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Eur Respir Rev ; 27(148)2018 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-29769294


Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression (i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD (i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide (DLCO) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted DLCO Only five studies specifically aimed to validate the PFTs: two concluded that DLCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that DLCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression.

Doenças Pulmonares Intersticiais/diagnóstico , Pulmão/fisiopatologia , Testes de Função Respiratória , Escleroderma Sistêmico/complicações , Biópsia , Progressão da Doença , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/terapia , Valor Preditivo dos Testes , Prognóstico , Capacidade de Difusão Pulmonar , Reprodutibilidade dos Testes , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total , Capacidade Vital
J Am Med Inform Assoc ; 23(6): 1159-1165, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27026613


OBJECTIVE: The sexual transmission of enteric diseases poses an important public health challenge. We aimed to build a prediction model capable of identifying individuals with a reported enteric disease who could be at risk of acquiring future sexually transmitted infections (STIs). MATERIALS AND METHODS: Passive surveillance data on Montreal residents with at least 1 enteric disease report was used to construct the prediction model. Cases were defined as all subjects with at least 1 STI report following their initial enteric disease episode. A final logistic regression prediction model was chosen using forward stepwise selection. RESULTS: The prediction model with the greatest validity included age, sex, residential location, number of STI episodes experienced prior to the first enteric disease episode, type of enteric disease acquired, and an interaction term between age and male sex. This model had an area under the curve of 0.77 and had acceptable calibration. DISCUSSION: A coordinated public health response to the sexual transmission of enteric diseases requires that a distinction be made between cases of enteric diseases transmitted through sexual activity from those transmitted through contaminated food or water. A prediction model can aid public health officials in identifying individuals who may have a higher risk of sexually acquiring a reportable disease. Once identified, these individuals could receive specialized intervention to prevent future infection. CONCLUSION: The information produced from a prediction model capable of identifying higher risk individuals can be used to guide efforts in investigating and controlling reported cases of enteric diseases and STIs.

Infecções Bacterianas/transmissão , Enteropatias/complicações , Doenças Sexualmente Transmissíveis/transmissão , Adolescente , Adulto , Técnicas de Apoio para a Decisão , Feminino , Homossexualidade Masculina , Humanos , Modelos Logísticos , Masculino , Modelos Biológicos , Vigilância em Saúde Pública , Quebeque , Medição de Risco , Doenças Sexualmente Transmissíveis/etiologia , Adulto Jovem
Clin Rheumatol ; 32(10): 1467-74, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23733274


In systemic sclerosis (SSc), impaired diffusing capacity for carbon monoxide (DLCO) can indicate interstitial lung disease (ILD), pulmonary hypertension (PH), and/or other disease manifestations, including anemia. We undertook this study to compare the various measures of DLCO in the setting of a complex disease like SSc. We analyzed the pulmonary function tests of a cohort of SSc subjects, as a whole and among subjects with isolated PH and ILD separately. Associations were assessed using Spearman correlation coefficients, Student's t tests, and F tests by one-way ANOVA. P values <0.05 were considered statistically significant. This study included 225 subjects (mean age, 57 years; 88 % women; mean disease duration, 9.6 years; 32 % with diffuse disease, 44 % with ILD, and 17 % with PH). Mean percent predicted DLCO values were 75 % for DLCOsb and 83 % for DLCOrb. Adjustment for alveolar volume (VA) resulted in near normalization of both DLCOsb/VAsb (91 %) and DLCOrb/VArb (91 %). Subjects with ILD had significantly lower DLCOsb but not DLCOsb/VAsb, whereas those with PH had significantly lower DLCOsb and DLCOsb/VAsb. Among the various measures of DLCO, DLCOsb had the strongest and most consistent associations with clinical outcomes of interest. Adjusting for alveolar volume dampened the associations except with PH, with which DLCOsb/VAsb was more strongly associated than DLCOsb. Low DLCOsb is the most sensitive measure to detect abnormalities in gas exchange in SSc but reflects both parenchymal lung disease and pulmonary vascular disease. Low DLCOsb/VAsb is more specific for pulmonary vascular disease and should be the preferred measure of gas exchange in SSc.

Monóxido de Carbono/química , Capacidade de Difusão Pulmonar , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia , Idoso , Estudos de Coortes , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Testes de Função Respiratória/métodos , Fatores de Tempo , Capacidade Vital
J Rheumatol ; 39(9): 1829-34, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22859351


OBJECTIVE: To determine the prevalence of renal disease and the course of renal function over time in patients with systemic sclerosis (SSc). METHODS: We performed a multicenter, longitudinal study of 561 patients with SSc followed in the Canadian Scleroderma Research Group registry. Renal function was measured by the estimated creatinine clearance rate (eCcr) using the Cockcroft-Gault formula. Longitudinal changes in renal function were modeled using statistical analyses that adjusted for patient dropout. RESULTS: Among the study subjects, 112 (20%) had abnormal renal function with no history of scleroderma renal crisis (SRC) and 29 (5%) had a history of SRC at baseline. In models adjusting for patient dropout, we found that patients with abnormal baseline renal function experienced the same annual decline in eCcr as patients with normal baseline renal function (-0.89% per year, 95% CI -2.02%, 0.26%), which is similar to that observed in the general population. Patients with a history of SRC also showed the same rate of decline, although starting from a lower baseline. CONCLUSION: Renal dysfunction is common in SSc, even among those without a history of SRC. It is generally mild and renal function declines at a rate similar to the general population. These data are of considerable prognostic value for clinicians caring for patients with SSc.

Nefropatias/fisiopatologia , Rim/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Nefropatias/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Escleroderma Sistêmico/complicações