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sarcoidosis guidelines

B Jayakrishnan, Nasser Al-Busaidi, Ahsan Al-Lawati, Jojy George, Omar A Al-Rawas, Yaqoub Al-Mahrouqi, Nabil Al-Lawati
BACKGROUND: Though clinical features of sarcoidosis follow a similar pattern, some heterogeneity is seen in different ethnic and racial groups. OBJECTIVES: To describe for the first time the clinical characteristics of sarcoidosis patients in the Sultanate of Oman. METHODS: The data on all cases of sarcoidosis followed up in the two tertiary hospitals in Oman were retrieved retrospectively. RESULTS: Of the 92 patients, for representing the ethnic data only Omani patients (n=83) were included...
October 7, 2016: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
Makoto Sano, Hiroshi Satoh, Kenichiro Suwa, Masao Saotome, Tsuyoshi Urushida, Hideki Katoh, Hideharu Hayashi, Takeji Saitoh
Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM...
September 26, 2016: World Journal of Cardiology
Evan Deschuyteneer, R Rongé, A Riffi, K De Pierre, F Vandenbroucke, C Boulet, A Goossens, W Vincken
We here report a patient with histologically proven sarcoidosis of the knee, a rare localization of sarcoidosis, which usually presents itself as a pulmonary disease. Case reports of radiological images that suggest osseous sarcoidosis of the appendicular skeleton are not so rare, however few are histologically proven. Since in our patient MRI could not distinguish between sarcoidosis and another (possibly malignant) disease, histological proof was obtained through a CT-guided biopsy. Imaging and treatment guidelines for extrapulmonary sarcoidosis are inexistent, due to lack of randomized trials...
September 23, 2016: Acta Clinica Belgica
Rizwan Zafar, Muhammad Haris, Salman Assad, Muhammad Usman Shabbir, Haider Ghazanfar, Sarah A Malik, Tehreem Khalid, Ali H Abbas, Asad A Saleem
PURPOSE:  Heart failure presents a huge burden for individual patients and the healthcare system as a whole. This study aims to assess the adherence to these core measures as identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/ American Heart Association (AHA) by physicians of Pakistan. MATERIALS AND METHODOLOGY:  We conducted a cross-sectional study in Shifa International Hospital, Islamabad, Pakistan from the period of April 2013 to April 2016...
2016: Curēus
David R Okada, Paco E Bravo, Tomas Vita, Vikram Agarwal, Michael T Osborne, Viviany Taqueti, Hicham Skali, Panithaya Chareonthaitawee, Sharmila Dorbala, Garrick Stewart, Marcelo Di Carli, Ron Blankstein
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS...
September 9, 2016: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
Bert Strookappe, Lesley Ann Saketkoo, Marjon Elfferich, Anne Holland, Jolanda De Vries, Ton Knevel, Marjolein Drent
INTRODUCTION: Sarcoidosis is a multisystemic inflammatory disorder with a great variety of symptoms, including fatigue, dyspnea, pain, reduced exercise tolerance and muscle strength. Physical training has the potential to improve exercise capacity and muscle strength, and reduce fatigue. The aim of this review and survey was to present information about the role of physical training in sarcoidosis and offer practical guidelines. AREAS COVERED: A systematic literature review guided an international consensus effort among sarcoidosis experts to establish practice-basic recommendations for the implementation of exercise as treatment for patients with various manifestations of sarcoidosis...
October 2016: Expert Review of Respiratory Medicine
David H Birnie, Pablo B Nery, Andrew C Ha, Rob S B Beanlands
Clinically manifest cardiac involvement occurs in perhaps 5% of patients with sarcoidosis. The 3 principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. An estimated 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic cardiac involvement (clinically silent disease). In 2014, the first international guideline for the diagnosis and management of CS was published. In patients with clinically manifest CS, the extent of left ventricular dysfunction seems to be the most important predictor of prognosis...
