1
|
Corrêa RDS, Leal-Calvo T, Mafort TT, Santos AP, Leung J, Pinheiro RO, Rufino R, Moraes MO, Rodrigues LS. Reanalysis and validation of the transcriptional pleural fluid signature in pleural tuberculosis. Front Immunol 2024; 14:1256558. [PMID: 38288122 PMCID: PMC10822927 DOI: 10.3389/fimmu.2023.1256558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Pleural tuberculosis (PlTB), the most common site of extrapulmonary TB, is characterized by a paucibacillary nature and a compartmentalized inflammatory response in the pleural cavity, both of which make diagnosis and management extremely challenging. Although transcriptional signatures for pulmonary TB have already been described, data obtained by using this approach for extrapulmonary tuberculosis and, specifically, for pleural tuberculosis are scarce and heterogeneous. In the present study, a set of candidate genes previously described in pulmonary TB was evaluated to identify and validate a transcriptional signature in clinical samples from a Brazilian cohort of PlTB patients and those with other exudative causes of pleural effusion. Methods As a first step, target genes were selected by a random forest algorithm with recursive feature elimination (RFE) from public microarray datasets. Then, peripheral blood (PB) and pleural fluid (PF) samples from recruited patients presenting exudative pleural effusion were collected during the thoracentesis procedure. Transcriptional analysis of the selected top 10 genes was performed by quantitative RT-PCR (RT-qPCR). Results Reanalysis of the public datasets identified a set of candidate genes (CARD17, BHLHE40, FCGR1A, BATF2, STAT1, BTN3A1, ANKRD22, C1QB, GBP2, and SEPTIN4) that demonstrated a global accuracy of 89.5% in discriminating pulmonary TB cases from other respiratory diseases. Our validation cohort consisted of PlTB (n = 35) patients and non-TB (n = 34) ones. The gene expressions of CARD17, GBP2, and C1QB in PF at diagnosis were significantly different between the two (PlTB and non-TB) groups (p < 0.0001). It was observed that the gene expressions of CARD17 and GBP2 were higher in PlTB PF than in non-TB patients. C1QB showed the opposite behavior, being higher in the non-TB PF. After anti-TB therapy, however, GBP2 gene expression was significantly reduced in PlTB patients (p < 0.001). Finally, the accuracy of the three above-cited highlighted genes in the PF was analyzed, showing AUCs of 91%, 90%, and 85%, respectively. GBP2 was above 80% (sensitivity = 0.89/specificity = 0.81), and CARD17 showed significant specificity (Se = 0.69/Sp = 0.95) in its capacity to discriminate the groups. Conclusion CARD17, GBP2, and C1QB showed promise in discriminating PlTB from other causes of exudative pleural effusion by providing accurate diagnoses, thus accelerating the initiation of anti-TB therapy.
Collapse
Affiliation(s)
- Raquel da Silva Corrêa
- Laboratory of Immunopathology, Medical Sciences Faculty, Rio de Janeiro State University (FCM/UERJ), Rio de Janeiro, Brazil
| | - Thyago Leal-Calvo
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Pulmonary Care, Pedro Ernesto University Hospital, Rio de Janeiro State University (HUPE/UERJ), Rio de Janeiro, Brazil
| | - Ana Paula Santos
- Department of Pulmonary Care, Pedro Ernesto University Hospital, Rio de Janeiro State University (HUPE/UERJ), Rio de Janeiro, Brazil
| | - Janaína Leung
- Department of Pulmonary Care, Pedro Ernesto University Hospital, Rio de Janeiro State University (HUPE/UERJ), Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Pulmonary Care, Pedro Ernesto University Hospital, Rio de Janeiro State University (HUPE/UERJ), Rio de Janeiro, Brazil
| | - Milton Ozório Moraes
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Silva Rodrigues
- Laboratory of Immunopathology, Medical Sciences Faculty, Rio de Janeiro State University (FCM/UERJ), Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Bessa EJC, Ribeiro FDMC, Rodrigues RS, Henrique da Costa C, Rufino R, Pinheiro GDRC, Lopes AJ. Association between clinical, serological, functional and radiological findings and ventilatory distribution heterogeneity in patients with rheumatoid arthritis. PLoS One 2023; 18:e0291659. [PMID: 37862308 PMCID: PMC10588833 DOI: 10.1371/journal.pone.0291659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/02/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND In rheumatoid arthritis (RA), the involvement of the pulmonary interstitium can lead to structural changes in the small airways and alveoli, leading to reduced airflow and maldistribution of ventilation. The single-breath nitrogen washout (SBN2W) test is a measure of the ventilatory distribution heterogeneity and evaluates the small airways. This study aimed to find out which clinical, serological, functional and radiological findings are useful to identify RA patients with pathological values of the phase III slope (SIII) measured by the SBN2W test. METHODS This was a cross-sectional study in which RA patients were assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Clinical Disease Activity Index (CDAI) and underwent serological analysis of autoantibodies and inflammatory markers. In addition, they underwent pulmonary function tests (including the SBN2W test) and chest computed tomography (CT). RESULTS Of the 60 RA patients evaluated, 39 (65%) had an SIII >120% of the predicted value. There were significant correlations between SIII and age (r = 0.56, p<0.0001), HAQ-DI (r = 0.34, p = 0.008), forced vital capacity (FVC, r = -0.67, p<0.0001), total lung capacity (r = -0.46, p = 0.0002), residual volume/total lung capacity (TLC) (r = 0.44, p = 0.0004), and diffusing capacity of the lungs for carbon monoxide (r = -0.45, p = 0.0003). On CT scans, the subgroup with moderate/severe disease had a significantly higher SIII than the normal/minimal/mild subgroup (662 (267-970) vs. 152 (88-283)% predicted, p = 0.0004). In the final multiple regression model, FVC, extent of moderate/severe involvement and age were associated with SIII, explaining 59% of its variability. CONCLUSIONS In patients with RA, FVC, extent of lung involvement and age, all of which are easily obtained variables in clinical practice, identify poorly distributed ventilation. In addition, the presence of respiratory symptoms and deteriorated physical function are closely related to the distribution of ventilation in these patients.
Collapse
Affiliation(s)
- Elizabeth Jauhar Cardoso Bessa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rosana Souza Rodrigues
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Mateus SP, Ribeiro-Alves M, Salles REB, Costa W, da Costa CH, Lopes AJ, Bártholo TP, Mafort TT, Tura BR, Rufino R. Mortality and comorbidities in patients with bronchiectasis over a 3-year follow-up. Medicine (Baltimore) 2022; 101:e32537. [PMID: 36596005 PMCID: PMC9803512 DOI: 10.1097/md.0000000000032537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To identify the risk factors associated with all-cause mortality in patients with noncystic fibrosis bronchiectasis (NCFB). This prospective cohort study included 120 adult patients with NCFB, who were regularly treated at a specialized outpatient clinic of a university hospital between January 2017 and June 2020. All patients were diagnosed using high-resolution computed tomography. Demographic and clinical data, pulmonary function tests, and the Euro-quality-of-life 5-domain 3-level questionnaire were analyzed. The factors associated with death were determined using the Cox proportional hazards model. The all-cause mortality rate at 41 months was 10.8%. Adjusted multivariate analysis showed that the main contributing predictors for mortality were female sex, smoking, diabetes, chronic obstructive pulmonary disease, emergency visits, use of antibiotics due to exacerbation, secretion color change, exacerbation, predicted forced expiratory volume in 1 second, predicted forced vital capacity, lack of respiratory physiotherapy, absence of vaccination against pneumococci, and mobility domain. Multiple factors contribute to unfavorable outcomes in patients with NCFB, and early recognition of these factors may improve care management.
Collapse
Affiliation(s)
- Simone Paulo Mateus
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | | | - Walter Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Claudia Henrique da Costa
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Prudente Bártholo
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil
- * Correspondence: Rogério Rufino, Department of Chest Diseases, -Rio de Janeiro State University, Pulmonology Service, Rio de Janeiro, Brazil (e-mail: )
| |
Collapse
|
4
|
Mateus SP, Salles REB, Costa W, Costa CHD, Lopes AJ, Tura BR, Rufino R. Follow-up of a cohort of patients with noncystic fibrosis bronchiectasis for 1 year. Rev Assoc Med Bras (1992) 2022; 68:329-336. [PMID: 35442359 DOI: 10.1590/1806-9282.20210710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the quality of life of patients with noncystic fibrosis bronchiectasis during a 1-year follow-up by using the EuroQol - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire. METHODS A cohort study was conducted with 100 patients with noncystic fibrosis bronchiectasis and followed up with face-to-face visits or by telephone contact every 3 months for 1 year. All patients were recruited from a single referral center for bronchiectasis. At the time of recruiting and at the end of 1 year, the EQ-5D-3L questionnaire was applied to evaluate the patients' quality of life. Variables, such as exacerbation, emergency care, comorbidities, hemoptysis, colonization, and hospitalization, were assessed. RESULTS Of the 100 patients, 99 completed the study and 72% were women. There were no marked limitations in the mobility and self-care domains during the follow-up. At the end of the follow-up, 32 patients were extremely anxious or depressed. The quality of life assessed by using EQ-5D-3L had an initial mean score of 0.545 and of 0.589 after 1 year, which was statistically significant (p=0.011). CONCLUSION Patients with noncystic fibrosis bronchiectasis have a poor quality of life, and the EQ-5D-3L questionnaire may be a tool for monitoring patients with bronchiectasis.
