Molecular profiling in bee venom allergy: clinical and therapeutic characterization in a Portuguese cohort.

Summary: Background. Bee venom allergy (BVA) can trigger local and systemic allergic reactions, including anaphylaxis. Recently, the molecular sensitization profile has gained importance in the reaction's stratification and venom immunotherapy (VIT). Methods. Retrospective analysis of patients with hypersensitivity to BVA, confirmed by specific sIgE to Apis mellifera ≥0.35 kU/L and/or positive skin tests to bee venom commercial extract, evaluated in specialized consultation. Demographic, clinical, and laboratory data (including molecular Api m 1, 4, and 10) were analyzed, looking for risk factors associated with the severity of the index reaction and reactions during VIT. Results. 93 patients were included (55.9% male; median age of 46 years), 57.3% with atopic comorbidities, and 23.4% with cardiovascular comorbidities. The median specific IgE to Apis mellifera was 6.7 kU/L (IQR 1.0-20.3) kU/L. Regarding the molecular profile, the median IgE to Api m 1 was 0.5 kU/L (57.5% positive out of all measurements); Api m 4 - 0.01 kU/L (11.9% positive), and Api m 10 - 0.3 kU/L (50.0% positive). No patient was monosensitized to Api m 4. The median age of the most severe sting reaction was 36 (IQR 26-48) years, with a median severity (Müeller scale) of 3 (IQR 2-3). Forty-seven patients (50.5%) underwent VIT, with 35.6% of reactions recorded. Allergic reactions during VIT were recorded in 35.6% of cases. The severity of the index reaction correlated positively with older ages (p=0.040; r=0.249), in contrast to monosensitization to Api m 1, which was an independent predictor of milder reactions (p=0.015). Sensitization to Api m 10 was associated with a higher likelihood of reactions during VIT (p=0.038) but potentially less systemic reactions at re-stings (p=0.097). Conclusions. Molecular sensitization profile appears to be relevant not only to the severity of index reactions but also during VIT. Studies of a large cohort of patients with molecular profiles are essential to validate these results and improve the clinical and therapeutic approach to BVA.

Hypoglycemic effect of Coffea arabica leaf extracts and major bioactive constituents.

The present study focused on investigating the antioxidant, antiglycation activity, digestive enzymes inhibition, bioaccessibility and hypoglycemic effect of C. arabica leaves extracts. The extracts deactivated the O2•-, ROO•, H2O2, HOCl reactive oxygen species. Coffee leaves showed strong inhibition of α-glucosidase (IC50 = 40.30 µg mL-1) greater than the isolated metabolites and acarbose. There was also inhibition of pancreatic lipase (IC50 = 56.43 µg mL-1) in addition to a hypoglycemic effect in zebrafish similar to acarbose and metformin. With the exception of rutin, all biocompounds were detected at all stages of in vitro digestion. Finally, these results suggest that C. arabica leaf extracts possess antidiabetic and anti-obesity properties that can be attributed to the main metabolites and the synergistic action between them.Communicated by Ramaswamy H. Sarma.

Treatment of Molar-incisor Hypomineralization: A Case Report of 11-year Clinical Follow-up.

The purpose of this case report was to describe an 11-year follow-up of a patient presenting with molar-incisor hypomineralization (MIH) having yellowish and porous permanent incisors and molars. Clinical examination revealed demarcated brown opacities on one upper and one lower central incisor and three first permanent molars. Initially, treatment involved oral hygiene and periodic fluoride varnish application. Subsequently, the occlusal surfaces of the affected molars were restored or sealed with glass ionomer cement. At-home dental bleaching was also performed. Areas of unsatisfactory esthetics on the incisors were replaced by composite resins. This report discussed the patient's needs and expectations, the difficulties of prolonged treatment for patients with MIH, and the restorative protocol involving at-home dental bleaching and composite resins.

Sensitization to genuine markers of timothy grass pollen (Phleum pratense) in the North-Central region of Portugal.

Summary: Pollens are the main cause of respiratory allergies which prevalence is increasing. The most important cause of pollinosis in Europe and especially in the Mediterranean countries as Portugal is Poaceae family pollen. Timothy grass (Phleum pratense) is one of the most common pollen sources, and one of the best characterized allergenic grasses. The major allergens Phl p1 and Phl p5 are considered markers of genuine grass pollen sensitization. A characterization of Phl p1 and Phl p5 sensitization in the North-Central region of Portugal was made in children and adults. Phl p1 sensitization was the most frequent.

Occupational management of healthcare workers exposed to COVID-19.

