CARLOS ROBERTO RIBEIRO DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
16 resultados
Resultados de Busca
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- Computed tomography in hypersensitivity pneumonitis: main findings, differential diagnosis and pitfalls(2018) DIAS, Olivia Meira; BALDI, Bruno Guedes; PENNATI, Francesca; ALIVERTI, Andrea; CHATE, Rodrigo Caruso; SAWAMURA, Marcio Valente Yamada; CARVALHO, Carlos Roberto Ribeiro de; ALBUQUERQUE, Andre Luis Pereira deIntroduction: Hypersensitivity pneumonitis (HP) is a disease with variable clinical presentation in which inflammation in the lung parenchyma is caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Alterations of the acute, subacute and chronic forms may eventually overlap, and the diagnosis based on temporality and presence of fibrosis (acute/inflammatory HP vs. chronic HP) seems to be more feasible and useful in clinical practice. Differential diagnosis of chronic HP with other interstitial fibrotic diseases is challenging due to the overlap of the clinical history, and the functional and imaging findings of these pathologies in the terminal stages.Areas covered: This article reviews the essential features of HP with emphasis on imaging features. Moreover, the main methodological limitations of high-resolution computed tomography (HRCT) interpretation are discussed, as well as new perspectives with volumetric quantitative CT analysis as a useful tool for retrieving detailed and accurate information from the lung parenchyma.Expert commentary: Mosaic attenuation is a prominent feature of this disease, but air trapping in chronic HP seems overestimated. Quantitative analysis has the potential to estimate the involvement of the pulmonary parenchyma more accurately and could correlate better with pulmonary function results.
- Texture-based classification of lung disease patterns in chronic hypersensitivity pneumonitis and comparison to clinical outcomes(2021) PENNATI, F.; ALIBONI, L.; ANTONIAZZA, A.; BERETTA, D.; DIAS, O.; BALDI, B. G.; SAWAMURA, M.; CHATE, R. C.; CARVALHO, C. R. R. De; ALBUQUERQUE, A.; ALIVERTI, A.Computer-aided detection algorithms applied to CT lung imaging have the potential to objectively quantify pulmonary pathology. We aim to develop an automatic classification method based on textural features able to classify healthy and pathological patterns on CT lung images and to quantify the extent of each disease pattern in a group of patients with chronic hypersensitivity pneumonitis (cHP), in comparison to pulmonary function tests (PFTs). 27 cHP patients were scanned via high resolution CT (HRCT) at full-inspiration. Regions of interest (ROIs) were extracted and labeled as normal (NOR), ground glass opacity (GGO), reticulation (RET), consolidation (C), honeycombing (HB) and air trapping (AT). For each ROI, statistical, morphological and fractal parameters were computed. For automatic classification, we compared two classification methods (Bayesian and Support Vector Machine) and three ROI sizes. The classifier was therefore applied to the overall CT images and the extent of each class was calculated and compared to PFTs. Better classification accuracy was found for the Bayesian classifier and the 16x16 ROI size: 92.1 +/- 2.7%. The extent of GGO, HB and NOR significantly correlated with forced vital capacity (FVC) and the extent of NOR with carbon monoxide diffusing capacity (DLCO).
- The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline(2020) ROCHWERG, Bram; EINAV, Sharon; CHAUDHURI, Dipayan; MANCEBO, Jordi; MAURI, Tommaso; HELVIZ, Yigal; GOLIGHER, Ewan C.; JABER, Samir; RICARD, Jean-Damien; RITTAYAMAI, Nuttapol; ROCA, Oriol; ANTONELLI, Massimo; MAGGIORE, Salvatore Maurizio; DEMOULE, Alexandre; HODGSON, Carol L.; MERCAT, Alain; WILCOX, M. Elizabeth; GRANTON, David; WANG, Dominic; AZOULAY, Elie; OUANES-BESBES, Lamia; CINNELLA, Gilda; RAUSEO, Michela; CARVALHO, Carlos; DESSAP-MEKONTSO, Armand; FRASER, John; FRAT, Jean-Pierre; GOMERSALL, Charles; GRASSELLI, Giacomo; HERNANDEZ, Gonzalo; JOG, Sameer; PESENTI, Antonio; RIVIELLO, Elisabeth D.; SLUTSKY, Arthur S.; STAPLETON, Renee D.; TALMOR, Daniel; THILLE, Arnaud W.; BROCHARD, Laurent; BURNS, Karen E. A.Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.
