CAROLINA SALIM GONCALVES FREITAS CHULAM
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Evaluation Of The Functional Impact Of The Use Of Doxycycline For Three Years In Patients With Lymphangioleiomyomatosis(2014) BALDI, B. G.; PIMENTA, S. P.; ARAUJO, M. S.; FREITAS, C. S. G.; KAIRALLA, R. A.; CARVALHO, C. R. R.- Mechanisms of Exercise Limitation and Prevalence of Pulmonary Hypertension in Pulmonary Langerhans Cell Histiocytosis(2020) HEIDEN, Glaucia Itamaro; SOBRAL, Juliana Barbosa; FREITAS, Carolina Salim Goncalves; ALBUQUERQUE, Andre Luis Pereira de; SALGE, Joao Marcos; KAIRALLA, Ronaldo Adib; FERNANDES, Caio Julio Cesar dos Santos; CARVALHO, Carlos Roberto Ribeiro; SOUZA, Rogerio; BALDI, Bruno GuedesBACKGROUND: Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH). RESEARCH QUESTION: What are the mechanisms of exercise limitation, the exercise capacity , and the prevalence of dynamic hyperinflation (DH) and PH in PLCH? STUDY DESIGN AND METHODS: In a cross-sectional study, patients with PLCH underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography. Those patients with lung diffusing capacity for carbon monoxide (D-LCO) < 40% predicted and/or transthoracic echocardiogram with tricuspid regurgitation velocity > 2.5 m/s and/or with indirect PH signs underwent right heart catheterization. RESULTS: Thirty-five patients were included (68% women; mean age, 47 +/- 11 years). Ventilatory and cardiocirculatory limitations, impairment suggestive of PH, and impaired gas exchange occurred in 88%, 67%, 29%, and 88% of patients, respectively. The limitation was multifactorial in 71%, exercise capacity was reduced in 71%, and DH occurred in 68% of patients. FEV1 and D-LCO were 64 +/- 22% predicted and 56 +/- 21% predicted. Reduction in D-LCO, an obstructive pattern, and air trapping occurred in 80%, 77%, and 37% of patients. FEV1 and D-LCO were good predictors of exercise capacity. The prevalence of PH was 41%, predominantly with a precapillary pattern, and mean pulmonary artery pressure correlated best with FEV1 and tricuspid regurgitation velocity. INTERPRETATION: PH is frequent and exercise impairment is common and multifactorial in PLCH. The most prevalent mechanisms are ventilatory, cardiocirculatory, and suggestive of PH limitations.
conferenceObject Rapamycin As Treatment Of Lymphangioleiomyomatosis: Favorable Response In Different Clinical Manifestations(2014) FREITAS, C. S. G.; ARAUJO, M. S.; BALDI, B. G.; KAIRALLA, R. A.; CARVALHO, C. R. R.conferenceObject Constrictive Bronchiolitis Mimicking Pulmonary Lymphangioleiomyomatosis(2016) TOLEDO, A. P.; ENDLICH, B. N.; ARIMURA, F. E.; FREITAS, C. S.; NASCIMENTO, E. C. T.; BERNARDI, F. D. C.; DOLHNIKOFF, M.; KAIRALLA, R. A.; BALDI, B. G.; CARVALHO, C. R.- Concentration of serum vascular endothelial growth factor D and its correlation with functional and clinical variables in patients with lymphangioleiomyomatosis from a Brazilian reference centre(2017) OLIVEIRA, Martina Rodrigues; AMARAL, Alexandre Franco; ARIMURA, Fabio Eiji; FREITAS, Carolina Salim; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto Ribeiro de; BALDI, Bruno Guedes
article 25 Citação(ões) na Scopus CLINICAL COURSE AND CHARACTERISATION OF LYMPHANGIOLEIOMYOMATOSIS IN A BRAZILIAN REFERENCE CENTRE(2014) BALDI, B. Guedes; SALIM, C.; FREITAS, G.; ARAUJO, M. Sponholz; DIAS, O. Meira; PEREIRA, D. A. Silva; PIMENTA, S. Pinheiro; KAIRALLA, R. A.; CARVALHO, C. R. RibeiroBackground and objective: Lymphangioleiomyomatosis (LAM) is a rare disease that promotes pulmonary cystic destruction and impairs pulmonary function. We aim to describe features and clinical course of LAM patients from Brazil. Methods: We described the clinical and functional features, performance in six minute walk test (6MWT), management details, survival and clinical course of 84 LAM patients followed in a Brazilian reference centre. Results: All subjects were women, the average age at onset of symptoms was 38 years, and the average at diagnosis was 42 years. The major symptoms during the course of the disease were dyspnoea and pneumothorax. The patients experienced impaired quality