Navegando por Palavras-chave "Sarcoidose"
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- ItemAcesso aberto (Open Access)Delayed diagnosis of sarcoidosis is common in Brazil(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-09-01) Rodrigues, Mauri Monteiro; Coletta, Ester Nei Aparecida Martins [UNIFESP]; Ferreira, Rimarcs Gomes [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; São Paulo Hospital for State Civil Servants Department of Respiratory Diseases; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil.METHODS:We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment).RESULTS:We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively).CONCLUSIONS:The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.
- ItemAcesso aberto (Open Access)Doenças granulomatosas ocupacionais(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-05-01) Bagatin, Ericson; Pereira, Carlos Alberto De Costa [UNIFESP]; Afiune, Jorge Barros; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Instituto Clemente FerreiraA variety of diseases are encompassed in the didactic denomination of granulomatous diseases of probable occupational etiology. As well as presenting similar clinical aspects, such diseases are characterized by certain common traits: formation of granulomas; systemic and respiratory manifestations; environmental or occupational exposure to organic or inorganic agents; and T lymphocyte involvement in the pathogenesis. Included in this category are hypersensitivity pneumonitis, mycobacteriosis (all forms) and sarcoidosis, as well as beryllium disease and other lung diseases caused by exposure to heavy metals. In order to highlight the risk of developing one of these diseases as a result of environmental or occupational exposure to etiologic agents, we address aspects related to epidemiology, pathogenesis and evaluation of exposure of these diseases, as well as those related to diagnostic criteria, prevention and control. We have given special emphasis to groups of individuals considered to be at high risk for developing these diseases, as well as to the need for health care professionals to remain aware of the potential occupational etiology of such diseases, a decisive factor in devising effective measures of prevention and epidemiological surveillance.
- ItemSomente MetadadadosEscore Multidimensional Simples Para Predição Do Curso Clínico Da Sarcoidose Na Avaliação Inicial(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Castro, Marina Dornfeld Cunha [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is variable and is mainly related to persistent inflammation process and development of fibrosis. Prognostic features have been described, but there is no validated model to predict the evolution of the disease. Aim: To find predictive features associated to clinical course of sarcoidosis at initial evaluation and develop a predictive score. Methods: This was a retrospective study of a cohort of patients with diagnosis of sarcoidosis, followed in reference centers involved in interstitial lung disease. Clinical, radiographic and functional data were compared by univariate analysis between patients with limited course – spontaneous involution or stability after a course of therapy and persistent – relapse or resistance to treatment, persistent treatment or chronic stable disease. Data related to persistent disease were selected by multivariate analysis and a prognostic score was developed.Results: 200 patients were included. 63% were female. Mean age at diagnosis was 50 years old. Median of time of symptoms was 12 months. Early diagnosis was characterized by time of symptoms ≤ 12 months and was found in 57% of cases. Dyspnea and cough were the most common pulmonary symptoms. Treatment for tuberculosis was prescribed before diagnosis in 44 patients. The most common radiologic stage was II (lung parenchyma and thoracic adenopathy). Mean forced vital capacity (FVC) was 84.9 ± 18.8% of predicted, with 37% of the cases with FVC below lower limit of reference. Relevant systemic involvement was detected in 37% of the patients. During the evolution, 77% of the cases needed immunosuppressive treatment and the course of disease was classified as persistent in 115 cases. By logistic regression, excluding 40 patients with pulmonary fibrosis, the findings related to persistent disease were: parenchymal lung involvement [odds ratio (OR) 3.83], late diagnosis (OR 2.82), dyspnea (OR 2.80), systemic involvement (OR 2.55) and reduced FVC (OR 2.33). A score was developed, taking into account the weight of the variable (1 point each), with positive predictive value for persistent disease in A score (≤ 1 point) and C score (≥ 4 points) of 17% and 88% respectively. Conclusion: A predictive score for sarcoidosis outcome can be derived by multiple variables at initial evaluation, allowing prediction of the clinical course of disease in a significant number of cases. The results should be confirmed in a validation cohort.
