Caio Julio César Santos Fernandes (original) (raw)

Papers by Caio Julio César Santos Fernandes

Pulmonary Circulation, 3rd edition, 2011

Journal of the American College of Cardiology, 2010

The objective of this study was to evaluate the natural history of untreated schistosomiasis-asso... more The objective of this study was to evaluate the natural history of untreated schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients as compared to idiopathic pulmonary arterial hypertension (IPAH) with respect to hemodynamics recorded at presentation and 36 months survival. Background Schistossomiasis (Sch) is one of the most prevalent chronic infectious diseases in the world. Nevertheless data regarding one of its most severe clinical complications, pulmonary arterial hypertension (PAH), is scarce. Methods We retrospectively analyzed case notes of all consecutive patients diagnosed of Sch-PAH and IPAH referred to the Heart Institute in São Paulo, Brazil, between 2004 and 2008. None of the Sch-PAH received PAH specific treatment whereas all IPAH patients did. Results Sch-PH patients (n ϭ 54) had less severe pulmonary hypertension as evidenced by lower levels of pulmonary vascular resistance (11.3 Ϯ 11.3 W vs. 16.7 Ϯ 10.6 W; p ϭ 0.002) and mean pulmonary artery pressure (56.7 Ϯ 18.7 mm Hg vs. 64.6 Ϯ 17.4 mm Hg; p ϭ 0.01) and higher cardiac output (4.62 Ϯ 1.5 l/min vs. 3.87 Ϯ 1.5 l/min; p ϭ 0.009) at presentation than IPAH patients (n ϭ 95). None of the Sch-PAH patients demonstrated a positive response to acute vasodilator testing, whereas 16.2% of IPAH patients did (p ϭ 0.015). Survival rates at 1, 2, and 3 years were 95.1%, 95.1%, and 85.9% and 95%, 86%, and 82%, for Sch-PAH and IPAH, respectively (p ϭ 0.49). Both groups had a higher survival rate when compared to IPAH survival as estimated by the NIH equation (71%, 61%, and 52%, respectively). Conclusions Sch-PAH has a more benign clinical course than IPAH despite a lack of demonstrable acute vasoreactivity at hemodynamic evaluation.

Pulmonary Circulation

Triple combination therapy is suggested in current pulmonary arterial hypertension guidelines in ... more Triple combination therapy is suggested in current pulmonary arterial hypertension guidelines in case of unsatisfactory treatment with oral double combination therapy. However, there is a lack of evidence concerning some of the drug combinations currently employed. We demonstrate the clinical and hemodynamical benefits of inhaled iloprost as third add-on therapy in idiopathic pulmonary arterial hypertension.

European Respiratory Journal, Sep 1, 2013

Body: Chronotropic impairment is associated with decreased survival in Idiopathic Pulmonary Arter... more Body: Chronotropic impairment is associated with decreased survival in Idiopathic Pulmonary Arterial Hypertension (IPAH) patients. However, little is known if this could be one of the factors that influence the different clinical course seen in schistosomiasis associated PAH (Sch-PAH). Objetive: To compare the performance and heart rate (HR) response of Sch-PAH and IPAH patients during maximal cardiopulmonary exercise (CPET). Method: Retrospective analysis of 23 CPETs (15 IPAH, 7 Sch-PAH). Gas exchange, ventilatory and chronotropic parameters were analyzed during rest, anaerobic threshold (AT) and peak. HR, VO2 and VO2/HR were analyzed as absolute and as a proportion of maximum predicted values (HR%pred, VO2%pred, VO2/HR%pred) at each point. HR recovery (HRR) was the difference between peak HR and HR on the first minute after exercise interruption. Results: IPAH patients tended to be younger (37.6 ± 10.7 vs 47.8 ± 12.5 yrs, p=0.053), with higher proportion of female patients and similar hemodynamics and VO2%pred. IPAH had higher VO2/HR%pred during rest (0.37 ± 0.12 vs 0.23 ± 0.12, p=0.04), with no differences found at AT or peak exercise. Both groups had similar HR, HR%pred and VE/VCO2 at each point. HRR was also similar between groups (16.9 ± 8.2 vs 14.8 ± 12.6bpm, for IPAH and Sch-PAH respectively, p=0.72). Conclusion: No differences were found in HR response between IPAH and Sch-PAH. Although VO2/HR was higher for resting iPAH, this difference was not found during exercise. Our results suggest that chronotropic impairment may not be the mechanism explaining the survival difference seen in IPAH and Sch-PAH.

