SAMIA ZAHI RACHED
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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- Prognostic Value of Frequent Exacerbations in Bronchiectasis: The Relationship With Disease Severity(2019) MARTINEZ-GARCIA, Miguel Angel; ATHANAZIO, Rodrigo; GRAMBLICKA, Giorgina; CORSO, Monica; LUNDGREN, Fernando Cavalcanti; FIGUEIREDO, Mara Fernandes de; ARANCIBIA, Francisco; RACHED, Samia; GIRON, Rosa; CARRO, Luis Maiz; CARRILLO, David de la Rosa; PRADOS, Concepcion; OLVEIRA, CasildaIntroduction: Bronchiectasis is a very heterogeneous disease but some homogeneous groups with similar clinical characteristics and prognosis have been identified. Exacerbations have been shown to have a negative impact on the natural history of bronchiectasis. The objective of this study was to identify the definition and characteristics of the ""frequent exacerbator patient"" with the best prognostic value and its relationship with the severity of bronchiectasis. Methods: A historical cohort of 651 patients diagnosed with bronchiectasis was included. They had all received 5 years of follow-up since their radiological diagnosis. Exacerbation was defined as a worsening of the symptoms derived from bronchiectasis that required antibiotic treatment. The main outcome was all-cause mortality at the end of follow-up. Results: The mean age was 48.2 (16) years (32.9% males). 39.8% had chronic infection by Pseudomonas aeruginosa. Mean BSI, FACED, and E-FACED were 7 (4.12), 2.36 (1.68), and 2.89 (2.03), respectively. There were 95 deaths during follow-up. The definition of the ""frequent exacerbator patient"" that presented the greatest predictive power for mortality was based on at least two exacerbations/year or one hospitalization/year (23.3% of patients; AUC-ROC: 0.75 [95% CI: 0.69-0.81]). Its predictive power was independent of the patient's initial severity. The clinical characteristics of the frequent exacerbator patient according to this definition varied according to the initial severity of bronchiectasis, presence of systemic inflammation, and treatment. Conclusions: The combination of two exacerbations or one hospitalization per year is the definition of frequent exacerbator patient that has the best predictive value of mortality independent of the initial severity of bronchiectasis.
- Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts(2017) ATHANAZIO, Rodrigo; PEREIRA, Monica Corso; GRAMBLICKA, Georgina; CAVALCANTI-LUNDGREN, Fernando; FIGUEIREDO, Mara Fernandes de; ARANCIBIA, Francisco; RACHED, Samia; ROSA, David de la; MAIZ-CARRO, Luis; GIRON, Rosa; OLVEIRA, Casilda; PRADOS, Concepcion; MARTINEZ-GARCIA, Miguel AngelBackground: The FACED score is an easy-to-use multidimensional grading system that has demonstrated an excellent prognostic value for mortality in patients with bronchiectasis. A Spanish group developed the score but no multicenter international validation has yet been published. Methods: Retrospective and multicenter study conducted in six historical cohorts of patients from Latin America including 651 patients with bronchiectasis. Clinical, microbiological, functional, and radiological variables were collected, following the same criteria used in the original FACED score study. The vital status of all patients was determined in the fifth year of follow-up. The area under ROC curve (AUC-ROC) was used to calculate the predictive power of the FACED score for all-cause and respiratory deaths and both number and severity of exacerbations. The discriminatory power to divide patients into three groups of increasing severity was also analyzed. Results: Mean (SD) age of 48.2 (16), 32.9% of males. The mean FACED score was 2.35 (1.68). During the follow up, 95 patients (14.6%) died (66% from respiratory causes). The AUC ROC to predict all-cause and respiratory mortality were 0.81 (95% CI: 0.77 to 0.85) 0.84 (95% CI: 0.80 to 0.88) respectively, and 0.82 (95% CI: 078-0.87) for at least one hospitalization per year. The division into three score groups separated bronchiectasis into distinct mortality groups (mild: 3.7%; moderate: 20.7% and severe: 48.5% mortality; p < 0.001). Conclusions: The FACED score was confirmed as an excellent predictor of all-cause and respiratory mortality and severe exacerbations, as well as having excellent discriminative capacity for different degrees of severity in various bronchiectasis populations.