Collapse
Affiliation(s)
- Simone Paulo Mateus
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Raquel Esteves Brandão Salles
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Walter Costa
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Claudia Henrique da Costa
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | - Agnaldo José Lopes
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| | | | - Rogério Rufino
- Universidade do Estado do Rio de Janeiro, Pulmonology Service, Department of Chest Diseases - Rio de Janeiro (RJ), Brazil
| |
Collapse
|
5
|
Santos AP, Ribeiro-Alves M, Corrêa R, Lopes I, Silva MA, Mafort TT, Leung J, Rodrigues LS, Rufino R. Hyporexia and cellular/biochemical characteristics of pleural fluid as predictive variables on a model for pleural tuberculosis diagnosis. J Bras Pneumol 2022; 48:e20210245. [PMID: 34909921 PMCID: PMC8946557 DOI: 10.36416/1806-3756/e20210245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Pleural tuberculosis (PlTB) diagnosis is a challenge due to its paucibacillary nature and to the need of invasive procedures. This study aimed to identify easily available variables and build a predictive model for PlTB diagnosis which may allow earlier and affordable alternative strategy to be used in basic health care units. Methods An observational cross-sectional study compared PlTB and non-TB patients followed at a tertiary Brazilian hospital between 2010 and 2018. Unconditional logistic regression analysis was performed and a Decision Tree Classifier (DTC) model was validated and applied in additional PlTB patients with empiric diagnosis. The accuracy (Acc), sensitivity (Se), specificity (Sp), positive and negative predictive values were calculated. Results From 1,135 TB patients, 160 were considered for analysis (111 confirmed PlTB and 49 unconfirmed PlTB). Indeed, 58 non-TB patients were enrolled as controls. Hyporexia [adjusted odds ratio (aOR) 27.39 (95% CI 6.26 – 119.89)] and cellular/biochemical characteristics on pleural fluid (PF) (polimorphonuclear in two categories: 3-14% aOR 26.22, 95% CI 7.11 – 96.68 and < 3% aOR 28.67, 95% CI 5.51 – 149.25; and protein ≥ 5g/dL aOR 7.24, 95% CI 3.07 – 17.11) were associated with higher risk for TB. The DTC constructed using these variables showed Acc=87.6%, Se=89.2%, Sp=84.5% for PlTB diagnosis and was successfully applied in unconfirmed PlTB patients. Conclusion The DTC model showed an excellent performance for PlTB diagnosis and can be considered as an alternative diagnostic strategy by using clinical patterns in association with PF cellular/biochemical characteristics, which were affordable and easily performed in basic health care units.
Collapse
Affiliation(s)
- Ana Paula Santos
- Departamento de Pneumologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Marcelo Ribeiro-Alves
- Laboratório de Pesquisa Clínica em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil
| | - Raquel Corrêa
- Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Isabelle Lopes
- Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Mariana Almeida Silva
- Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Thiago Thomaz Mafort
- Departamento de Pneumologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Janaina Leung
- Departamento de Pneumologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Luciana Silva Rodrigues
- Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Rogério Rufino
- Departamento de Pneumologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| |
Collapse
|
6
|
Vilela VS, Vanhaecke A, da Silva BRA, da Costa CH, Lopes AJ, Rufino R, Cutolo M, Smith V. Is There a Link Between Nailfold Videocapillaroscopy and Pulmonary Function Tests in Systemic Sclerosis Patients?: A 24-Month Follow-up Monocentric Study. J Clin Rheumatol 2022; 28:26-32. [PMID: 34741001 DOI: 10.1097/rhu.0000000000001798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to explore the associations between nailfold videocapillaroscopy (NVC) and pulmonary function tests (PFTs) in systemic sclerosis (SSc) patients. METHODS This was a longitudinal study with follow-up of unselected Brazilian SSc patients. Baseline clinical examination, serological workup, high-resolution chest tomography, and NVC were performed. Pulmonary function test was performed at baseline and after 24 months. Pulmonary function test worsening over time was defined as either a ΔFVC decline ≥10% or a ΔFVC decline ≥5% and <9%, combined with a ΔDLCO decline ≥15%, at 24 months. The NVC parameters were quantitatively (capillary density number, dimension, morphology, and hemorrhages) and qualitatively (NVC pattern) evaluated according to the consented standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. RESULTS Seventy-nine patients were included. Fifty-nine were rated to have a scleroderma pattern (6 "early"/16 "active"/37 "late"). The mean FVC and DLCO were 76.8% and 67.2% at baseline and 73.8% and 64.3% at 24 months, respectively. After multivariate analysis, we found that a reduced baseline FVC was associated with reduced capillary density (odds ratio [OR], 11; 95% confidence interval [CI], 1.5-90.7; p = 0.03) and a reduced baseline DLCO associated with the late scleroderma pattern (OR, 6.75; 95% CI, 1.09-42; p = 0.03). No association between worsening of PFT over time and NVC was found. CONCLUSIONS The association between NVC and PFTs might corroborate the link between microangiopathy and interstitial lung disease in patients with SSc. This finding might strengthen the idea of incorporating NVC as a tool to predict progressive interstitial lung disease in these patients in the future.
Collapse
Affiliation(s)
- Verônica Silva Vilela
- From the Department of Rheumatology, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bruno Rangel Antunes da Silva
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique da Costa
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Thorax Diseases, University Hospital Pedro Ernesto, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | | |
Collapse
|
7
|
Lopes AJ, Mafort TT, da Cal MS, Monnerat LB, Litrento PF, Ramos I, de Oliveira RFJ, da Costa CH, Rufino R. Impulse Oscillometry Findings and Their Associations With Lung Ultrasound Signs in COVID-19 Survivors. Respir Care 2021; 66:1691-1698. [PMID: 34493607 PMCID: PMC9993544 DOI: 10.4187/respcare.09193] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Because impulse oscillometry (IOS) can detect changes in the small airways and is safer to perform during the COVID-19 pandemic than other pulmonary function tests, it may have value in investigating pulmonary sequelae in COVID-19 survivors. This study evaluated the performance of IOS in detecting lung abnormalities in COVID-19 survivors and investigated the associations of the findings with those of lung ultrasound (LUS) and spirometry. METHODS In this cross-sectional study, 117 subjects underwent IOS at a frequency range of 4-20 Hz 2 months after COVID-19 diagnosis. They also underwent spirometry and LUS, and their aeration scores were calculated. RESULTS On IOS, the resonance frequency was > 12 Hz, and the area under the reactance curve was > 3.60 cm H2O/L/s in 70 (59.8%) and 55 (47.0%) subjects, respectively. A heterogeneity of resistance between R4 and R20 (R4-R20) > 20% was observed in 60 (51.3%) participants. Based on their abnormalities in resistive and reactive parameters, 76 (65.0%) participants had abnormal IOS. Spirometry abnormalities were detected in 40 (34.2%) cases. LUS was abnormal in 51 (43.6%) participants, and the median aeration score was 0 (0-8) points. Abnormal IOS was associated with abnormal LUS (P < .001) and abnormal spirometry (P = .002). Abnormal spirometry had a significant but weaker association with abnormal LUS (P = .031). In participants who reported hospitalization, abnormal IOS was associated with both abnormal LUS (P = .001) and abnormal spirometry (P = .006). In participants who did not report hospitalization, abnormal IOS was associated with abnormal LUS (P < .001) but not abnormal spirometry (P = .063). CONCLUSIONS In COVID-19 survivors, IOS detected changes even when spirometry was normal. In these individuals, IOS parameters were more strongly associated with abnormalities on LUS than with abnormalities on spirometry.
Collapse
Affiliation(s)
- Agnaldo J Lopes
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
- Postgraduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Rehabilitation Sciences Postgraduation Program, Augusto Motta University Center, Rio de Janeiro, Brazil
| | - Thiago T Mafort
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana S da Cal
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura B Monnerat
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia F Litrento
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ingrid Ramos
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Claudia H da Costa
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Vilela VS, Dias MM, Salgado ÂA, da Silva BRA, Lopes AJ, Bessa EJC, Bruno LP, da Costa CH, Levy RA, Rufino R. Pulmonary hypertension in systemic sclerosis: diagnosis by systematic screening and prognosis after three years follow-up. BMC Pulm Med 2021; 21:251. [PMID: 34325685 PMCID: PMC8323291 DOI: 10.1186/s12890-021-01618-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a rare disease, and the presence of pulmonary hypertension can be a determining factor in prognosis. The aim of this study was to evaluate the diagnosis, profile, and prognosis of systemic sclerosis pulmonary hypertension (SSc-PH) diagnosed by systematic screening in a Brazilian population.
Methods A cohort of SSc patients underwent systematic screening for SSc-PH. Patients were referred for right heart catheterization (RHC) according to transthoracic echocardiogram or a combination of diagnostic tools. The clinical, immunological, and hemodynamic features and prognosis after 3 years were evaluated.
