Dyspnea perception during the inspiratory resistive loads test in obese subjects waiting bariatric surgery

Identifcation of low dyspnea perception is relevant, since this condition is signifcantly associated with worse outcomes. We investigated dyspnea perception during the inspiratory resistive loads test on obese subjects waiting bariatric surgery in comparison with normal subjects. Secondarily, we analysed the proportion of obese subjects with low, moderate and high dyspnea perception. This observational study included subjects with body mass index (BMI)≥35kg/m2, compared to healthy subjects with BMI ≥18 and <25kg/m2. Subject underwent clinical evaluation, inspiratory test with progressive resistive loads and spirometry. We studied 23 obese subjects (mean BMI=51.9±9.3kg/ m2) and 25 normal subjects (mean BMI=24.3±2.3kg/m2). With the increase magnitude of resistive loads there was a signifcant increase in dyspnea score (p<0.001) and progressive increase of the generated inspiratory pressure (p<0.001), but there was no diference between the groups in terms of dyspnea score (p=0.191) and no interaction efect (p=0.372). Among the obese subjects, 4 individuals were classifed as low perception, 11 as moderate and 8 as high. In conclusion, the degree of dyspnea perception during the inspiratory progressive resistive loads test did not difer between obese and normal subjects. Among obese subjects, only 17% were classifed as low dyspnea perception

Percepção da dispneia em pacientes com obesidade mórbida candidatos a cirugia bariátrica

Introdução: A avaliação da dispneia por meio de métodos objetivos tem assumido importância para a identificação do grupo de pacientes com baixa percepção do sintoma. Objetivos: Avaliar o grau de percepção da dispneia durante o teste de cargas resistivas inspiratórias progressivas em indivíduos obesos candidatos a cirurgia bariátrica em comparação com indivíduos normais. Secundariamente, analisar a proporção de indivíduos obesos com baixa, moderada e alta percepção da dispneia. Métodos: Estudo transversal, incluindo indivíduos com índice de massa corporal (IMC) ≥ 35 kg/m2, em comparação com indivíduos sadios com IMC ≥ 18 e < 25 kg/m2. Cada participante foi submetido a avaliação clínica, teste com cargas resistivas inspiratórias para a quantificação da percepção da dispneia (escala de Borg modificada) e espirometria. Resultados: Foram estudados 23 indivíduos obesos, com média de idade de 43,7 ± 12,1 anos e IMC= 51,9 ± 9,3 kg/m2 e 25 indivíduos normais com média de idade de 39,8 ± 12,2 anos e IMC= 24,3 ± 2,3 kg/m2. Com o incremento da magnitude das cargas resistivas, foi observado significativo aumento do escore de dispneia (p<0,001) e aumento progressivo da pressão inspiratória gerada (p<0,001), mas não houve diferença entre os grupos quanto ao escore de dispneia (p=0,191). Não houve efeito de interação (p=0,372) entre grupo e escore de dispneia. Os indivíduos obesos geraram pressões inspiratórias maiores que os indivíduos normais (p=0,009) e com progressivo aumento ao longo das diferentes cargas resistivas (efeito de interação=0,009). Dentre os obesos, 4 indivíduos foram classificados como baixa percepção, 11 como moderada e 8 como alta. Houve significativa associação entre idade e grupo de percepção de dispneia (p=0,008), sendo a média de idade no grupo de baixa percepção (58,0 ± 6,8 anos) significativamente maior do que no grupo de elevada percepção (36,5 ± 9,3 anos) e não diferindo do de moderada percepção (36,5 ± 9,3 anos); o grupo de moderada intensidade não diferiu significativamente do de alta percepção. Não houve associação significativa do sexo (p=0,642) nem do IMC p=0,271) com a classificação de percepção da dispneia. Conclusões: O grau de percepção da dispneia durante o teste de cargas resistivas inspiratórias progressivas em indivíduos obesos candidatos a cirurgia bariátrica não diferiu de indivíduos normais. Os indivíduos obesos geraram pressões inspiratórias maiores do que os indivíduos normais ao longo das crescentes cargas resistivas. Dentre os indivíduos obesos, 17% foram classificados como baixa percepção da dispneia, 48% como moderada percepção e 35% como alta percepção. A proporção de indivíduos classificados como baixa, moderada e alta percepção de dispneia não diferiu entre obesos e normais. Nos obesos, a baixa percepção da dispneia associou-se com idade mais avançada.Introduction: The evaluation of dyspnea through objective methods has assumed importance for the identification of the group of patients with poor perception of the symptoms. Objectives: To assess the degree of perception of dyspnea during the inspiratory test with progressive resistive loads on obese individuals candidates for bariatric surgery in comparison with normal subjects. Secondly, to analyze the proportion of obese individuals with low, moderate and high perception of dyspnea. Methods: Cross-sectional study, including individuals with body mass index (BMI) ≥ 35 kg/m2, compared to healthy subjects with BMI ≥ 18 and < kg/m2. Each participant underwent clinical evaluation, inspiratory test with resistive loads to quantify the perception of dyspnea (modified Borg scale) and spirometry. Results: We studied 23 obese subjects, with a mean age of 43.7 ± 12.1 years and BMI=51.9 ± 9.3 kg/m2 and 25 normal subjects with a mean age of 39.8 ± 12.2 years, BMI=24.3 ± 2.3 kg/m2. With the increase of the magnitude of resistive loads, there was a significant increase in dyspnea score (p <0.001) and progressive increase of the generated inspiratory pressure (p <0.001), but there was no difference between the groups in terms of dyspnea score (p=0.191). There was no interaction effect (p = 0.372) between dyspnea score and group. Obese individuals generate higher inspiratory pressures than normal individuals (p=0.009) progressively increasing throughout the different resistive loads (interaction effect=0.009). Among the obese, 4 individuals were classified as low perception, 11 as moderate and 8 as high. There was a significant association between age group and perception of dyspnea (p=0.008), and the average age in the low perception group (58.0 ± 6.8 years) was significantly higher than in the high group perception (36, 5 ± 9.3 years) and did not differ from moderate perception (36.5 ± 9.3 years); the moderate intensity group did not differ significantly from the high perception. There was no significant association of gender (p=0,642) or BMI (p=0.271) with the perception classification of dyspnea. Conclusions: The degree of perception of dyspnea during the inspiratory test with progressive resistive loads on obese individuals candidates for bariatric surgery did not differ from normal individuals. Obese individuals generated higher inspiratory pressures than normal subjects over the increasing resistive load. Among obese individuals, 17% were classified as lower perception of dyspnea, 48% as moderate perception and 35% as high perception. The proportion of individuals classified as low, moderate and high perception of dyspnea did not differ between obese and normal individuals. In obese individuals, low perception of dyspnea was associated with older age