- A textural approach for quantitative CT in chronic hypersensitivity pneumonitis (cHP)(2019) PENNATI, Francesca; DIAS, Olivia; ANTONIAZZA, Alessio; BERETTA, Davide; ALIBONI, Lorenzo; BALDI, Bruno Guedes; SAWAMURA, Marcio; CHATE, Rodrigo Caruso; CARVALHO, Carlos Roberto Ribeiro De; ALBUQUERQUE, Andre; ALIVERTI, Andrea
- COVID-19 in Lymphangioleiomyomatosis An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition(2022) BALDI, Bruno Guedes; RADZIKOWSKA, Elzbieta; COTTIN, Vincent; DILLING, Daniel F.; ATAYA, Ali; CARVALHO, Carlos Roberto Ribeiro; HARARI, Sergio; KOSLOW, Matthew; GRUTTERS, Jan C.; INOUE, Yoshikazu; GUPTA, Nishant; JOHNSON, Simon R.
- Mechanisms of exercise limitation in patients with chronic hypersensitivity pneumonitis(2018) DIAS, Olivia Meira; BALDI, Bruno Guedes; FERREIRA, Jeferson George; CARDENAS, Leticia Zumpano; PENNATI, Francesca; SALITO, Caterina; CARVALHO, Carlos Roberto Ribeiro; ALIVERTI, Andrea; ALBUQUERQUE, Andre Luis Pereira deSmall airway and interstitial pulmonary involvements are prominent in chronic hypersensitivity pneumonitis (cHP). However, their roles on exercise limitation and the relationship with functional lung tests have not been studied in detail. Our aim was to evaluate exercise performance and its determinants in cHP. We evaluated maximal cardiopulmonary exercise testing performance in 28 cHP patients (forced vital capacity 57 +/- 17% pred) and 18 healthy controls during cycling. Patients had reduced exercise performance with lower peak oxygen production (16.6 (12.3-19.98) mL.kg(-1).min(-1) versus 25.1 (16.9-32.0), p=0.003), diminished breathing reserve (% maximal voluntary ventilation) (12 (6.4-34.8)% versus 41 (32.7-50.8)%, p<0.001) and hyperventilation (minute ventilation/carbon dioxide production slope 37 +/- 5 versus 31 +/- 4, p<0.001). All patients presented oxygen desaturation and augmented Borg dyspnoea scores (8 (5-10) versus 4 (1-7), p=0.004). The prevalence of dynamic hyperinflation was found in only 18% of patients. When comparing cHP patients with normal and low peak oxygen production (<84% pred, lower limit of normal), the latter exhibited a higher minute ventilation/carbon dioxide production slope (39 +/- 5.0 versus 34 +/- 3.6, p=0.004), lower tidal volume (0.84 (0.78-0.90) L versus 1.15 (0.97-1.67) L, p=0.002), and poorer physical functioning score on the Short form-36 health survey. Receiver operating characteristic curve analysis showed that reduced lung volumes (forced vital capacity %, total lung capacity % and diffusing capacity of the lung for carbon dioxide %) were high predictors of poor exercise capacity. Reduced exercise capacity was prevalent in patients because of ventilatory limitation and not due to dynamic hyperinflation. Reduced lung volumes were reliable predictors of lower performance during exercise.
