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The Glittre ADL-test is based on important and common activities of daily living (ADLs), and it is an useful test to objectively distinguish patients with and without self-reported functional limitations. This study aims to analyze if difficulty to perform ADLs, as self-reported by patients with COPD, would reflect a worse Glittre ADL-test performance. In the first visit, patients were evaluated for clinical and nutritional status, spirometry, maximal cardiopulmonary exercise test on a treadmill. One week later, the patients performed two Glittre ADL-tests. Maximal voluntary ventilation (MVV) and the VE

BACKGROUND: The Glittre activities of daily living (ADL) test is supposed to evaluate the functional capacity of COPD patients. The physiological requirements of the test and the time taken to perform it by COPD patients in different disease stages are not well known. The objective of this work was to compare the metabolic, ventilatory, and cardiac requirements and the time taken to carry out the Glittre ADL test by COPD subjects with mild, moderate, and severe disease. METHODS: Spirometry, Medical Research Council questionnaire, cardiopulmonary exercise test, and 2 Glittre ADL tests were evaluated in 62 COPD subjects. Oxygen uptake (VO2), carbon dioxide production, pulmonary ventilation, breathing frequency, heart rate, SpO2, and dyspnea were analyzed before and at the end of the tests. Maximum voluntary ventilation, Glittre peak VO2/cardiopulmonary exercise test (CPET) peak VO2, Glittre VE/maximum voluntary ventilation, and Glittre peak heart rate/CPET peak heart rate ratios were calculated to analyze their reserves. RESULTS: Subjects carried out the Glittre ADL test with similar absolute metabolic, ventilatory, and cardiac requirements. Ventilatory reserve decreased progressively from mild to severe COPD subjects (P CONCLUSIONS: As the degree of air-flow obstruction progresses, the COPD subjects present significant lower ventilatory reserve to perform the Glittre ADL test. In addition, metabolic and cardiac reserves may differentiate the severe subjects. These variables may be better measures to differentiate functional performance than Glittre ADL time.

BACKGROUND: No specific quality-of-life scale for stroke patients has previously been translated and evaluated for reproducibility, for use in the Portuguese language. Internationally, the instrument for this purpose is the Stroke Impact Scale 2.0 (SIS). Use of of SIS enables comprehensive analysis on the impact of mild and moderate stroke on patients’ lives. The aims here were to translate SIS into Portuguese, adapt it culturally, evaluate its reproducibility and correlate it with SF-36 among stroke patients. DESIGN AND SETTING: Translation and validation study. METHODS: The process of initial and retrograde translation was performed, in addition to cultural adaptation to the Brazilian language and culture. SIS was applied to 40 patients, who answered the questions three times. On the first day, the scale was applied twice by two independent researchers (to evaluate interobserver reproducibility). Fifteen days later, the scale was applied for a third time by another researcher (intraobserver reproducibility). The intraclass correlation coefficient (ICC) was used to measure the reproducibility of the SIS scale. RESULTS: The reproducibility of the whole scale was very good (ICC: 0.73 to 0.99). Intraobserver reproducibility in all domains was also very good (ICC: 0.85 to 0.95). Comparison of SIS with SF-36 showed that the domains of strength, mobility and activities of daily living (ADLs) correlated moderately with the functional capacity domain, as did the ADL domain with general health status. The other correlations were weak. The depression domain showed a moderate negative correlation with the memory and communication domains. CONCLUSION: The translation of the SIS 2.0 scale was easy to understand and it had good reproducibility among stroke patients.

Although the internet is an important tool for entertainment, work, learning, shopping, and communication, it is also a possible source for information on health and disease. The aim of this study was to evaluate the proportion of subjects with COPD in São Paulo, Brazil, who use the internet to obtain information about their disease.Subjects (N = 382) with COPD answered a 17-question survey, including information regarding computer use, internet access, and searching for sites on COPD. Our sample was distributed according to the socioeconomic levels of the Brazilian population (low, 17.8%; medium, 66.5%; and high, 15.7%).Most of the subjects in the sample were male (62.6%), with a mean age of 67.0 ± 9.9 y. According to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, 74.3% of the subjects were in stage II or III. In addition, 51.6% of the subjects had a computer, 49.7% accessed the internet, and 13.9% used it to search for information about COPD. The internet was predominantly accessed by male (70.3%) and younger (64.6 ± 9.5 y of age) subjects compared with female (29.7%, P = .04) and older (67.5 ± 9.6 y of age, P.007) subjects. Searching for information about COPD on the internet was associated with having a computer (5.9-fold), Medical Research Council dyspnea level 1 (5.3-fold), and high social class (8.4-fold). The search for information on COPD was not influenced by GOLD staging.A low percentage of subjects with COPD in São Paulo use the internet as a tool to obtain information about their disease. This search is associated with having a computer, low dyspnea score, and high socioeconomic level.

