Resumen en Inglés:

ABSTRACT Objective: To describe the rates of adherence to the 2019 European Society of Cardiology guideline recommendations on the setting of care for patients with acute pulmonary embolism (PE) of varying severity. Methods: This was a retrospective cohort study of PE patients treated in a referral hospital in Colombia between 2019 and 2022. Results: We analyzed 506 patients with acute PE (median age, 67 years). Of those, 58% were women, and 33% had a history of cancer. In-hospital mortality was 9.2%, and 30-day mortality was 17.9%. Of the total of patients, 8.3% were classified as low-risk patients, 77.6% were classified as intermediate-low-risk patients, 11.2% were classified as intermediate-high-risk patients, and 2.7% were classified as high-risk patients. Of the total of low-risk patients, 9.5% were discharged early in accordance with the guideline recommendations. Of the total of intermediate-high-risk patients, 43.8% were treated in the general ward instead of being transferred to the ICU for monitoring. Of the total of high-risk patients, 92.8% were treated in the ICU. No cancer patients were discharged early. Conclusions: These results suggest that clinical practice guideline recommendations regarding the setting of care for patients with acute PE are not being followed. This is particularly true for low-risk PE patients who may be candidates for early discharge. Further studies are needed to investigate the reasons why low-risk patients are not being discharged early.

Resumen en Inglés:

ABSTRACT Objective: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis, which was recognized by the World Health Organization (WHO) as a global epidemic in 1993. TB is the leading infectious disease associated with silicosis, with studies showing an increased risk when compared to healthy individuals. We conducted an association study to evaluate the influence of polymorphisms in the ACE, FAM13A, FAS, FASLG, IL1RN, NOS2, TGFB1, and TNF genes on TB susceptibility. Methods: Nine polymorphisms were genotyped using Polymerase Chain Reaction (PCR) in a sample of 143 patients with silicosis in Rio de Janeiro (RJ), Brazil. Results: Seventy (49%) patients had a confirmed prior diagnosis of TB, of whom 25 (35.7%) had simple silicosis and 45 (64.3%) had complicated silicosis. The TG genotype of rs2609255 in FAM13A showed a protective effect against TB (OR=0.46; 95% CI: 0.22-0.98; p=0.040) compared to the GG genotype, and also when compared to the two combined homozygous genotypes (TT+GG) (OR=0.43; 95% CI: 0.20-0.90; p=0.024). Logistic regression analysis, including independent clinical variables, confirmed the protective effect of the TG genotype. Conclusion: This study suggests that the rs2609255 polymorphism in FAM13A may play a role in TB risk among patients with silicosis. Given the limited research on genetic polymorphisms and TB susceptibility in silicosis patients, further studies are needed to validate these findings.

Resumen en Inglés:

ABSTRACT Objective: To assess nicotine product use among incoming students at public and private universities in Brazil. Methods: This was a multicenter cross-sectional study including a convenience sample of incoming university students (≥ 18 years of age). Current use of conventional cigarettes, electronic cigarettes, and other nicotine products, as well as indicators of dependence and knowledge of the consequences of active use of or passive exposure to nicotine products were investigated with the use of a 38-item questionnaire. Descriptive statistics were used to analyze the data. Results: A total of 863 students completed the questionnaire. Of those, most (61%) were female, and most (76.6%) identified themselves as White. In addition, most (86%) were in the 18- to 24-year age bracket, and most (88.6%) attended a public university. In the past 30 days, 20.7% reported using electronic cigarettes, 23.2% reported using conventional cigarettes, and more than 50% reported using other nicotine products. More than 80% agreed that electronic cigarettes are harmful to health and are as damaging as other types of smoking. Over half of the respondents reported using the product shortly after waking up, and, paradoxically, 81% stated that they would quit whenever they wanted. Passive exposure was reported by 21.6%, occurring at home (in 33.6%), in other indoor environments (in 41.7%), and in open environments (in 87.5%). Conclusions: Experimentation and current use of nicotine products are high among incoming students at public and private universities in Brazil. Passive exposure to nicotine products is commonplace. Advanced communication tools are needed, particularly to emphasize the dangers of nicotine dependence. Being a legal drug, nicotine is often perceived as harmless, reinforcing the misconception that it can be used without consequences.

