Currently, topical are studies that examine different reasons for delay of tuberculosis (TB) diagnosis and its impact on disease prognosis. The aim was to examine three time periods associated with ...treatment delay: patient related, health system related and total delay. This retrospective-prospective study included 100 consecutive patients hospitalized at Department of Pulmonology, Clinical Center of Serbia, in the period from March to December 2015. Study results showed median patient delay to be 92.5 days. Total delay was affected by patient related delay. Median healthcare delay was 18.5 days. Patients that reported excessive alcohol consumption were more likely to have prolonged time to seek medical help. Years of alcohol consumption yielded moderate positive correlation with patient related delay (r=0.362, p<0.001). Correlation between the number of cigarettes and patient delay was moderate, positive and statistically significant (r=0.314, p=0.001). Delay in seeking medical help was more likely in patients with negative family history of TB. There was no difference in the effect of the presence of symptoms on patient related delay (p>0.05). Clinical characteristics such as patient TB category and chest radiograph abnormalities were not associated with prolonged patient related delay (p>0.05). Study results point to the importance of health education and/or health intervention in the population group at a high risk of TB.Key words: Tuberculosis; Prognosis; Retrospective Studies; Prospective Studies; Serbia; Alcohol Drinking; Health EducationTrenutno su veoma aktualne studije koje istrazuju razloge za kasnjenje dijagnosticiranja tuberkuloze (TB) te njihov utjecaj na prognozu bolesti. Cilj je bio ispitati tri razdoblja povezana s kasnjenjem dijagnoze: bolesnikovo, zdravstvenog sustava i ukupno kasnjenje. Ovo retrospektivno-prospektivno istrazivanje ukljucilo je 100 uzastopnih bolesnika s dijagnozom TB i hospitaliziranih u Klinici za pulmologiju Klinickog centra Srbije izmedu ozujka i prosinca 2015. Studija je pokazala medijan vremena kasnjenja bolesnika od 92,5 dana, sto je utjecalo i na ukupno vrijeme kasnjenja. Medijan vremena kasnjenja zdravstvenog sustava bio 18,5 dana. Kod bolesnika koji su prekomjerno konzumirali alkohol bilo je vjerojatnije da ce imati produzeno vrijeme do trazenja lijecnicke pomoci. Godine konzumiranja alkohola bile su u pozitivnoj i umjerenoj korelaciji s vremenom kasnjenja bolesnika (r=0,362, p<0,001). Odnos broja popusenih cigareta i vremena kasnjenja bolesnika bio je umjeren, pozitivan i statisticki znacajan (r=0,314, p=0,001). Bolesnici s negativnom obiteljskom anamnezom za TB imali su vecu vjerojatnost kasnjenja dijagnoze. Nije bilo razlike u utjecaju prisutnosti simptoma na vrijeme kasnjenja bolesnika (p>0,05). Kategorija bolesnika s TB i nenormalnosti radiograma nisu bile povezane s vremenom kasnjenja bolesnika (p>0,05). Sve ovo ukazuje na vaznost zdravstvenog odgoja i/ili zdravstvene intervencije kod stanovnistva s visokim rizikom od TB.Kljucne rijeci: tuberkuloza; prognoza; retrospektivne studije; prospektivne studije; Srbija; alkohol, konzumacija; zdravstveni odgoj
In diagnostics of neurosarcoidosis, radiological diagnostic procedures are available, non-invasive and they contribute significantly to the diagnosis of this disease. The aim of this paper is to ...present a brief overview of the radiological diagnostic methods, their application, and their importance in daily clinical work with these patients. RADIOLOGICAL PRESENTATION OF NEUROSARCOIDOSIS: Magnetic resonance is the method of choice in diagnostics of this disease. Computed tomography can also be helpful in patients with contraindications for magnetic resonance, although it is less precise in assessing the involvement of the periventricular white matter, hypothalamus, and cranial nerves. The number of lesions and the degree of involvement of the parenchyma and leptomeninges are better seen by magnetic resonance than by computed tomography scan. It is important to note that the magnetic resonance imaging may be normal in patients with neurosarcoidosis, especially in patients with cranial neuropathy, or in patients treated with corticosteroids. There is a number of variability in the occurrence of neurosarcoidosis on radiological images.