The aim of this study was to develop an efficient, low-cost, home-based pulmonary rehabilitation program and to evaluate the impact of the program on exercise as measured by the 6-min walk test (6MWT) and treadmill endurance test.Twenty-nine subjects with COPD (FEV1 = 62.4 ± 10.7% of predicted, 62.4 ± 10.7 y old) were included in a randomized and prospective pulmonary rehabilitation program, and they performed 24 sessions, 5 d/week. The control group included 15 subjects (FEV1 = 54 ± 26.2% of predicted, 65.3 ± 8 y old). They were evaluated pre-intervention and post-intervention by the 6MWT, St George Respiratory Questionnaire (SGRQ), treadmill endurance test, and spirometry. The home-based pulmonary rehabilitation program consisted of walking for 40 min along a corridor or a street, climbing stairs for 15 min, and exercising the arms with an oil can (1 kg) using diagonal movements for 15 min. Subjects were called once each week for encouragement and verification of adherence. Both groups received the usual pharmacologic treatment; in addition, the control group received a telephone call without guidance on exercise.The 2 groups were similar regarding age, FEV1, and FVC. The home-based pulmonary rehabilitation group increased by 65 m in the 6MWT (P.05) and 316.6 ± 81.8 m in the endurance test (P.05) and decreased by4 units in all SGRQ domains. The control group showed no difference in any variable.This study demonstrates that a simple, low-cost, home-based pulmonary rehabilitation program adapted to real-life situations leads to improvement in exercise capacity and quality of life.

OBJETIVO:Determinar a taxa de subdiagnóstico em novos casos de DPOC em uma amostra de pacientes após nove anos de seguimento do estudo Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO) e compará-la à taxa de subdiagnóstico obtida na fase inicial do estudo, assim como identificar as características clínicas dos indivíduos subdiagnosticados na fase de seguimento.MÉTODOS:A população desse estudo foi composta por 1.000 residentes na cidade de São Paulo que fizeram parte do estudo PLATINO. Desses, 613 indivíduos participaram da fase de seguimento. Os indivíduos foram avaliados utilizando-se os mesmos instrumentos e equipamentos na fase inicial do estudo. O teste do qui-quadrado ou o teste t para amostras independentes foi utilizado para analisar a taxa de subdiagnóstico e identificar as características dos indivíduos subdiagnosticados durante a fase de seguimento.RESULTADOS:A taxa de subdiagnóstico para novos casos da DPOC após nove anos de acompanhamento foi de 70,0%. A taxa de subdiagnóstico na fase de seguimento foi 17,5% menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento apresentavam poucos sintomas respiratórios, função pulmonar mais preservada e menor gravidade da doença do que aqueles previamente diagnosticados com DPOC.CONCLUSÕES:A taxa de subdiagnóstico na fase de seguimento foi menor que a da fase inicial do estudo. Os indivíduos subdiagnosticados na fase de seguimento do estudo PLATINO apresentavam o mesmo perfil clínico daqueles subdiagnosticados na fase inicial. Esses achados reforçam a necessidade da utilização da espirometria para o diagnóstico de DPOC e possibilitar a intervenção precoce. OBJECTIVE:To determine the underdiagnosis rate in new COPD cases at the end of a nine-year follow-up period-in the study designated Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO, Latin-American Pulmonary Obstruction Investigation Project)-and compare that with the underdiagnosis rate during the initial phase of the study, as well as to identify the clinical features exhibited by the subjects who were not diagnosed until the end of the follow-up phase.METHODS:The study population comprised the 1,000 residents of the city of São Paulo, Brazil, who took part in the PLATINO study. Of those, 613 participated in the follow-up phase, during which the subjects were assessed with the same instruments and equipment employed in the initial phase of the study. We used the chi-square test or the independent sample t-test to analyze the underdiagnosis rate and to identify the characteristics of the subjects who were not diagnosed until the end of the follow-up phase.RESULTS:The underdiagnosis rate for new COPD cases at the end of the nine-year follow-up period was 70.0%. The underdiagnosis rate during the follow-up phase was 17.5% lower than that reported for the initial phase of the study. The subjects who were not diagnosed until the end of the follow-up phase presented with fewer respiratory symptoms, better pulmonary function, and less severe disease than did those previously diagnosed with COPD.CONCLUSIONS:The underdiagnosis rate for new COPD cases was lower in the follow-up phase of the study than in the initial phase. The subjects who were not diagnosed until the end of the follow-up phase of the PLATINO study presented with the same clinical profile as did those who were not diagnosed in the initial phase. These findings underscore the need for spirometry in order to confirm the diagnosis of COPD and provide early intervention. Federal University of São Paulo Sao Camilo University Center Department of Physical Therapy Federal University of São Paulo Department of Pulmonology Instituto Nacional de Enfermedades Respiratorias Federal University of Pelotas School of Medicine Department of Clinical Medicine UNIFESP, Department of Pulmonology SciELO

