Respiratory viral infections and effects of meteorological parameters and air pollution in adults with respiratory symptoms admitted to the emergency room

Background Respiratory viral infections (RVIs) are the most common causes of respiratory infections. The prevalence of respiratory viruses in adults is underestimated. Meteorological variations and air pollution are likely to play a role in these infections. Objectives The objectives of this study were to determine the number of emergency visits for influenza-like illness (ILI) and severe acute respiratory infection (SARI) and to evaluate the association between ILI/SARI, RVI prevalence, and meteorological factors/air pollution, in the city of Porto Alegre, Brazil, from November 2008 to October 2010. Methods Eleven thousand nine hundred and fifty-three hospitalizations (adults and children) for respiratory symptoms were correlated with meteorological parameters and air pollutants. In a subset of adults, nasopharyngeal aspirates were collected and analyzed through IFI test. The data were analyzed using time-series analysis. Results Influenza-like illness and SARI were diagnosed in 3698 (30 9%) and 2063 (17 7%) patients, respectively. Thirty-seven (9 0%) samples were positive by IFI and 93 of 410 (22 7%) were IFI and/or PCR positive. In a multivariate logistic regression model, IFI positivity was statistically associated with absolute humidity, use of air conditioning, and presence of mold in home. Sunshine duration was significantly associated with the frequency of ILI cases. For SARI cases, the variables mean temperature, sunshine duration, relative humidity, and mean concentration of pollutants were singnificant. Conclusions At least 22% of infections in adult patients admitted to ER with respiratory complaints were caused by RVI. The correlations among meteorological variables, air pollution, ILI/SARI cases, and respiratory viruses demonstrated the relevance of climate factors as significant underlying contributors to the prevalence of RVI

Cystic fibrosis : ten-year analysis of a cohort of an adult program

Introdução: A fibrose cística (FC) que já foi considerada doença da criança, é agora doença do adulto e requer programa para adultos. Objetivo: Definir características clínicas de uma coorte de 10 anos de um programa para adultos com FC e determinar as características associadas com desfechos clínicos. Métodos: Coorte retrospectiva de pacientes com FC (idade & 16 anos) atendida pelo Programa para Adultos do Hospital de Clínicas de Porto Alegre, de outubro de 1998 a outubro de 2008. Foram coletados dados demográficos, dados clínicos, status nutricional, função pulmonar, testes laboratoriais e microbiologia do escarro. Foram definidos como desfechos clínicos: sobrevivência, sobrevivência com transplante pulmonar e óbito. Resultados: Foram atendidos 94 pacientes pelo programa para adultos. A média de idade foi 24,0 ± 7,4 anos e a média do volume expiratório forçado no primeiro segundo (VEF1) foi 56,4 ± 28,8%. Setenta e sete pacientes foram sobreviventes, 6 sobreviventes com transplante pulmonar e 11 morreram. Na análise univariada, etnia caucasiana (P =0,016), mutação F508del (P =0,04), escore clínico (P <0,001), índice de massa corporal (P <0,001), oxigenoterapia (P <0,001), capacidade vital forçada (P =0,023) e VEF1 (P <0,001) se associaram com os desfechos clínicos. A análise de regressão logística identificou fatores associados com desfecho precário: VEF1 (RC =0,72, IC 95% =0,54-0,94, P =0,017) e escore clínico (RC =0,70, IC =0,50-0,97, P =0,034). Insuficiência respiratória crônica exacerbada por infecção respiratória aguda foi causa imediata de morte na maioria dos casos. Conclusão: Este estudo descreveu uma coorte de 94 pacientes com FC atendidos por um programa de adultos. VEF1 e escore clínico se associaram com os desfechos clínicos.Background: Once considered a childhood disease, cystic fibrosis (CF) is now also a disease of adults and requires adult CF care. Aim: To define the clinical characteristics of a ten-year cohort of an adult CF program and to determine the characteristics associated with clinical outcomes. Methods: The study comprised a retrospective cohort study of CF patients (age &16 years) attending to the adult program of Hospital de Clínicas de Porto Alegre (HCPA), during October 1998 and October 2008. Data collected included patient demographics, clinical data, nutritional status, pulmonary function, laboratory tests and sputum microbiology. Clinical outcomes were defined as survival, survival with lung transplantation and death. Results: Ninety-four patients attended to the adult CF program. The mean age was 24.0 ± 7.4 years and the mean forced expiratory volume in the first second (FEV1) was 56.4 ± 28.8%. Seventy-seven patients were survivors, 6 were survivors with lung transplantation and 11 died. In the univariate analysis, caucasian ethnicity (P = 0.016), F508del mutation (P = 0.04), clinical score (P <0.001), body mass index (P <0.001), oxygen therapy (P <0.001), forced vital capacity (P =0.023) and FEV1 (P <0.001) were associated with clinical outcomes. Logistic regression analysis identified two factors associated with poor outcome: FEV1 (OR =0.72, CI 95% =0.54-0.94, P =0.017) and clinical score (OR =0.70, CI =0.50-0.97, P =0.034). Chronic respiratory failure exacerbated by respiratory infection was the immediate reason of death in the majority of cases. Conclusion: This study described a ten-year cohort of 94 CF patients attending to an adult program. FEV1 and clinical score were associated with clinical outcomes