Perguntamos: qual o diagnóstico?

Centro de Medicina Diagnóstica FleuryUniversidade Federal de São Paulo (UNIFESP)University of British ColumbiaUNIFESPSciEL

Exercise oxygen uptake efficiency slope independently predicts poor outcome in pulmonary arterial hypertension

Universidade Federal de São Paulo UNIFESP, São Paulo Sch Med EPM, Dept Med, Pulm Vasc Grp, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, Dept Med, Div Resp Dis,Pulm Funct & Clin Exercise Physiol U, São Paulo, BrazilQueens Univ, Dept Med, Div Resp & Crit Care Med, Kingston, ON K7L 3N6, CanadaUniversidade Federal de São Paulo UNIFESP, São Paulo Sch Med EPM, Dept Med, Pulm Vasc Grp, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, Dept Med, Div Resp Dis,Pulm Funct & Clin Exercise Physiol U, São Paulo, BrazilWeb of Scienc

Contrasting Cardiopulmonary Responses to Incremental Exercise in Patients with Schistosomiasis-Associated and Idiopathic Pulmonary Arterial Hypertension with Similar Resting Hemodynamic Impairment

It has been reported that schistosomiasis-associated PAH (Sch-PAH) has a more benign clinical course compared with idiopathic PAH (IPAH). We therefore hypothesized that Sch-PAH subjects would present with less impaired cardiopulmonary and metabolic responses to exercise than IPAH patients, even with similar resting pulmonary hemodynamic abnormalities. the aim of this study was to contrast physiologic responses to incremental exercise on cycle ergometer between subjects with Sch-PAH and IPAH. We performed incremental cardiopulmonary exercise tests (CPET) in subjects newly diagnosed with IPAH (n = 9) and Sch-PAH (n = 8), within 1 month of the hemodynamic study and before the initiation of specific therapy for PAH. There were no significant between-group differences in cardiac index, pulmonary vascular resistance or mean pulmonary artery pressure. However, mean peak oxygen uptake (VO2) was greater in Sch-PAH than IPAH patients (75.5 +/- 21.4 vs 54.1 +/- 16.1% predicted, p = 0.016), as well as the ratio of increase in VO2 to work rate (8.1 +/- 1.0 vs 6.8 +/- 1.8 mL/min/W, p = 0.03). Additionally, the slope of the ventilatory response as a function of CO2 output was lower in Sch-PAH (40.3 +/- 3.9 vs 55.6 +/- 19.8; p = 0.04), and the heart rate response for a given change in VO2 was also diminished in Sch-PAH compared to IPAH (80.1 +/- 20.6 vs 123.0 +/- 39.2 beats/L/min; p = 0.02). in conclusion, Sch-PAH patients had less impaired physiological responses to exercise than IPAH subjects with similar resting hemodynamic dysfunction. Our data suggest a more preserved cardiopulmonary response to exercise in Sch-PAH which might be related to its better clinical course compared to IPAH.Fed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilQueens Univ, Dept Med, Div Resp & Crit Care Med, Kingston, ON K7L 3N6, CanadaFed Univ São Paulo UNIFESP, Dept Med, Div Resp Dis, São Paulo, BrazilFed Univ São Paulo UNIFESP, Dept Med, Div Cardiol, São Paulo, BrazilWeb of Scienc

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia accompanied by airflow obstruction