Results Twenty patients underwent RHC. SSc pulmonary arterial hypertension (SSc-PAH) was the most common group of SSc-PH. These patients had long disease duration, high urate levels and highly elevated mean pulmonary arterial pressure (mPAP) and peripheral vascular resistance (PVR) on hemodynamics. Patients with mPAP > 20– < 25 mmHg had hemodynamic features of intermediate disease. Patients with SSc-PH associated to interstitial lung disease (SSc-ILD-PH) had signs of vasculopathy on hemodynamics. In patients with no-SSc-PH, the survival at 1, 2, and 3 years was 96%, 92% and 92%, respectively and in patients with SSc-PH it was 86.7%, 60% and 53.3%, respectively. Conclusions Patients identified with SSc-PAH and SSc-ILD-PH in our screening had severe clinical and hemodynamic features. Mortality remains high in SSc-PH but was more related to Bo-PAH and SSc-ILD-PH, while in SSc-PAH, the prognosis was better. Trial registration: Current Controlled Trials ISRCTN 72968188, July 8th, 2021. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01618-z.
Collapse
Affiliation(s)
- Verônica Silva Vilela
- Rheumatology Discipline, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Marcio Macri Dias
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Ângelo Antunes Salgado
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Bruno Rangel Antunes da Silva
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Agnaldo José Lopes
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Elizabeth Jauhar Cardoso Bessa
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Leonardo Palermo Bruno
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Cláudia Henrique da Costa
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil
| | - Roger Abramino Levy
- Rheumatology Discipline, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil.,Immunology and Specialty Medicine, GSK, 1250 Collegville Rd, Collegeville, PA, 19426, USA
| | - Rogério Rufino
- Cardiology Discipline, Thorax Diseases Department, State University of Rio de Janeiro, Hospital Universitário Pedro Ernesto, Third Floor, Boulevard 28 de Setembro 77, Rio de Janeiro, 20551-031, Brazil.
| |
Collapse
|
9
|
Lopes AJ, Mafort TT, da Costa CH, Rufino R, de Cássia Firmida M, Kirk KM, Cobo CG, da Costa HDSB, da Cruz CMBQ, Mogami R. Comparison Between Lung Ultrasound and Computed Tomographic Findings in Patients With COVID-19 Pneumonia. J Ultrasound Med 2021; 40:1391-1399. [PMID: 32996607 PMCID: PMC7537266 DOI: 10.1002/jum.15521] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 09/11/2020] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The aim of this study was to describe findings from lung ultrasound (LUS) and computed tomography (CT) in health professionals with coronavirus disease 2019 pneumonia and to evaluate the associations of the findings of both tests. METHODS This cross-sectional observational study evaluated 45 health professionals who were initially seen in screening tents and had a diagnosis of coronavirus disease 2019 as confirmed by a reverse transcription polymerase chain reaction and lung involvement diagnosed by LUS. Subsequently, these individuals were admitted to the hospital, where chest CT was performed. Aeration scores were obtained for the LUS examinations based on the following findings: more than 2 B-lines, coalescent B-lines, and subpleural consolidations. A subjective assessment of the extent of lung disease on CT was performed on the basis of the percentage of lung parenchyma involvement as follows: 25% or less, 25% to 50%, and greater than 50%. RESULTS Regarding LUS signs, more than 2 B-lines, coalescent B-lines, and subpleural consolidations were present in 73.3%, 68.2%, and 24.4% of cases, respectively. The main findings on CT were ground glass opacities, a crazy-paving pattern, and consolidations (66.7%, 20%, and 20% of cases); 17.8% of cases had examinations without abnormalities. Patients with more than 2 B-lines on LUS had more ground glass opacity areas on CT (P = .0007), whereas patients with subpleural consolidations on LUS had more consolidations on CT (P < .0001). In addition, patients with higher LUS aeration scores had more extensive disease on CT (P < .0001). CONCLUSIONS Lung ultrasound can detect lung injury even in the presence of normal CT results. There are associations between the abnormalities detected by both methods, and a relationship also exists between LUS aeration scores and the disease extent on CT.
Collapse
Affiliation(s)
- Agnaldo José Lopes
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Rehabilitation Sciences Postgraduation ProgramAugusto Motta University CenterRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Thiago Thomaz Mafort
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Cláudia Henrique da Costa
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Rogério Rufino
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Mônica de Cássia Firmida
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Kennedy Martins Kirk
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of PulmonologyPiquet Carneiro Policlinic, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Carolina Gianella Cobo
- Department of RadiologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | | | | | - Roberto Mogami
- Postgraduation Program in Medical SciencesSchool of Medical Sciences, State University of Rio de JaneiroRio de JaneiroBrazil
- Department of RadiologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| |
Collapse
|
10
|
Brito GMXD, Mafort TT, Ribeiro-Alves M, Reis LVTD, Leung J, Leão RS, Rufino R, Rodrigues LS. Diagnostic performance of the Xpert MTB/RIF assay in BAL fluid samples from patients under clinical suspicion of pulmonary tuberculosis: a tertiary care experience in a high-tuberculosis-burden area. ACTA ACUST UNITED AC 2021; 47:e20200581. [PMID: 34008762 PMCID: PMC8332835 DOI: 10.36416/1806-3756/e20200581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of the Xpert MTB/RIF assay, a rapid molecular test for tuberculosis, comparing it with that of AFB staining and culture, in BAL fluid (BALF) samples from patients with clinically suspected pulmonary tuberculosis (PTB) who are sputum smear-negative or produce sputum samples of insufficient quantity. METHODS This was a retrospective study of 140 cases of suspected PTB in patients who were smear-negative or produced insufficient sputum samples and were evaluated at a tertiary teaching hospital in the city of Rio de Janeiro, Brazil. All of the patients underwent fiberoptic bronchoscopy with BAL. The BALF specimens were evaluated by AFB staining, mycobacterial culture, and the Xpert MTB/RIF assay. RESULTS Among the 140 patients, results for all three microbiological examinations were available for 73 (52.1%), of whom 22 tested positive on culture, 17 tested positive on AFB staining, and 20 tested positive on the Xpert MTB/RIF assay. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for AFB staining were 68.1%, 96.1%, 88.2%, 87.5%, and 87.6%, respectively, compared with 81.8%, 96.1%, 90.0%, 92.4%, and 91.8%, respectively, for the Xpert MTB/RIF assay. The agreement between AFB staining and culture was 82.3% (kappa = 0.46; p < 0.0001), whereas that between the Xpert MTB/RIF assay and culture was 91.8% (kappa = 0.8; p < 0.0001). CONCLUSIONS In BALF samples, the Xpert MTB/RIF assay performs better than do traditional methods, providing a reliable alternative to sputum analysis in suspected cases of PTB. However, the rate of discordant results merits careful consideration.
Collapse
Affiliation(s)
- Guilherme Machado Xavier de Brito
- . Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Thiago Thomaz Mafort
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Marcelo Ribeiro-Alves
- . Laboratório de Pesquisas Clínicas em DST/AIDS, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Larissa Vieira Tavares Dos Reis
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Janaína Leung
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Robson Souza Leão
- . Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Rogério Rufino
- . Disciplina de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Luciana Silva Rodrigues
- . Laboratório de Imunopatologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| |
Collapse
|
11
|
Mafort TT, Rufino R, da Costa CH, da Cal MS, Monnerat LB, Litrento PF, Parra LLZ, Marinho ADSEDS, Lopes AJ. One-month outcomes of patients with SARS-CoV-2 infection and their relationships with lung ultrasound signs. Ultrasound J 2021; 13:19. [PMID: 33835273 PMCID: PMC8033556 DOI: 10.1186/s13089-021-00223-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background The role of lung ultrasound (LUS) in evaluating the mid- and long-term prognoses of patients with COVID-19 pneumonia is not yet known. The objectives of this study were to evaluate associations between LUS signs at the time of screening and clinical outcomes 1 month after LUS and to assess LUS signs at the time of presentation with known risk factors for COVID-19 pneumonia. Methods This was a retrospective study of data prospectively collected 1 month after LUS screening of 447 adult patients diagnosed with COVID-19 pneumonia. Sonographic examination was performed in screening tents with the participants seated. The LUS signs (B-lines > 2, coalescent B-lines, and subpleural consolidations) were captured in six areas of each hemithorax and a LUS aeration score was calculated; in addition, the categories of disease probability based on patterns of LUS findings (high-probability, intermediate-probability, alternate, and low-probability patterns) were evaluated. The LUS signs at patients’ initial evaluation were related to the following outcomes: symptomatology, the need for hospitalization or invasive mechanical ventilation (IMV), and COVID-19-related death. Results According to the evaluations performed 1 month after LUS screening, 36 patients were hospitalised, eight of whom required intensive care unit (ICU) admission and three of whom died. The presence of coalescent B-lines was associated with the need for hospitalization (p = 0.008). The presence of subpleural consolidations was associated with dyspnoea (p < 0.0001), cough (p = 0.003), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.002). A higher aeration score was associated with dyspnoea (p < 0.0001), the need for hospitalization (p < 0.0001), the need for ICU admission (p < 0.0001), and death (p = 0.003). In addition, patients with a high-probability LUS pattern had a higher aeration score (p < 0.0001) and more dyspnoea (p = 0.024) and more often required hospitalization (p < 0.0001) and ICU admission (p = 0.031). Conclusions In patients with COVID-19 pneumonia, LUS signs were related to respiratory symptoms 1 month after LUS screening. Strong relationships were identified between LUS signs and the need for hospitalization and death.