BACKGROUND: Extubation failure is defined as the re-institution of respiratory support ranging from 24 to 72 hours following scheduled extubation and occurs in 2% to 25% of extubated patients. The aim of this study was to determine clinical and surgical risk factors that may predict extubation failure in patients submitted to non-emergency intracranial surgery. METHODS: This was a prospective observational cohort study. The study was carried out on 317 subjects submitted to nonemergency intracranial surgery for tumors, aneurysms, and arteriovenous malformation. Preoperative assessment was performed and subjects were followed up for the determination of extubation failure until either discharge from hospital or death. RESULTS: Twenty-six (8.2%) of the 317 subjects experienced extubation failure following surgery. The following variables were considered for the multivariate analysis: level of consciousness at the time of extubation, duration of mechanical ventilation prior to extubation, sex and the use of intraoperative mannitol. The multivariate analysis determined that the most important variable for extubation failure was the level of consciousness at the time of extubation (P .001), followed by female sex, which also showed to be significant (P .006). CONCLUSIONS: Lower level of consciousness (GCS 8T-10T) and female sex were considered risk factors for extubation failure in subjects submitted to elective intracranial

CONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action. CONTEXTO E OBJETIVO: Estudos têm demonstrado que alterações fisiopatológicas no sistema respiratório podem ocorrer após cirurgia torácica e abdominal. A laminectomia é considerada uma cirurgia periférica, mas é possível que as cirurgias de coluna torácica exerçam maior influência sobre a função pulmonar. O objetivo do estudo foi avaliar os volumes pulmonares e as pressões respiratórias máximas em pacientes submetidos a cirurgia de coluna cervical, torácica ou lombar. TIPO DE ESTUDO E LOCAL: Estudo prospectivo em hospital universitário terciário. MÉTODOS: Sessenta e três pacientes submetidos a laminectomia com diagnóstico tumor ou hérnia de disco foram avaliados. Foram avaliados, no pré-operatório, no primeiro e no segundo dias de pós-operatório, capacidade vital, volume corrente, volume por minuto e pressões respiratórias máximas. Possíveis associações entre as variáveis respiratórias e duração da cirurgia, diagnóstico cirúrgico e tabagismo foram investigadas. RESULTADOS: A capacidade vital e a pressão inspiratória máxima apresentaram redução no primeiro dia de pós-operatório (20.9% and 91.6%, respectivamente) nas cirurgias torácicas; P = 0,01), e a pressão expiratória máxima apresentou redução no primeiro dia de pós-operatório de cirurgia cervical (15.3%; P = 0,004). A incidência de complicações pulmonares foi de 3,6%. CONCLUSÕES: Houve redução da capacidade vital e das pressões respiratórias máximas no período pós-operatório em pacientes submetidos a laminectomia. A cirurgia na região torácica apresentou associação com maiores reduções na capacidade vital e na pressão inspiratória máxima em comparação com a cirurgia cervical e lombar. Assim, a manipulação cirúrgica da região torácica parece ter maior influência na função pulmonar e na ação dos músculos respiratórios.

