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Pulmonary SarcoidosisCoronavirus (COVID-19): Silence Silence Silence Angiotensin Convert Enzyme (Blood)Do you have other names?Sound angiotensin converting enzyme, SACE What is this test? This test measures how much the angiotensin (ACE) conversion enzyme is in your blood. Your ACE levels can be higher if you have a condition called sarcoidosis. In sarcoidosis, small abnormal knots of immune cells called granulomas forms in several parts of the body. The most common place is in the lungs. These cells can cause health problems. Granulomas can also form in other conditions, so you may need other tests to find out the exact cause. It's normal to have some ACE in your body. Certain medicines called ACE inhibitors act on ACE to control blood pressure. Why do I need this test? You may need this test if you have symptoms of sarcoidosis. Symptoms may include:Cough, wheezing or shortness of breath FeverExtreme tired chest painWeight loss without explanation and loss of appetite Rigid or rigid joints Vision problems DrymouthHeadacheUnusual skin changes, including sores, rashes or hardened spots What other tests might have along with this test? Your health care provider may also order these tests: Image tests of such CT scan to see if you have granulomas in your organs chest X-raysSputum seizure, or sample fluid from your lungs Biopsy of tissue samples What do my test results mean? Many things can affect the results of the lab test. These include the method that each laboratory uses to test. Even if your test results are different from normal value, you I may not have a problem. To know what the results mean for you, talk to your health care supplier. The results are given in nanomoles per milliliter per minute (nmol/mL/min). Normality range for ACE is less than 40 nmol/mL/min. The highest levels of ACE can mean that you They have sarcoidosis. But it can have normal ACE levels and still have sarcoidosis. Other conditions that may cause higher levels of ACE include: Primary Blear Cyrrhosis Alcoholic Hepatic DiseaseHyperparathyroidismhyperthyroidismDiabetes Multiple Myeloma Pulmonary DiseaseAmyloidosis Gaucher Leprosy Disease How is this test done? The test requires a sample of blood, which is drawn through a needle of a vein in your arm. Does this test pose risks? Taking a blood sample with a needle carries risks that include bleeding, infection, bruises, or feel dizzy. When the needle tightens your arm, you can feel a light sting sensation or pain. Then the site may be slightly pained. What could affect my test results? Being exposed to tuberculosis, using IV intravenous drugs and working in a place with aerial or chemical particles such as beryllium can affect their results. Certain medicines can also affect your results. How can I prepare for this test? You don't need to get ready for this test. But make sure your healthcare provider knows about it about all the medications, herbs, vitamins and supplements you are taking. This includes medicines that do not need a prescription and any illicit drugs you can use. Medical journals: Medical journals: ©2021 University of Rochester Medical Center Rochester, NYViewing: K2

Warning: The NCBI website requires JavaScript to operate. Level of Serum ACE in Sarcoidosis Patients with Typical and Atypic Demonstration of the RRHHC Shahram Kahkouee1 University of Tehran, University of Tehran, University of Tehran, University of Tehran, Medical Diseases of Shahid, Tehran, Tehran, IranKatayoon Samadi2 Department of Radiology, National Institute of Tuberculos Research HRCT can distinguish between active inflammatory changes and irreversible fibrosis. In this study, we analyze different levels of ACE in 148 patients diagnosed with sarcoidosis. Material/methods we categorize these patients based on their results in four groups: 1) patients diagnosed with chronic disease; 2) patients diagnosed with non-chronic disease; 3) patients who exhibited typical HCT changes; and 4) patients who presented atypical changes in HCT. Then the average level of ECA of each group was calculated and compared. Results The HHHC RH scanners of chronic sarcoidosis patients tended to show more atypical sarcoidosis patterns. In addition, there was an inverse correlation between the chronicle and the ACE level (P-value ConclusionsHRCT is another modality that would be useful when the diagnosis of sarcoidosis is not defined. BackgroundLaarcoidosis is an inflammatory disease that affects several organs, has undetermined origins, and is associated with non-curricular granuloma-epithelioid cells and lymphocytic alveolitis [,]. Areas affected by this disease in 90% of patients with sarcoidosis are the hilar and mediastin lymph nodes and pulmonary parenchyma []. Although lung and constitutional symptoms are common in these patients, 50% of them are asymptomatic and are diagnosed unexpectedly after anomalies are discovered in chest X-rays [,]. Before the widespread use of computed tomography (CT), the severity of sarcoidosis, based on chest x-ray anomalies, was categorized according to the Kveim-Siltzbach method []. High-resolution computed tomography (HRCT), is very effective for detecting minor lung parenchyma abnormalities in the early stages of sarcoidosis [,]. In addition, HHHHCT can distinguish between active inflammatory changes and irreversible fibrosis. For example, findings such as parenchymal nodules, opacity of low glass and alveolar opacity are indicative of granulomatous inflammation, which is usually reversible after therapy []. On the other hand, abnormalities such as panal changes, the formation of bulls and thick septal bronchymiactasis bands are indicative of irreversible fibrosis [,] (–). Round glass appearance in atypical sarcoidosis. Bronchitis bands in chronic sarcoidosis. Typical sarcoidosis. A reliable way to diagnose sarcoidosis is by measuring serum markers. Angiotensin (ACE) conversion enzyme, produced by epithelioid cells derived from activated macrophages, is a known marker for sarcoidosis. The ACE level is correlated with the amount of whole body granuloma (not those found in the lungs only) [] and the severity of the disease [,]. The ACE level rises in other granulomatous diseases, such as leprosy [] and histoplasmosis [], and in non- granulomatous diseases, such as hyperthyroidism [,] and lymphoma []. A difficulty that arises in the diagnosis of sarcoidosis according to the pathological analysis of the specimen is the similarity in the pathological