Collapse
Affiliation(s)
- Thiago Thomaz Mafort
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Rogério Rufino
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Claudia Henrique da Costa
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil.,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil
| | - Mariana Soares da Cal
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Laura Braga Monnerat
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Patrícia Frascari Litrento
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Laura Lizeth Zuluaga Parra
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Arthur de Sá Earp de Souza Marinho
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil
| | - Agnaldo José Lopes
- Department of Pulmonology, Piquet Carneiro Policlinic, State University of Rio de Janeiro, Av. Mal. Rondon, 381, São Francisco Xavier, Rio de Janeiro, 20950-003, Brazil. .,Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manuel de Abreu, 444, 2° andar, Vila Isabel, Rio de Janeiro, 20550-170, Brazil. .,Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rua Dona Isabel, 94, Bonsucesso, Rio de Janeiro, 21032-060, Brazil.
| |
Collapse
|
12
|
Ferrari da Cruz T, Rufino R, Lopes A, Henrique Costa C. Small airway evaluation in three subjects with alpha-1 antitrypsin deficiency without diagnosed lung disease. BMJ Case Rep 2021; 14:14/3/e239146. [PMID: 33785603 PMCID: PMC8011716 DOI: 10.1136/bcr-2020-239146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe three cases of female subjects (aged 16, 44 and 41 years) with no respiratory symptoms, who have alpha-1 antitripsyn mutation (PiSZ, PiZZ and PiZZ) and who performed traditional pulmonary function tests and the single breath nitrogen washout test. They still did not have chronic obstructive pulmonary disease (COPD) or any identifiable change in traditional pulmonary function tests but already have change in nitrogen washout tests. Alpha-1 antitrypsin deficiency is a genetic disorder associated with early-onset COPD. There is evidence that although patients who have well-preserved FEV1 may already have signs of emphysema associated with symptoms. Therefore, the nitrogen washout test is considered to have more sensitive outcomes than other pulmonary function tests for early investigation of small airways disease and could allow the monitoring pulmonary function and evaluating of therapeutic decision.
Collapse
Affiliation(s)
| | - Rogério Rufino
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Agnaldo Lopes
- Pneumology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
13
|
Mafort TT, Lopes AJ, da Costa CH, da Cal MS, Lopes MC, da Silva BRA, Faria LF, Faria AC, Costa W, Salles REB, de Castro MCS, Rufino R. Changes in lung ultrasound of symptomatic healthcare professionals with COVID-19 pneumonia and their association with clinical findings. J Clin Ultrasound 2020; 48:515-521. [PMID: 32827163 PMCID: PMC7461470 DOI: 10.1002/jcu.22905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate ultrasound signs of coronavirus disease-19 (COVID-19) pneumonia in symptomatic healthcare professionals and to correlate those changes with clinical findings. METHODS All patients underwent real-time polymerase chain reaction (RT-PCR), lung ultrasound (LUS) and clinical evaluation on the same day. In each of the 12 areas evaluated in the LUS, the LUS signs were scored to generate the aeration score. RESULTS A total of 409 participants had positive PCR, with a median age of 41 (35-51) years. All participants had clinical symptoms, with cough in 84.1%, fever in 69.7%, and dyspnea in 36.2% of cases. In the LUS, 72.6% of participants had B-lines >2, 36.2% had coalescent B-lines, and 8.06% had subpleural consolidations. The median aeration score was 3 (2-7). The aeration score differed significantly regarding the presence of cough (P = .002), fever (P = .001), and dyspnea (P < .0001). The finding of subpleural consolidations in the LUS showed significant differences between participants with or without dyspnea (P < .0001). CONCLUSIONS In healthcare professionals with COVID-19, LUS plays a key role in the characterization of lung involvement. Although B-lines are the most common ultrasound sign, subpleural consolidations are those that most impact the respiratory condition.
Collapse
Affiliation(s)
- Thiago Thomaz Mafort
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
- Postgraduate Program in Medical Sciences, School of Medical SciencesState University of Rio de JaneiroRio de JaneiroBrazil
| | - Agnaldo José Lopes
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
- Postgraduate Program in Medical Sciences, School of Medical SciencesState University of Rio de JaneiroRio de JaneiroBrazil
| | - Cláudia Henrique da Costa
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
- Postgraduate Program in Medical Sciences, School of Medical SciencesState University of Rio de JaneiroRio de JaneiroBrazil
| | - Mariana Soares da Cal
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Mariana Carneiro Lopes
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | | | - Luana Fortes Faria
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Anamelia Costa Faria
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | - Walter Costa
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
| | | | | | - Rogério Rufino
- Department of PulmonologyPedro Ernesto University Hospital, State University of Rio de JaneiroRio de JaneiroBrazil
- Postgraduate Program in Medical Sciences, School of Medical SciencesState University of Rio de JaneiroRio de JaneiroBrazil
| |
Collapse
|
14
|
da Silva RJ, da Silva Corrêa R, Sardella IG, de Paulo Mulinari AC, Mafort TT, Santos AP, Rufino R, Rodrigues LS, Saad MHF. IgA and IgG antibody detection of mycobacterial antigens in pleural fluid and serum from pleural tuberculous patients. BMC Immunol 2019; 20:36. [PMID: 31623558 PMCID: PMC6798396 DOI: 10.1186/s12865-019-0315-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/09/2019] [Indexed: 01/16/2023] Open
Abstract
Background A previous study demonstrated pleural fluid (PF) IgA immunodominance for the fused MT10.3:MPT64 protein in pleural tuberculosis (PLTB) cases. However, no clue on the role of IgA and IgG against this and other antigens in PF and serum concerning improved diagnosis is available. Thus, the aim of the present study was to validate PF IgA-MT10.3:MPT64 and evaluate PF and serum IgA and IgG reactivity against this protein, its peptides (F2) and single MPT64, MT10.3 and the PPE59 mycobacterial specific antigens. IgA and IgG ELISA were measured against the antigen in PLTB (n = 29) and other non-TB pleurisy (n = 39) patient samples. Results The immunodominance of PF IgA-MT10.3:MPT64 was confirmed in PLTB (86.2%) followed by PPE59 (62%), while serum IgA-F2 exhibited 51.7% sensitivity. PF and serum IgG-MT10.3:MPT64 led to 65.5 and 51.7% sensitivity, respectively. However, MT10.3 and MPT64 displayed overall lower sensitivity (≤34.5) for both antibodies. All results at 95% fixed specificity. Combinatory results indicated 93.1% sensitivity for PF IgA-MT10.3:MPT64/−PPE59 and IgA/IgG-MT10.3:MPT64 at 92.3% specificity, followed by IgA-MT10.3:MPT64/−MPT64 or /−F2 (89.6%) without jeopardizing specificity (94.9%). The combinatory results of the PF adenosine deaminase test (ADA) and IgA-MT10.3:MPT64/−F2 demonstrated the highest sensitivity (96.6%), with a specificity of 92.3%. Conclusions The PF IgA-MT10:MPT64 immune dominance was validated in PLTB, and its combinatory results with PPE59 or MPT64 or F2 antigens as well as with IgG, are reported herein for the first time, improving their potential to assist diagnosis. Combining PF-ADA and IgA-MT10.3:MPT64/−F2 results achieved better accuracy. Moreover, serum IgG, although less accurate, displays potential beyond microbiological tests.
