The study verified the relationship between the gender in the composition of the board of directors and the audit committee with the audit delay. The survey sample consisted of 75 companies belonging to the IBrX 100 index. The variables surveyed were the presence of women on the board of directors and on the audit committee, size of the audit committee, independence of the board of directors, expertise, company size, debt, size of the audit firm and audit fees. Data collection took place in the Reference Form and the Economática® database. Data analysis was performed using descriptive statistics and multiple linear regression using SPSS® software. It was found that the presence of women is greater on the board than on the audit committee, with a small number of experienced members. The results showed that the presence of women on the audit committee has a negative and significant association with the audit delay, that is, the presence of women in this organism of corporate governance contributes to the reduction of the period of disclosure of the auditor's report. In addition, the size of the company and the independence of the board of directors were also important in the final model in relation to the audit delay. The presence of women on the board of directors was not significant with the delay in the audit.
The bronchogenic cyst is a common congenital malformation, generally located in the mediastinum; however, it can develop in other areas, such as the diaphragm. A rare case of intradiaphragmatic bronchogenic cyst is described here, discovered in a 32 year-old patient, who experienced thoracic pain and dyspnea following thoracic trauma. The pre-operative exams were compatible with left diaphragmatic hernia. The patient was submitted to a left post-lateral thoracotomy with the operative discovery of a cystic lesion enveloped by the diaphragm with mucinous content, and a partial resection of the diaphragm was performed. The histological findings of the operated portion revealed ciliated cylindrical epithelium, compatible with bronchogenic cysts. The post-operative outcome was excellent.
INTRODUÇÃO: O Mycobacterium kansasii é uma micobactéria não tuberculosa que pode causar colonização ou infecção pulmonar. OBJETIVO: Relatar experiência com doença pulmonar causada pelo M. kansasii em uma série de seis pacientes diagnosticados ao longo de cinco anos. MÉTODO: Entre junho de 1995 e junho de 2000 foram admitidos 1.349 pacientes no Dispensário do Ipiranga Ari Nogueira da Silva-Sanatorinhos, com o diagnóstico de tuberculose pulmonar, dos quais seis tiveram cultura positiva para M. kansasii. RESULTADOS: Cinco pacientes eram homens e a idade variou entre 25 e 77 anos. Todos apresentavam pneumopatia crônica e eram sintomáticos respiratórios com teste negativo para síndrome de imunodeficiência humana. As radiografias de tórax eram compatíveis com a presença de doença pulmonar prévia: cavidades de paredes finas foram notadas em todos e espessamento pleural subjacente às cavidades foi observado em dois pacientes. Todos foram tratados inicialmente com isoniazida, rifampicina, pirazinamida (INH-RMP-PZA) e etambutol (EMB) foi introduzido precocemente em dois pacientes por intolerância à pirazinamida, enquanto que em outros dois a introdução foi feita ao ser conhecido o resultado da cultura. Todos os pacientes foram tratados por mais de nove meses, tendo sido observada recidiva em um deles. Um paciente com silicose faleceu após dois anos por insuficiência respiratória, depois de ter sido considerado curado. CONCLUSÕES: A micobacteriose por M. kansasii foi encontrada com baixa freqüência, podendo estar relacionada às características dos pacientes encaminhados ao nosso serviço. O esquema INH-RMP-PZA, com substituição eventual da PZA por etambutol, mostrou sucesso terapêutico.