of life, with worse scores in the physical and emotional domains. The most common abnormalities in pulmonary function tests were an obstructive pattern and reduced diffusion capacity, whereas a quarter of the patients had normal spirometric results. In the 6MWT, although patients had preserved exercise capacity, more than half of the patients had significant desaturation. Hormonal blockage and doxycycline were the most common treatment modalities employed in our patients. The survival probability from diagnosis was 90% at 5 years, whereas the mean annual rate of decline in FEV1 was 60 +/- 78 mL. Conclusions: Clinical and functional features of the LAM patients from our centre are similar to those from other countries. Our sample showed preserved exercise capacity, with desaturation in the 6MWT, and impaired quality of life. Survival was similar, whereas the annual rate of decline of FEV1 was slightly lower than in recent studies.- Exercise in patients with pulmonary Langerhans cell histiocytosis: performance and mechanisms of limitation(2017) HEIDEN, Glaucia Itamaro; FREITAS, Carolina; SOBRAL, Juliana Barbosa; KAIRALLA, Ronaldo; CARVALHO, Carlos Roberto; SALGE, Joao Marcos; ALBUQUERQUE, Andre Luis; SOUZA, Rogerio; BALDI, Bruno
- Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases(2021) BALDI, Bruno Guedes; FERNANDES, Caio Julio Cesar dos Santos; HEIDEN, Glaucia Itamaro; FREITAS, Carolina Salim Goncalves; SOBRAL, Juliana Barbosa; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto Ribeiro; SOUZA, RogerioTo investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs). We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves. Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 +/- 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 +/- 20% and 38 +/- 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 +/- 6 mm and 0.95 +/- 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio <= 1. The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
- Use of sirolimus in the treatment of lymphangioleiomyomatosis: favorable responses in patients with different extrapulmonary manifestations(2015) FREITAS, Carolina Salim Gonçalves; BALDI, Bruno Guedes; ARAÚJO, Mariana Sponholz; HEIDEN, Glaucia Itamaro; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto RibeiroOBJECTIVE: Lymphangioleiomyomatosis (LAM) is a rare disease that is currently considered a low-grade neoplasm with metastatic potential and variable progression. Mammalian target of rapamycin (mTOR) inhibitors, such as sirolimus and everolimus, have recently become a treatment option for LAM patients, especially those with extrapulmonary manifestations. The objective of the present study was to describe a case series of four patients with LAM in Brazil who showed significant improvement, particularly in their extrapulmonary manifestations, after treatment with sirolimus (at 1-4 mg/day). METHODS: We describe four cases of LAM patients with different extrapulmonary manifestations who were treated with sirolimus. RESULTS: After treatment with sirolimus for 12 months, one patient presented resolution of severe chylothorax; one had a significant reduction in renal angiomyolipoma volume; and one showed significant regression of retroperitoneal lymphangioleiomyomas and abdominal lymph node enlargement. After treatment with sirolimus for 6 months, the remaining patient had a significant reduction in the volume of a massive retroperitoneal lymphangioleiomyoma. CONCLUSIONS: Our findings confirm that mTOR inhibitors are beneficial for patients with LAM, especially those with extrapulmonary manifestations, such as renal angiomyolipoma, lymphangioleiomyomas, and chylous effusions. However, certain aspects, such as the optimal dose, duration of treatment, and long-term adverse effects, have yet to be sufficiently clarified for mTOR inhibitors to be incorporated into LAM management protocols.
conferenceObject Sarcoid-Like Pulmonary Reaction Due To Chronic Lymphocitic Leukaemia(2017) KAWASSAKI, A. M.; BALDI, B. G.; AMARAL, A. F.; PEREIRA, D. A. S.; LIMA, L. G. C. A.; FREITAS, C. S. G.; CARVALHO, C. R. R.; KAIRALLA, R. A.