Introduction. Sarcoidosis affects the central nervous system more frequently
than it was previously believed. Since the diagnosis of neurosarcoidosis is
often delayed, it may result in serious ...complications. Being non-specific
when present, the symptoms may be subtle and resemble those of other
neurological diseases. While the cranial nerves are most frequently affected,
neurosarcoidosis can involve other nervous system tissues including the
meninges, brain parenchyma (especially the hypothalamic region), spinal cord,
peripheral nerve and muscle. Discussion and Review of Literature. During the
past decade, a significant progress was made in understanding the
epidemiology and pathophysiology of neurosarcoidosis, as well as the
possibility to diagnose and treat this disease. Studies have shown that the
optimal diagnostic imaging modality for neurosarcoidosis is magnetic
resonance imaging with gadolinium because it enhances visualization of
granulomatous infiltration in neural tissue. Subclinical neurosarcoidosis may
not be uncommon in patients with sarcoidosis. It is now evident that
neurosarcoidosis does not invariably present as a catastrophic event. Adverse
effects associated with high-dose systemic corticosteroids, the standard
therapy, have discouraged practitioners from initiating treatment in the
absence of significant symptomatic neurological disease. However, other
immunosuppressive agents as well newer biologic agents have emerged as an
effective, well-tolerated therapeutic alternative to corticosteroids, which
are often effective in corticosteroid- recalcitrant cases. Conclusion.
Neurosarcoidosis, as a localized granulomatous disease, is possible and not
so rare. Early recognition of neurological involvement in patients with
undiagnosed or diagnosed sarcoidosis is crucial to prevent complications,
which can sometimes be life-threatening.
Introduction. Aberrations in pulmonary function test are present in about 20%
of patients with radiographic stage I sarcoidosis, whereas the pulmonary
function is damaged in 40-80% of patients with ...parenchymal infiltrates
(stages II, III or IV). Discussion and Review of Literature. Reductions in
lung volumes (vital capacity and total lung capacity) are characteristic. The
diffusing capacity of lungs is often reduced, but it is less pronounced in
sarcoidosis than in idiopathic pulmonary fibrosis. Oxygenation is usually
preserved until late in the course of sarcoidosis. Airflow obstruction
(reduced forced expiratory volume in one second and expiratory flow rates)
and bronchial hyper-reactivity occur in 30-50% of sarcoidosis patients with
pulmonary parenchymal involvement. Conclusion. While restrictive spirometry
pattern could easily be explained by fibrous changes in lung parenchyma,
especially in late stages of the lung disease, pathogenesis of airflow
limitation can be attributed mostly to endobronchial involvement
(intraluminal granuloma or fibrous scars formation), airway compression due
to enlarged lymph nodes and to distortion of small airways due to established
pulmonary fibrosis.
Introduction. Abnormalities in the electrocardiogram are more frequent in
patients with cardiac sarcoidosis than in those having other diseases. The
aim of this study was to determine the types and ...incidence of abnormalities
in the electrocardiogram in patients with cardiac sarcoidosis. Results. The
study sample included 30 patients (22 women and 8 men), their mean age being
45 years (23- 64). The clinical diagnosis was confirmed by echocardiography
in 25 (83%) and by radionuclide ventriculography technetium-99m in five
patients (17%). Abnormal electrocardiograms were found in 28 (93%) patients.
The rhythm disturbance was recorded in 21 (69%): arrhythmias in 11 (37%),
conduction disturbances in eight (26%), associated in two (6%), changes in
the ST-T in 7 (23%). Micro R from V1 to V3 was observed in 15 (50%).patients.
The recorded echocardiography granuloma in the septum and occurrence of
arrhythmias were highly correlated with electrocardiogram findings ?micro R?
V1 to V3 (p <0.007, p <0.02). Conclusion. Unusual, nonspecific changes in the
electrocardiogram of patients with cardiac sarcoidosis, such as the finding
of reduced tooth R V1-V3, shows a possible affection of the septum and
frequent occurrences of dysrhythmias.
Analsysis of frequency of tuberculosis in smokers Skodric-Trifunovic, Vesna; Mihailovic-Vucinic, Violeta; Stjepanovic, Mihailo ...
Medicinski pregled,
2013, Letnik:
66, Številka:
suppl. 1
Journal Article
Recenzirano
Odprti dostop
Introduction. Smoking and tuberculosis are among the most important problems
of public health. Smoking and tuberculosis are responsible for 5 million and
2 million deaths per year, respectively, ...whereas smoking is responsible for
half a million deaths in patients with tuberculosis. Discussion and Review
of Literature. Nicotine is a significant suppressor of function of
macrophages, dendritic cells and T-cells, which explains the
immunosuppressive features of smoking that help develop the infection.
Tobacco smoke contains many substances with immunomodulatory effects,
including nicotine, carbon monoxide, acrolein, peroxynitrite and many
others. The dominant immune and pathophysiological mechanism is the
reduction of synthesis of tumor necrosis factor in lung macrophages, leading
to increased susceptibility of persons who are exposed to tobacco smoke for
developing active tuberculosis after infection and increased susceptibility
to the development of other infections, such as infections of Gram-negative
bacteria. Based on epidemiological studies and studies on this problem in
the past 50 years, the World Health Organization has published the finding
that smoking increases the risk of infection with M. tuberculosis, increases
the risk of progression of infection to active disease and the risk of
death. The prevalence of tuberculosis is higher in smokers and former
smokers than in nonsmokers. The risk of tuberculosis depends on the number
of cigarettes smoked and length of period the person has been a smoker.
