Pulmonary tuberculosis followed by sarcoidosis in an HIV-infected patient: a case report and a simplified diagnostic flowchart for diagnosis and treatment of sarcoidosis

The diagnosis of sarcoidosis in a patient living with HIV infection is an uncommon event and a challenge for clinicians. Clinical manifestations are variable and fluctuating depending to adherence to ARV therapy and to the level of CD4 count. We analyze here one chronic case in which sarcoidosis appeared clinically two years after pulmonary tuberculosis. The course of the disease was influenced and prolonged by frequent interruptions of antiretroviral therapy. Moreover the diagnosis and the decision to treat have been delayed by the need of exclusion of other pathologies, principally tuberculosis reactivation/reinfection, other mycobacterial diseases, hematologic malignancies. We propose a simplified flowchart for diagnosis and follow up of sarcoidosis, which may also be applied to patients with HIV infection. Diagnosis of latent tuberculosis infection (LTBI) may be difficult in these patients, because the immunological paradox of sarcoidosis. For this reason, following exclusion of active tuberculosis, we advise to submit all sarcoidosis patients to IPT (isoniazid preventive therapy), when immunosuppressive therapy is started

Quality of life in sarcoidosis

Having sarcoidosis often has a major impact on quality of life of patients and their families. Improving quality of life is prioritized as most important treatment aim by many patients with sarcoidosis, but current evidence and treatment options are limited. In this narrative review, we describe the impact of sarcoidosis on various aspects of daily life, evaluate determinants of health-related quality of life (HRQoL), and provide an overview of the different patient-reported outcome measures to assess HRQoL in sarcoidosis. Moreover, we review the current evidence for pharmacological and non-pharmacological interventions to improve quality of life for people with sarcoidosis.</p

Optimal data pooling for shared learning in maintenance operations

We study optimal data pooling for shared learning in two common maintenance operations: condition-based maintenance and spare parts management. We consider systems subject to Poisson input – the degradation or demand process – that are coupled through an unknown rate. Decision problems for these systems are high-dimensional Markov decision processes (MDPs) and are thus notoriously difficult to solve. We present a decomposition result that reduces such an MDP to two-dimensional MDPs, enabling structural analyses and computations. Leveraging this decomposition, we (i) show that pooling data can lead to significant cost reductions compared to not pooling, and (ii) prove that the optimal policy for the condition-based maintenance problem is a control limit policy, while for the spare parts management problem, it is an order-up-to level policy, both dependent on the pooled data

Optimal data pooling for shared learning in maintenance operations

We study optimal data pooling for shared learning in two common maintenance operations: condition-based maintenance and spare parts management. We consider systems subject to Poisson input – the degradation or demand process – that are coupled through an unknown rate. Decision problems for these systems are high-dimensional Markov decision processes (MDPs) and are thus notoriously difficult to solve. We present a decomposition result that reduces such an MDP to two-dimensional MDPs, enabling structural analyses and computations. Leveraging this decomposition, we (i) show that pooling data can lead to significant cost reductions compared to not pooling, and (ii) prove that the optimal policy for the condition-based maintenance problem is a control limit policy, while for the spare parts management problem, it is an order-up-to level policy, both dependent on the pooled data

Pain and autonomic dysfunction in patients with sarcoidosis and small fibre neuropathy

Small fibre neuropathy (SFN) has been demonstrated in sarcoidosis. However, a systematic analysis of neuropathic pain and autonomic symptoms, key features of SFN, has not been performed. Clinimetric evaluation of pain and autonomic symptoms using the neuropathic pain scale (NPS) and the modified Composite Autonomic Symptoms Scale (mCOMPASS) was used in sarcoidosis patients for this study. A total of 91 sarcoidosis patients (n = 23 without SFN symptoms, n = 43 with SFN symptoms but normal intraepidermal nerve fibre density (IENFD), n = 25 with SFN symptoms and reduced IENFD) were examined. NPS and mCOMPASS were assessed twice (reliability studies). Severity of pain was compared between the subgroups. Correlation between NPS and a visual analogue pain scale (VAS) was assessed (validity studies). Healthy controls (n = 105) completed the mCOMPASS for comparison with patients’ scores. Patients with sarcoidosis, SFN complaints, and reduced IENFD demonstrated more severe pain scores on the NPS. The mCOMPASS differentiated between subjects with and without SFN symptoms. A significant correlation was obtained between the NPS and VAS, indicating good construct validity. Good reliability values were obtained for all scales. The use of the NPS to evaluate SFN symptoms is suggested, as it shows differences between patients with SFN symptoms with normal or reduced IENFD values. The mCOMPASS might be used to select patients for further testing

WHOQOL-BREF Questionnaire as a Measure of Quality of Life in Sarcoidosis

The aim of this study was to evaluate the usefulness of a short form of the WHOQOL questionnaire, the WHOQOL- -BREF, which consists of 24 questions, in evaluating quality of life (QOL) in sarcoidosis patients. A group of 97 sarcoidosis patients and a matched group of 97 healthy controls took part in the study. Their QOL was examined by means of the WHOQOL-BREF, and the respiratory functions were measured in sarcoidosis patients. The WHOQOL-BREF revealed significantly poorer QOL of sarcoidosis patients in the domains of Physical and Psychological Health in comparison to healthy controls. In contrast, sarcoidosis patients perceived their QOL significantly better than healthy controls in the domains of Social Relations and Environment. Differences between sarcoidosis patients and healthy controls were found in several items from the WHOQOL-BREF and some of them were modified by gender. However, the WHOQOL- -BREF did not prove to be a sensitivemeasure of fatigue, which is themost common symptom in sarcoidosis patients

Small fibre neuropathy in sarcoidosis

Sarcoidosis is characterized by multisystem granulomatous formation particularly in the chest. In this case report, we present an uncommon case highlighting significant peripheral nerve involvement, a phenomenon that is not well recognized &nbsp;in sarcoidosis. The patient presented with severe incapacitating pain. Sarcoidosis as being the underlying cause was only established after extensive investigations. This case highlights the importance of recognizing small fibre peripheral polyneuropathy as a possible presentation of sarcoidosis. This could help to direct appropriate &nbsp;medical intervention