OBJECTIVE: To evaluate the impact of asthma on activities of daily living and on health status in patients with controlled, partially controlled, or uncontrolled asthma in Brazil. METHODS: We used data related to 400 patients in four Brazilian cities (São Paulo, Rio de Janeiro, Salvador, and Curitiba), obtained in a survey conducted throughout Latin America in 2011. All study subjects were > 12 years of age and completed a standardized questionnaire in face-to-face interviews. The questions addressed asthma control, hospitalizations, emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. The level of asthma control was determined in accordance with the Global Initiative for Asthma criteria. RESULTS: Among the 400 respondents, asthma was controlled in 37 (9.3%), partially controlled in 226 (56.5%), and uncontrolled in 137 (34.2%). The numbers of patients with uncontrolled or partially controlled asthma who visited the emergency room, who were hospitalized, and who missed school/work were higher than were those of patients with controlled asthma (p = 0.001, p = 0.05, and p = 0.01, respectively). Among those with uncontrolled asthma, the impact of the disease on activities of daily living, sleep, social activities, and normal physical exertion was greater than it was among those with controlled or partially controlled asthma (p < 0.001). CONCLUSIONS: In Brazil, asthma treatment should be monitored more closely in order to increase treatment adherence and, consequently, the level of asthma control, which can improve patient quality of life and minimize the negative impact of the disease. OBJETIVO: Avaliar o impacto da asma nas atividades da vida diária e na saúde em pacientes com asma controlada, parcialmente controlada ou não controlada no Brasil. MÉTODOS: Foram utilizados dados de 400 pacientes de quatro cidades brasileiras (São Paulo, Rio de Janeiro, Curitiba e Salvador) obtidos em um inquérito realizado em países da América Latina em 2011. Todos os indivíduos do estudo tinham idade > 12 anos e responderam a um questionário padronizado por meio de entrevista presencial. As questões abordavam o controle da asma, número de hospitalizações, de consultas de urgência, absenteísmo na escola/trabalho e impacto da asma na qualidade de vida, sono e lazer. O nível de controle da asma foi verificado segundo os critérios da Global Initiative for Asthma. RESULTADOS: Entre 400 entrevistados, a asma estava controlada em 37 (9,3%); parcialmente controlada, em 226 (56,5%); e não controlada, em 137 (34,2%). O número de pacientes com asma não controlada ou parcialmente controlada que apresentaram hospitalizações, visitas ao pronto-socorro e faltas na escola/trabalho foi maior do que o daqueles com asma controlada (p = 0,001, p = 0,05 e p = 0,01, respectivamente). Os participantes com asma não controlada apresentaram um maior impacto da doença em atividades da vida diária, sono, atividades sociais e esforço físico normal do que aqueles com asma parcialmente controlada ou controlada (p < 0,001). CONCLUSÕES: Medidas terapêuticas devem ser mais intensamente adotadas em nosso país para melhorar o controle da asma e estimular a aderência ao tratamento. Isso, seguramente, proporcionará uma melhor qualidade de vida aos pacientes e uma redução do impacto negativo da doença.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: Patients with chronic obstructive pulmonary disease (COPD) have some limitations during activities of daily living that involve the arms. There is little information on the benefits of shoulder girdle training and its repercussions for activities of daily living in patients with COPD. the purpose of this study was to investigate whether shoulder girdle training with diagonal movements increases upper limb muscle strength and improves performance of activities of daily living in patients with COPD.Methods: Thirty-five patients with moderate to severe COPD (forced expiratory volume in one second 1.22 +/- 0.49 L) and aged 36-80 years were recruited. Endurance time, maximal sustained weight, oxygen saturation, heart rate, respiratory rate, dyspnea, and arm fatigue were evaluated during an incremental upper limb test and eight simulated activities of daily living before and after an 8-week exercise training program.Results: A significant gain was observed for upper limb strength (P < 0.05). At the peak of the upper limb incremental test, the respiratory rate dropped from 33 to 27 breaths per minute, the Borg dyspnea score decreased from 2 to 0.5, and the upper limb fatigue score decreased from 3 to 2 (P < 0.05). No change was seen in any of these parameters during performance of activities of daily living.Conclusion: Although shoulder girdle training increased upper limb strength, no improvement was detected in performance of activities of daily living. Universidade Federal de São Paulo, Pulm Rehabil Ctr, Assoc Assistencia Crianca Deficiente Unifesp AACD, São Paulo, Brazil Universidade Federal de São Paulo, Pulm Rehabil Ctr, Assoc Assistencia Crianca Deficiente Unifesp AACD, São Paulo, Brazil Web of Science