- ItemSomente MetadadadosEstudo prospectivo das alterações oculares em pacientes com sarcoidose com biopsia extra-ocular positiva(Universidade Federal de São Paulo (UNIFESP), 2001) Moraes Junior, Haroldo Vieira de [UNIFESP]; Universidade Federal de São Paulo [UNIFESP]
- ItemAcesso aberto (Open Access)Frequência relativa de doenças pulmonares intersticiais incidentes em seis centros no Brasil(Universidade Federal de São Paulo, 2022-08-05) Matias, Simone Lobo Krupok [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; http://lattes.cnpq.br/9232295231546605; http://lattes.cnpq.br/8392177226123005Não existem dados epidemiológicos sobre a frequência relativa das diferentes doenças pulmonares intersticiais no Brasil. Objetivo: Análise de um registro multicêntrico para avaliar a frequência relativa de casos incidentes das doenças pulmonares intersticiais (DPI) em seis centros no Brasil. Métodos: Levantamento retrospectivo de casos novos de DPIs realizados entre o período de janeiro de 2013 a janeiro de 2019. Os diagnósticos para as DPI relacionada às doenças do tecido conjuntivo (DPI-DTC), sarcoidose, e condições mais raras seguiram os critérios descritos na literatura. Critérios para diagnóstico de fibrose pulmonar idiopática não biopsiados e sem faveolamento na tomografia de tórax foram baseados em um algoritmo próprio. O diagnóstico de pneumonite de hipersensibilidade se baseou nos critérios sugeridos por Johannson e Pérez (2022). Foram excluídos os casos de DPIs secundárias a doenças neoplásicas, infecções e doenças cardíacas. Todos os casos foram revisados centralmente para consistência diagnóstica. Resultados: Foram incluídos 1406 pacientes, com idade = 61 ± 14 anos, 54% do sexo feminino. Exposição a agentes orgânicos estava presente em 56%, a agentes inorgânicos em 13%. Sintomas de RGE foram referidos por 49% dos casos. História familiar de doença intersticial foi relatada por 8% dos casos. A CVF foi 68±19% do previsto. Na TCAR achados indicativos de fibrose estavam presentes em 74%, faveolamento em 21%. Autoanticorpos em títulos relevantes estavam presentes em 33% dos casos, sendo o FAN o mais frequente (21%). Biópsia transbrônquica foi realizada em 23% dos casos, tendo mostrado achados diagnósticos ou compatíveis em 36%. Biópsia pulmonar cirúrgica foi realizada em 241 (17,1%) dos casos; em 4,1% os achados foram inconclusivos. Os diagnósticos finais nas doenças presentes em mais de 1% dos casos, em ordem decrescente, foram: DPI-DTC 27%, pneumonite de hipersensibilidade 23%, FPI 14%, doenças não classificadas 10%, sarcoidose 6%, silicose 3%, doenças induzidas por drogas 3%, doenças tabaco-relacionadas 2%, pneumonia intersticial não específica 2%, bronquiolites diversas 2%, pneumonia em organização criptogênica em 1% e doença por microaspiração em 1% dos casos. Os diagnósticos variaram significativamente por centro (x2=312,4, p<0,001). As DPI-DTC mais frequentes foram: esclerose sistêmica 31%, artrite reumatoide 18%, Pneumonia intersticial com achados de autoimunidade 15%, síndrome de Sjögren 11% e miosites 10%. Exposição não aparente para PH foi observada em apenas 10 (3%) dos casos. Conclusão: No Brasil, as DPI-DTC são a causa mais comum de doenças pulmonares intersticiais, seguidas de perto pela pneumonite de hipersensibilidade. Sarcoidose incidente foi observada em apenas 6% dos casos. Este padrão difere do observado em outros países.
- ItemSomente MetadadadosRevisao critica das possiveis relacoes entre a sindrome de Melkersson-Rosenthal e a sarcoidose(Universidade Federal de São Paulo (UNIFESP), 1984) Frucchi, Humberto [UNIFESP]