Radiological procedures are on the very top of diagnostic pyramid of this disease due to their availability, non-invasiveness, and precision.
Introduction
Sarcoidosis is a highly variable disease in terms of organ involvement, type of onset and course. Associations of genetic polymorphisms with sarcoidosis phenotypes have been observed and ...suggest genetic signatures.
Methods
After obtaining a positive vote of the competent ethics committee we genotyped 1909 patients of the deeply phenotyped Genetic-Phenotype Relationship in Sarcoidosis (GenPhenReSa) cohort of 31 European centers in 12 countries with 116 potentially disease-relevant single-nucleotide polymorphisms (SNPs). Using a meta-analysis, we investigated the association of relevant phenotypes (acute vs. sub-acute onset, phenotypes of organ involvement, specific organ involvements, and specific symptoms) with genetic markers. Subgroups were built on the basis of geographical, clinical and hospital provision considerations.
Results
In the meta-analysis of the full cohort, there was no significant genetic association with any considered phenotype after correcting for multiple testing. In the largest sub-cohort (Serbia), we confirmed the known association of acute onset with TNF and reported a new association of acute onset an HLA polymorphism. Multi-locus models with sets of three SNPs in different genes showed strong associations with the acute onset phenotype in Serbia and Lublin (Poland) demonstrating potential region-specific genetic links with clinical features, including recently described phenotypes of organ involvement.
Discussion
The observed associations between genetic variants and sarcoidosis phenotypes in subgroups suggest that gene–environment-interactions may influence the clinical phenotype. In addition, we show that two different sets of genetic variants are permissive for the same phenotype of acute disease only in two geographic subcohorts pointing to interactions of genetic signatures with different local environmental factors. Our results represent an important step towards understanding the genetic architecture of sarcoidosis.
Sarcoidosis can affect any part of the central nervous system presenting with an extremely diverse clinical picture. Clinical presentations actually depend on the localization ofgranulomas in the ...central nervous system. Making diagnosis according to the localization and the clinical variations is often a clinical challenge. DIAGNOSIS OF NEUROSARCOIDOSIS: Diagnosis is based on the clinical picture, clinical and radiological findings (magnetic resonance imaging with contrast endocranium), laboratory findings (angio-tenzin-converting enzyme and chitotriosidase in cerebrospinal fluid); however, it is necessary first to exclude all other possible causes of granulomatous inflammation. Recent studies in patients with neurosarcoidosis show a high value of at least one marker of the disease. The safest way and the gold standard in diagnosing this disease would be histopathological confirmation, which is rarely performed due to its invasiveness.
New diagnostic methods will contribute to better methods of bypassing invasive procedures, and they will significantly facilitate the diagnosis of neurosarcoidosis, which is a real challenge even for experienced clinicians who deal with this disease.
Potassium iodine (KI) is used as a drug therapy for treating numerous diseases such as small-vessel vasculitis, erythema nodosum, vasculitis nodularis, Sweet's syndrome, tuberculosis and ...granulomatosis, and for iodized salt. At the same time, KI can be harmful. Iodine intake may increase the frequency of thyroiditis in humans, and may induce the occurrence of experimental thyroiditis (ET) in animals. Investigations on an experimental model for the examination of thyroiditis in Wistar rats have clearly showed morphological changes in the rat thyroid evoked by KI administration.
The purpose of this study was to compare the effects of low and high doses of KI on the thyroid gland of Wistar rats and determine the effect on hormone status (T4, T3 and TSH) in this rat strain.
Two groups of rats from the Wistar strain were treated with a low iodine dose (225 microg/g BW) and with a high iodine dose (675 microg/g BW) of KI solutions. Untreated nonimmunized animals served as controls. The solution was administrated daily intraperitoneally during the period of 26 consecutive days.
Monitoring hormone status (TSH, T3 and T4) and morphological changes it was found that therapeutic doses of KI applied in treatment induced the occurrence of experimental thyroiditis (chronic destructive Hashimoto's thyroiditis in humans) and cell necrosis in animals not carrying a genetic susceptibility. Significant inflammatory changes were observed in rats treated with a high iodine dose.
The early iodine induced cell necrosis and inflammation in the nonimmunized animals without genetic susceptibility is a new experimental model of thyroiditis.
