ABSTRACT
Introducción: La enfermedad pulmonar intersticial (EPI) es una complicación común de la esclerosis sistémica (ES). El empleo de la tomografía computarizada de alta resolución (TACAR) se ve muy limitado, y el ultrasonido pulmonar (USP) puede ser un instrumento alternativo para la evaluación de la EPI. Objetivo: Determinar la validez del USP en la detección temprana de la EPI en pacientes con ES. Métodos: Se incluyeron 68 pacientes con ES≥18 años sin síntomas respiratorios. Un reumatólogo valoró el estado respiratorio subclínico, otro reumatólogo, cegado a la evaluación clínica realizó el USP. Para determinar la validez concurrente se realizó una TACAR. Resultados: Un 41,2% de pacientes mostró EPI por USP, a diferencia de los controles sanos (4,8%) (p=0,0001). Las variables asociadas con los hallazgos de EPI al USP fueron anticuerpos anti-centrómero (p=0,005) y la puntuación de piel RSS (p=0,004). Se encontró una correlación positiva entre los hallazgos de EPI por USP y TACAR (p=0,001). La sensibilidad fue del 91,2% y la especificidad de 88,6%. Una buena confiabilidad entre observadores de los hallazgos por USP fue observada (k=0,72). Conclusiones: Al ser una herramienta alternativa válida, confiable y factible, consideramos que el USP puede ser implementado para la detección temprana de EPI en ES.(AU)
Introduction: Interstitial lung disease (ILD) is a common comorbidity present in patients with systemic sclerosis (SSc). Employment of high-resolution computed tomography (HRCT) is very limited and lung ultrasound (LUS) can be an alternative tool for the early evaluation of ILD. Objective: To determine the validity of LUS in the early detection of ILD in patients with SSc.Methods: Sixty-eight patients with SSc ≥18 years without respiratory symptoms were included. A rheumatologist rated the subclinical respiratory condition, another rheumatologist blinded to the clinical assessment performed the LUS. To determine validity HRCT was performed as well. Results: Prevalence of ILD in SSc patients was 41.2% in contrast to the 4.8% healthy controls (P=.0001). Variables associated with LUS and HRCT findings were anti-centromere antibodies (P=.005) and the Rodnan skin score (P=.004). A positive correlation was present between the findings of HRCT and LUS (P=.001). Sensitivity and specificity were 91.2% and 88.6% respectively. Good reliability in the LUS findings was found between observers (k=.72). Conclusions: By proving to be a valid, trustworthy and feasible alternative tool, we consider that LUS can be implemented for the early detection of ILD in SSc.(AU)
Subject(s)
Humans , Male , Female , Pilot Projects , Ultrasonics , Scleroderma, Systemic , Lung Diseases, Interstitial , Tomography, X-Ray Computed , Clinical Evolution , Rheumatology , Rheumatic Diseases , RheumatologistsABSTRACT
INTRODUCTION: Interstitial lung disease (ILD) is a common comorbidity present in patients with systemic sclerosis (SSc). Employment of high-resolution computed tomography (HRCT) is very limited and lung ultrasound (LUS) can be an alternative tool for the early evaluation of ILD. OBJECTIVE: To determine the validity of LUS in the early detection of ILD in patients with SSc. METHODS: Sixty-eight patients with SSc ≥18 years without respiratory symptoms were included. A rheumatologist rated the subclinical respiratory condition, another rheumatologist blinded to the clinical assessment performed the LUS. To determine validity HRCT was performed as well. RESULTS: Prevalence of ILD in SSc patients was 41.2% in contrast to the 4.8% healthy controls (P=.0001). Variables associated with LUS and HRCT findings were anti-centromere antibodies (P=.005) and the Rodnan skin score (P=.004). A positive correlation was present between the findings of HRCT and LUS (P=.001). Sensitivity and specificity were 91.2% and 88.6% respectively. Good reliability in the LUS findings was found between observers (k=.72). CONCLUSIONS: By proving to be a valid, trustworthy and feasible alternative tool, we consider that LUS can be implemented for the early detection of ILD in SSc.
ABSTRACT
Foi analisado o processo de gerenciamento colegiado implementado pelas Açöes Integradas de Saúde (AIS), no Estado de Säo Paulo, na década de 80. A base de dados foi constituída por informaçöes coletadas junto à Comissäo Interinstitucional de Saúde (CIS-SP). Foram também investigadas a participaçäo dos diversos representantes, as decisöes e as resoluçöes originadas nessa instância de gerenciamento do sistema de saúde. A análise conjunta das informaçöes coletadas mostrou que houve mudança substancial no papel de gerenciamento do setor saúde no Estado, principalmente a partir de 1987. O processo de gestäo colegiada, iniciada com as AIS, foi sendo substituído paulatinamente pela gestäo única , com a separaçäo nítida das responsabilidades entre os níveis de governo municipal, estadual e federal. Esta mudança dificultou o processo de negociaçäo e de definiçäo de objetivos comuns entre os responsáveis pela política de saúde, que vinham sendo constituídos no Estado desde as AIS
Subject(s)
Public Administration/trends , Sanitary Management/trends , Interinstitutional Relations , Health Systems/organization & administration , Organization and Administration , Brazil , Healthcare Financing , Symptoms Hierarchy , Health Systems Plans/organization & administration , Health Policy , Public Policy , Social Security/trendsABSTRACT
Recupera as políticas de saúde da última década e suas repercussöes no Estado de Säo Paulo. Tendo como base a diretriz de descentralizaçäo, identifica as principais diretrizes, tanto no nível federal, quanto no estadual, que corroboraram para a constituiçäo do novo papel do município na prestaçäo de serviços de saúde
Subject(s)
Cities , Politics , Health Policy/history , Local Health Strategies , Healthcare Financing/economics , Regional Health Planning/trends , Health Services/trends , Health Systems/trendsABSTRACT
Recupera as políticas de saúde da última década e suas repercussöes no Estado de Säo Paulo. Tendo como base a diretriz de descentralizaçäo, identifica as principais diretrizes, tanto no nível federal, quanto no estadual, que corroboraram para a constituiçäo do novo papel do município na prestaçäo de serviços de saúde (AU)