BACKGROUND: The year 2020 was marked by the new coronavirus pandemic, resulting in millions of cases and deaths, placing healthcare workers at high risk of infection. AIMS: The aim of this study was to describe the role of an occupational health service during coronavirus disease 2019 pandemic in an oncologic hospital and characterize the most likely sources of viral infection. METHODS: The information of all healthcare workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from 11 March to 15 December 2020 was collected through an epidemiological survey conducted during contact tracing. The data extracted included gender, age, comorbidities, occupational group, source of infection, clinical presentation, duration of the disease, need for hospitalization and persistent or late symptoms after disease or upon returning to work. RESULTS: Out of a total of 2300 workers, 157 were infected, consisting of nurses (36%), nurse assistants (33%) and diagnostic and therapeutic professionals (10%). Physicians and administrative staff accounted for 8% each. The most frequently reported source of infection was occupational (43%), owing to worker-to-worker transmission (45%) and patient-to-worker transmission (36%). The most frequent moments of infection perceived corresponded to the removal of protective equipment during meals and moments of rest in the staff and changing rooms. CONCLUSIONS: The study revealed that occupational transmission from patients and colleagues might be an important source of SARS-CoV-2 infection in healthcare workers. Spread between colleagues accounted for 45% of the occupational source infections reported. Implementing physical distancing measures and limiting the number of people in changing and rest rooms could significantly reduce infection and related absenteeism.

Accuracy of a spontaneous breathing trial for extubation of neonates.

BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates' extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1-98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5-82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.

Chest CT imaging features of COVID-19 pneumonia: First radiological insights from Porto, Portugal.

INTRODUCTION: The outbreak of a highly infectious respiratory disease - COVID-19 - has spread globally and a novel type of coronavirus (SARS-CoV-2) was identified as its cause. Chest CT findings have been described as an aid for COVID-19 diagnosis and management. We aimed to describe the CT imaging characteristics in a group of COVID-19 patients while we also intended to assess if any of these radiological features were associated with short-term prognosis. MATERIALS AND METHODS: CT examinations from 164 consecutive patients with at least one positive RT-PCR nucleic acid assay for SARS-CoV-2 were retrospectively analyzed. Numerous CT imaging features were recorded independently by two radiologists. Patients were grouped according to their status 14 days after the initial CT scan in either discharged/hospitalized in a non-ICU ward (favorable prognosis group) versus deceased/admitted to an intensive care unit (unfavorable prognosis group). RESULTS: Ground-glass opacities (89.0 %) and consolidations (73.2 %) with multilobar involvement were the predominant imaging findings, while a nodular pattern (3.7 %) and cavitation (1.2 %) were uncommon. Mean age was higher in the mortality/ICU group. Ground-glass opacities and consolidations were dominant in both groups, but distribution pattern of abnormalities was different, being more often diffuse in the mortality/ICU group. Linear opacities and opacities that were rounded in shape were more frequently observed in the favorable prognosis group. CT severity index was significantly higher in the mortality/ICU group. For assessing unfavorable prognosis, the best cut-off for CT severity index was 24 (sensitivity 78 %; specificity 59 %). Interobserver agreement for all CT findings was excellent. CONCLUSION: COVID-19 pneumonia in Porto, Portugal, manifests as multilobar ground-glass opacities and consolidations. Older age, diffuse distribution and increasing CT severity index are associated with worse short-term prognosis while linear opacities resembling organizing pneumonia and rounded opacities herald a more favorable prognosis.

Rheology and soft tribology of thickened dispersions aiming the development of oropharyngeal dysphagia-oriented products.

Dysphagia is a swallowing disorder that mainly affects elderly but can be minimized by thickening of liquid foods. Flaxseed gum (FG) was studied as a potential alternative thickener for dysphagia patients in comparison to commercial thickeners based on xanthan gum (XG) and modified starch (MS). Rheological and tribological responses of biopolymer-based thickening solutions (0.75-3% w/w) incorporated in different food matrices (water, orange-flavoured soy juice and skim milk) were recorded and correlated. In general, the increase in gums concentration led to increases in viscosity, viscoelastic properties and lubricating capacity. An opposite behavior was observed for the MS-based products, since an increase in concentration led to a lower increase in viscosity and viscoelastic properties but caused a decrease in the lubricating capacity. These results indicated that associating tribology to rheology is crucial to further define formulations with pleasant swallowing characteristics.

Starch-based nanocomposites with cellulose nanofibers obtained from chemical and mechanical treatments.