Resumen en Inglés:

ABSTRACT Objective: To evaluate the impact of the elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) combination on the small airways in adults with cystic fibrosis (CF), a genetic disorder that primarily affects the respiratory system, leading to progressive lung disease. In CF, the small airways play a critical role, contributing to chronic symptoms such as cough, sputum production, and dyspnea. Methods: This was a single-center, retrospective observational study of adults with CF treated with ELX/TEZ/IVA for 12 months. We compared the patients who were homozygous for the F508del mutation of the CF transmembrane conductance regulator (CFTR) gene with those who were heterozygous for that mutation, in terms of lung function outcomes (FEV1, FEF25-75%, and the RV/TLC ratio) and the extent of non-homogeneous ground-glass opacity. Among the patients within the cohort, the same parameters were evaluated separately in those who had advanced lung disease and in those who had previously undergone CFTR modulator therapy. Results: There was a significant post-treatment improvement in lung function, with a median increase of 0.42 L/s in the FEF25-75% (p < 0.001) and a 5% reduction in the mean RV/TLC ratio (p < 0.001). There was a trend toward a higher improvement the F508del homozygous patients. A significant reduction in non-homogeneous ground-glass opacity was observed in 79.5% of the patients. Among the patients with advanced lung disease, there were notable post-treatment improvements in all of the parameters assessed. Conclusions: Our results highlight the positive impact that ELX/TEZ/IVA treatment can have on small airway function in patients with CF, with potential benefits even for those with advanced lung disease. Further research is needed in order to evaluate the long-term effects of this treatment and its relationship with patient-reported outcomes.

Resumen en Inglés:

ABSTRACT Objective: To investigate the level of agreement between the GINA questionnaire and the Asthma Control Test (ACT) in children and adolescents with asthma, as well as to compare the clinical, laboratory, and spirometric characteristics of patients with controlled and uncontrolled asthma as assessed by the two questionnaires. Methods: Children and adolescents with asthma had their level of asthma control cross-sectionally assessed by the GINA questionnaire and the ACT, the Childhood ACT (C-ACT) being used for the children in the sample. The participating patients also underwent spirometry, clinical assessment (for passive smoking, asthma severity, medication use, and type of inhaler device used), and laboratory measurements of vitamin D levels, blood eosinophils, and total IgE. Results: A total of 76 patients were assessed. Of those, 62% were male, and the mean age was 10 [9-12] years. In addition, 42% and 20% were classified as having uncontrolled asthma by the GINA questionnaire and the C-ACT/ACT, respectively. There was moderate agreement between the two questionnaires regarding identification of controlled and uncontrolled asthma (k = 0.505; p < 0,0001). The patients classified as having uncontrolled asthma by the GINA questionnaire had worse results in terms of daily inhaled corticosteroid dose, asthma severity, passive smoking, and spirometric parameters (FVC, FEV1, and FEF25-75%). However, there was no significant difference between patients classified as having controlled or uncontrolled asthma by the C-ACT/ACT. Conclusions: In children and adolescents with asthma, the level of agreement between the GINA questionnaire and the C-ACT/ACT appears to be moderate. The GINA questionnaire appears to have a stronger association with functional parameters, indicating better clinical assessment with less underreporting of uncontrolled asthma.

Resumen en Inglés:

ABSTRACT Objective: Depression and anxiety have been documented in people with cystic fibrosis (CF), jeopardizing treatment adherence. To date, no studies have assessed the prevalence of psychosocial issues in adolescents with CF in Brazil. We sought to assess the prevalence of depression and anxiety in adolescents with CF in Brazil, as well as the impact of depression and anxiety on treatment adherence. Methods: This was a multicenter, prospective, observational, longitudinal study conducted between 2017 and 2019 at 14 CF referral centers in Brazil. We used standardized tools such as the nine-item Patient Health Questionnaire (for depression), the seven-item Generalized Anxiety Disorder scale (for anxiety), and the eight-item Morisky Medication Adherence Scale (for treatment adherence) in order to collect data on 218 CF patients at two different time points. Results: The prevalence of depression was 19.1% at time point 1 and 15.4% at time point 2. The prevalence of anxiety was 19.1% at time point 1 and 18.0% at time point 2. Depression and anxiety were significantly higher in female patients and lower in those who underwent home physiotherapy or had psychological support. Significant correlations were found between depression and anxiety at both time points, the associations being strongest at time point 1 (r = 0.68; p < 0.001). Most (66.7%) of the study participants reported low adherence to treatment, and the remainder reported either average adherence (in 28%) or high adherence (in 5.3%). Depression and anxiety showed inverse correlations with treatment adherence. Conclusions: The prevalence of depression and anxiety in adolescents with CF in Brazil appears to be similar to that reported in other countries, being higher in females and lower in those undergoing home physiotherapy or receiving psychological care. Depression and anxiety appear to correlate with lower treatment adherence. Treating psychosocial issues may effectively improve rates of treatment adherence in adolescents with CF.