O leflunomide é uma droga anti-reumática com ação imunomoduladora. Pneumonia intersticial granulomatosa nunca foi descrita com o uso de leflunomide. Relata-se o caso de uma mulher de 33 anos que apresentou dor torácica, emagrecimento e síndrome infecciosa respiratória no quinto mês de monoterapia com leflunomide para artrite reumatóide, progredindo para insuficiência respiratória no sexto mês. A radiografia de tórax revelou infiltrado pulmonar intersticial e alveolar bilateral predominando em lobos superior e médio, micronódulos esparsos e ausência de alterações mediastinais. Suspendeu-se o leflunomide. Após a resolução da infecção persistiram lesões intersticiais retículo-nodulares predominantemente na periferia dos terços superiores do pulmão direito e terço médio do pulmão esquerdo, entremeadas por padrão de vidro fosco em lobos superiores. Biópsia pulmonar a céu aberto revelou granulomas tuberculóides sem necrose central. Foi realizada extensa investigação etiológica, que resultou negativa. Ocorreu resolução espontânea do quadro após quatro meses. O quadro sugere que as manifestações pulmonares neste caso foram causadas pelo leflunomide.
INTRODUCTION: A great emphasis has been placed on health-related quality of life of COPD patients and specific questionnaires have been developed in order to measure it. OBJECTIVE: This study describes the language and cultural adaptation of a new (and short) disease-specific health status questionnaire developed for chronic obstructive pulmonary diseases: the Airways Questionnaire 20 (AQ20). METHODS: In order to validate this questionnaire in Brazil, it was initially translated into Portuguese. The cultural adaptation was taken into consideration and then a back translation to English was undertaken, in order to obtain a final Portuguese version. Correlations were made with FEV1, SpO2, BMI and another disease-specific health status questionnaire, the Saint George Respiratory Questionnaire (SGRQ), previously validated in Brazil. The interclass correlation ratio was done to test the reproducibility of AQ20. RESULTS: The interclass correlation ratio for the total score was a = 0.90 (intra-observer variability) and a = 0.93 (inter-observer variability) (p < 0.05 for both). The correlation with total SGRQ score was 0.76, with p < 0.001. The average time to answer the AQ20 was 4 min and 6 s. CONCLUSION: The Brazilian Portuguese version of AQ20 is reproducible, of fast application and with good a correlation with SGRQ total score, which makes it a valid questionnaire to measure health status in obstructive patients in Brazil.
A male farmer, 20 years old, from the countryside of the State of Piauí, developed acute respiratory infection. Despite adequate antimicrobial therapy, his conditions worsened, requiring mechanical ventilation. His X-rays showed diffuse pulmonary infiltrates. His PaO2/FiO2 ratio was 58. Direct microscopy and culture of tracheal aspirates showed the presence of Coccidioides immitis. Autochthonous cases of coccidioidomycosis have only recently been described in Brazil, most of them from the State of Piauí. C. immitis has been isolated from humans, dogs and armadillos (Dasypus novemcinctus), and also from soil samples of armadillo's burrows. Failure to respond to antimicrobial therapy and a patient's origin from recognized endemic areas should alert to the possibility of acute pulmonary coccidioidomycosis.
Hipertensão pulmonar grave é uma doença debilitante, com expectativa de vida reduzida, que acomete adultos jovens. Complicações pleuropulmonares no lúpus eritematoso sistêmico ocorrem em 50% a 70% dos pacientes. A hipertensão pulmonar grave no lúpus eritematoso sistêmico é rara e tem prognóstico reservado. Descreve-se, pela primeira vez, um paciente com hipertensão pulmonar grave associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio secundário que apresentou boa resposta ao uso do sildenafil oral, após falha do tratamento convencional com corticosteróides, ciclofosfamida, warfarin e diltiazem.