- Risk of breast cancer in patients with lymphangioleiomyomatosis(2019) NUNEZ, Olivier; BALDI, Bruno G.; RADZIKOWSKA, ElZbieta; CARVALHO, Carlos R. R.; HERRANZ, Carmen; SOBIECKA, Malgorzata; TORRES, Olga; HARARI, Sergio; VERGEER, Menno A. M. H.; KOLBE, John; POLLAN, Marina; PUJANA, Miguel AngelLymphangioleiomyomatosis (LAM) is a rare metastasizing pulmonary disease that shares some clinical, cellular, and molecular similarities with metastatic breast cancer to lung. LAM cells have been identified circulating in various body fluids of patients and, intriguingly, diverse evidence indicates that these cells may originate from a different organ to the lung. Following on from these observations, we hypothesized the existence of a common risk basis between LAM and breast cancer, and suggested increased risk of breast cancer among LAM patients. Here, by studying two additional LAM cohorts with more detailed epidemiological, life-style, and disease-related data, we show consistent results; a potential excess of estrogen-receptor-positive young breast cancer cases in LAM. This observation further suggests the need of prospective studies to precisely assess the association between both diseases.
- Forced Oscillation Technique and Small Airway Involvement in Chronic Hypersensitivity Pneumonitis(2019) DIAS, Olivia Meira; BALDI, Bruno Guedes; CHATE, Rodrigo Caruso; CARVALHO, Carlos Roberto Ribeiro de; DELLACA, Raffaele L.; MILESI, Ilaria; ALBUQUERQUE, Andre Luis Pereira deObjective: Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low-molecular weight substances in genetically susceptible individuals. Although small airway involvement is prominent in patients with chronic HP, conventional pulmonary function tests (PFTs) are relatively insensitive to identify it. Thus, the authors aimed to evaluate resistance (R5) and reactance (X5) values at 5 Hz on inspiration, expiration, and whole breath, as well as small airway resistance (R5-19) values using a forced oscillation technique (FOT) in patients with chronic HP, and their responses after bronchodilator. In addition, R5 and X5 values according to the presence or absence of mosaic attenuation on computed tomography (CT) were compared. Methods: PFTs with plethysmography, diffusing capacity of the lungs for carbon monoxide (DLco) and FOT measurements were performed pre-bronchodilator and post-bronchodilator. High-resolution CT was performed at the same visit, and classified according to the presence or absence of mosaic attenuation. R5 and X5 values were then compared according to the presence or absence of mosaic attenuation on CT. Results: Twenty-eight patients with chronic HP (57.1% female; mean age, 56 +/- 11.5 years; mean forced vital capacity 57 +/- 17% predicted) were evaluated. All patients had low X5 values, reflecting lower lung compliance, and only three (8%) demonstrated elevated R5 (whole-breath) values. No patients exhibited bronchodilator response in R5, X5 and R5_19 values. In patients who exhibited greater extension of mosaic attenuation (n =11), R5 and X5 values could not discriminate those with a greater presence of these areas on CT. Conclusions: The results suggest that FOT does not help to additionally characterise concomitant small airway involvement in patients with chronic fibrotic HP who demonstrate restrictive ventilatory pattern in conventional PFTs. Nevertheless, FOT appeared to better characterise decreased lung compliance due to fibrosis through X5. Bronchodilator therapy did not appear to induce an acute response in chronic HP patients with restrictive disease. The precise role of FOT in subacute HP and obstructive chronic HP, therefore, must be evaluated.
