RESUMO
OBJECTIVE: To compare the efficacy of local quality control (QC) of BOLD (Burden of Obstructive Lung Disease) Trinidad and Tobago study with spirometer machine quality grades as well as with BOLD Pulmonary Function Reading Centre QC standards at Imperial College, London. METHODOLOGY: Quality of the randomly chosen two hundred spirometries was independently assessed by the local team based on the 2005 ATS/ERS spirometry standards. Central QC quality assessment results were blinded to the local team. However, the machine quality grades were readily available to both the central and local teams during interpretation. Local and machine QC performances were correlated with the central QC which was taken as the gold standard for this study. RESULTS: According to central QC, 17.5% of the spirometries were declared as unacceptable. The noted common errors were prolonged peak expiratory flow time(14.5%), submaximal blasts (11.5%), variable efforts (11%) and poor reproducibility (10%). Cronbachs alpha assessment revealed an overall reliability of 0.82 and a correlation of 0.73 between central and local QC. The correlation between central and machine QC was poor(0.548). Local QC exhibited 89.1% sensitivity and 94.3% specificity relative to the central QC. Though the machine QC displayed a better sensitivity (97.6%), its specificity was significantly lower 45.7%). CONCLUSION: Local QC was effective when compared with the central QC and executed better performance than the machines QC. This expertise can now be utilized for the future spirometry based local research studies. Due to limitations in identifying various errors, machine QC should not solely be used as the determinant of acceptability.
Assuntos
Humanos , Espirometria , Pneumopatias , Pneumopatias/diagnóstico , Equipamentos e Provisões/análiseRESUMO
Angiotensin converting enzyme inhibitors (ACEIs) are reported to have a lower efficacy in black hypertensive patients, particularly in monotherapy. However, no studies have examined the efficacy of ACEIs in a Caribbean population. A dose titration study was performed with perindopril in the English and Dutch Caribbean islands to assess the efficacy and acceptability of perindopril in this population. 435 patients with essential hypertension, with a diastolic BP between 95 and 125 mmHg were enrolled into this 3-month open study. Out of 333 patients who complete the study, 285 patients (69.3 percent) were successfully controlled (diastolic BP<90 mmHg). An additional 45 (7.81 percent) patients were controlled with the addition of hydrochlorothiazide 25 mg. Supine BP was reduced from 168.2 mmHg (ñ1.08) systolic and 105.6 mmHg (ñ0.48) diastolic to 149.12 mmHg (ñ0.98) systolic and 91.95 mmHg (ñ0.55) diastolic (p<0.001) after 2 months of perindopril in monotherapy. Supine BP was reduced further at the end of the 3-month treatment period to 144.3 mmHg (ñ0.91) systolic and 88.39 mmHg (ñ0.46) diastolic (p<0.001). There was no significant difference between the black population and the total population. Perindopril was well tolerated with a low reported incidence of cough. Withdrawal due to adverse events was also low at 2.3 percent (10 patients). The anti-hypertensive efficacy of perindopril in a Caribbean population and more specifically, the black Caribbean population with mild to moderate hypertension, is confirmed in this study together with its clinical and biological acceptability (AU)