Chronic obstructive pulmonary disease (COPD) is a public health problem. Tobacco smoking is the major cause, but not the only one. Air pollution, exposure to chemicals, environmental smoke exposure, and passive smoking are among other contributing causes; being viral and bacterial infections also risk factors. Gender and weight are associated to the severity of the disease. Co-morbidity is frequent. OBJECTIVE: To characterize a population of COPD outpatients followed at an outsourced medical service. METHODS: Questionnaires were applied to patients with COPD. The data included gender, age, weight, body mass index (BMI), oxygen delivery users, and FEV1, exposure to tobacco smoke, exposure to wood smoke, history of tuberculosis and co-morbid diseases. RESULTS: Of the 70 patients enrolled in the study, 70% (49) were men with an average age of 64 ± 10 years, average weight of 63 ± 16 kg and average BMI of 22 ± 5 kg/m². Mean FEV1 was 35 ± 14% and 45.7% were oxygen dependent. Nine (12.8%) patients never smoked, while 78.8% had quit tobacco smoking, (38 ± 11 pack/years was the average). Nine (12.8%) smoked corn husk cigarettes. Eighteen (25.7%) were exposed to wood smoke. Eleven (15.7%) patients had tuberculosis, 5.7% complained of asthma symptoms, 2.8% had bronchiectasis, 11.4% diabetes mellitus, 51.4% hypertension, and 20% Cor pulmonale. CONCLUSION: Other possible COPD etiologies must be investigated. Determinants of the pulmonary injury could be environmental smoke exposure associated to former infections. Men with low BMI are typically representative of this severe patient population. Hypertension and Cor Pulmonale are frequent co-morbidity factors.
OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59%) boys, ages ranging from nine months to nine years (median = 23 months). In 32 (94%) children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%). A clinical history of foreign body inhalation was obtained in 27 (80%) cases. Most of the foreign bodies removed were organic (65%) and more frequently found in the right bronchial tree (59%). Foreign bodies were removed within 24 hours in 18 (53%) cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%), and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.
Tuberculosis compulsory treatment:advancement or retrogression?Considering that tuberculosis (Tb) still kills approximately 3 million people per year in the world and it is the third infectious disease in the number of people killed, several reflections are valid to improve the drop-outs, which are the main problem of the programs of tuberculosis control, since the treatment schedules currently available are highly efficient.Since 1993, tuberculosis control was pointed out as a worldwide emergency situation by the World Health Organization (WHO).Goals were established to cure 85% of the new cases, to diagnose 70% of the new patients in 2005 and to reduce the mortality in 50% in 2010.In 1963, Fox (1) , admitted that the regularity and efficacy of the schedule used were of major importance, and Addington (2) , in 1979 considered treatment drop-out as the most severe problem in tuberculosis control.WHO recommends the administration of medicines by means of directly observed therapy (DOT), i.e., observing the patient swallowing the medication.Later on, according to local conditions, this WHO method was transformed into DOTS strategy (directly observed therapy short-course), which should be adapted to each particular local condition (3,4) .Therefore DOTS strategy should fulfill five basic rules: 1) government involvement with Tuberculosis Program/trained and interested working team, 2) laboratory net with equipment and qualified human resources (BAAR research), 3) to administer and observe the patient swallowing the medication, 4) supply of free medication for treatment (including rifampicin), 5) information system to monitor the cases, their treatment, evolution and results (3,5,6) .DOTS experience in NY, from 1992 to 1995, showed a substantial improvement in the local tuberculosis control program, reducing the incidence of new cases in 35% and the incidence of multi-resistant tuberculosis cases in 75%, with a cost of approximately 40 million dollars to treat 3.000 patients (7,8) .DOTS-related and autoadministrated treatment cost analyses showed the advantage of DOTS, taking into consideration the early reduction of transmission, increased number of cured cases, early detection of drop-outs and reduction of cases of multiresistant tuberculosis (9,10) .Dots treatment quickly spread to other states in the U.S.However, even placing almost 90% of tuberculosis patients in the DOTS strategy in the USA, approximately 18% do not adhere (11) .Simultaneous studies on tuberculosis transmission confirmed by means of molecular biology, new Tb cases coming from strain of nonadherent patients.With the concern of being able to also treat the non-adherent patients with DOTS, New York was the first U.S. state to develop quarantine laws (7) .According to a metanalysis on DOTS, four studies used involuntatory hospitalizations for non-adherent patients in 2000 (New York, Baltimore, South Carolina and Tarrant) (12) .New York City Health Code, of April 1993, states that all patients with Tb or suspected to have Tb must: be examined; complete treatment for Tb; adhere to a DOT program (or CoDOT, when administered by a justice commissary; be retained throughout the transmission period and be restrained even without active infection, until the cure, if necessary, and when other more reasonable treatment alternatives failed (7) .Therefore, renitent patients were treated under a CoDOTS system or admitted to "closed" hospitals specifically directed towards this purpose, they were "released" to DOTS when the adherence to the treatment improved and there were no risk of bacillus transmission to the community (13) .Thus, in the Denver Program of Tuberculosis Control, 5% of the patients were treated in a "closed" hospital plan due to their non-adherence, and in 5% of these patients there was a loss of follow-up, and if these patients were found, they became candidates to a new compulsory hospitalization (13) .In New York and South Carolina, less than 1% of the patients was compulsorily admitted.In Tarrant, Texas, 6.2% were submitted to compulsory hospitalization or put in quarantine due to non-adherence.The existence of regional differences in DOTS and confinement criteria must be emphasized, and that in all cases of compulsory hospitalization there was a predominance of alcoholic, psychiatric, homeless and drug addict patients (14) .