Int J Clin Pract, 2010

... Get PDF (147K). Summary. ... 14 Pozzan G, Souza R, Jardim C et al. Histopathological features... more ... Get PDF (147K). Summary. ... 14 Pozzan G, Souza R, Jardim C et al. Histopathological features of pulmonary vascular disease in chronic Schistosomia mansoni infection are not different from those in idiopathic pulmonary hypertension. Am J Respir Crit Care Med 2008; 177: A443. ...

Jornal Brasileiro De Pneumologia Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia, Jul 1, 2008

Embora a esquistossomose seja uma causa de hipertensão pulmonar (HP), o papel da ecodopplercardio... more Embora a esquistossomose seja uma causa de hipertensão pulmonar (HP), o papel da ecodopplercardiografia na avaliação de pacientes com esta patologia não está bem definido. Objetivos Determinar o valor da ecodopplercardiografia na avaliação de pacientes com esquistossomose. Conclusões Uma porcentagem significativa de pacientes com esquistossome ativa apresentaram hipertensão pulmonar determinada pela ecocardiografia e quando comparamos os grupos com esquistossomose x controle podemos observar presença de alteração na função diastólica do VE, bem como a presença de hipertensão arterial pulmonar, demonstrando ser a esquistossomose uma doença sistêmica que leva ao desenvolvimento de hipertensão arterial pulmonar.

Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia

Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simul... more Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simulate obstructive pulmonary diseases, such as asthma and chronic obstructive pulmonary disease, and patients with benign tracheal tumors often undergo long-term treatment for such diseases, without any improvement, Therefore, these tumors should be included in the differential diagnosis in patients presenting tracheobronchial tree obstruction. This report describes the case of a patient with a tracheal polyp. The patient presented symptoms for three years, and the spirometry findings suggested intrathoracic obstruction. The patient presented complete clinical and spirometric recovery after bronchoscopic resection of the tumor.

Arquivos brasileiros de cardiologia, 2006

Phosphodiesterase inhibitors like sildenafil have already been shown to improve functional capaci... more Phosphodiesterase inhibitors like sildenafil have already been shown to improve functional capacity and hemodynamics in the treatment of pulmonary arterial hypertension. Few studies address the effects of new phosphodiesterase inhibitors as tadalafil. We report a case of a patient with idiopathic pulmonary arterial hypertension in functional class IV (New York Heart Association) with significant response to treatment with tadalafil.

Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2009

To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate... more To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate patients with pulmonary arterial hypertension (PAH). The study population comprised 73 patients with PAH, diagnosed by means of right heart catheterization, with or without NO inhalation. All patients performed a hallway 6MWT and three tread6MWTs based on a pre-determined incremental speed protocol and interposed by a rest period. The patients who had been submitted to hemodynamic testing using NO performed the third tread6MWT while inhaling the same dose of NO that had been used during the catheterization. We found that the treadmill six-minute walk distance (tread6MWD) correlated with hemodynamic data, functional class and the hallway six-minute walk distance (6MWD). In addition, the tread6MWD correlated significantly with survival, thereby confirming the correlation with disease severity. Inhalation of NO during the tread6MWT led to variations that were consistent with the hemodynami...

C57. PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS, 2010

C57 PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS Poster... more C57 PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS Poster Session / Tuesday, May 18/8:15 AM-4:00 PM / Area K, Hall G (First Level), Morial Convention Center ... Endothelial Dysfunction In Patients With ...