Cellulose nanofibers (CNFs) were isolated from unripe banana peel by acid hydrolysis, with different acid concentrations (0.1%, 1.0% and 10% v/v), followed by mechanical treatment with high-pressure homogenizer. Banana starch-based films added with CNFs (0.2% w/w) as a reinforcing agent were produced by the casting method. The rheological behavior of aqueous dispersions of CNFs (1.0% w/w) and their effects on the properties of nanocomposite films were investigated. All aqueous dispersions of CNFs showed gel-like behavior and, when incorporated to the films, CNFs improved their water barrier properties and mechanical resistance as demonstrated by the increase in tensile strength and Young's modulus. Moreover, CNFs were well dispersed in the composite matrix. CNFs prepared at higher concentration, followed by mechanical treatment (FNM1 and FNM10), formed films with low moisture (13.66%) and solubility in water (24.1%). Whereas, CNFs prepared at the lowest acid concentration without mechanical treatment (FN0.1) led to films with high elongation at break (30.6%) and good tensile strength (12.3 MPa). Regardless of the used CNFs, all the nanocomposites displayed lower UV/light transmission than control film. The nanocomposite has potential use in food packaging, since the use of CNFs can promote improvements on barrier, optical and mechanical properties. Cellulose nanofibers isolated from agro-industrial residues offer the potential to reinforce composites of biodegradable polymers, producing a value-added material.

Expressão e caracterização da glicoproteína D do herpesvírus equídeo 1 em Pichia pastoris / Expression and characterization of equid herpesvirus 1 glycoprotein D in Pichia pastoris

O herpesvírus equídeo 1 (EHV-1) apresenta distribuição mundial e causa graves prejuízos à equideocultura. É agente de surtos de doença respiratória, reprodutiva e neurológica, em equídeos jovens e adultos. A glicoproteína D (gD) do envelope viral é essencial para ligação e penetração em células permissivas e direcionamento do sistema imunológico do hospedeiro, induz respostas imunes humorais e celulares, sendo um antígeno apropriado para ser utilizado em vacinas e imunodiagnóstico. O objetivo deste trabalho foi expressar e caracterizar a gD do EHV-1 em Pichia pastoris para posterior utilização como antígeno em técnicas de imunodiagnóstico e formulação de vacinas recombinantes. Uma sequência de DNA que codifica uma forma truncada da gDEHV-1 foi clonada no vetor pPICZαA de expressão em P. pastoris. Obteve-se uma proteína de ~41 kDa, como esperado. A proteína apresentou glicosilação entre 4 kDa e 16 kDa, demonstrada por deglicosilação enzimática. A proteína recombinante foi caracterizada antigenicamente e imunogenicamente por Western blot, utilizando-se anticorpos policlonais equinos anti-EHV-1, e por ELISA indireto em modelo murino, demonstrando que a gD recombinante manteve epítopos similares aos da proteína nativa. Esses resultados sugerem que a gDEHV-1 é um antígeno promissor para uso como imunobiológico no controle do EHV-1.(AU)

Equine herpesvirus 1 (EHV-1) has a worldwide distribution and causes serious damage to horse breeding. It is an agent of respiratory, reproductive and neurological disease outbreaks in young and adult equids. Viral envelope glycoprotein D (gD) is essential for binding and penetration into permissive cells and targeting the host immune system, inducing humoral and cellular immune responses, and is an appropriate antigen for use in vaccines and immunodiagnostics. The objective of this work was to express in Pichia pastoris and to characterize EHV-1 gD for later use as an antigen in immunodiagnostic techniques and formulation of recombinant vaccines. A DNA sequence encoding a truncated form of gDEHV-1 has been cloned into the P. pastoris expression vector pPICZαA. A protein of ~41 kDa was obtained as expected. The protein presented glycosylation between 4 kDa and 16 kDa, demonstrated by enzymatic deglycosylation. The recombinant protein was antigenically and immunogenically characterized by Western blot using equine polyclonal anti-EHV-1 antibodies, and by indirect ELISA in a murine model, demonstrating that the recombinant gD maintained epitopes similar to those of the native protein. These results suggest that gDEHV-1 is a promising antigen for use as an immunobiological in the control of EHV-1.(AU)

Use of synthetic oligonucleotides for determination of HTLV-1 proviral load by real-time PCR: a helpful alternative approach in the clinical management.