BACKGROUND: Several factors influence the pulmonary function values considered normal. In children of short stature, there are difficulties in interpreting the pulmonary function. OBJECTIVE: To assess spirometric values in children and adolescents with short stature and to identify a correction factor to adequately predict the expected values for this population. METHOD: A prospective selection of 77 patients was made, all with short stature and no respiratory disease. These patients were submitted to spirometry, transcutaneous hemoglobin oxygen saturation, chest perimeter measurement, and immediate hypersensitivity testing. Bone age was assessed by wrist X-rays. The data obtained by spirometry (FVC, FEV1, and FEF25-75%) were compared with those of Polgar and Promadhat (1971), predicted in three ways: a) by actual height; b) by height estimated at the 50th percentile for chronological age (CA); c) by height estimated at the 50th percentile for bone age (BA). RESULTS: The mean height was 133.3 ± 13.2 cm, and the deficit in relation to the third percentile was 5.4 ± 6.0 cm. The values obtained for FVC, FEV1, FEF25-75%, were significantly higher than those predicted by actual height. The mean FEV1 obtained was 2.42 ± 0.71 L, and the predicted (actual height) was 2.10 ± 0.64 L; according to the height estimated by BA and CA, the values were 2.27 and 2.86 L, respectively. The mean FVC1 was 2.20 ± 0.6 L, and the predicted was 1.90 ± 0.55 L. With the height estimated for bone age and chronologic age, the predicted values were 2.10 and 2.60 L, respectively. CONCLUSION: Children and adolescents with short stature have higher spirometric values than predicted for their actual height. These findings suggest that the height estimated at the 50th percentile for bone age can be used to evaluate pulmonary function.
INTRODUÇÃO: A hemoptise volumosa é uma condição com alta morbidade e mortalidade, independentemente do tratamento instituído. Vários métodos são utilizados para o controle do sangramento agudo. A instilação de soro fisiológico gelado através de broncoscópio rígido foi descrita em 1980. OBJETIVO: Determinar a eficácia de instilações repetidas de soro fisiológico gelado a 4ºC através de broncoscópio rígido no controle agudo de hemoptise maciça. MÉTODO: Uma série de 94 pacientes, com hemoptise maciça, foi tratada durante sangramento ativo com broncoscopia rígida e lavagem do pulmão sangrante com soro fisiológico gelado. Foi considerado sucesso terapêutico a ausência de sangramento nos 15 dias subseqüentes. Causas de hemoptise, com o respectivo número de pacientes: tuberculose pulmonar, 78 (83%), sendo tuberculose ativa em 48 e seqüela de tuberculose em 30; bronquiectasias, seis; câncer de pulmão, cinco; aspergiloma intracavitário, três, e desconhecida, dois. O sítio de sangramento foi localizado em 93 pacientes (99%). O volume médio de soro infundido durante a broncoscopia foi de 528ml e variou de 160ml a 2.500ml. RESULTADOS: O sangramento cessou durante o procedimento em todos os pacientes. Em 15 pacientes foi feita alguma intervenção (cirurgia, embolização ou radioterapia) num prazo menor que 15 dias, e nestes a eficácia da lavagem não pôde ser avaliada. A hemoptise recorreu em 20 dos 79 pacientes acompanhados por mais de 15 dias. Houve necessidade de nova lavagem com soro fisiológico uma vez em 13 pacientes, duas vezes em seis e três vezes em um paciente. CONCLUSÃO: O controle imediato da hemorragia traqueobrônquica com a administração de soro fisiológico gelado através de broncoscopia rígida é efetivo e pode ser repetido em caso de recorrência do sangramento. O procedimento é seguro e permite que o tratamento definitivo possa ser realizado em melhores condições clínicas.