Lung, 2014

The aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF ... more The aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF in schistosomiasis-associated pulmonary hypertension. Patients with three distinct clinical profiles were enrolled in the study: IPAH(n = 11), schistosomiasis-associated PH (Sch-PH))(n = 13), and schistosomiasis without PH (Sch) (n = 13). Healthy volunteers, were recruited as a control group(n = 13). Echocardiography was performed in all groups, and the PH patients underwent right heart catheterization. Plasma soluble adhesion molecules E- and P-Selectin, PDGF-AB, PDGF-BB were determined by ELISA. E-selectin was significantly increased in the IPAH group compared with the other groups [the control, Sch + PH and Sch groups) (p < 0.001) (Fig. 2)]. P-selectin was lower in Sch (20.2 + 8.9 × 103 pg/mL) as compared to the control, (43 16.8 × 103 pg/mL), IPAH (35.8 7.8 × 103 pg/mL), and Sch + PH (36.8 ± 15.7 × 103 pg/mL) (p = 0.005) groups. Serum PDGF-BB levels were higher in the control group (8.9 ± 4.8 × 103 pg/mL) compared with the IPAH (3.7 ± 2.17 × 103 pg/mL), Sch + PH (5.2 ± 3.7 × 103 pg/mL) and Sch (2.4 ± 1.7 × 103 pg/mL) groups (p < 0.05). PDGF-AB levels were also higher in the control group (25.6 ± 8.6 × 103 pg/mL), compared with the other three groups, being the Sch group the one with lower serum levels of this marker (11.4 ± 8.6 × 103 pg/mL) (p = 0.006). In conclusion, vascular inflammation in schistosomiasis, with or without PH, is different from IPAH suggesting distinct pathophysiological mechanisms associated with the development of pulmonary hypertension.

Health and Quality of Life Outcomes, 2014

Background: Improvement in quality of life together with better survival are the ultimate goals i... more Background: Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment. Methods: Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months. Results: After treatment, the patients demonstrated an improved 6MWT (414 ± 124 m vs. 440 ± 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores. Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58). Conclusions: Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving predetermined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.

BMC pulmonary medicine, Jan 25, 2014

Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the in... more Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the individuals. Pulmonary involvement is common in immunocompromised subjects, but very rare in immunocompetents and there are scarce reports of tomographic findings in the literature. The aim of the study is to describe three immunocompetent patients diagnosed with acute pulmonary toxoplasmosis and their respective thoracic tomographic findings. Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis. The patients were two female and one male, and were 38, 56 and 36 years old. Similarly they presented a two-week febrile illness and progressive dyspnea before admission. Laboratory tests demonstrated lymphocytosis, slight changes in liver enzymes and high inflammatory markers. ...

Jornal Brasileiro de Pneumologia, 2007

Tumores benignos primários da traquéia são raros, sendo o mais freqüente a papilomatose benigna r... more Tumores benignos primários da traquéia são raros, sendo o mais freqüente a papilomatose benigna recorrente. Muitas vezes simulam doenças pulmonares obstrutivas, como asma e doença pulmonar obstrutiva crônica, sendo os pacientes tratados como portadores de tais doenças por longo período sem apresentar melhora. Deve-se, portanto, incluí-los no diagnóstico diferencial dos quadros de obstrução da árvore traqueobrônquica. Relata-se um caso de paciente com pólipo traqueal com evolução de três anos e espirometria evidenciando padrão de obstrução intratorácica variável, que evoluiu com melhora clínica e funcional completa após ressecção por via broncoscópica.