Collapse
Affiliation(s)
- Renan Jeremias da Silva
- Laboratorio de Microbiologia Celular, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Av. Brazil, 4365, Rio de Janeiro, 21040-360, Brazil
| | - Raquel da Silva Corrêa
- Laboratório de Immunopatologia (LIP), Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Isabela Gama Sardella
- Laboratorio de Microbiologia Celular, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Av. Brazil, 4365, Rio de Janeiro, 21040-360, Brazil
| | - Ana Carla de Paulo Mulinari
- Laboratorio de Microbiologia Celular, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Av. Brazil, 4365, Rio de Janeiro, 21040-360, Brazil
| | - Thiago Thomaz Mafort
- Serviço de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto (HUPE)/UERJ, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Santos
- Serviço de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto (HUPE)/UERJ, Rio de Janeiro, RJ, Brazil
| | - Rogério Rufino
- Serviço de Pneumologia e Tisiologia, Hospital Universitário Pedro Ernesto (HUPE)/UERJ, Rio de Janeiro, RJ, Brazil
| | - Luciana Silva Rodrigues
- Laboratório de Immunopatologia (LIP), Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria Helena Féres Saad
- Laboratorio de Microbiologia Celular, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Av. Brazil, 4365, Rio de Janeiro, 21040-360, Brazil.
| |
Collapse
|
15
|
Vilela VS, da Silva BRA, da Costa CH, Lopes AJ, Levy RA, Rufino R. Effects of treatment with rituximab on microcirculation in patients with long-term systemic sclerosis. BMC Res Notes 2018; 11:874. [PMID: 30526656 PMCID: PMC6288955 DOI: 10.1186/s13104-018-3994-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the effect of rituximab on microcirculation in long-term SSc. Results Four patients with diffuse SSc over 3 years of disease received rituximab cycles of two 1-g infusions every 6 months for 2 years. Videocapillaroscopy was performed at baseline, 12 months, and 24 months and semi-quantitative scoring of videocapillaroscopy abnormalities was performed and the microangiopathy evolution score (MES: range 0–9) was calculated. The mean disease duration was 5 years (range 3–15). On videocapillaroscopy, giant capillaries and hemorrhages remained stable from baseline to 24 months. Capillary loss, abnormally-shaped capillaries, and MES stabilized at 12 months and increased by 24.5% and 28% at 24 months. Rituximab improves microcirculation in long-term SSc. Stabilization and reduced progression of microcirculation abnormalities were achieved at 12 and 24 months, respectively. Electronic supplementary material The online version of this article (10.1186/s13104-018-3994-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | | | | | - Rogério Rufino
- State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
16
|
Santos AP, Corrêa RDS, Ribeiro-Alves M, Soares da Silva ACO, Mafort TT, Leung J, Pereira GMB, Rodrigues LS, Rufino R. Application of Venn's diagram in the diagnosis of pleural tuberculosis using IFN-γ, IP-10 and adenosine deaminase. PLoS One 2018; 13:e0202481. [PMID: 30148839 PMCID: PMC6110466 DOI: 10.1371/journal.pone.0202481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/04/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pleural tuberculosis (PlTB) is the most common extrapulmonary manifestation of this infectious disease which still presents high mortality rates worldwide. Conventional diagnostic tests for PlTB register multiple limitations, including the lack of sensitivity of microbiological methods on pleural specimens and the need of invasive procedures such as pleural biopsy performance. In this scenario, the search for biological markers on pleural fluid (PF) has been the target of several studies as a strategy to overcome the limitations of PlTB diagnosis. This study aims to evaluate the use either isolated or in combination with adenosine deaminase (ADA), interferon-gamma (IFN-γ), interferon-gamma inducible protein of 10-kD (IP-10) levels on PF in order to guide an accurate anti-TB treatment in microbiologically non-confirmed cases. METHODS AND FINDINGS Eighty patients presenting pleural effusion under investigation were enrolled in a cross-sectional study conducted at Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil. Peripheral blood (PB) and PF samples collected from all patients were applied to the commercial IFN-γ release assay, QuantiFERON-TB Gold In-Tube, and samples were analyzed for IFN-γ and IP-10 by immunoassays. ADA activity was determined on PF by the colorimetric method. Based on microbiological and histological criteria, patients were categorized as follow: confirmed PlTB (n = 16), non-confirmed PlTB (n = 17) and non-PlTB (n = 47). The Mycobacterium tuberculosis antigen-specific production of IFN-γ and IP-10 on PB or PF did not show significant differences. However, the basal levels of these biomarkers, as well as the ADA activity on PF, were significantly increased in confirmed PlTB in comparison to non-PlTB group. Receiver operating characteristics curves were performed and the best cut-off points of these three biomarkers were estimated. Their either isolated or combined performances (sensitivity [Se], specificity [Sp], positive predictive value [PPV], negative predictive value [NPV] and accuracy [Acc]) were determined and applied to Venn's diagrams among the groups. Based on the confirmed PlTB cases, IFN-γ showed the best performance of them at a cut-off point of 2.33 IU/mL (Se = 93.8% and Sp = 97.9%) followed by ADA at a cut-off of 25.80 IU/L (Se = 100% and Sp = 84.8%) and IP-10 (Cut-point = 4,361.90 pg/mL, Se = 75% and Sp = 82.6%). IFN-γ plus ADA (cut-point: 25.80 IU/L) represent the most accurate biomarker combination (98.4%), showing Se = 93.7%, Sp = 100%, PPV = 100% and NPV = 97.9%. When this analysis was applied in non-confirmed PlTB, 15/17 (88.2%) presented at least two positive biomarkers in combination. CONCLUSION IFN-γ, IP-10, and ADA in PlTB effusions are significantly higher than in non-PlTB cases. IFN-γ is an excellent rule-in and rule-out test compared to IP-10 and ADA. The combination of IFN-γ and ADA, in a reviewed cut-off point, showed to be particularly useful to clinicians as their positive results combined prompts immediate treatment for TB while both negative results suggest further investigation.
Collapse
Affiliation(s)
- Ana Paula Santos
- Department of Pulmonary Care, Pedro Ernesto University Hospital (HUPE)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Raquel da Silva Corrêa
- Laboratory of Immunopathology, Medical Sciences Faculty (FCM)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Marcelo Ribeiro-Alves
- Laboratory of Clinical Research on STD/AIDS, National Institute of Infectology Evandro Chagas (INI)–Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | | | - Thiago Thomaz Mafort
- Department of Pulmonary Care, Pedro Ernesto University Hospital (HUPE)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Janaína Leung
- Department of Pulmonary Care, Pedro Ernesto University Hospital (HUPE)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Geraldo Moura Batista Pereira
- Laboratory of Immunopathology, Medical Sciences Faculty (FCM)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Laboratory of Cellular Microbiology, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Luciana Silva Rodrigues
- Laboratory of Immunopathology, Medical Sciences Faculty (FCM)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Rogério Rufino
- Department of Pulmonary Care, Pedro Ernesto University Hospital (HUPE)—State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
17
|
de Souza Y, da Silva KM, Condesso D, Figueira B, Noronha Filho AJ, Rufino R, Gosselink R, da Costa CH. Use of a Home-Based Manual as Part of a Pulmonary Rehabilitation Program. Respir Care 2018; 63:1485-1491. [PMID: 30087196 DOI: 10.4187/respcare.05656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary rehabilitation programs improve exercise capacity and quality of life in patients with COPD. Domiciliary strategies to maintain these benefits have been proposed. OBJECTIVE This study aimed to determine whether a rehabilitation manual would facilitate the maintenance of the benefits acquired during out-patient pulmonary rehabilitation. METHODS Fifty subjects with stable COPD were included (26 women and 24 men). All the subjects were evaluated during screening and after 12 wk of out-patient rehabilitation, and then were randomly divided into 2 groups, with one group that received the rehabilitation manual for home use (manual group) and the other group only received verbal recommendations (control group). At this point, the 2 groups were similar. After 12 wk at home, both groups were evaluated a third time. All evaluations included a 6-min walk test (6MWT), 6-min step test, COPD Assessment Test, and measurement of dyspnea by using the modified Medical Research Council dyspnea scale. RESULTS When comparing the results of the 6MWT and 6-min step test done at out-patient discharge and after 12 wk at home, the manual group presented no differences (6MWT, 0 ± 25 m; 6-min step test, 1 ± 32 steps), whereas the control subjects lost part of the gain obtained during rehabilitation (6MWT -46 ± 36 m; 6-min step test -39 ± 33 steps). There was a significant difference between the groups (P < .05). When comparing the same time points, the change in the COPD Assessment Test score was -1 ± 1 for the manual group and 1 ± 2 for the control group (P = .01). For the modified Medical Research Council dyspnea scale, the change in score was 0 ± 1 for the manual group and 1 ± 1 for the control group (P = .01). CONCLUSIONS The use of a simple, well-illustrated manual facilitated the maintenance of the benefits acquired in out-patient pulmonary rehabilitation over a period of 3 months after study termination.
Collapse
Affiliation(s)
- Yves de Souza
- Department of Physical Therapy, Veiga de Almeida University, Rio de Janeiro, Rio de Janeiro, Brazil. .,Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kenia Maynard da Silva
- Department of Physical Therapy, Veiga de Almeida University, Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Condesso
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca Figueira
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arnaldo J Noronha Filho
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Rufino
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Cláudia H da Costa
- Department of Pulmonary Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
18
|
Silva BRA, Rodrigues RS, Rufino R, Costa CH, Vilela VS, Levy RA, Guimarães ARM, Carvalho ARS, Lopes AJ. Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings. PLoS One 2018; 13:e0200754. [PMID: 30067820 PMCID: PMC6070209 DOI: 10.1371/journal.pone.0200754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of patients with scleroderma and to correlate these findings with data on clinical and pulmonary function. METHODS This was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS). RESULTS Most patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03). CONCLUSIONS In a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA.
Collapse
Affiliation(s)
- Bruno Rangel Antunes Silva
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Veronica Silva Vilela
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Abramino Levy
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Ranieri Medeiros Guimarães
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alysson Roncally Silva Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Pulmonary Engineering, Biomedical Engineering Programme, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
19
|
Costa E, Caetano R, Werneck GL, Bregman M, Araújo DV, Rufino R. Estimated cost of asthma in outpatient treatment: a real-world study. Rev Saude Publica 2018; 52:27. [PMID: 29641652 PMCID: PMC5893272 DOI: 10.11606/s1518-8787.2018052000153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.