INTRODUÇÃO: O hábito de fumar em geral se inicia na adolescência. No Brasil, as estimativas da freqüência deste hábito entre adolescentes variam de 1% até 35%. OBJETIVO: Estimar a prevalência do tabagismo entre os adolescentes da oitava série do ensino fundamental à terceira série do curso médio, em escolas de Salvador - Bahia, Brasil. MÉTODO: Feito um estudo do tipo corte transversal de caráter exploratório. Foram aplicados 3.500 questionários a alunos matriculados entre a 8ª série do ensino fundamental e a 3ª série do ensino médio, em cinco escolas da região metropolitana de Salvador (BA). Análise estatística: medidas descritivas e de associação (razão de prevalência) e o teste t de Student e o do qui-quadrado. RESULTADOS: A prevalência do tabagismo entre adolescentes de Salvador (BA) foi de 9,6%, considerando-se os 3.180 questionários válidos, sendo maior no sexo masculino (14%) que no feminino (6%). À medida que aumentava a idade, elevava-se essa prevalência. A média de idade do início do tabagismo foi de 14 ± 2 anos. Dentre adolescentes, 46% experimentaram o cigarro e 20% destes continuaram fumando. Entre filhos de fumantes a freqüência foi maior. O número médio de cigarros consumidos por dia pelos adolescentes que fumavam diariamente (n = 132) foi de 7 ± 6, sendo maior no sexo masculino. CONCLUSÃO: A prevalência do tabagismo em uma amostra selecionada de adolescentes escolares de Salvador (BA) foi de 9,6%, sendo maior entre os indivíduos do sexo masculino. A experimentação e a influência dos pais foram associadas ao tabagismo nos adolescentes.
Underrating is not an unusual attitude in front of infections caused by Streptococcus pneumoniae, since they are classically a community disease and universally sensitive to penicillin. The importance of pneumococcus infections is however undeniable. It is one of the main agents causing community meningitis and pneumonia. Invasive pneumococcus infections present high mortality rates. For example, in a Brazilian study, 50% of patients with a bacteremic infection died (1) . Another aggravating factor in the treatment of these infections is the increasing resistance to penicillin and to other antimicrobial drugs commonly used to fight them. There are few Brazilian studies on the prevalence of pneumococcus resistance to penicillin. They were usually carried out in large cities, such as Sao Paulo, Ribeirao Preto, Rio de Janeiro (2-4) , and may not reflect what is occurring in other parts of the country. That is what makes the study published by Spiandorello et al. in this issue of Jornal de Pneumologia so important. Because of the severity of the invasive pneumococcus infection, it is often necessary to start an empirical therapy even before culture and antimicrobial resistance sensitiveness test results are available. Recommendations published in domestic consensus papers and foreign guidelines frequently direct the choice of drugs in this situation. The prevalence of resistance certainly shows a regional variation in Brazil, as it occurs in other countries (5) , and the consensus directions may not apply to different regions or even to different cities or hospitals of the same region. Although resistance to penicillin has rapidly increased over time in many countries,
Hemorragia alveolar, como causa de insuficiência respiratória, é pouco freqüente, com diversas etiologias possíveis. Entre elas, o lúpus eritematoso sistêmico, que se apresenta geralmente como síndrome pulmão-rim, possui alta morbimortalidade. Acredita-se que a patogênese da microangiopatia, tanto renal como pulmonar, esteja associada ao depósito de imunocomplexos, que ativariam as vias de apoptose celular. Relatam-se dois casos de pacientes com nefrite lúpica que evoluíram com hemorragia alveolar associada à insuficiência respiratória necessitando de ventilação mecânica com evoluções totalmente distintas frente às terapias farmacológicas. O achado de anticorpos antimembrana basal em um dos casos evidencia a multiplicidade de mecanismos fisiopatológicos possivelmente envolvidos, que poderiam justificar as respostas heterogêneas frente aos tratamentos disponíveis.