D70. MECHANICAL FORCES AND HEMODYNAMICS IN RESPONSE TO EXERCISE, 2012

Pulmonary Circulation, 3rd edition, 2011

Journal of the American College of Cardiology, 2010

The objective of this study was to evaluate the natural history of untreated schistosomiasis-asso... more The objective of this study was to evaluate the natural history of untreated schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients as compared to idiopathic pulmonary arterial hypertension (IPAH) with respect to hemodynamics recorded at presentation and 36 months survival. Background Schistossomiasis (Sch) is one of the most prevalent chronic infectious diseases in the world. Nevertheless data regarding one of its most severe clinical complications, pulmonary arterial hypertension (PAH), is scarce. Methods We retrospectively analyzed case notes of all consecutive patients diagnosed of Sch-PAH and IPAH referred to the Heart Institute in São Paulo, Brazil, between 2004 and 2008. None of the Sch-PAH received PAH specific treatment whereas all IPAH patients did. Results Sch-PH patients (n ϭ 54) had less severe pulmonary hypertension as evidenced by lower levels of pulmonary vascular resistance (11.3 Ϯ 11.3 W vs. 16.7 Ϯ 10.6 W; p ϭ 0.002) and mean pulmonary artery pressure (56.7 Ϯ 18.7 mm Hg vs. 64.6 Ϯ 17.4 mm Hg; p ϭ 0.01) and higher cardiac output (4.62 Ϯ 1.5 l/min vs. 3.87 Ϯ 1.5 l/min; p ϭ 0.009) at presentation than IPAH patients (n ϭ 95). None of the Sch-PAH patients demonstrated a positive response to acute vasodilator testing, whereas 16.2% of IPAH patients did (p ϭ 0.015). Survival rates at 1, 2, and 3 years were 95.1%, 95.1%, and 85.9% and 95%, 86%, and 82%, for Sch-PAH and IPAH, respectively (p ϭ 0.49). Both groups had a higher survival rate when compared to IPAH survival as estimated by the NIH equation (71%, 61%, and 52%, respectively). Conclusions Sch-PAH has a more benign clinical course than IPAH despite a lack of demonstrable acute vasoreactivity at hemodynamic evaluation.

Pulmonary Circulation

Triple combination therapy is suggested in current pulmonary arterial hypertension guidelines in ... more Triple combination therapy is suggested in current pulmonary arterial hypertension guidelines in case of unsatisfactory treatment with oral double combination therapy. However, there is a lack of evidence concerning some of the drug combinations currently employed. We demonstrate the clinical and hemodynamical benefits of inhaled iloprost as third add-on therapy in idiopathic pulmonary arterial hypertension.

European Respiratory Journal, Sep 1, 2013

Body: Chronotropic impairment is associated with decreased survival in Idiopathic Pulmonary Arter... more Body: Chronotropic impairment is associated with decreased survival in Idiopathic Pulmonary Arterial Hypertension (IPAH) patients. However, little is known if this could be one of the factors that influence the different clinical course seen in schistosomiasis associated PAH (Sch-PAH). Objetive: To compare the performance and heart rate (HR) response of Sch-PAH and IPAH patients during maximal cardiopulmonary exercise (CPET). Method: Retrospective analysis of 23 CPETs (15 IPAH, 7 Sch-PAH). Gas exchange, ventilatory and chronotropic parameters were analyzed during rest, anaerobic threshold (AT) and peak. HR, VO2 and VO2/HR were analyzed as absolute and as a proportion of maximum predicted values (HR%pred, VO2%pred, VO2/HR%pred) at each point. HR recovery (HRR) was the difference between peak HR and HR on the first minute after exercise interruption. Results: IPAH patients tended to be younger (37.6 ± 10.7 vs 47.8 ± 12.5 yrs, p=0.053), with higher proportion of female patients and similar hemodynamics and VO2%pred. IPAH had higher VO2/HR%pred during rest (0.37 ± 0.12 vs 0.23 ± 0.12, p=0.04), with no differences found at AT or peak exercise. Both groups had similar HR, HR%pred and VE/VCO2 at each point. HRR was also similar between groups (16.9 ± 8.2 vs 14.8 ± 12.6bpm, for IPAH and Sch-PAH respectively, p=0.72). Conclusion: No differences were found in HR response between IPAH and Sch-PAH. Although VO2/HR was higher for resting iPAH, this difference was not found during exercise. Our results suggest that chronotropic impairment may not be the mechanism explaining the survival difference seen in IPAH and Sch-PAH.

Int J Clin Pract, 2010

... Get PDF (147K). Summary. ... 14 Pozzan G, Souza R, Jardim C et al. Histopathological features... more ... Get PDF (147K). Summary. ... 14 Pozzan G, Souza R, Jardim C et al. Histopathological features of pulmonary vascular disease in chronic Schistosomia mansoni infection are not different from those in idiopathic pulmonary hypertension. Am J Respir Crit Care Med 2008; 177: A443. ...