Collapse
Affiliation(s)
- Eduardo Costa
- Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Medicina Interna. Rio de Janeiro, RJ, Brasil
| | - Rosangela Caetano
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Política, Planejamento e Administração em Saúde. Rio de Janeiro, RJ, Brasil
| | - Guilherme Loureiro Werneck
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Maurício Bregman
- Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Programa de Bolsas de Iniciação Científica. Rio de Janeiro, RJ, Brasil
| | - Denizar Vianna Araújo
- Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Clínica Médica. Rio de Janeiro, RJ, Brasil
| | - Rogério Rufino
- Universidade do Estado do Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Doenças do Tórax. Rio de Janeiro, RJ, Brasil
| |
Collapse
|
20
|
Rufino R, Costa CH, Lopes AJ, Maiworm AI, Maynard K, Silva LMRA, Dias RM. Spirometry reference values in the Brazilian population. ACTA ACUST UNITED AC 2017; 50:e5700. [PMID: 28273211 PMCID: PMC5378453 DOI: 10.1590/1414-431x20175700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.
Collapse
Affiliation(s)
- R Rufino
- Departamento de Doenças do Tórax, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - C H Costa
- Departamento de Doenças do Tórax, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A J Lopes
- Departamento de Doenças do Tórax, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A I Maiworm
- Departamento de Doenças do Tórax, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - K Maynard
- Departamento de Doenças do Tórax, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - L M R A Silva
- Faculdade de Economia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - R M Dias
- Departamento Cardiopulmonar, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
21
|
Silva BRA, Rufino R, Costa CH, Vilela VS, Levy RA, Lopes AJ. Ventilation distribution and small airway function in patients with systemic sclerosis. Rev Port Pneumol (2006) 2017; 23:132-138. [PMID: 28258938 DOI: 10.1016/j.rppnen.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/09/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the importance of traditional pulmonary function tests (PFTs) in managing systemic sclerosis (SSc), many patients with pulmonary disease diagnosed by computed tomography (CT) present with normal PFTs. OBJECTIVE To evaluate the efficacy of the nitrogen single-breath washout (N2SBW) test in diagnosing SSc and to correlate N2SBW parameters with the PFT indexes used in the follow-up of these patients, clinical data, and CT findings. METHODS Cross-sectional study in which 52 consecutive SSc patients were subjected to spirometry, body plethysmography, analysis of the diffusing capacity for carbon monoxide (DLCO), analysis of respiratory muscle strength, N2SBW testing, and CT analysis. RESULTS Twenty-eight patients had a forced vital capacity (FVC) that was <70% of the predicted value. In the N2SBW test, 44 patients had a phase III slope (Phase III slopeN2SBW) that was >120% of the predicted value, while 15 patients had a closing volume/vital capacity (CV/VC) that was >120% of the predicted value. A significant difference in Phase III slopeN2SBW was observed when the patients with predominant traction bronchiectasis and honeycombing were compared to the patients with other CT patterns (p<0.0001). The Phase III slopeN2SBW was correlated with FVC (rs=-0.845, p<0.0001) and DLCO (rs=-0.600, p<0.0001), and the CV/VC was correlated with FVC (rs=-0.460, p=0.0006) and residual volume/total lung capacity (rs=0.328, p=0.017). CONCLUSION Ventilation heterogeneity is a frequent finding in SSc patients that is associated with restrictive damage, changes in pulmonary diffusion, and CT patterns. In addition, approximately one-third of the patients presented with findings that were compatible with small airway disease.
Collapse
Affiliation(s)
- B R A Silva
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Rufino
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C H Costa
- Department of Pulmonology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - V S Vilela
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - R A Levy
- Department of Rheumatology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - A J Lopes
- Laboratory of Respiratory Physiology, State University of Rio de Janeiro, and Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| |
Collapse
|
22
|
Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016; 11:28. [PMID: 27408717 PMCID: PMC4940831 DOI: 10.1186/s40248-016-0066-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/10/2016] [Indexed: 12/11/2022] Open
Abstract
Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.
Collapse
Affiliation(s)
- Thiago Thomaz Mafort
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil
| | - Rogério Rufino
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Cláudia Henrique Costa
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| | - Agnaldo José Lopes
- Laboratory of Respiration Physiology, Pulmonary Medicine Department, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, Vila Isabel, 20551-030 Rio de Janeiro Brazil ; Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, Av. Prof. Manoel de Abreu, 444, Vila Isabel, 20550-170 Rio de Janeiro Brazil
| |
Collapse
|
23
|
José Lopes A, Thomaz Mafort T, Rufino R, Henrique Costa C. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med 2016. [DOI: 10.4081/mrm.2016.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Obesity is currently one of the major epidemics of this millennium and affects individuals throughout the world. It causes multiple systemic complications, some of which result in severe impairment of organs and tissues. These complications involve mechanical changes caused by the accumulation of adipose tissue and the numerous cytokines produced by adipocytes. Obesity also significantly interferes with respiratory function by decreasing lung volume, particularly the expiratory reserve volume and functional residual capacity. Because of the ineffectiveness of the respiratory muscles, strength and resistance may be reduced. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure. It is noteworthy that patterns of body fat distribution significantly influence the function of the respiratory system, likely via the direct mechanical effect of fat accumulation in the chest and abdominal regions. Weight loss caused by various types of treatment, including low-calorie diet, intragastric balloon, and bariatric surgery, significantly improves lung function and metabolic syndrome and reduces body mass index. Despite advances in the knowledge of pulmonary and systemic complications associated with obesity, longitudinal randomized studies are needed to assess the impact of weight loss on metabolic syndrome and lung function.
Collapse
|
24
|
Baddini-Martinez J, Baldi BG, Costa CHD, Jezler S, Lima MS, Rufino R. Update on diagnosis and treatment of idiopathic pulmonary fibrosis. J Bras Pneumol 2016; 41:454-66. [PMID: 26578138 PMCID: PMC4635093 DOI: 10.1590/s1806-37132015000000152] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.
Collapse
Affiliation(s)
- José Baddini-Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Bruno Guedes Baldi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Rogério Rufino
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| |
Collapse
|
25
|
da Costa CH, da Silva KM, Maiworm A, Raphael Y, Parnayba J, Da Cal M, Figueira B, Condesso D, Rufino R. Can we use the 6-minute step test instead of the 6-minute walking test? An observational study. Physiotherapy 2015; 103:48-52. [PMID: 27012823 DOI: 10.1016/j.physio.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To verify whether or not heart rate is maintained below the calculated submaximal level in healthy, sedentary subjects when they perform the 6-minute step test (6MST) and the 6-minute walking test (6MWT), and to compare the maximal heart rate achieved by the subjects at the end of each test. DESIGN Observational, cross-sectional study. SETTING One tertiary centre. PARTICIPANTS Two hundred and fifty-three participants from a pool of 330 healthy and sedentary subjects between 20 and 80 years of age. INTERVENTIONS Both the 6MWT and the 6MST were performed in accordance with the American Thoracic Society's statement. Dyspnoea, blood pressure, oxygen saturation and heart rate were measured before and after each test. RESULTS Mean heart rate immediately after the 6MST was significantly higher than mean heart rate immediately after the 6MWT {125 [standard deviation (SD) 19] vs 111 (SD 17) beats/minute; mean difference 13 (95% confidence interval of the difference 10 to 16); P<0.001}. Moreover, mean heart rate during (3minutes after commencement) the 6MST [118 (SD 18) beats/minute] was statistically higher than mean heart rate at the end of the 6MWT [111 (SD 18) beats/minute; P<0.001]. None of the subjects achieved the calculated submaximal heart rate. CONCLUSIONS The 6MST and 6MWT are safe and produce submaximal effort in healthy participants. However, they are not interchangeable, and the 6MST requires more energy than the 6MWT.
Collapse
Affiliation(s)
- C H da Costa
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - K M da Silva
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - A Maiworm
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Y Raphael
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - J Parnayba
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - M Da Cal
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - B Figueira
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - D Condesso
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - R Rufino
- Respiratory Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
26
|
Rufino R. Treatment of lymphangioleiomyomatosis and Camões. J Bras Pneumol 2015; 41:295-6. [PMID: 26398747 PMCID: PMC4635947 DOI: 10.1590/s1806-37132015000400001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rogério Rufino
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, BR
| |
Collapse
|
27
|
de Lima Azambuja R, da Costa Santos Azambuja LSE, Costa C, Rufino R. Adiponectin in Asthma and Obesity: Protective Agent or Risk Factor for More Severe Disease? Lung 2015; 193:749-55. [PMID: 26315710 DOI: 10.1007/s00408-015-9793-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE The relationship between asthma and obesity is well established, although the pathophysiological mechanisms linking both diseases remain unknown. Adiponectin is a hormone secreted by adipose cells, plays a role in the modulation of inflammation and may be the key linking these two types of inflammation. METHODS We conducted a cross-sectional study with asthma with different body mass indices (BMI); the patients were classified as eutrophic, overweight, or obese. We assessed disease control using the GINA consensus, and the levels of adiponectin, C-reactive protein (CRP) and interleukin 33 (IL-33) in each of the patients. RESULTS We evaluated 75 of the 96 patients eligible for the study, including 25 in each BMI group. The CRP levels were significantly higher in the obese patients compared with both the eutrophic (p = 0.01) and the overweight (p = 0.03) patients. The mean adiponectin level was 21.82 ± 9.93 mg/L for the eutrophic asthmatics, which is a level that was significantly higher than in the overweight (15.31 ± 6.27 mg/L, p = 0.0140) and the obese (16.69 ± 11.45 mg/L, p = 0.0287) patients. The patients with higher adiponectin levels exhibited smaller FEV1 (p = 0.02) and lower FVC (p = 0.003). The IL-33 levels were not different between the groups. CONCLUSIONS Adiponectin does not protect against the development of inflammation in the setting of asthma and may in fact exacerbate the disease via its anti-TH1 inflammatory effects, allowing for increased TH2 differentiation and a more severe allergic response.