- Natural history of incidental sporadic and tuberous sclerosis complex associated lymphangioleiomyomatosis(2020) MARCO, Fabiano Di; TERRANEO, Silvia; DIAS, Olivia Meira; IMERI, Gianluca; CENTANNI, Stefano; RINALDO, Rocco Francesco; GIULIANI, Lisa; LESMA, Elena; PALUMBO, Giuseppina; WANDERLEY, Mark; CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno GuedesLymphangioleiomyiomatosis (LAM) is a rare disease affecting women in childbearing age. A sporadic form (SLAM) affecting previously healthy women, and a form associated with Tuberous Sclerosis Complex (TSC-LAM) are described. Some data suggested that TSC-LAM could be a milder disease compared to S-LAM. To investigate whether the different disease behavior is real or due to overdiagnosis of screened TSC women, we compared the natural history of S-LAM and TSC-LAM in patients with incidental diagnosis. Clinical, and functional data from 52 patients (23 with S-LAM and 29 with TSC-LAM) were analysed. At diagnosis functional impairment was mild without differences between groups [FEV1 % pred was 97% (88-105) and 94% (82-106) in TSC-LAM and S-LAM, respectively, p = 0.125]. Patients with S-LAM had less renal angiomyolipoma, and lower VEGF-D serum levels than TSC-LAM. There was no difference in the baseline extent of pulmonary cysts on CT scan and no difference in yearly rate of functional decline between TSC-LAM, and S-LAM patients [e.g. yearly rate of decline of FEV1 % pred was 0.51 (1.59 2.24) and 0.90 (1.92 -0.42) in TSC-LAM and S-LAM, respectively, p = 0.265]. In conclusion, the natural history of TSC-LAM and S-LAM, when a potential selection bias due to screening in the latter group is balanced, is similar. Our study suggests that the prevalence of S-LAM can be significantly underestimated due to a tendency to diagnosis more frequently patients with more severe impairment, without identifying several ones with asymptomatic disease.
- Quantitative CT Analysis in Chronic Hypersensitivity Pneumonitis: A Convolutional Neural Network Approach(2022) ALIBONI, Lorenzo; DIAS, Olivia Meira; PENNATI, Francesca; BALDI, Bruno Guedes; SAWAMURA, Marcio Valente Yamada; CHATE, Rodrigo Caruso; CARVALHO, Carlos Roberto Ribeiro; ALBUQUERQUE, Andre Luis Pereira de; ALIVERTI, AndreaRationale and Objectives: Chronic hypersensitivity pneumonitis (cHP) is a heterogeneous condition, where both small airway involvement and fibrosis may simultaneously occur. Computer-aided analysis of CT lung imaging is increasingly used to improve tissue characterization in interstitial lung diseases (ILD), quantifying disease extension, and progression. We aimed to quantify via a convolutional neural network (CNN) method the extent of different pathological classes in cHP, and to determine their correlation to pulmonary function tests (PFTs) and mosaic attenuation pattern. Materials and Methods: The extension of six textural features, including consolidation (C), ground glass opacity (GGO), fibrosis (F), low attenuation areas (LAA), reticulation (R) and healthy regions (H), was quantified in 27 cHP patients (age: 56 +/- 11.5 years, forced vital capacity [FVC]% = 57 +/- 17) acquired at full-inspiration via HRCT. Each class extent was correlated to PFTs and to mosaic attenuation pattern. Results: H showed a positive correlation with FVC%, FEV1% (forced expiratory volume), total lung capacity%, and diffusion of carbon monoxide (DLCO)% (r = 0.74, r = 0.78, r = 0.73, and r = 0.60, respectively, p < 0.001). GGO, R and C negatively correlated with FVC% and FEV1% with the highest correlations found for R (r = -0.44, and r = -0.46 respectively, p < 0.05); F negatively correlated with DLCO% (r = -0.42, p < 0.05). Patients with mosaic attenuation pattern had significantly more H (p = 0.04) and lower R (p = 0.02) and C (p = 0.0009) areas, and more preserved lung function indices (higher FVC%; p = 0.04 and DLCO%; p = 0.05), but did not show more air trapping in lung function tests. Conclusion: CNN quantification of pathological tissue extent in cHP improves its characterization and shows correlation with PFTs. LAA can be overestimated by visual, qualitative CT assessment and mosaic attenuation pattern areas in cHP represents patchy ILD rather than small-airways disease.