AIMS: To evaluate the potential use of synthetic oligonucleotides as a standard curve for proviral load (PVL) of human T-cell leukaemia virus type 1 (HTLV-1) quantification in peripheral blood mononuclear cells (PBMC) of HTLV-1-infected individuals by quantitative real-time polymerase chain reaction (qPCR) analysis. METHODS AND RESULTS: Synthetic oligonucleotides based on HTLV-1 genome were customized to use as a standard curve. Twelve anti-HTLV-1-positive samples with known HTLV-1 PVL, previously quantified by qPCR assay using TARL-2 cells as a conventional standard curve, were submitted to the new protocol. The proviral quantification levels had a high concordance with qPCR results using a conventional standard curve. The results demonstrate that the conventional standard curve can be replaced by a synthetic standard curve due to its ability to quantification based on the linearity and qPCR efficiency and similar results with a validated qPCR assay using a conventional standard curve. CONCLUSIONS: Synthetic oligonucleotides standard curves could be a very useful tool on HTLV-1 diagnosis and absolute HTLV-1 PVL quantification. SIGNIFICANCE AND IMPACT OF THE STUDY: HTLV-1 PVL determination using synthetic oligonucleotides standard curve by qPCR could be a helpful alternative for the laboratories that monitor infected patients as an important prognostic factor in HTLV-1-associated diseases progression. Also, it can decrease costs and overcome the biological limitations of the plasmid curve.

Hypersensitivity pneumonitis: Main features characterization in a Portuguese cohort.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) which varies in prevalence across the world, depending on disease definition, diagnostic methods, exposure type and intensity, geographical environments, agricultural and industrial practices, and host risk factors. This study aimed to deepen knowledge about HP's clinical characteristics, diagnosis and functional and imaging features in a cohort of HP patients from the North of Portugal. To achieve this goal, a retrospective assessment of the clinical and diagnostic data was carried out, and patients were classified and compared according to disease presentation (acute, sub-acute and chronic HP forms). Of the 209 HP patients included (mean age 58.3 ±â€¯16.0 years), 52.6% were female and 73.7% presented a chronic form. Most patients had prior exposure to birds (76.6%). Dyspnoea and cough were the most frequently experienced symptoms, but no statistically significant differences were found between groups (p = 0.089, p = 0.418, respectively). Fever was most common in acute HP form (p < 0.001). The most common patterns found in Chest CT were ground glass (p = 0.002) in acute/subacute presentation, and reticulation (p < 0.001) in chronic form, while mosaic attenuation, although was also frequently observed, no statistically significant differences were found between groups (p = 0.512). The most common functional pattern was restrictive (38% of patients, 73.7% with chronic HP form). Bronchoalveolar lavage lymphocytes were higher in acute and subacute forms although not reaching statistical significance (p = 0.072), with lowest CD4/CD8 ratio (p = 0.001) in acute forms. Thus, given the significant disease heterogeneity, further studies with different populations and ambient exposures are needed to achieve a better stratification of the exposure risk, to provide proper implementation of avoidance methods and a precise diagnostic and therapeutic approach.

Effect of extraction temperature on rheological behavior and antioxidant capacity of flaxseed gum.

Soluble flaxseed gum (SFG) extracted at different temperatures (25, 40, and 60 °C) was analyzed in relation to the yield, polysaccharides and phenolics composition, surface charge, color, and rheological properties. The yield of SFG extract increased as the extraction temperature increased. The SFG xylan was the main component regardless the extraction temperature, but a reduction of substituents on the xylose chain was observed when increasing the extraction temperature. The phenolic compounds were also affected by the extraction temperature, influencing the antioxidant capacity of the gum. For all the extraction temperatures, SFG aqueous solutions showed a shear time-independent and shear-thinning behavior. Furthermore, oscillatory measurements showed a prevailing viscous character, but the decrease of the extraction temperature resulted in an increase of both G' and G". Therefore, SFG extracted at low extraction temperatures showed higher viscous and elastic properties, while high extraction temperatures increased the antioxidant activity.

Heterozygous TERT gene mutation associated with familial idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown cause that occurs sporadically, but it can also occur in families and so named as Familial Pulmonary Fibrosis (FPF). Some forms of FPF overlaps IPF features, namely the radiological and histological pattern of usual interstitial pneumonia (UIP). Genetic and environmental factors commonly play an important role in the pathogenesis of FPF and the most commonly identified mutations involve the telomerase complex. Here, we report a rare case of FPF in a male at the age of 44, in whom genetic testing showed heterozygous variants for the telomerase reverse transcriptase gene (TERT). Our report highlights the importance of compiling a thorough family history in younger patients identified with UIP serving as a resource for identifying the current and future genetic links to disease. Families with UIP hold a great promise in defining UIP pathogenesis, potentially suggesting targets for the development of future therapies.