- Comparação entre medidas objetivas do tabagismo e tabagismo autodeclarado em pacientes com asma ou DPOC: será que nossos pacientes dizem a verdade?(2015) STELMACH, Rafael; FERNANDES, Frederico Leon Arrabal; CARVALHO-PINTO, Regina Maria; ATHANAZIO, Rodrigo Abensur; RACHED, Samia Zahi; PRADO, Gustavo Faibischew; CUKIER, AlbertoObjective: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. Methods: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. Results: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. Conclusions: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management and counseling.
article 0 Citação(ões) na Scopus Right lung exclusion in massive pulmonary thromboembolism(2015) ATHANAZIO, Rodrigo Abensur; RACHED, Samia Zahi- Incremental Shuttle Walking Test: A Reproducible and Valid Test to Evaluate Exercise Tolerance in Adults With Noncystic Fibrosis Bronchiectasis(2014) CANNARGO, Anderson Alves de; AMARAL, Tatiane S.; RACHED, Samia Z.; ATHANAZIO, Rodrigo A.; LANZA, Fernanda C.; SAMPAIO, Luciana M.; CARVALHO, Celso R. de; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalObjective: To analyze the reliability, validity, and determinants of the incremental shuttle walk test (ISWT) in adults with noncystic fibrosis bronchiectasis. Design: Cross-sectional study. Setting: Outpatient clinic. Participants: Subjects (N=75; 26 men) underwent, on different days, cardiopulmonary exercise testing (CPET) and 2 ISWTs, 30 minutes apart. The number of steps in daily life was recorded. Concurrent validity was tested by the relation between distance walked with peak load and oxygen consumption (V) over doto(2). Interventions: None. Main Outcome Measures: Distance walked (m) was compared between the first and second ISWTs; greatest distance walked was correlated with peak load and Vo(2)peak obtained from CPET, steps per day, and dyspnea evaluated by the Medical Research Council (MRC) scale; and desaturation was compared between CPET and the ISWT. Results: Distance walked was equivalent between the first ISWT (441 +/- 152m) and the second ISWT (445 +/- 153m) with an excellent intraclass correlation coefficient (.995; 95% confidence interval, .99-.997). There were significant correlations between distance walked and peak load (r=.82), (V) over doto(2) (r=.72), steps per day (r=.61), and the MRC scale (r=-.69). Age, body mass index, sex, forced vital capacity (% predicted), dyspnea, and steps per day explained 70% of the variation in distance walked (m) and 60% of the variance when expressed as percent predicted. Higher desaturation was observed during the ISWT (-4%+/- 4%) than cycling (-2 +/- 3%) (P<.001). Conclusions: The ISWT is reliable, represents functional capacity, and induces greater desaturation than cycling. Age, body composition, pulmonary function, dyspnea, and physical activity in daily life are determinants of the distance walked on the ISWT. (C) 2014 by the American Congress of Rehabilitation Medicine
- What is the optimal large airway size reduction value to determine malacia: exploratory bronchoscopic analysis in patients in Mounier-Kuhn syndrome(2021) LIMA, Evelise; GENTA, Pedro Rodrigues; ATHANAZIO, Rodrigo Abensur; RODRIGUES, Ascedio Jose; APARECIDA, Maria; NAKAMURA, Maria Aparecida Miyuki; RACHED, Samia Zahi; COSTA, Eduardo Leite Vieira; STELMACH, Rafael
- Pulmonary arterial enlargement is a predictor of higher risk of exacerbations in non-cystic fibrosis bronchiectasis patients(2021) FREITAS, Leonardo Vinicius De; NUNES, Blenda; MIRANDA, Renato; MAIA, Ana Luisa; RACHED, Samia; CUKIER, Alberto; STELMACH, Rafael; PINTO, Regina Carvalho; ATHANAZIO, Rodrigo
bookPart DPOC exacerbada(2018) RACHED, Samia Zahi; ALMEIDA, Guilherme Eler de; CARVALHO, Carlos Roberto Ribeiro deconferenceObject Clinical, Radiological And Functional Features In Mounier Kuhn Syndrome(2013) MAIORANO, M. C. N. T.; RACHED, S. Z.; ATHANAZIO, R. A.; CARVALHO-PINTO, R. M.; STELMACH, R.; CUKIER, A.- Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis(2018) CAMARGO, Anderson Alves de; BOLDORINI, Jacqueline C.; HOLLAND, Anne E.; CASTRO, Rejane A. Silva de; LANZA, Fernanda de Cordoba; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CARVALHO-PINTO, Regina; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone DalBackground. Bronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function. Objective. The purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis. Design. This study used a cross-sectional design. Methods. The participants' quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer. Results. Participants had reduced quadriceps femoris muscle strength (mean difference to control group = 7 kg, 95% CI = 3.8-10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CI = 0.7-3.4 kg), ISWT (227 m, 95% CI = 174-281 m), peak VO2 (6.4 ml/Kg/min, 95% CI = 4.0-8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CI = 1,758-4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R-2 = 0.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R-2 = 0.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance. Limitations. Number of steps per day was evaluated by a pedometer. Conclusion. People with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.