The role of vitamin D in multisystem sarcoidosis Mihailović-Vučinić Violeta; Ignjatović Svetlana; Dudvarski-Ilić Aleksandra ...
Journal of medical biochemistry,
10/2012, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Recently published data indicate that vitamin D abnormalities are common in sarcoidosis patients. The purpose of this study was to compare serum vitamin 25(OH)D levels among sarcoidosis patients with ...different clinical courses of the disease. The study also included the first observations on cognitive functions (i.e. depression and fatigue syndrome) in relation to vitamin D deficiency in sarcoidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measured using the Elecsys® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of serum vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant correlation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Square=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean forced vital capacity (FVC) by 380 mL, and forced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the predictor of fatigue (R2=0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R2=0.80; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in predicting the course of chronic disease, significant lung function impairments and cognitive failures such as fatigue and depression. The fact that the majority of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable.
Currently, topical are studies that examine different reasons for delay of tuberculosis (TB) diagnosis and its impact on disease prognosis. The aim was to examine three time periods associated with ...treatment delay: patient related, health system related and total delay. This retrospective-prospective study included 100 consecutive patients hospitalized at Department of Pulmonology, Clinical Center of Serbia, in the period from March to December 2015. Study results showed median patient delay to be 92.5 days. Total delay was affected by patient related delay. Median healthcare delay was 18.5 days. Patients that reported excessive alcohol consumption were more likely to have prolonged time to seek medical help. Years of alcohol consumption yielded moderate positive correlation with patient related delay (r=0.362, p <0.001). Correlation between the number of cigarettes and patient delay was moderate, positive and statistically significant (r=0.314, p=0.001). Delay in seeking medical help was more likely in patients with negative family history of TB. There was no difference in the effect of the presence of symptoms on patient related delay (p>0.05). Clinical characteristics such as patient TB category and chest radiograph abnormalities were not associated with prolonged patient related delay (p>0.05). Study results point to the importance of health education and/or health intervention in the population group at a high risk of TB.
Introduction. Sarcoidosis is a chronic, multi-organ, inflammatory disease
which predominantly affects the lungs. Although direct osseous involvement in
sarcoidosis is rare, patients with this ...disease, regardless of the presence
of osseous lesions, are at a great risk of developing osteoporosis.
Osteoporosis is a consequence of the disease itself, as well as of its
treatment. Osteodensitometry. Osteodensitometry is the gold standard for
osteoporosis diagnosis, and it is based on the assessment of the bone mineral
density. One of the main drawbacks of osteodensitometry as a method for
osteoporosis verification is its inability to determine bone
micro-architectonics, which is a significant element of bone strength.
Mineral Bone Density in Patients with Sarcoidosis. It has been shown that
newly diagnosed, yet untreated patients with sarcoidosis have rapid bone
remodeling, although their mineral bone density is normal or low to normal.
This suggests that the low bone strength in patients with sarcoidosis is a
consequence of mechanisms that predominantly disturb the bone
micro-architectonics, but they do not have a significant effect on the bone
mineral density at the same time. Vertebral Fractures and their Diagnosis in
Patients with Sarcoidosis. Normal bone mineral density in patients with
sarcoidosis does not preclude skeletal fractures, primarily vertebral
fractures. Osteodensitometry devices allow a relatively easy detection of
vertebral fractures in patients with sarcoidosis. Conclusion.
Osteodensitometry is recommended in every patient with sarcoidosis initially
as well as during the follow up and treatment. Even if osteodensitometry is
normal, the possibility of vertebral fractures should not be overlooked in
these patients.
nema
FDG PET/CT in bone sarcoidosis Grozdic Milojevic, Isidora; Sobic-Saranovic, Dragana; Videnovic-Ivanov, Jelica ...
Sarcoidosis, vasculitis, and diffuse lung diseases,
2016-Mar-29, Letnik:
33, Številka:
1
Journal Article
Recenzirano
Bone sarcoidosis is rare manifestation of disease usually accompanied with pulmonary involvement. Until today, exact prevalence of bone sarcoidosis is not known, since reported prevalence varies ...widely depending on the studied population and the used diagnostic techniques.
To determine the prevalence of bone involvement and distribution pattern in active chronic sarcoidosis by using FDG PET/CT.
Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for presence of bone sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level.
