes, enfermeiros e alunos da Universidade Federal de São Paulo e a aceitabilidade de um programa antifumo. PACIENTES E MÉTODOS: Foram analisadas as respostas obtidas a partir de um questionário contendo 51 questões, distribuídos para as diferentes categorias. RESULTADOS: A porcentagem total de questionários respondidos foi de 48,6% (2.613) sendo 37,3% para funcionários, 49,0% para docentes, 52,7% para enfermeiras e 76,5% para alunos. Verificou-se que a porcentagem total de fumantes na UNIFESP foi de 15,5%, sendo 23,7% entre funcionários, 18% entre docentes, 16% entre enfermeiros e 8,6% entre alunos. A faixa etária de maior prevalência de fumantes foi a de 31 a 40 anos (26,6%). Não houve diferença estatística entre a prevalência de fumantes entre homens e mulheres. Em ambos os sexos, para todas as faixas etárias, os indivíduos com maior nível de instrução fumavam menos. Das pessoas que responderam o questionário, 82,5% estavam preocupadas em serem fumantes passivas. Dos fumantes, 55% estão pensando em largar de fumar e 42% julgam precisar de algum tipo de ajuda. CONCLUSÃO: Programas educacionais e de cessação do tabagismo em nível institucional são necessários e bem aceitos na UNIFESP, devendo ser realizados para que as leis de restrição do fumo dentro da instituição sejam efetivamente cumpridas.

PURPOSE: To evaluate the prevalence of tobacco smoking among health workers, professores, nurses and students of Federal University of São Paulo and the acceptance of an institutional program for quitting smoking. METHODS: We analized the answers of a questionnairy with 51 questions, distributed to people from different categories. RESULTS: The total percentage of answered questionnaires was 48.6% (2613). The answers obtained from health workers were 37.3%, professors 49.0%, nurses 52.7% and students 76.5% The total percentage of smokers at UNIFESP was 15.5%: 23.7% for health workers, 18% for professors, 16% for nurses and 8.6% for students. There was no significant statistical difference between the prevalence of smoking among females (17.3%) and males (16.3%). The age of major prevalence of smoking was between 31 to 40 years (26.6%). For all ages, people who have university level smoked less, independent of sex. Eighty three percent (83%) of the UNIFESP workers and students are worried of being passive smokers. Between the smokers, 55% were thinking of quiting and 42% declared that need some help to quit. CONCLUSION: We concluded that educational programs and help for cessation at institutional level are necessary and well accepted at UNIFESP, and the completion of these programs will contribute to the obeying of the prohibitive laws of no smoking within the community.

Os beta2-agonistas constituem um dos pilares do tratamento da asma brônquica, porém sua curta duração de ação exige uso freqüente e a associação com outras drogas broncodilatadoras. O surgimento dos beta2-agonistas de longa ação pode representar um avanço na terapêutica da asma brônquica. OBJETIVO: O presente estudo propõe-se a avaliar, em nosso meio, a eficácia e a tolerabilidade do salmeterol (SM), comparativamente ao salbutamol (SB), em pacientes com asma leve e moderada. MÉTODOS: Após uma etapa de estabilização de duas semanas, os pacientes utilizaram salmeterol 50mcg duas vezes ao dia, e salbutamol 200mcg quatro vezes ao dia, durante o período de quatro semanas, seguindo um esquema duplo cego, aleatório, de grupos paralelos. Foram estudados 60 pacientes que preencheram os seguintes critérios de inclusão: VEF1(Volume Expiratório Forçado no 1º segundo) >50%; variação diurna do PFE (Pico do Fluxo Expiratório) > 15% ou resposta do VEF1 ao BD >15%, gradação de sintomas >2 (escala de 0 a 5 ) em quatro dos últimos sete dias. RESULTADOS: Dos 60 pacientes estudados, sete foram excluídos no período de tratamento (ver Métodos), sendo concluído o estudo com 25 pacientes no grupo salmeterol e 28 no grupo salbutamol. No período de estabilização, não houve diferença significante entre os grupos, comparando-se os valores de VEF1 em % do prev., PFE matinal, gradação de sintomas e gravidade da asma. O percentual de melhora do VEF1 e do PFE matinal nos pacientes que receberam salmeterol foi significantemente mais elevado entre 2 e 4 semanas de tratamento, em relação aos pacientes que receberam salbutamol (p<0,05). Da mesma forma, o grupo salmeterol apresentou redução significante nos valores médios dos sintomas no período noturno na 1º quinzena de tratamento. Em relação ao número de inalações de socorro utilizadas, efeitos colaterais, freqüência cardíaca, pressão arterial sistêmica e dosagem de potássio, não houve diferença significante entre os grupos. CONCLUSÃO: Este estudo demonstrou que, em pacientes com asma leve e moderada, o salmeterol na dose de 100mcg/dia elevou o VEF1, o PFE matinal e apresentou diminuição significantemente maior dos sintomas noturnos em relação aos observados no grupo salbutamol, e que a tolerância aos medicamentos estudados foi semelhante nos dois grupos.

B2-agonists are considered one of the cornerstones of the asthma therapy, but their short action requires frequent administration and an association with other broncodilators. The development of long-acting beta2-agonists may represent an important improvement in asthma treatment. PURPOSE: The present study was designed to assess the efficacy and safety of inhaled salmeterol compared to salbutamol in patients with mild-to-moderate asthma. METHODS: After the two run-in weeks, the patients received either salmeterol 50mg twice a day or salbutamol 200 mg four times a day, over a four week period, following a double blind, parallel group study. Sixty patients had the following inclusion criteria: FEV1 > 50% or PEFR over the past seven days >50% of predicted normal; reversibility of FEV1 >15%; symptoms scores >2 (score 0 and 5) in 4 of the last seven days or PEFR variation >15% . RESULTS: Seven patients discontinued the protocol (see methods). Of the 53 analyzable patients, 25 were of the salmeterol group and 28 of the salbutamol group. Our results showed that in the run-in period there were not differences among the groups comparing the values of FEV1 in % predicted, morning PEFR and asthma symptoms scores. The improvement rate of morning FEV1 and PEFR in patients who received salmeterol was significantly higher (p<0.05) compared to the patients who received salbutamol, for two and four weeks of treatment. Also, the salmeterol group have shown reduction of the symptoms in the nocturnal period(significantly in the first fortnight of treatment) demonstrated by the significative increase in the symptoms improvement rate when compared salmeterol and to salbutamol groups. The number of rescue medication inhaled, side effects, heart rate, blood pressure, serum potassium dosage and electrocardiograms, did no show significative differences between the groups. CONCLUSION:This study showed that in mild to moderate asthmatic patients, salmeterol in the dosage of 100mg/day raised the FEV1 and the morning PEF and led to pronounced decrease in the nocturnal symptoms as compared to salbutamol. The side effects were similar.