Jornal Brasileiro De Pneumologia Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia, Jul 1, 2008

Embora a esquistossomose seja uma causa de hipertensão pulmonar (HP), o papel da ecodopplercardio... more Embora a esquistossomose seja uma causa de hipertensão pulmonar (HP), o papel da ecodopplercardiografia na avaliação de pacientes com esta patologia não está bem definido. Objetivos Determinar o valor da ecodopplercardiografia na avaliação de pacientes com esquistossomose. Conclusões Uma porcentagem significativa de pacientes com esquistossome ativa apresentaram hipertensão pulmonar determinada pela ecocardiografia e quando comparamos os grupos com esquistossomose x controle podemos observar presença de alteração na função diastólica do VE, bem como a presença de hipertensão arterial pulmonar, demonstrando ser a esquistossomose uma doença sistêmica que leva ao desenvolvimento de hipertensão arterial pulmonar.

Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia

Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simul... more Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simulate obstructive pulmonary diseases, such as asthma and chronic obstructive pulmonary disease, and patients with benign tracheal tumors often undergo long-term treatment for such diseases, without any improvement, Therefore, these tumors should be included in the differential diagnosis in patients presenting tracheobronchial tree obstruction. This report describes the case of a patient with a tracheal polyp. The patient presented symptoms for three years, and the spirometry findings suggested intrathoracic obstruction. The patient presented complete clinical and spirometric recovery after bronchoscopic resection of the tumor.

Arquivos brasileiros de cardiologia, 2006

Phosphodiesterase inhibitors like sildenafil have already been shown to improve functional capaci... more Phosphodiesterase inhibitors like sildenafil have already been shown to improve functional capacity and hemodynamics in the treatment of pulmonary arterial hypertension. Few studies address the effects of new phosphodiesterase inhibitors as tadalafil. We report a case of a patient with idiopathic pulmonary arterial hypertension in functional class IV (New York Heart Association) with significant response to treatment with tadalafil.

Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2009

To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate... more To develop and validate a protocol for the treadmill six-minute walk test (tread6MWT) to evaluate patients with pulmonary arterial hypertension (PAH). The study population comprised 73 patients with PAH, diagnosed by means of right heart catheterization, with or without NO inhalation. All patients performed a hallway 6MWT and three tread6MWTs based on a pre-determined incremental speed protocol and interposed by a rest period. The patients who had been submitted to hemodynamic testing using NO performed the third tread6MWT while inhaling the same dose of NO that had been used during the catheterization. We found that the treadmill six-minute walk distance (tread6MWD) correlated with hemodynamic data, functional class and the hallway six-minute walk distance (6MWD). In addition, the tread6MWD correlated significantly with survival, thereby confirming the correlation with disease severity. Inhalation of NO during the tread6MWT led to variations that were consistent with the hemodynami...

C57. PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS, 2010

C57 PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS Poster... more C57 PULMONARY HYPERTENSION: BIOMARKERS, GENETICS, AND GENOMICS: INSIGHTS INTO PATHOGENESIS Poster Session / Tuesday, May 18/8:15 AM-4:00 PM / Area K, Hall G (First Level), Morial Convention Center ... Endothelial Dysfunction In Patients With ...

