RESUMO
PURPOSE AND METHODS: Cognitive behavior therapy (CBT) constitutes the basis of smoking cessation programs. Quitting rates are usually increased by the concomitant use of CBT and pharmacotherapy. There are studies showing the efficacy of bupropion and nortriptyline compared to placebo, but there is just one published comparison between these drugs, unfortunately with low power to detect significant differences. This study was designed to compare the efficacy of bupropion, nortriptyline and placebo in a group of smokers who also received intensive counseling therapy. We conducted a double blind, double-dummy, placebo-controlled trial for smoking cessation that lasted 9 weeks. Patients were randomized to receive nortriptyline 75 mg/day (52 subjects), bupropion 300 mg/day (53 subjects) or placebo (51 subjects). All smokers also received the same intensive cognitive behavior therapy. The target day for quitting smoking was usually day 10. Intensive counseling was provided at baseline, weekly during treatment, and at 10, 13, 16, 20 and 26 weeks. Abstinence was defined as continuous when the subject was not smoking since the target-quitting day (self-report) and had an expired carbon monoxide concentration of 10 ppm or less. RESULTS: The sustained abstinence rates at 6 months were 21.6% in the placebo group, 30.8% in the nortriptyline group (p = 0.40), and 41.5% in the bupropion group (p = 0.05). The odds ratio was not statistically different for smokers using nortriptyline or bupropion (OR 1.60; 95% CI 0.66-3.86; p = 0.35). The most common adverse events were dry mouth and drowsiness in the nortriptyline group and dry mouth and insomnia in the bupropion group. CONCLUSIONS: Treatment with CBT + bupropion resulted in a better 6-month rate of smoking cessation compared to CBT+nortriptyline or CBT + placebo. Abstinence rate in the nortriptyline group was not statistically different from patients in the bupropion or placebo group.
Assuntos
Bupropiona/uso terapêutico , Preparações de Ação Retardada/administração & dosagem , Nortriptilina/uso terapêutico , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Inibidores da Captação Adrenérgica/administração & dosagem , Inibidores da Captação Adrenérgica/efeitos adversos , Inibidores da Captação Adrenérgica/uso terapêutico , Bupropiona/administração & dosagem , Aconselhamento , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nortriptilina/administração & dosagem , Nortriptilina/efeitos adversos , Fases do Sono/efeitos dos fármacos , Fumar/psicologia , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Síndrome de Abstinência a Substâncias/fisiopatologia , Síndrome de Abstinência a Substâncias/psicologia , Fatores de Tempo , Resultado do Tratamento , Xerostomia/induzido quimicamenteRESUMO
OBJECTIVE: To evaluate the stable microbubble test (SMT) ability to select candidates for surfactant prophylaxis for respiratory distress syndrome (RDS). STUDY DESIGN: We followed patients treated according to a new routine for surfactant prophylaxis based on the SMT to determine timing of the initial dose of surfactant, proportion of infants using surfactant, and the predictive value of the SMT. Gastric secretions were collected after birth. Newborns with < 25 microbubbles (MB)/mm(2) received prophylactic surfactant. Surfactant was given only after confirmation of RDS (rescue therapy) to newborns with > or =25 MB/mm(2). RESULTS: Fifty-four (55%) had a low MB count and received prophylactic surfactant. Three out of 44 infants with a high MB count required rescue therapy (negative predictive value 93%; CI:81.3-98.6%). The median interval and interquartile range between surfactant administration and birth in the prophylaxis group was 20 (17-27) minutes. Surfactant was used in 23 of 28 (82%) infants born at < 28 weeks of gestation and in 34 of 70 (49%) infants between 28 and 31 weeks. CONCLUSIONS: The SMT may be useful to determine surfactant prophylaxis (< 30 min after birth). This approach may reduce costs and the number of unnecessary interventions.
Assuntos
Suco Gástrico/química , Microbolhas , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Valor Preditivo dos Testes , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/estatística & dados numéricos , Fatores de Tempo , Resultado do TratamentoRESUMO
Descreve-se um caso de histiocitose pulmonar de células de Langerhans com relação estreita entre cessação do tabagismo e melhora radiológica. A tomografia computadorizada de alta resolução revelava múltiplos nódulos pequenos localizados em lobos superiores e campos médios de ambos os pulmões. O exame microscópico dessas lesões mostrava infiltração histiocitária, que se corava fortemente pela proteína S100. Apesar de a remissão espontânea poder ser uma possível explicação para essa evolução, este relato de caso mostra um rápido desaparecimento das lesões após o abandono do tabagismo.