July 26, 2016: Journal of the American College of Cardiology
Takahiro Nakajima, Kazuhiro Yasufuku, Taiki Fujiwara, Ichiro Yoshino
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive modality for sampling of mediastinal and hilar lymph nodes as well as pulmonary lesions adjacent to the airway. Guidelines for staging of lung cancer suggest that EBUS-TBNA should be considered the best first test of nodal staging for radiologically abnormal lymph nodes that are accessible by this approach. The application of EBUS-TBNA in pulmonary medicine and thoracic oncology is expanding with its role in the diagnosis of sarcoidosis, lymphoma, and tuberculosis...
July 2016: Respiratory Investigation
Heleen A Crommelin, Leone M van der Burg, Adriane D M Vorselaars, Marjolein Drent, Coline H M van Moorsel, Ger T Rijkers, Vera H M Deneer, Jan C Grutters
BACKGROUND: Tumor necrosis factor-alpha (TNF-α) inhibitors are regarded as the third-line therapy in sarcoidosis, the first choice generally being infliximab. To date, data regarding response to adalimumab in sarcoidosis patients intolerant to infliximab are lacking. The objective of this retrospective observational study was to establish if adalimumab could achieve stabilization or improvement of the disease in refractory sarcoidosis patients who developed intolerance to infliximab...
June 2016: Respiratory Medicine
Ammaiyappan Chockalingam, Ranganathan Duraiswamy, Madhavan Jagadeesan
BACKGROUND: Bronchoalveolar lavage (BAL) has gained acceptance for diagnosis of Interstitial lung disease (ILD). The advent of high-resolution computed tomography (HRCT) has reduced the clinical utility of BAL. This work has utilized the recommendations of the American Thoracic Society (ATS) to optimize BAL and the findings have been associated with clinical examination and HRCT to precisely narrow down the cause of ILD. MATERIALS AND METHODS: BAL was performed on ILD suspects at the target site chosen based on HRCT...
May 2016: Lung India: Official Organ of Indian Chest Society
Umer Syed, Hassan Alkhawam, Mena Bakhit, Rafael A Ching Companioni, Aron Walfish
Sarcoidosis is typically characterized as a non-caseating granulomatous disease that has the ability to affect multiple different organ systems. Although extra-thoracic sarcoidosis can occur in the presence and also without lung involvement, isolated extra-pulmonary disease is rare. The liver is the third most commonly affected organ system after the lungs and lymph nodes. When discussing hepatic sarcoidosis it is important to keep in mind that many patients in this population may not present as one would typically expect since most of the patients are asymptomatic or have mild presentations...
September 2016: Scandinavian Journal of Gastroenterology
Ana Kadkhodayan, Panithaya Chareonthaitawee, Subha V Raman, Leslie T Cooper
Myocarditis is a recognized but underdiagnosed cause of cardiomyopathy due to its wide clinical spectrum and nonspecific presentation. Accurate diagnosis is important because 25% of patients with acute myocarditis develop cardiomyopathy, and of those, approximately 5% per year require heart transplantation or die. Current guidelines for the recognition and treatment of the inflammatory cardiomyopathies are limited. The gold standard for diagnosis, endomyocardial biopsy, has low sensitivity, and thus, multimodality imaging of inflammation plays a crucial role in defining the cardiac abnormalities and in assisting with diagnosis and management...
May 2016: JACC. Cardiovascular Imaging
Mirjam J G Van Manen, Monique Wapenaar, Bert Strookappe, Marjolein Drent, Marjon Elfferich, Jolanda de Vries, Harry R Gosker, Surinder S Birring, Amit S Patel, Leon van den Toorn, Bernt van den Blink, Karin Boomars, Elske Hoitsma, Marlies S Wijsenbeek
BACKGROUND: The King's Sarcoidosis Questionnaire (KSQ) is a brief questionnaire assessing health status using five modules (General Health Status, Lung, Eyes, Skin, Medication) in patients with sarcoidosis. The KSQ was only validated in one English sarcoidosis cohort. OBJECTIVE: The aim of this study was to validate the KSQ in a Dutch sarcoidosis population. METHODS: The KSQ was translated according to international guidelines and tested in interviews with patients...