CONTEXT AND OBJECTIVE There are no reports on reintubation incidence and its causes and consequences during the postoperative period following elective intracranial surgery. The objective here was to evaluate the incidence of reintubation and its causes and complications in this situation. DESIGN AND SETTING Prospective cohort study, using data obtained at a tertiary university hospital between 2003 and 2006. METHODS 169 patients who underwent elective intracranial surgery were studied. Preoperative assessment was performed and the patients were followed up until hospital discharge or death. The rate of reintubation with its causes and complications was ascertained. RESULTS The incidence of reintubation was 12.4%, and the principal cause was lowered level of consciousness (71.5%). There was greater incidence of reintubation among females (P = 0.028), and greater occurrence of altered level of consciousness at the time of extubation (P < 0.0001). Reintubated patients presented longer duration of mechanical ventilation (P < 0.0001), longer stays in the intensive care unit (ICU) and in the hospital (P < 0.0001), greater incidence of pulmonary complications (P < 0.0001), greater need for reoperation and tracheostomy, and higher mortality (P < 0.0001). CONCLUSION The incidence of reintubation in these patients was 12.4%. The main cause was lowering of the level of consciousness. Female gender and altered level of consciousness at the time of extubation correlated with higher incidence of reintubation. Reintubation was associated with pulmonary complications, longer durations of mechanical ventilation, hospitalization and stay in the ICU, greater incidence of tracheostomy and mortality. CONTEXTO E OBJETIVO Não há relatos sobre incidência de reintubação, suas causas e consequências no pós-operatório de cirurgia intracraniana eletiva. O objetivo foi avaliar a incidência de reintubação, suas causas e complicações em pós-operatório de cirurgia intracraniana eletiva. TIPO DE ESTUDO E LOCAL Estudo de coorte prospectivo, com dados que foram obtidos de 2003 a 2006 em um hospital universitário terciário. MÉTODO 169 pacientes submetidos a cirurgia intracraniana eletiva foram estudados. Foi realizada avaliação pré-operatória e os pacientes foram acompanhados até a alta hospitalar ou óbito, verificando a taxa de reintubação, suas causas e complicações. RESULTADOS A incidência de reintubação foi de 12,4% sendo a principal causa o rebaixamento do nível de consciência (71,5%). Houve maior incidência de reintubação no sexo feminino (P = 0,028), bem como do nível de consciência alterado no momento da extubação (P < 0,0001). Pacientes reintubados apresentaram maior tempo de ventilação mecânica (P < 0,0001) e de internação em unidade de terapia intensiva (UTI) e hospitalar (P < 0,0001), maior incidência de complicações pulmonares (P < 0,0001), maior necessidade de reoperação e traqueostomia, além de aumento de mortalidade (P < 0,0001). CONCLUSÃO A incidência de reintubação nesses pacientes foi de 12,4%. A principal causa da reintubação foi o rebaixamento do nível de consciência. O sexo feminino e nível de consciência alterado no momento da extubação foram relacionados à maior incidência de reintubação. A reintubação foi associada a complicações pulmonares, maior tempo de ventilação mecânica, de internação e de permanência na UTI, maior incidência de traqueostomia e mortalidade.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) CONTEXTO E OBJETIVOS: A avaliação da qualidade de vida dos pacientes com tumor cerebral é importante, considerando que novos tratamentos têm aumentado sua sobrevida. O objetivo deste trabalho foi traduzir o questionário Functional Assessment of Cancer Therapy-Brain (FACT-Br) (versão 4) para a língua portuguesa, realizar a adaptação cultural e avaliar sua reprodutibilidade. DESIGN E LOCAL: Estudo de coorte realizado na Universidade Federal de São Paulo (UNIFESP). MÉTODO: Quarenta pacientes com tumor cerebral provenientes do Ambulatório de Neuro-oncologia participaram do estudo. O processo de tradução inicial e retrógrada foi realizado, além da adaptação cultural para a língua e cultura brasileira. O coeficiente de correlação intraclasse (CCI) foi utilizado para testar a reprodutibilidade do FACT-Br (versão 4). RESULTADOS: A reprodutibilidade do questionário foi excelente (CCI = 0,95; intervalo de confiança, IC 95% 0,89-0,97). O CCI com intervalo médio de 15 dias entre aplicações do questionário, em todos os domínios, foi muito bom (CCI = 0,87 a 0,95). O tempo médio de resposta ao questionário foi de 6,27 minutos ± 2,26 minutos, variando de 3 minutos a 11 minutos. CONCLUSÃO: A tradução e a adaptação à língua e à cultura brasileira do questionário FACT-Br (versão 4) mostrou-se de fácil entendimento e com muito boa reprodutibilidade em pacientes com diagnóstico de tumor cerebral. CONTEXT AND OBJECTIVE: Quality of life assessment among patients with brain tumors is important, given that new treatments have increased patient survival. The aim of this study was to translate the Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaire (version 4) into Portuguese, carry out cross-cultural adaptation and assess its reproducibility. DESIGN AND SETTING: Cohort at the Universidade Federal de São Paulo (UNIFESP). METHODS: Forty patients with a brain tumor seen at the neuro-oncology outpatient clinic participated in the study. The process of translation and back-translation was carried out, along with adaptation to the Portuguese language and Brazilian culture. The intraclass correlation coefficient (ICC) was used to test the reproducibility of the FACT-Br (version 4). RESULTS: The reproducibility of the questionnaire was excellent (ICC = 0.95; 95% confidence interval, CI: 0.89-0.97). The ICC with a mean interval of 15 days between applications of the questionnaire was very good in all domains (ICC = 0.87 to 0.95). The mean time taken to answer the questionnaire was 6.27 ± 2.26 minutes, ranging from 3 to 11 minutes. CONCLUSION: The translated version of the FACT-Br questionnaire (version 4) adapted to the Portuguese language and Brazilian culture proved to be easily understood and achieved very good reproducibility among patients with diagnoses of brain tumors. Universidade Federal de São Paulo (UNIFESP) Respiratory Division Neurosurgery Physiotherapy Research Group Universidade Federal de São Paulo (UNIFESP) Neurology Division Universidade Federal de São Paulo (UNIFESP) Physiotherapy Department Universidade Federal de São Paulo (UNIFESP) Respiratory Division UNIFESP Pulmonary Rehabilitation Center Lar Escola São Francisco UNIFESP, Respiratory Division Neurosurgery Physiotherapy Research Group UNIFESP, Neurology Division UNIFESP, Physiotherapy Department UNIFESP, Respiratory Division UNIFESP, Pulmonary Rehabilitation Center SciELO