Collapse
Affiliation(s)
| | | | - Cláudia Costa
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, CEP 20551-030, Brazil
| | - Rogério Rufino
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
- Pulmonology Department, Hospital Universitário Pedro Ernesto, Avenida 28 de Setembro, 77, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
| |
Collapse
|
28
|
Faria AC, da Costa CH, Rufino R. Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD? Int J Gen Med 2015; 8:275-81. [PMID: 26345497 PMCID: PMC4554480 DOI: 10.2147/ijgm.s86479] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD. Methods The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics. Results In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329–0.745, P=0.75) and 0.69 (95% CI: 0.47–0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606–0.943, P=0.02). Conclusion SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD.
Collapse
Affiliation(s)
- Anamelia Costa Faria
- Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Rogério Rufino
- Cardiopulmonology Department, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
29
|
Abstract
OBJECTIVE To compare the absolute serum von Willebrand factor (vWF) levels and relative serum vWF activity in patients with clinically stable COPD, smokers without airway obstruction, and healthy never-smokers. METHODS The study included 57 subjects, in three groups: COPD (n = 36); smoker (n = 12); and control (n = 9). During the selection phase, all participants underwent chest X-rays, spirometry, and blood testing. Absolute serum vWF levels and relative serum vWF activity were obtained by turbidimetry and ELISA, respectively. The modified Medical Research Council scale (cut-off score = 2) was used in order to classify COPD patients as symptomatic or mildly symptomatic/asymptomatic. RESULTS Absolute vWF levels were significantly lower in the control group than in the smoker and COPD groups: 989 ± 436 pg/mL vs. 2,220 ± 746 pg/mL (p < 0.001) and 1,865 ± 592 pg/mL (p < 0.01). Relative serum vWF activity was significantly higher in the COPD group than in the smoker group (136.7 ± 46.0% vs. 92.8 ± 34.0%; p < 0.05), as well as being significantly higher in the symptomatic COPD subgroup than in the mildly symptomatic/asymptomatic COPD subgroup (154 ± 48% vs. 119 ± 8%; p < 0.05). In all three groups, there was a negative correlation between FEV1 (% of predicted) and relative serum vWF activity (r2 = -0.13; p = 0.009). CONCLUSIONS Our results suggest that increases in vWF levels and activity contribute to the persistence of systemic inflammation, as well as increasing cardiovascular risk, in COPD patients.
Collapse
Affiliation(s)
| | | | - Rogério Rufino
- Department of Pulmonology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
30
|
Torres GR, Acar J, Brito AC, Pimentel N, Polisseni N, da Costa CH, Rufino R. Fever, thoracic pain, skin lesions and Hampton hump. Thorax 2014; 69:879-80. [PMID: 24764112 DOI: 10.1136/thoraxjnl-2013-204913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Joana Acar
- State University of Rio de Janeiro, Pulmonology Service, Rio de Janeiro, Brazil
| | - Ana Carolina Brito
- State University of Rio de Janeiro, Pulmonology Service, Rio de Janeiro, Brazil
| | - Nelson Pimentel
- State University of Rio de Janeiro, Pulmonology Service, Rio de Janeiro, Brazil
| | - Nadja Polisseni
- State University of Rio de Janeiro, Pulmonology Service, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- State University of Rio de Janeiro, Pulmonology Service, Rio de Janeiro, Brazil
| |
Collapse
|
31
|
Rufino R, Marques BL, Azambuja RDL, Mafort T, Pugliese JG, da Costa CH. Pleural cholesterol to the diagnosis of exudative effusion. Open Respir Med J 2014; 8:14-7. [PMID: 24799966 PMCID: PMC4009737 DOI: 10.2174/1874306401408010014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction: Diagnostic approaches to patients with a pleural effusion must be precise because many
procedures depend on the nature of the fluid in the effusion. To date, no biochemical test is considered an appropriate
alternative to Light’s criteria. This study compared the absolute pleural cholesterol (PC) level and the pleural
cholesterol/serum cholesterol (PC/SC) ratio with Light’s criteria to determine exudative pleural effusions. Materials and Methodology: This study was a case series of 100 consecutive patients with pleural effusions. The clinical
parameters that were used to diagnosis an exudative effusion included the cholesterol level, a pleural cholesterol level ≥
50 mg/dL, a pleural/serum ratio ≥ 0.4, and Light’s criteria. The sensitivity, specificity, and positive and negative
predictive values of each test for the diagnosis of an exudative effusion were assessed. Results: A total of 79 patients were definitively diagnosed with an exudative effusion and were included in the trial and
analyzed. The mean PC level in the exudates was 90.39 mg/dL. The PC levels demonstrated a sensitivity of 97.22%, a
specificity of 85.71%, a positive predictive value of 98.59% and a negative predictive value of 75%. The PC/SC ratio
demonstrated a sensitivity of 81.48%, a specificity of 57.14%, a positive predictive value of 93.61% and a negative
predictive value of 28.57%. Conclusion: The pleural cholesterol dosage level and the pleural/serum cholesterol ratio can be utilized as unique
biomarkers to identify an exudative effusion and replace Light’s criteria.
Collapse
Affiliation(s)
- Rogério Rufino
- State University of Rio de Janeiro, Pulmonology Department, Rio de Janeiro, 20551-030, Brazil
| | - Bruna L Marques
- State University of Rio de Janeiro, Pulmonology Department, Rio de Janeiro, 20551-030, Brazil
| | - Renato de Lima Azambuja
- State University of Rio de Janeiro, Pulmonology Department, Rio de Janeiro, 20551-030, Brazil
| | - Thiago Mafort
- State University of Rio de Janeiro, Pulmonology Department, Rio de Janeiro, 20551-030, Brazil
| | - José G Pugliese
- State University of Rio de Janeiro, Pulmonology Department, Rio de Janeiro, 20551-030, Brazil
| | | |
Collapse
|
32
|
da Costa CH, Silva VL, Fabricio-Silva GM, Usnayo M, Rufino R, Porto LC. HLA in a cohort of Brazilian patients with sarcoidosis. Hum Immunol 2013; 74:1326-32. [PMID: 23911360 DOI: 10.1016/j.humimm.2013.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/09/2013] [Accepted: 07/19/2013] [Indexed: 12/12/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Hereditary etiology has been proposed as a cause of the sarcoidosis, and some Human Leucocyte Antigen (HLA) alleles have been related to the diagnosis or severity of the disease. Löfgren's syndrome has been linked to patients with the DRB1*03 allele, and non-resolving disease has been associated with the DRB1*07, DRB1*14 and DRB1*15 alleles. However, the results observed in Caucasian patients are not reproducible in other populations, such as in Japanese individuals. The aim of this study is to examine the HLA alleles in Brazilian patients with sarcoidosis confirmed by biopsy. Sixty-three patients were included in the study, and the HLA alleles were compared with 126 control individuals. HLA-A, -B, -C, -DRB1 and -DQB1 genes were typed using a Luminex Multi-analyte profiling system (One Lambda, Inc. Canoga Park, CA). Among sarcoidosis patients, the HLA A*23, A*80, B*08, B*41, DQB1*05 and DRB1*14 antigens tended to be more common than in the controls, whereas the B*44, B*45, B*51, B*58, DRB1*15 and DRB1*16 alleles were more frequently found in control subjects than in the sarcoidosis patients. However, after Bonferroni correction, only the HLA-DRB1*14 allele was found to be significantly different between sarcoidosis patients and controls (pC=0.0047, OR=11.69, CI=2.47-55.22). This allele was more frequent in mestizos and black patients. The presence of an HLA-DRB1*14 allele might determine the risk of sarcoidosis in Brazilian individuals, especially in mestizos and black patients.