The lack of resources intended for higher education in the last decade followed projects clearly designed to strangle the public sector.We daily watch our colleagues' in directive positions struggling to receive grants at any cost to keep research projects going.In order to reach this goal, almost anything is valid: using the University's facilities to teach paid courses, the use of our best brains to carry out research guided by the pharmaceutical industry; trying to reach an agreement with medical groups to do exams and hospitalizations, etc.In addition to that, the salary degradation and the lack of career opportunities prevent admitting new researchers and staff.Some seat comfortably in their "chairs" feeling privileged and comfortable as such.In the last few years, the education budget was dictated by economic and financial international organizations, specially the World Bank, which recommends to the authorities of the so called third world countries that, in general terms, basic education should be free and college, paid.Priority must be given to basic education, which is correct.The problem is that this priority occurs mostly at the cost of college and university education.The new government seems to have put aside the idea of paid higher education.Another concept is that research is something for rich countries, which would already have material and human resources to develop it.In Brazil, only some centers with international competitiveness would be maintained.Within the core of this idea came the concept of efficiency evaluation, whose bottom line correlates costs and income.This idea is coated with modernity, where the key-words are efficiency, professionalism and competitiveness.Recently, we were appalled by a survey on the "cost" of a thesis in a well-known public university -about U$ 8,600.00.The absurdity of this idea would require an "amazement mark", still to be invented, instead of an exclamation mark.Another clear guideline refers to international competitiveness.In order to demonstrate efficiency and continue to receive research grants, the privileged centers must prove they have the skills to compete with other countries, and the researchers must publish their papers in journals indexed in the Medline.Publish or perish is a mantra.The consequence is a widening of the gap -the ranking creates islands of excellence and oceans of need, and inside the island of excellence the colleagues belong to the first class (the researchers) or to the third class -the ones dedicated to the clinical practice who try to transmit their knowledge to students, residents, and even graduate students, but who at the end will have to assist their patients to survive in the future, after doing one single research in their lives -for their Theses.The new president of CNPq has the goal of increasing the number of fellowships, reducing their individual cash values, and decentralizing them.Some resources may be allocated to clinical research, since competitiveness prioritizes the Genoma and similar projects, which consume most resources (but they are so modern...)Researchers with international publications impress "Native Indians".The Journal of Pneumology suffers the consequences -it is put aside, whereas colleagues struggle through obscure indexed journals, seldom read.The purpose is to reach the goal -at least one paper per year."The blow hits us harder" -replies our heroic Editor of the Journal of Pneumology.And life goes on...A quick survey of the year 2002 shows that many colleagues prefer to publish in Brazilian journals indexed in Medline, such as the journal of the São Paulo Medical Association, or others more difficult to access, such as the Brazilian Journal of Medical and Biological Research.Some got published in better known international journals.Two or three are relevant to what matters -the clinical practice.The Journal of Pneumology in English will soon be available in our site.A respectable Editorial Board was created.The objectives are clear -to index the Journal of Pneumology.To do that, it is necessary to break the vicious cycle and the prejudice, and to make our Pneumology more respectable, as it deserves.