Lung, 2014

The aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF ... more The aim of this study was to evaluate the expression profiles of the relevant selectins and PDGF in schistosomiasis-associated pulmonary hypertension. Patients with three distinct clinical profiles were enrolled in the study: IPAH(n = 11), schistosomiasis-associated PH (Sch-PH))(n = 13), and schistosomiasis without PH (Sch) (n = 13). Healthy volunteers, were recruited as a control group(n = 13). Echocardiography was performed in all groups, and the PH patients underwent right heart catheterization. Plasma soluble adhesion molecules E- and P-Selectin, PDGF-AB, PDGF-BB were determined by ELISA. E-selectin was significantly increased in the IPAH group compared with the other groups [the control, Sch + PH and Sch groups) (p < 0.001) (Fig. 2)]. P-selectin was lower in Sch (20.2 + 8.9 × 103 pg/mL) as compared to the control, (43 16.8 × 103 pg/mL), IPAH (35.8 7.8 × 103 pg/mL), and Sch + PH (36.8 ± 15.7 × 103 pg/mL) (p = 0.005) groups. Serum PDGF-BB levels were higher in the control group (8.9 ± 4.8 × 103 pg/mL) compared with the IPAH (3.7 ± 2.17 × 103 pg/mL), Sch + PH (5.2 ± 3.7 × 103 pg/mL) and Sch (2.4 ± 1.7 × 103 pg/mL) groups (p < 0.05). PDGF-AB levels were also higher in the control group (25.6 ± 8.6 × 103 pg/mL), compared with the other three groups, being the Sch group the one with lower serum levels of this marker (11.4 ± 8.6 × 103 pg/mL) (p = 0.006). In conclusion, vascular inflammation in schistosomiasis, with or without PH, is different from IPAH suggesting distinct pathophysiological mechanisms associated with the development of pulmonary hypertension.

Health and Quality of Life Outcomes, 2014

Background: Improvement in quality of life together with better survival are the ultimate goals i... more Background: Improvement in quality of life together with better survival are the ultimate goals in the treatment of pulmonary arterial hypertension (PAH) patients. The objective of this study was to evaluate the health-related quality of life (HRQL) of pulmonary arterial hypertension (PAH) patients with the SF-36 generic questionnaire and to identify the prognostic implication of this assessment. Methods: Fifty-four consecutive newly diagnosed PAH patients (WHO classification group I) in a single PAH reference center were included. Patients were evaluated at baseline for clinical and hemodynamic parameters, and they subsequently received first-line therapy with either an endothelin receptor antagonist or a phosphodiesterase-5 inhibitor. After 16 weeks of specific PAH therapy, all patients were re-evaluated using a 6MWT and a SF 36 questionnaire, and then they were followed up for at least 36 months. Results: After treatment, the patients demonstrated an improved 6MWT (414 ± 124 m vs. 440 ± 113 m, p = 0.001). Specific PAH therapy also improved the HRQL scores. Patients with a baseline Physical Component Score (PCS) higher than 32 had a better survival rate than those who had a score under 32 (p = 0.04). Similarly, patients with a PCS of at least a 38 after the 16 week therapy period had a better survival rate when compared with those who did not achieve this value (p = 0.016). Unlike the absolute PCS values, the post-treatment PCS variability was unable to predict better survival rates (p = 0.58). Conclusions: Our findings suggest that HRQL is associated with prognosis in PAH. Furthermore, achieving predetermined PCS scores might represent a specific goal to be reached in treatment-to-target strategies.

BMC pulmonary medicine, Jan 25, 2014

Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the in... more Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the individuals. Pulmonary involvement is common in immunocompromised subjects, but very rare in immunocompetents and there are scarce reports of tomographic findings in the literature. The aim of the study is to describe three immunocompetent patients diagnosed with acute pulmonary toxoplasmosis and their respective thoracic tomographic findings. Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis. The patients were two female and one male, and were 38, 56 and 36 years old. Similarly they presented a two-week febrile illness and progressive dyspnea before admission. Laboratory tests demonstrated lymphocytosis, slight changes in liver enzymes and high inflammatory markers. ...

Jornal Brasileiro de Pneumologia, 2007

Tumores benignos primários da traquéia são raros, sendo o mais freqüente a papilomatose benigna r... more Tumores benignos primários da traquéia são raros, sendo o mais freqüente a papilomatose benigna recorrente. Muitas vezes simulam doenças pulmonares obstrutivas, como asma e doença pulmonar obstrutiva crônica, sendo os pacientes tratados como portadores de tais doenças por longo período sem apresentar melhora. Deve-se, portanto, incluí-los no diagnóstico diferencial dos quadros de obstrução da árvore traqueobrônquica. Relata-se um caso de paciente com pólipo traqueal com evolução de três anos e espirometria evidenciando padrão de obstrução intratorácica variável, que evoluiu com melhora clínica e funcional completa após ressecção por via broncoscópica.

D70. MECHANICAL FORCES AND HEMODYNAMICS IN RESPONSE TO EXERCISE, 2012