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.

Spirometry is the gold standard for diagnosing chronic obstructive pulmonary disease (COPD). Although there are a number of different guideline criteria for deciding who should be selected for spirometric screening, to date it is not known which criteria are the best based on sensitivity and specificity. Firstly, to evaluate the proportion of subjects in the PLATINO Study that would be recommended for spirometry testing according to Global initiative for Obstructive Lung Disease (GOLD)-modified, American College of Chest Physicians (ACCP), National Lung Health Education Program (NLHEP), GOLD and American Thoracic Society/European Respiratory Society (ATS/ERS) criteria. Secondly, we aimed to compare the sensitivity, specificity, and positive predictive and negative predictive values, of these five different criteria. Data from the PLATINO study included information on respiratory symptoms, smoking and previous spirometry testing. The GOLD-modified spirometry indication criteria are based on three positive answers out of five questions: the presence of cough, phlegm in the morning, dyspnoea, age over 40 years and smoking status. Data from 5,315 subjects were reviewed. Fewer people had an indication for spirometry (41.3%) according to the GOLD-modified criteria, and more people had an indication for spirometry (80.4%) by the GOLD and ATS/ERS criteria. A low percentage had previously had spirometry performed: GOLD-modified (14.5%); ACCP (13.2%); NLHEP (12.6%); and GOLD and ATS/ERS (12.3%). The GOLD-modified criteria showed the least sensitivity (54.9) and the highest specificity (61.0) for detecting COPD, whereas GOLD and ATS/ERS criteria showed the highest sensitivity (87.9) and the least specificity (20.8). There is a considerable difference in the indication for spirometry according to the five different guideline criteria. The GOLD-modified criteria recruit less people with the greatest sum of sensitivity and specificity. A new study reveals the most useful criteria for indicating spirometry testing in patients with chronic obstructive pulmonary disease (COPD). Spirometry, which assesses lung function by measuring how much air is inhaled and how quickly it is exhaled, is the most accurate diagnostic test for COPD but there are different criteria indicating its use. An international group of researchers led by Jose R. Jardim, Universidade Federal de Sao Paulo, Brasil, evaluated the proportion of individuals from a 5,315-patient study carried out in Latin America that met criteria for spirometry testing according to five different guidelines. They found that the modified GOLD (Global Initiative for COPD) criteria, which consider symptoms and history of flare-ups as well as the degree of airflow obstruction, are the most sensitive and specific for diagnosing COPD.

Objectives: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.