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia with airflow obstruction is a rare form of lung injury. All of the reported cases have been diagnosed by surgical lung biopsy. Only three of the reported cases presented with diffuse interstitial lung opacities on HRCT scans. We report three additional cases of this entity. All of the patients were female and presented with mild-to-moderate airflow obstruction. In the first case, transbronchial biopsy and imaging data were sufficient to make the diagnosis. Although the HRCT scans of all three cases revealed a mosaic pattern, that of the third patient also revealed diffuse interstitial infiltrate. In extremely rare cases, HRCT findings can simulate those seen in other interstitial lung diseases.A hiperplasia de células neuroendócrinas pulmonares difusas com obstrução ao fluxo aéreo é uma lesão pulmonar rara. Todos os casos publicados foram diagnosticados por biópsia pulmonar cirúrgica. Apenas três casos relatados apresentavam opacidades intersticiais difusas na TCAR. Nós relatamos três casos adicionais desta entidade. Todos eram mulheres, com obstrução leve ou moderada ao fluxo aéreo. No primeiro caso, uma biópsia transbrônquica, associada com dados de imagem foram considerados suficientes para o diagnóstico. Um padrão em mosaico foi observado nos três casos, mas no terceiro um infiltrado pulmonar difuso foi também observado. Em casos muito raros, o aspecto na TCAR pode simular aquele encontrado em outras doenças pulmonares intersticiais.Universidade Federal de São Paulo (UNIFESP) Departamento de PatologiaHospital do Servidor Público EstadualHospital do Servidor Publico Estadual Serviço de PneumologiaUniversidade Federal de São Paulo (UNIFESP)Hospital de MessejanaHospital Beneficiência Portuguesa Centro Integrado de PatologiaUNIFESP, Depto. de PatologiaUNIFESPSciEL

Survival in idiopathic pulmonary fibrosis - cytotoxic agents compared to corticosteroids

Study objective: To compare the survival of patients with IPF treated retrospectively with corticosteroids atone, to survival of patients treated with immunosuppressive and corticosteroids combined. Design: Non-randomized retrospective cohort study.Setting: Three tertiary centers in Brazil.Patients: Eighty-two IPF patients were included. the diagnosis was confirmed by open lung biopsy in 48. Patients received either corticosteroids alone (group 1) or cytotoxic agents in addition to corticosteroids (group 11).Measurements and results: the primary end-point was mortality. Secondary outcome included longitudinal changes in FVC. Mean age was 66+8 years. FVC was 71 +/- 17% of predicted. There were 48 deaths during the study period (59%), 44 secondary to respiratory causes. From preliminary univariate analysis, for the group as a whole, worse survival was found to be associated with FVC% = 70% and = 70% (Log Rank = 6.84, P = 0.009).Conclusions: the combination of immunosuppressive agents and prednisone results in better survival when compared to prednisone alone in patients with IPF the benefit seems to occur only in patients with less severe disease, as reflected by FVC >= 70%. (c) 2005 Elsevier B.V. All rights reserved.Universidade Federal de São Paulo, Dept Pulmonol, Paulista Sch Med, BR-04082001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pulmonol, Paulista Sch Med, BR-04082001 São Paulo, BrazilWeb of Scienc

Subacute and chronic hypersensitivity pneumonitis: Histopathological patterns and survival

Background: in hypersensitivity pneumonitis (HP), survival can be predicted on the basis of the severity of fibrosis in surgical lung biopsy, but few data are available on the influence of clinical, functional, tomographic and histologic findings on prognosis. Objectives: To describe the impact on survival. of clinical data, histological patterns, and HRCT findings in subacute/chronic HP.Methods: A retrospective analysis of 103 patients diagnosed with HP submitted to surgical lung biopsy. Chronic HP was characterized by HRCT findings indicative of fibrosis (n = 76).Results: the most relevant exposures were to molds and birds. Lung biopsies revealed typical HP with granulomas in 46 patients, bronchiolocentric interstitial pneumonia in 27, and nonspecific interstitial pneumonia (NSIP) in 16. By univariate analysis, several findings were predictors of mortality: older age, mate sex, velcro crackles, higher FEV(1)/FVC ratio, lower oxygen saturation during exercise, and absence of mosaic pattern/air trapping and presence of fibrosis on HRCT. By multivariate analysis, remained significant: age (p = 0.007), oxygen saturation during exercise (p = 0.003), and mosaic pattern/air trapping on HRCT (p = 0.004). Patients with NSIP had a greater survival than did those with typical histology and those with bronchiolocentric pneumonia (p = 0.033).Conclusions: A wide range of histological features are found in FIR Typical findings are seen in 45% of cases, Other common patterns are NSIP and centriacinar lesions. Survival is better in patients with NSIP and worse in those with older age, desaturation during exercise, and absence of mosaic pattern/air trapping on HRCT. (c) 2009 Etsevier Ltd. All rights reserved.Universidade Federal de São Paulo, Div Resp Dis, Dept Med, Escola Paulista Med, BR-04023062 São Paulo, BrazilHosp Servidor Publ Estadual, Div Resp Dis, Dept Med, BR-04023062 São Paulo, BrazilUniversidade Federal de São Paulo, Div Resp Dis, Dept Med, Escola Paulista Med, BR-04023062 São Paulo, BrazilWeb of Scienc

Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19

ABSTRACT Objective: To identify factors associated with prolonged weaning and mortality in critically ill COVID-19 patients admitted to ICUs and under invasive mechanical ventilation. Methods: Between March of 2020 and July of 2021, we retrospectively recorded clinical and ventilatory characteristics of critically ill COVID-19 patients from the day of intubation to the outcome. We classified the patients regarding the weaning period in accordance with established criteria. A logistic regression analysis was performed to identify variables associated with prolonged weaning and mortality. Results: The study involved 303 patients, 100 of whom (33.0%) had a prolonged weaning period. Most of the patients were male (69.6%), 136 (44.8%) had more than 50% of pulmonary involvement on chest CT, and 93 (30.6%) had severe ARDS. Within the prolonged weaning group, 62% died within 60 days. Multivariate analysis revealed that lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were significantly associated with prolonged weaning, whereas age and prolonged weaning were significantly associated with mortality. Conclusions: Prolonged weaning can be used as a milestone in predicting mortality in critically ill COVID-19 patients. Lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were identified as significant predictors of prolonged weaning. These results might provide valuable information for healthcare professionals when making clinical decisions regarding the management of critically ill COVID-19 patients who are on mechanical ventilation

Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Curso de Pós-Graduação de Doenças Pulmonares IntersticiaisUniversidade Federal de Ciências da Saúde de Porto AlegreSanta Casa de Porto Alegre Ambulatório de Doenças IntersticiaisSES Hospital Regional da Asa Norte Serviço de Doenças TorácicasFundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho Serviço de MedicinaUniversidade Estadual de Campinas Faculdade de Ciências Médicas Departamento de Clínica MédicaUniversidade Federal do Estado do Rio de JaneiroUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PatologiaHospital do Servidor Público Estadual de São Paulo Serviço de Anatomia PatológicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto Divisão de PneumologiaUniversidade Federal de Santa Catarina Departamento de Clínica MédicaUniversidade Federal de Santa Catarina Hospital UniversitárioHospital de Messejana Ambulatório de Doenças IntersticiaisHospital do Servidor Público Estadual de São Paulo Ambulatório de Doenças IntersticiaisUniversidade de São Paulo Faculdade de Medicina Instituto do CoraçãoUniversidade Federal FluminenseUniversidade de São Paulo Faculdade de MedicinaHospital Sírio Libanês Núcleo Avançado de TóraxUniversidade Federal da BahiaHospital do Servidor Público Estadual de São PauloHospital do Câncer Antônio Cândido CamargoUNIFESP, EPM, Curso de Pós-Graduação de Doenças Pulmonares IntersticiaisUNIFESP, EPM, Depto. de PatologiaUNIFESP, EPMSciEL

Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases

Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.As doenças pulmonares intersticiais (DPIs) são afecções heterogêneas, envolvendo um elevado número de condições, cuja abordagem ainda é um grande desafio para o pneumologista. As Diretrizes de DPIs da Sociedade Brasileira de Pneumologia e Tisiologia, publicadas em 2012, foram estabelecidas com o intuito de fornecer aos pneumologistas brasileiros um instrumento que possa facilitar a abordagem dos pacientes com DPIs, padronizando-se os critérios utilizados para a definição diagnóstica das diferentes condições, além de orientar sobre o melhor tratamento nas diferentes situações. Esse artigo teve como objetivo descrever resumidamente os principais destaques dessas diretrizes.28229