Banana starch nanocomposite with cellulose nanofibers isolated from banana peel by enzymatic treatment: In vitro cytotoxicity assessment.

The potential use of cellulose nanofibers (CNFs) as a reinforcing agent in banana starch-based nanocomposite films was investigated. CNFs were isolated from banana peel (Musa paradisiaca) by enzymatic hydrolysis. Banana starch-based nanocomposite films were prepared with CNFs using the casting method. CNFs effect on cell viability and on nanocomposite films properties' was investigated. The cytotoxicity of CNFs was assessed on Caco-2 cell line. CNFs were not cytotoxic at 50-2000 µg/mL. However, CNFs above 2000 µg/mL significantly decreased cell viability. Topography analysis showed that the incorporation of CNFs modified the film structure. The nanocomposites exhibited a complex structure due to strong interactions between CNFs and starch matrix, promoting a remarkable improvement on mechanical and water barrier properties, opacity and UV light barrier compared to the control film. CNFs can offer a great potential as reinforcing material for starch-based nanocomposite films, producing a value-added food packaging from a waste material.

Detection of East/Central/South African genotype Chikungunya virus during an outbreak in a southeastern state of Brazil.

Chikungunya virus (CHIKV) is an arbovirus transmitted by Aedes mosquitoes that was first identified in Brazil in 2014. It causes a febrile illness characterised by severe arthralgia and rash. Our group investigated a suspected CHIKV outbreak in Governador Valadares, state of Minas Gerais, Brazil and from 25 acute-phase patients, 10 had qRT-PCR positive sera samples and had E1 partial sequence amplified and Sanger sequenced. Samples were identified as East/Central/South African (ECSA) genotype by phylogenetic analysis and clustered with CHIKV sequences isolated in the neighbour state of Bahia. Our findings confirm previous predictions that ECSA genotype would spread through northeast and southeast of Brazil.

"Cell ELISA" como ferramenta auxiliar no controle da adenite equina / "Cell ELISA" as an auxiliary tool for the control of equine adenitis

Este trabalho relata o desenvolvimento e a avaliação de um ensaio imunoenzimático (ELISA) como ferramenta auxiliar no controle da adenite equina. Foi avaliada a presença de anticorpos anti-Streptococcus equi subsp. equi em equinos com doença clínica de garrotilho, portadores assintomáticos e potros vacinados. Equinos doentes demonstraram absorbâncias médias superiores (P<0,05) às médias observadas nas demais categorias examinadas. Equinos portadores assintomáticos apresentaram valores médios de absorbância superiores (P<0,05) aos animais com cultura negativa. Logo após a vacinação, potros apresentaram elevação nos níveis de anticorpos, seguida de um decréscimo nos níveis 90 dias após a segunda vacinação. O "Cell ELISA" foi eficiente para a detecção de anticorpos em equinos expostos a antígenos de S. equi, diferenciando-se de infecções por S. zooepidemicus. O "Cell ELISA" mostrou-se uma alternativa clínica para o diagnóstico indireto da adenite equina, diferenciando-se, entre equinos assintomáticos, os potenciais portadores da infecção. Os resultados observados em potros vacinados confirmam o potencial de utilização desse teste como ferramenta em programas de vacinação contra garrotilho pelo monitoramento de rebanhos pós-vacinação. Esses resultados sugerem que o "Cell ELISA" é uma promissora ferramenta auxiliar no controle da adenite equina.(AU)

This study reports the development and evaluation of the use of "Cell ELISA" as a tool for clinical interpretation for the control of strangles. The presence of anti-S. equi antibodies was evaluated in horses with strangles, in asymptomatic carriers and in vaccinated foals. Equine positive for strangle showed higher average of absorbance (P<0.05) when compared with the average for the other categories of horses studied. Asymptomatic S. equi equine carriers had higher average of absorbance (P<0.05) than equines with negative culture. After vaccination, foals presented an increase in antibody levels, followed by a decrease in antibody levels 90 days post the second vaccination. The "Cell ELISA" was efficient for the detection of antibodies in horses exposed to S. equi antigens, differentiating infections with S. zooepidemicus. Thus, the test might be a clinical tool for indirect diagnosis of the strangles, differentiating, between the asymptomatic horses, the potential carriers of infection. The results observed in vaccinated foals confirm the potential use of this test as an auxiliary instrument for strangles vaccination programs based in the serological monitoring of the herd after immunization. These results suggest that the "Cell ELISA" is a promising auxiliary tool in the control of equine adenitis.(AU)

Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients.

Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).