Collapse
Affiliation(s)
- Cláudia Henrique da Costa
- Department of Pulmonary Medicine, Faculdade de Ciências Médicas, Rio de Janeiro State University, Brazil.
| | | | | | | | | | | |
Collapse
|
33
|
Bártholo TP, Pugliese JG, Mafort TT, Silva VLD, Costa CHD, Rufino R. Hemophagocytic syndrome due to pulmonary sarcoidosis. J Bras Pneumol 2012; 38:666-71. [PMID: 23147060 DOI: 10.1590/s1806-37132012000500017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 04/03/2012] [Indexed: 11/21/2022] Open
Abstract
Although hemophagocytic syndrome is a rare clinical condition, it is associated with high mortality and the number of cases described in the literature has progressively increased. The diagnosis of hemophagocytic syndrome is made on the basis of a finding of hemophagocytosis. Sarcoidosis is a highly prevalent disease whose course and prognosis might correlate with the initial clinical presentation and the extent of the disease. We report the case of a patient with long-standing sarcoidosis who presented with intermittent fever and fatigue. The diagnosis of hemophagocytic syndrome was made by bone marrow aspiration, and specific treatment was ineffective. This is the third case of sarcoidosis-related hemophagocytic syndrome reported in the literature and the first reported in Latin America. All three cases had unfavorable outcomes.
Collapse
|
34
|
Lemos-Silva V, Araújo PB, Lopes C, Rufino R, da Costa CH. Epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. J Bras Pneumol 2012; 37:438-45. [PMID: 21881733 DOI: 10.1590/s1806-37132011000400005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/24/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the epidemiological characteristics of sarcoidosis patients in the city of Rio de Janeiro, Brazil. METHODS A descriptive, case-control study involving 100 sarcoidosis patients under outpatient treatment between 2008 and 2010 at the Pedro Ernesto University Hospital, located in the city of Rio de Janeiro, Brazil. The diagnosis of sarcoidosis was based on clinical, radiological, biochemical, and histopathological criteria. RESULTS There was a predominance of females in the 35-40 year age bracket (range, 7-69 years), who accounted for 65% of the sample, although there was a second peak at approximately 55 years of age. The most common symptom was dyspnea (in 47%), and the most common radiological findings were pulmonary and lymph node involvement (stage II; in 43%), followed by stage III (in 20%), stage I (in 19%), stage 0 (in 15%), and stage IV (in 3%). No pleural effusion or digital clubbing was observed at diagnosis. The tuberculin skin test was negative in 94 patients. Spirometric findings at diagnosis were normal in 61 patients; indicative of obstructive lung disease in 21; and indicative of restrictive lung disease in 18. The most common biopsy sites were the lungs (principally by bronchoscopy) and the skin, the diagnosis being confirmed by biopsy in 56% and 29% of the cases, respectively. Treatment with prednisone was initiated in 75% of the patients and maintained for more than 2 years in 19.7%. CONCLUSIONS This study corroborates the findings of previous studies regarding the epidemiological characteristics of sarcoidosis patients.
Collapse
Affiliation(s)
- Vinicius Lemos-Silva
- Pedro Ernesto University Hospital, Rio de Janeiro State University School of Medical Sciences – Rio de Janeiro, Brazil
| | | | | | | | | |
Collapse
|
35
|
Bártholo TP, Pugliese JG, Vaz LCA, Costa CHD, Rufino R. Characteristic aspects of alveolar proteinosis diagnosis. J Bras Patol Med Lab 2012. [DOI: 10.1590/s1676-24442012000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
36
|
Pugliese JG, Bártholo TP, Santos HTAD, Saito EH, Costa CHD, Rufino R. [Usefulness of chest CT in the diagnosis of pulmonary sequestration]. J Bras Pneumol 2010; 36:260-4. [PMID: 20485949 DOI: 10.1590/s1806-37132010000200016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 01/12/2010] [Indexed: 11/21/2022] Open
Abstract
Pulmonary sequestration is a rare congenital anomaly, characterized by nonfunctional embryonic pulmonary tissue. Pulmonary sequestration accounts for 0.15-6.40% of all congenital pulmonary malformations. This anomaly, which is classified as intralobar or extralobar, involves the lung parenchyma and its vascularization. We report the case of a 56-year-old male presenting with hemoptysis. A chest X-ray showed an area of opacity behind the cardiac silhouette in the base of the left hemithorax. Chest CT scans with intravenous contrast revealed pulmonary sequestration. The patient underwent surgery, in which the anomalous tissue was successful resected. The postoperative evolution was favorable, and the patient was discharged to outpatient treatment.
Collapse
Affiliation(s)
- José Gustavo Pugliese
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | | |
Collapse
|
37
|
Costa CHD, Rufino R, Lapa e Silva JR. Células inflamatórias e seus mediadores na patogênese da DPOC. Rev Assoc Med Bras (1992) 2009; 55:347-54. [DOI: 10.1590/s0104-42302009000300031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 09/16/2008] [Indexed: 11/22/2022] Open
|
38
|
Rufino R, Madi K, Mourad O, Judice A, Marsico G, Boasquevisque CH. Forma acelerada da fibrose pulmonar idiopática no pulmão nativo após transplante pulmonar unilateral. J Bras Pneumol 2007; 33:733-7. [DOI: 10.1590/s1806-37132007000600018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/21/2006] [Indexed: 11/22/2022] Open
Abstract
Relatamos o caso de um paciente de 56 anos submetido a transplante pulmonar unilateral esquerdo em decorrência de fibrose pulmonar idiopática (FPI). No pós-operatório imediato, sob intensa imunossupressão, houve progressão rápida da FPI no pulmão nativo direito, confirmada pela biópsia pulmonar videotoracoscópica, necessitando de ventilação mecânica durante 104 dias até a realização de outro transplante pulmonar à direita. Obteve alta hospitalar após o 26º dia do segundo pós-operatório.
Collapse
Affiliation(s)
| | - Kalil Madi
- Universidade Federal do Rio de Janeiro, Brasil
| | | | | | | | | |
Collapse
|
39
|
Rufino R, Rizzo L, da Costa CH, de Lima RJ, Madi K. Analysis of 39 cases of idiopathic chronic interstitial pneumonia. J Bras Pneumol 2007; 32:505-9. [PMID: 17435900 DOI: 10.1590/s1806-37132006000600006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 04/05/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. METHODS Samples from 252 open-lung biopsies of patients with interstitial lung disease, all performed between 1977 and 1999, were reviewed, and 39 cases of idiopathic interstitial lung disease were selected and re-evaluated by two pathologists in accordance with the American Thoracic Society/European Respiratory Society classification system. RESULTS Among those 39 cases, the diagnoses were maintained in 28 (71.8%). A new pathologic entity, nonspecific interstitial pneumonia, was included in the reclassification, and overlapping patterns were observed in 6 cases. Of the 28 cases in which the diagnosis of chronic idiopathic interstitial pneumonia remained unchanged, idiopathic pulmonary fibrosis was accompanied by cryptogenic organizing pneumonia in 4, cryptogenic organizing pneumonia was accompanied by nonspecific interstitial pneumonia in 1, and desquamative interstitial pneumonia was accompanied by nonspecific interstitial pneumonia in 1. All cases of idiopathic pulmonary fibrosis were confirmed, although 3 of those were found to be accompanied by cryptogenic organizing pneumonia. Virtually all prior diagnoses were maintained in the review of the biopsy samples (p > 0,05). CONCLUSION The American Thoracic Society/European Respiratory Society system of classifying interstitial lung disease is a useful tool for pathologists who deal with lung biopsies.
Collapse
Affiliation(s)
- Rogério Rufino
- National Heart and Lung Institute, Imperial College London, London, UK.
| | | | | | | | | |
Collapse
|
40
|
Abstract
A doença pulmonar obstrutiva crônica é uma doença inflamatória com participação ativa de macrófagos, neutrófilos e linfócitos CD8+ em sua patogênese, associada a estímulos oxidantes diretos das estruturas pulmonares, que desencadeiam reações bioquímicas, levando a progressiva desorganização das pequenas vias aéreas e ao remodelamento estrutural não reversível. A liberação de substâncias provenientes das células recrutadas e do estresse oxidativo leva ao desequilíbrio inicialmente temporário dos mecanismos de defesa pulmonar. A permanência desse desequilíbrio é uma das chaves da fisiopatogenia atual. Os autores descrevem as alterações celulares e bioquímicas da doença pulmonar obstrutiva crônica.
Collapse
Affiliation(s)
- Rogério Rufino
- Universidade Federal do Rio de Janeiro; Universidade do Estado do Rio de Janeiro, Brasil
| | | |
Collapse
|
41
|
Rufino R, Lapa e Silva JR. Cellular and biochemical bases of chronic obstructive pulmonary disease. J Bras Pneumol 2006; 32:241-8. [PMID: 17273614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 08/18/2005] [Indexed: 05/13/2023] Open
Abstract
Chronic obstructive pulmonary disease is an inflammatory disease. Together with oxidant stimuli, which directly affect lung structures, macrophages, neutrophils and CD8+ lymphocytes actively participate in the pathogenesis of the disease and promote biochemical reactions that result in progressive alteration of the upper airways and irreversible lung remodeling. The release of substances promoted by inflammatory cell recruitment and by oxidative stress lead to a temporary imbalance in the pulmonary defense mechanisms. Understanding the long-term maintenance of this imbalance is key to understanding the current physiopathology of the disease. The present study explores the cellular and molecular alterations seen in chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Rogério Rufino
- Universidade Federal do Rio de Janeiro, School of Medicine, Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
42
|
Rufino R. Effects of hypertension and smoke upon function and structure of heart and vessels. Am J Hypertens 2000. [DOI: 10.1016/s0895-7061(00)00955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|