Passive smoking accelerates the development of active tuberculosis. in
children who live with persons suffering from active tuberculosis,
Conclusion. Given the multiple consequences of the association between
smoking and tuberculosis, prevention of smoking may be an important measure
in the control of tuberculosis.
Introduction. The authors evaluated the application of 18 Ffluoro-2-deoxy-D:
-glucose positron emission tomography/computed tomography to diagnose the
activity in patients with chronic sarcoidosis. ...Material and Methods. The
study sample included 71 patients (48 females and 23 males, their mean age
being 47?3 years) with biopsy-proven sarcoidosis of chronic course. Results.
All patients underwent 18 F-fluoro-2-deoxy-D: -glucose positron emission
tomography/computed tomography, which detected inflammation in 65 patients
(91.5%) (maximum standardized uptake value, 8.1 ? 3.9).
Angiotensin-converting enzyme levels were significantly higher in the
patients with positive than in those with negative 18 F-fluoro-2-deoxy-D:
-glucose positron emission tomography/ computed tomography results.
Conclusion. 18 F-fluoro- 2-deoxy-D: -glucose positron emission
tomography/computed tomography revealed the functional inflammatory active
localizations in chronic sarcoidosis. The obtained results contribute to the
adequate therapeutic option.
The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United ...States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country.
This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status.
The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate.
The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.
PURPOSEThis study aimed to compare baseline to follow-up F-FDG PET/CT findings after treatment for active chronic sarcoidosis and to correlate changes on F-FDG PET/CT with changes in clinical status.
...PATIENTS AND METHODSThe sample included 66 patients with chronic sarcoidosis and evidence of active inflammation on baseline F-FDG PET/CT for which they received therapy. Of these 66 patients, 30 returned for the follow-up F-FDG PET/CT after 12 (5) months to evaluate response to treatment. They were also asked to indicate changes in clinical status. Baseline characteristics of patients who did and did not return for the follow-up were compared to assess selection bias.
RESULTSSUVmax was significantly decreased at the follow-up compared with baseline F-FDG PET/CT (8.46 3.52 vs 4.90 0.96; P = 0.006), primarily in the mediastinum. Inflammatory activity appeared absent in 9 patients, decreased in 12 patients, and increased in 9 patients, with the corresponding changes in SUVmax of −80%, −41%, and +54%, respectively. The changes on F-FDG PET/CT were in agreement with self-perceived changes in clinical symptoms (P = 0.019). The angiotensin-converting enzyme at the follow-up was not significantly different from baseline (49.80 19.25 vs 46.35 25.58, P = 0.522). There was no difference in baseline characteristics of patients who did and did not return for the follow-up.
CONCLUSIONSF-FDG PET/CT is able to detect clinically meaningful changes in magnitude and extent of inflammatory activity in patients receiving treatment for active chronic sarcoidosis. Thus, F-FDG PET/CT is a valuable adjunct to clinical evaluation for monitoring the response to treatment in these patients.
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 cour - ses 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 vi tal 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 majo rity of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable.
Nedavno objavljena istra`ivanja kod obo - le lih od sarkoidoze govore o ~estim abnormalnim vredno - stima vitamina D. Cilj ove studije bio je da se uporedi nivo vita mina 25(OH)D kod obolelih od sarkoidoze sa razli~itim klini~kim tokom bolesti. Tako|e, ova studija predstavlja prva za pa `anja o vezi izme|u kognitivnih funkcija (odnosno ose - }a ja depresije i zamora) i deficita vitamina D kod obolelih od sarko idoze. U Biohemijskoj laboratoriji Klini~kog centra Srbi - je vitamin D - 25(OH)D meren je kori{}enjem testa Elec sys® Vitamin D. Analizirano je 226 bolesnika sa sarkoidozom potvr|enom biopsijom. Prose~na srednja vrednost vitamina D u serumu bila je 9,47 mg/L, {to ukazuje na ozbiljan ne - dostatak. Statisti~ki zna~ajna korelacija na |e na je kod pa ci - je nata sa hroni~nom formom bolesti i niskim nivoom vitamina 25(OH)D u serumu (Xi-kvad rat=6,044; df=2; p=0,014). Grupa pacijenata sa nivoom vitamina D u serumu ve}im od 20 mg/L pokazuje ve}i nivo srednjeg for siranog vitalnog kapaciteta (FVC) za 380 mL i forsiranog ekspi ratornog volu - mena u prvoj sekundi (FEV1) za 220 mL u od nosu na grupu pacijenata sa ni`im nivoom D vitamina. Utvr|eno je da nivo vitamina 25(OH)D u serumu ima stati sti~ki zna~ajnu ulogu kao prediktor zamora i depresije kod obolelih od sarkoidoze. Insuficijencija 25(OH)D vitamina po kazala se kao va`an faktor u pred vi|anju toka hroni~ne bo le sti, zna ~aj nih o{te}enja plu}ne funkcije i kognitivnih po reme }a ja kao {to su zamor i depresija. ^injenica da ve}ina ana li ziranih bolesnika sa sar - koidozom ima potpuni nedo statak 25(OH)D u serumu u~i - nila je takav nalaz jo{ bitnijim.
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