Assuntos
Humanos , Masculino , Adulto , Histiocitose de Células de Langerhans/patologia , Remissão Espontânea , Abandono do Uso de Tabaco , Biópsia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: A possible association had previously been noted between gender and prognosis in non-small cell lung cancer (NSCLC), with a better survival rate for women. OBJECTIVE: The purpose of the current study was to further clarify the role of gender as a possible prognostic factor in NSCLC. METHODS: This retrospective cohort study examined the survival of NSCLC patients who underwent surgical curative treatment at the Hospital Sao Lucas da PUCRS, Porto Alegre, Brazil, between January 1, 1990, and December 31, 2000. Data were analyzed using Kaplan-Meier survival curves. In addition, a Cox proportional hazards regression model was used to adjust for potential confounding factors. RESULTS: In the period studied, lung resections were performed in 253 patients with NSCLC, of whom 114 had stage I tumors. Four patients were excluded because of death in the immediate postoperative period, and 1 committed suicide. The 5-year survival rate was 85.5% for women and 46.4% for men (P<0.0001). The median overall survival time was 44.7 months (interquartile range [IQR(25%-75%)], 17.4-72.3 months) and was longer in women than in men: 63.9 months (IQR(25%5%), 35.2-98.7 months) versus 32.3 months (IQR(25%-75%), 11.8-61.5 months), respectively (P<0.0001). Gender effect was still present after adjustment by Cox regression for several factors (age, smoking habits, hemoglobin, forced expiratory volume in 1 second, tumor size, tumor-node-metastasis stage, histology, postoperative complications, and surgery type). The adjusted hazard ratio in women was 0.23 (95% CI, 0.09-0.59; (P<0.0001) when compared with men. CONCLUSION: This study confirms previous findings that women live longer than men after surgery for stage I NSCLC. This effect persisted after adjusting for several factors. These results highlight the fact that analyses of long-term survival of NSCLC patients, usually generalized to men and women as a whole, may be an inadequate extrapolation. These results question whether analyses of long-term survival, which commonly group men and women together, provide an adequate prognosis of survival rates in women with NSCLC.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/mortalidade , Brasil/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Taxa de SobrevidaRESUMO
O objetivo deste artigo é avaliar o rendimento diagnóstico da Reação em Cadeia da Polimerase (PCR) em infecções respiratórias pelo Streptococcus pneumoniae em amostras de escarro. Foram analisadas 100 amostras de escarro de pacientes com infecção respiratória através dos métodos bacteriológicos convencionais (coloração de Gram e cultura) e da PCR para detecção do gene lytA do S. pneumoniae. Como grupo controle, swabs de orofaringe de 40 indivíduos saudáveis foram coletados e também submetidos à PCR. A identificação do pneumococo pelos métodos tradicionais ocorreu em 14 casos (14%). A PCR detectou 13 casos e mais 9 casos adicionais (22%). No grupo controle, a PCR deu resultados positivos em apenas 2 casos (5%), o que foi significativamente menos comum em comparação com os pacientes infectados (p < 0,05). Nossos achados demostram que a PCR aumenta o rendimento diagnóstico obtido pela coloração de Gram e a cultura e potencialmente pode ser usada para testar amostras clínicas de escarro.
Assuntos
Humanos , Masculino , Feminino , Escarro , Infecções Pneumocócicas , Infecções Respiratórias , Reação em Cadeia da Polimerase , Streptococcus pneumoniaeRESUMO
O estudo apresenta tabelas contendo valores relativos ao pico de fluxo expiratório (PFE) obtidos com o medidor miniWright em 1037 escolares saudáveis com idades entre 10 e 18 anos oriundos da rede pública estadual, localizada em uma área restrita e näo poluida da cidade de Porto Alegre. As equaçöes de regressäo calculadas foram, para o sexo feminino: 2,75 x altura + 2,34 x Idade - 80,12 e, para o sexo masculino: 3,,5 x Altura + 11,96 x Idade - 312,87