BackgroundThe major reasons to treat sarcoidosis are to lower the morbidity and mortality risk or to improve quality of life (QoL). The indication for treatment varies depending on which manifestation is the cause of symptoms: lungs, heart, brain, skin, or other manifestations. While glucocorticoids (GC) remain the first choice for initial treatment of symptomatic disease, prolonged use is associated with significant toxicity. GC-sparing alternatives are available. The presented treatment guideline aims to provide guidance to physicians treating the very heterogenous sarcoidosis manifestations.Materials and MethodsA European Respiratory Society Task Force (TF) committee composed of clinicians, methodologists, and patients with experience in sarcoidosis developed recommendations based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology. The committee developed eight PICO (Patients, Intervention, Comparison, Outcomes) questions and these were used to make specific evidence-based recommendations.ResultsThe TF committee delivered twelve recommendations for seven PICOs. These included treatment of pulmonary, cutaneous, cardiac, and neurologic disease as well as fatigue. One PICO question regarding small fiber neuropathy had insufficient evidence to support a recommendation. In addition to the recommendations, the committee provided information on how they use alternative treatments, when there was insufficient evidence to support a recommendation.ConclusionsThere are many treatments available to treat sarcoidosis. Given the diverse nature of the disease, treatment decisions require an assessment of organ involvement, risk for significant morbidity, and impact on QoL of the disease and treatment.MessageAn evidence based guideline for treatment of sarcoidosis is presented. The panel used the GRADE approach and specific recommendations are made. A major factor in treating patients is the risk of loss of organ function or impairment of quality of life.
Sarcoidosis-associated pulmonary hypertension (SAPH) is an important complication of advanced sarcoidosis. Over the past few years, there have been several studies dealing with screening, diagnosis and treatment of SAPH. This includes the results of two large SAPH-specific registries. A task force was established by the World Association of Sarcoidosis and Other Granulomatous disease (WASOG) to summarise the current level of knowledge in the area and provide guidance for the management of patients. A group of sarcoidosis and pulmonary hypertension experts participated in this task force. The committee developed a consensus regarding initial screening including who should undergo more specific testing with echocardiogram. Based on the results, the committee agreed upon who should undergo right-heart catheterisation and how to interpret the results. The committee felt there was no specific phenotype of a SAPH patient in whom pulmonary hypertension-specific therapy could be definitively recommended. They recommended that treatment decisions be made jointly with a sarcoidosis and pulmonary hypertension expert. The committee recognised that there were significant defects in the current knowledge regarding SAPH, but felt the statement would be useful in directing future studies.
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Com o avanço da quantidade de habitantes no espaço urbano surgem novas formas de modificações no ambiente, e, assim, há o favorecimento da intensificação do processo de antropização, como a supressão da cobertura vegetal, a descaracterização do relevo e danos aos cursos d’água. Frente a isso, o objetivo deste estudo é analisar e quantificar, em escala multitemporal, a dinâmica de uso, ocupação e cobertura da terra da cidade de Caxias/MA com foco na zona Leste por meio de ferramentas obtidas junto ao Sensoriamento Remoto. A metodologia utilizada foi pesquisa bibliográfica, documental e cartográfica. Os mapas temáticos foram confeccionados através da interpretação de imagens obtidas dos satélites Landsat 5 TM (Thematic Mapper) para o ano de 2000 e o Landsat 8 OLI (Operational Land Imager) para 2017, por meio do plugin SCP (Semi-Automatic Classification) do software QGIS 2.18.8. Com os resultados obtidos, constatou-se que, a vegetação secundária continuou representando a maior área, apesar da área urbana ter crescido (de 33% a 35%). Isso é caraterizado devido à grande área verde no bairro Pai Geraldo e no bairro Baixinha onde está localizada uma fazenda. Diante dos dados e com as etapas de sensoriamento remoto, de campo e de laboratório, este estudo representou uma análise de uso, ocupação e cobertura da terra ocorrida, onde, a partir dela constatou-se as mais diversas atividades desenvolvidas na área, relacionando, ainda, com distintos riscos e impactos socioambientais. Assim, reforça-se a necessidade de novos estudos e a contribuição do sensoriamento remoto para o alcance dos objetivos. Analyze multi-temporal the dynamics of use, land occupation and coverage the on east Zone of the city of Caxias/MA/Maranhão/Brazil A B S T R A C TWith the advancement of the amount of people in the urban area there are new forms of changes in environment, and thus there favoring intensifying anthropization process as suppression of vegetation, the relief adulteration and damage to water courses. Faced with this, the general objective of this study was to analyze in multi-temporal scale, the dynamics of use, land occupation and coverage of the city of Caxias/MA with a focus on east Zone East through tools obtained from the Remote Sensing. The methodology used was literature, documentary and cartographic. Thematic maps were made by interpreting images obtained from the Landsat 5 TM (Thematic Mapper) satellites for the year 2000 and the Landsat 8 OLI (Operational Land Imager) for 2017, using the SCP (Semi-Automatic Classification) plugin of the QGIS software 2.18.8. Through the results obtained, it was found that in the zona Leste secondary vegetation continued to represent the largest area, despite the urban area having grown (from 33% to 35%). It is characterized because of the large green area in the Pai Geraldo district and Baixinha where it is located a farm. In the face and the remote sensing steps, field and laboratory, this study represents an analysis of use, occupation and land cover occurred in two areas of the city of Caxias/MA where, from there it was found the most diverse activities in the area, also with different risks and environmental impacts. Thus, it reinforces the need for further studies and remote sensing to the achievement of goals.Keywords: land cover; remote sensing; East zone; Caxias/MA.
A sociedade atual vive exposta a uma infinidade de problemas ambientais de modo que estes veiculam características que geram danos à população e ao ambiente direta e indiretamente envolvidos. Diante disso, estudos sobre a vulnerabilidade ambiental tornam-se importantes instrumentos de estudo do espaço geográfico em questão, além de contribuir para o planejamento por meio de uma análise integrada entre aspectos sociais e ambientais. Nesse sentido, o objetivo deste estudo foi analisar a vulnerabilidade ambiental dos setores censitários às margens do rio Poti no município de Teresina/Piauí. Como recursos metodológicos podem ser citados: levantamento e análise teórico-conceitual, documental e cartográfica, incursões a área de estudo, utilização do Método Expedito, de Check-list, atividades laboratoriais, uso de softwares com QGis e Google Earth Pro, destaca-se ainda o tratamento estatístico (por meio da Análise Multivariada e Fatorial, além da Técnica de Cluster) dos dados relacionados aos 72 setores censitários e às 12 variáveis ambientais. Os resultados indicaram: 21 setores censitários caracterizados como de vulnerabilidade ambiental Baixa, seguido de 27 e 24 setores censitários com vulnerabilidade ambiental Média e Alta, respectivamente. Os valores obtidos e o enquadramento dos setores por classes deve-se principalmente às notas atribuídas às seguintes variáveis: cobertura vegetal, proximidade com corpos hídricos, adensamento populacional, e esgoto e lixo a céu aberto. Palavras-chave: vulnerabilidade ambiental; setores censitários; rio Poti; Teresina/Piauí.
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