Bone sarcoidosis was present in 18/82 patients with active sarcoidosis. FDG uptake in bones was focal in 8 (44.4%), diffuse in 6 (33.3%) and both diffuse and focal in 4 (22.2%) patients. CT indicated bone abnormalities only in 5% patients. Osseous involvement was present in: pelvis (61.1%), vertebrae (44.4%), ribs (27.8%) and bone marrow (16.7%). Some patients had two or more locations of disease. Follow-up FDG PET/CT showed normal findings in two patients, same localization of active disease in four patients and progression of disease in one.
In patients with active chronic sarcoidosis 22% of patients had osseous abnormalities on FDG PET/CT that mostly were not detected on CT.
Introduction: Sarcoidosis affects the central nervous system more frequently than it used to be believed. While the cranial nerves are most frequently affected, neurosarcoidosis can involve other ...nervous system tissues as well. Treatment of Neurosarcoidosis: Although a lot of drugs have proved useful in treating neurosarcoidosis, corticosteroids are still the gold standard in treatment of these patients. Therapeutic protocols differ regarding the dose of these drugs. Symptomatic neurosarcoidosis should always be treated with pulse corticosteroid therapy. People with diabetes, high blood pressure, osteoporosis and tuberculosis should be carefully monitored, as they are prone to complications associated with treatment with corticosteroids. In cases when treatment with corticosteroids does not show the desired results or therapy is discontinued due to the development of side effects, there are other pharmacologic options, such as methotrexate, mycophenolate mofetil, cyclophosphamide, chloroquine, azathioprine, thalidomide, and infliximab. It should be noted that the treatment response to the above mentioned regimens, except for infliximab, is relatively slow compared to corticosteroids; therefore, corticosteroids should be taken into account in all states and particularly in the acute phase of the disease. Conclusion: It is the existence of different forms of the disease, lack of local diagnostic criteria and different and non standardized therapy that makes the treatment of this disease difficult. Despite advances in pharmacotherapy and radiological diagnosis, it is necessary to develop better diagnostic strategies in order to set the optimal therapeutic approach. Key words: Sarcoidosis; Drug Therapy; Central Nervous System Diseases; Diagnosis; Immunosuppressive Agents; Glucocorticoids + therapeutic use Uvod. Sarkoidoza zahvata centralni nervi sistem cesce nego sto se ranije smatralo. Dok su kranijalni nervi najcesce pogodeni, neurosarkoidoza moze zahvatiti i druga tkiva nervnog sistema. Terapija neurosarkoidoze. Iako se dosta lekova pokazalo korisnim u lecenju neurosarkoidoze, kortikosteroidi i dalje predstavljaju zlatni standard u lecenju ovih bolesnika. Terapijski rezimi se razlikuju u pogledu doziranja lekova. Simptomatska neurosarkoidoza uvek se leci pulsnim dozama kortikosteroidne terapije. Osobe sa secernom bolesti, povisenim krvnim pritiskom, tuberkulozom i osteoporozom treba pazljivo pratiti, posto su sklone razvoju komplikacija u vezi sa terapijom kortikosteroidima. U slucajevima kada tretman kortikosteroidima ne pokazuje zeljene rezultate ili je terapija prekinuta zbog razvoja nezeljenih efekata, postoje i druge farmakoloske opcije, poput metotreksata, mikofenolat-mofetila, ciklofosfamida, hlorokina, azatioprina, talidomida i infliksimaba. Treba napomenuti da je na navedene terapijske rezime, izuzev infliksimaba, terapijski odgovor relativno spor u odnosu na kortikosteroide--dakle kortikosteroidi treba da se uzmu o obzir u svim stanjima, narocito u akutnoj fazi bolest. Zakljucak. Upravo postojanje razlicitih oblika ovog oboljenja, odsustvo dijagnostickih kriterijuma i razlicita i nestandardizovana terapija cine lecenje ove bolesti tezim. Uprkos napredovanjima u farmakoterapiji i radioloskoj dijagnostici, potrebno je razviti bolje dijagnosticke strategije kako bi se postavio sto optimalniji terapijski pristup. Kljucne reci: Sarkoidoza; Terapija; Oboljenja centralnog nervnog sistema; Dijagnoza; Imunosupresivna terapija; Glukokortikoidi + terapija
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