SAMIA ZAHI RACHED

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 38 Citação(ões) na Scopus
    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, Casilda
    Introduction: 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.
  • article 26 Citação(ões) na Scopus
    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 Angel
    Background: 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.
  • article 47 Citação(ões) na Scopus
    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, Alberto
    Objective: 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 31 Citação(ões) na Scopus
    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 Dal
    Objective: 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
  • article 26 Citação(ões) na Scopus
    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 Dal
    Background. 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.
  • article 0 Citação(ões) na Scopus
    A study of the psychometric properties of the Brazilian-Portuguese version of Bronchiectasis Health Questionnaire
    (2023) LUPPO, A.; CAMARGO, C. O. de; BIRRING, S. S.; LUNARDI, A. C.; RACHED, S. Z.; ATHANAZIO, R. A.; STELMACH, R.; CORSO, S. D.
    Introduction and objective: The Bronchiectasis Health Questionnaire (BHQ) is a simple, repeatable, and self-reporting health status questionnaire for bronchiectasis. This study aims to cross-culturally adapt the BHQ into Brazilian Portuguese and evaluate its measurement properties.Methods: The participants answered the Saint George's Respiratory Questionnaire (SGRQ) and the modified Medical Research Council (mMRC) scale for dyspnea. The Brazilian-Portuguese version of the Bronchiectasis Health Questionnaire (BHQ-Brazil) was used at baseline (test) and after 14 days (retest). The psychometric analyses included internal consistency, test-retest reliability, and construct validity: factorial validity, convergent validity, and discriminative validity, agreement, and ceiling and floor effects. Results: The BHQ-Brazil demonstrated adequate internal consistency (Cronbach's alpha = 0.92) and substantial reliability (intraclass correlation coefficient = 0.86; 95%CI: 0.79--0.90). The exploratory factorial analysis was considered suitable. All items presented a factorial load >0.40. The convergent validity of the BHQ-Brazil with mMRC was moderate (r = -0.53, p < 0.001), while concurrent validity with the SGRQ was strong (symptoms: r = -0.72, activities: r = -0.60, impact: r = -0.60, total score: r = -0.75, all p < 0.001). The standard error of measurement was 4.81 points. The discriminative validity demonstrated that individuals with more pulmonary exacerbations, colonization by Pseudomonas aeruginosa, worst dyspnea, and a higher number of affected lung lobes presented the lowest quality of life. No floor or ceiling effects were observed.Conclusion: The BHQ-Brazil presents adequate measurement properties to evaluate the impact of bronchiectasis on health-related quality of life, and can be used in clinical and research settings.(c) 2020 Sociedade Portuguesa de Pneumologia.
  • article 10 Citação(ões) na Scopus
    Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?
    (2017) JOSE, Anderson; HOLLAND, Anne E.; OLIVEIRA, Cristiane S. de; SELMAN, Jessyca P. R.; CASTRO, Rejane A. S. de; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone Dal
    Background: Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis.& para;& para;Objectives: To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis.& para;& para;Methods: An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. Interventions: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20 min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). Control: The patients will receive an educational manual and a recommendation to walk three times a week for 30 min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. Main outcome measures: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization.& para;& para;Discussion: The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis.
  • article 12 Citação(ões) na Scopus
    Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial
    (2021) JOSE, Anderson; HOLLAND, Anne E.; SELMAN, Jessyca P. R.; CAMARGO, Cristiane Oliveira de; FONSECA, Diogo Simoes; ATHANAZIO, Rodrigo A.; RACHED, Samia Z.; CUKIER, Alberto; STELMACH, Rafael; CORSO, Simone Dal
    Aim: To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. Methods: Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. Results: After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4-143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. Conclusion: HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.
  • article 1 Citação(ões) na Scopus
    Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association)
    (2023) ATHANAZIO, Rodrigo Abensur; TANNI, Suzana Erico; FERREIRA, Juliana; DALCIN, Paulo de Tarso Roth; FUCCIO, Marcelo B. de; ESPOSITO, Concetta; CANAN, Mariane Goncalves Martynychen; COELHO, Liana Sousa; FIRMIDA, Monica de Cassia; ALMEIDA, Marina Buarque de; MAROSTICA, Paulo Jose Cauduro; MONTE, Luciana de Freitas Velloso; SOUZA, Edna Lucia; PINTO, Leonardo Araujo; RACHED, Samia Zahi; OLIVEIRA, Veronica Stasiak Bednarczuk de; RIEDI, Carlos Antonio; SILVA FILHO, Luiz Vicente Ribeiro Ferreira da
    Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence- based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.
  • article 23 Citação(ões) na Scopus
    Brazilian consensus on non-cystic fibrosis bronchiectasis
    (2019) PEREIRA, Monica Corso; ATHANAZIO, Rodrigo Abensur; DALCIN, Paulo de Tarso Roth; FIGUEIREDO, Mara Rubia Fernandes de; GOMES, Mauro; FREITAS, Clarice Guimaraes de; LUDGREN, Fernando; PASCHOAL, Ilma Aparecida; RACHED, Samia Zahi; MAURICI, Rosemeri
    Bronchiectasis is a condition that has been increasingly diagnosed by chest HRCT. In the literature, bronchiectasis is divided into bronchiectasis secondary to cystic fibrosis and bronchiectasis not associated with cystic fibrosis, which is termed non-cystic fibrosis bronchiectasis. Many causes can lead to the development of bronchiectasis, and patients usually have chronic airway symptoms, recurrent infections, and CT abnormalities consistent with the condition. The first international guideline on the diagnosis and treatment of non-cystic fibrosis bronchiectasis was published in 2010. In Brazil, this is the first review document aimed at systematizing the knowledge that has been accumulated on the subject to date. Because there is insufficient evidence on which to base recommendations for various treatment topics, here the decision was made to prepare an expert consensus document. The Brazilian Thoracic Association Committee on Respiratory Infections summoned 10 pulmonologists with expertise in bronchiectasis in Brazil to conduct a critical assessment of the available scientific evidence and international guidelines, as well as to identify aspects that are relevant to the understanding of the heterogeneity of bronchiectasis and to its diagnostic and therapeutic management. Five broad topics were established (pathophysiology, diagnosis, monitoring of stable patients, treatment of stable patients, and management of exacerbations). After this subdivision, the topics were distributed among the authors, who conducted a nonsystematic review of the literature, giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. The authors reviewed and commented on all topics, producing a single final document that was approved by consensus.