2016: Sarcoidosis, Vasculitis, and Diffuse Lung Diseases: Official Journal of WASOG
Peter I Bonta, Laurence Crombag, Jouke T Annema
PURPOSE OF REVIEW: Linear endosonography, including intrathoracic lymph nodal sampling by endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) and endoesophageal ultrasound fine-needle aspiration (EUS-FNA), has an important role in the diagnosing and staging of lung cancer. Furthermore, endosonography is applied in the mediastinal evaluation of sarcoidosis, lymphoma, cysts, and nodal metastases of extrathoracic malignancies. Endosonography-related complications as well as sedation and training strategies are discussed...
May 2016: Current Opinion in Pulmonary Medicine
Girish Sindhwani, Nadia Shirazi, Rakhee Sodhi, Shailendra Raghuvanshi, Jagdish Rawat
BACKGROUND: Diffuse parenchymal lung diseases (DPLD) are a group of disorders characterized by chest radiological findings of bilateral diffuse shadowing. Lung biopsy is generally required to make an etiological diagnosis of DPLD's. Transbronchial lung biopsy (TBLB) is a minimally invasive method to achieve a lung sample which has been found to be a useful diagnostic tool in patients with DPLD. As per American Thoracic Society guidelines for management of idiopathic interstitial pneumonias, TBLB is not required in patients who have findings consistent with idiopathic pulmonary fibrosis (IPF) on HRCT scan thorax...
September 2015: Lung India: Official Organ of Indian Chest Society
Christian Jenssen, Jouke Tabe Annema, Paul Clementsen, Xin-Wu Cui, Mathias Maximilian Borst, Christoph Frank Dietrich
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging...
October 2015: Journal of Thoracic Disease
Christoph Frank Dietrich, Jouke Tabe Annema, Paul Clementsen, Xin Wu Cui, Mathias Maximilian Borst, Christian Jenssen
Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging...
September 2015: Journal of Thoracic Disease
Giulia Ganzetti, Anna Campanati, E Molinelli, A Offidani
Biologic treatments have modified the therapeutic armamentarium in the treatment of many dermatological and non- dermatological diseases and data on literature have widely focused on the efficacy and safety of TNF-alpha inhibitors in psoriasis. Although the etiopathogenesis has not completely elucidated, inflammation appears the lait motif unifying the immune-pathogenesis of diverse skin disease, as atopic dermatitis, alopecia areata and hidradenitis suppurativa. Actually, data on the off-label use of biologics in cutaneous immune-mediated inflammatory diseases are scarce and restricted to anecdotal cases and case series...
2016: Current Drug Safety
Dianna Liu, Andrea D Birnbaum
PURPOSE OF REVIEW: Sarcoidosis is a multisystem inflammatory disease, characterized by the presence of noncaseating granulomas. Ocular inflammation is often the first manifestation of the disease, and uveitis can be the driving force for treatment. The goal of this review was to provide an update on the relationship between ocular and systemic disease, with a particular focus on cardiac sarcoidosis. RECENT FINDINGS: Chest radiograph remains the best imaging tool for sarcoidosis, although newer modalities, such as whole-body PET scan, cardiac MRI, and chest computed tomography (CT), may provide additional valuable information in select populations...
November 2015: Current Opinion in Ophthalmology
Kenji Matsumoto, Shoichi Ehara, Mikumo Sakaguchi, Kenichiro Otsuka, Takao Hasegawa, Kenei Shimada, Minoru Yoshiyama
BACKGROUND: The presence of cardiac involvement in sarcoidosis, a multisystem granulomatous disease of unknown etiology, is associated with very poor prognosis. Therefore, early detection of cardiac sarcoidosis (C-sar) is very important for effective treatment. Recently, the value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR), which allows visualization of even minute amounts of myocardial damage, has been emphasized in diagnosing C-sar. Although the presence of LGE has been added as a minor criterion for diagnosing C-sar in the most recent Japan Ministry of Health and Welfare (JMHW) guidelines, its clinical utility remains unknown...
June 2015: Osaka City Medical Journal
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