Active case finding of tuberculosis (TB) in an emergency room in a region with high prevalence of TB in Brazil

Setting: Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. Objective: To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis. Methods: Cross sectional study. All patients $18 years seeking care at the ER were screened for respiratory symptoms and those with cough$2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acidfast bacilli smear and culture. Results: Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough $2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92–0.97; p,0.0001), sputum production (OR 0.18, 95% CI 0.06–0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45–32.93; p,0.0001). Conclusions: This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting

Active case finding of tuberculosis (TB) in an emergency room in a region with high prevalence of TB in Brazil

Setting: Public hospital emergency room (ER) in Porto Alegre, Brazil, a setting with high prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. Objective: To determine the prevalence of PTB, using a symptom based active case finding (ACF) strategy in the ER of a public hospital in an area with high prevalence of TB and HIV, as well as variables associated with pulmonary TB diagnosis. Methods: Cross sectional study. All patients $18 years seeking care at the ER were screened for respiratory symptoms and those with cough$2 weeks were invited to provide a chest radiograph and two unsupervised samples of sputum for acidfast bacilli smear and culture. Results: Among 31,267 admissions, 6,273 (20.1%) reported respiratory symptoms; 197 reported cough $2 weeks, of which pulmonary TB was diagnosed in 30. In multivariate analysis, the variables associated with a pulmonary tuberculosis diagnosis were: age (OR 0.94, 95% CI: 0.92–0.97; p,0.0001), sputum production (OR 0.18, 95% CI 0.06–0.56; p = 0.003), and radiographic findings typical of TB (OR 12.11, 95% CI 4.45–32.93; p,0.0001). Conclusions: This study identified a high prevalence of pulmonary TB among patients who sought care at the emergency department of a tertiary hospital, emphasizing the importance of regular screening of all comers for active TB in this setting

Study flow chart.

<p>Study flow chart.</p

Characteristics of the sample.

<p>Continuous variables (age) are presented as mean ± SD; other data are presented as n/N (%): number of cases with characteristic/total number of cases (percentage in the group), or median (interquartile range).</p><p>Characteristics of the sample.</p