Resumen en Inglés:

ABSTRACT Objective: To translate the Knowledge of, Attitude towards, and Preventive Behavior towards Tuberculosis questionnaire into Brazilian Portuguese and adapt it for use in Brazil. Methods: This methodological study followed internationally recommended guidelines for translation and cross-cultural adaptation. After permission was obtained from the original authors, the process of translation and cross-cultural adaptation began, including translation into Brazilian Portuguese by bilingual translators, synthesis of the translations, back-translation for similarity analysis, revision, and preparation of the final version. A pretest was conducted on 68 medical students. Results: Most of the questionnaire items showed strong content similarity, with minor semantic differences. The content validity index for the questionnaire was 0.882, and Cronbach’s alpha coefficients were 0.682, 0.809, and 0.613 for knowledge of tuberculosis, attitudes toward tuberculosis, and preventive behavior toward tuberculosis, respectively. Cronbach’s alpha and omega coefficients were a = 0.717, w1 = 0.673, w2 = 0.673, and w3 = 0.520. Conclusions: The process of translation and cross-cultural adaptation of the Knowledge of, Attitude towards, and Preventive Behavior towards Tuberculosis questionnaire was successful, making the Brazilian Portuguese version of the questionnaire reliable for reproducibility. It can be used in order to collect tuberculosis-related data and support changes in health education curricula.

Resumen en Portugués:

RESUMO O tromboembolismo venoso (TEV) é a terceira síndrome cardiovascular aguda atrás do infarto agudo do miocárdio e do acidente vascular encefálico. Nos últimos anos, observou-se o aumento da incidência de TEV relacionado ao envelhecimento populacional e às comorbidades mais comuns entre os idosos, como doenças cardiorrespiratórias crônicas e neoplasias. Por outro lado, a mortalidade relacionada à doença, em especial ao tromboembolismo pulmonar (TEP), mostra tendência de redução, o que pode ser explicado pelo ganho em capacidade diagnóstica, avanço nas terapias disponíveis e maior adesão a protocolos de manejo desses pacientes. Estas diretrizes têm como objetivo definir recomendações brasileiras para o tratamento do TEP, com base em evidências científicas e com foco em questões práticas e corriqueiras do atendimento médico. Foram elaboradas seis perguntas PICO [pacientes, intervenção, grupo comparador e outcome (desfecho)] por um grupo de especialistas brasileiros no tema. Foram feitas revisões sistemáticas da literatura para cada questão a partir de estudos clínicos randomizados, realizando-se meta-análises quando era possível metodologicamente. O nível de evidência dos trabalhos selecionados e a força das recomendações foram definidos de acordo com o sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). Com estas diretrizes, espera-se fornecer informações relevantes, atualizadas e com bases científicas sólidas para o tratamento do TEP.

Resumen en Inglés:

ABSTRACT Venous thromboembolism (VTE) is the third most common acute cardiovascular syndrome after acute myocardial infarction and stroke. In recent years, there has been an increase in the incidence of VTE, related to population aging and common comorbidities in the elderly, including chronic cardiorespiratory disease and cancer. On the other hand, disease-related mortality, particularly for pulmonary embolism (PE), shows a decreasing trend, which can be explained by improvements in diagnostic imaging, advances in available therapies, and greater adherence to patient management protocols. The guidelines presented here provide recommendations for the pharmacological treatment of PE in Brazil, on the basis of scientific evidence and with a focus on common practical issues. Six Patient, Intervention, Comparison, and Outcome questions were developed by a group of experts on the topic. Systematic reviews of randomized clinical trials were conducted for each question, with meta-analyses being performed when possible. The level of evidence and strength of recommendation were defined in accordance with the Grading of Recommendations Assessment, Development, and Evaluation approach. With these guidelines, we expect to provide relevant, up-to-date information on the pharmacological treatment of PE.