appearance between it and other granulomatous diseases, which also have a high level of ACE. As such, finding a relationship between the radiological pattern of the disease and the ACE level is of great value as a method of diagnosis when the ACE level and pathological analysis are not conclusive. In this study, we analyze different levels of CCA in 148 patients diagnosed with sarcoidosis. We categorize these patients based on their RRHC results in four groups: 1) patients diagnosed with chronic disease; 2) patients diagnosed with non-chronic disease; 3) patients who exhibited typical CHHHD changes; and 4) patients who presented atypical changes in HCH. Material and methods In this study we examine the hospital or clinical documents of 148 patients diagnosed with sarcoidosis, according to the European Society of Respiration/American Thoracic Society/World Association of Sarcoidosis and other patterns of granulomatous diseases []. These patients were referred to the Masih Daneshvari Hospital in Tehran, Iran, between 2011 and 2014. They were either patients in the pulmonary pavilion or patients referring to outpatient clinics for follow-up. Written and informed consent statements were obtained from all patients. All patients had sarcoidosis with pulmonary involvement. Patients were excluded from the study if they smoked or had a chronic concurrent lung disease, such as hyperreactive pneumonia or interstitial lung disease, or other systematic disease that leads to an increase in levels of ACE (such as chronic obstructive pulmonary disease, lung cancer or nephrotic syndrome). Patient information was recorded, including age, sex and last level of ACE. Two experts examined RRHC scans of patients with consensus. Abnormalities, such as the changes in the panal, the formation of bulls and the fibrotic band of tractional bronchitis, are generally suggestive of the chronic disease, so patients whose scans showed such anomalies were categorized in the chronic group, while patients whose scans showed reversible changes such as parenchimal nodules, or subterranean glass opacities. In contrast, symmetrical prehilling, medium-sstinal lymphadenopathy and perilite micronodules are representative of the typical changes of sarcoidosis (), and macronodules, pulmonary mass, miliary opacities and linear opacities are considered as atypical manifestation (). Subsequently, the average ACE level of each group was calculated and compared. Statistical AnalysisThe statistical analysis was performed using SPSS software (version 18). A descriptive analysis was performed to show quantitative variables as mean (standard deviation) and categorical variables as frequency (%). The cathereal data were compared using the chi-square equation. Statistical importance was considered to be less than 0.05. ResultsThis study included a hundred and forty-eight sarcoidosis patients. The average age of patients was 46 years (standard deviation, 16) with a range of 17-75. There were 86 (58%) women and 62 (42%) men. The average ACE level of patients was 68 U/L (standard deviation, 15) with a range of 3-259. As shown in, patients were categorized based on chronic, typical/atypical changes, and ACE level. The ACE level was divided into two groups, with 50 U/L as a cutting point [].Table 1 categorization of patients based on the ACE level and HRCT presentation. No. (%)ACE ±5086 (58.1) Among 127 patients with non-chronic disease, 82 (65%) had typical TCRH sarcoidosis manifestations, while among 21 patients with chronic disease, only seven (33%) had typical TCHH presentations. This relationship between the TCHH manifestation and the chronic disease was statistically significant (P=0.007). The correlation between the ACE level and the chronicle and the form of HRCT manifestation is shown in .Table level 2ACE correlation with the chronic disease and typical HRCT prono. ACE level convenient title50Discussion In this study, we evaluate the ACE levels and HRCT scanners of 148 patients of sarcoidosis. According to our results, there is a relationship between the chronicle of RRHC disease and patterns. RHHHC scanners of chronic sarcoidosis patients tended to show more atypical sarcoidosis patterns. In addition, there was an inverse correlation between the chronicle and the ACE level. In addition, there was no statistically significant difference between the typical and atypical presentation of RRHC based on a patient's ACE level. ACE is a serum marker that is increased in sarcoidosis. ACE is produced by epithelioid cells that are derived from newly activated macrophages in granulomas; therefore, ACE is an appropriate representative of whole body granuloma [].KI-6 and sIL-2R are two other serum markers that increase mainly in patients with radiographic upper stage sarcoidosis. In addition, these markers are particularly indicative of the progression of the disease and changes of lymphatic alveolitis [,,,].The researchers have shown that there is no correlation between the ACE level and the prognosis of sarcoidosis [] and this marker shows a general amount of granuloma in its entirety rather than pulmonary involvement []. Other studies that analyzed the increase in the level of ACE in other granulomatous and non- granulomatous diseases reported the sensitivity and specificity of this marker in the diagnosis of sarcoidosis between 40% and 100%, and 83% and 99% respectively [,] On the other hand, no difference has been reported in the levels of ACE between sexes and between different ages [,]. Many studies have shown that patients with higher levels of ACE suffer from more severe sarcoidosis [,,,]. Silverstein et al. [] showed that there was an inverse relationship between the chronicity of sarcoidosis and the ACE level, which is what we also found. Studies have shown [,] that prednisolone therapy leads to a reduction in the levels of ACE; therefore, it is recommended that patients stop taking prednisolone 2-4 weeks before the measurement of the ACE level. Since our study was performed retrospectively, a limitation was that the last level of ACE of some patients was measured during prednisolone therapy. Conclusions In this study, we show that the chronicle of sarcoidosis according to the presentations of the patients of CHC is inversely related to their CER levels. This is considered another diagnostic path in patients whose levels of ACE and pathological analysis are inconclusive. Recognition We thank John H. McCool, MA, Houston, Texas, USA, for providing editorial assistance in writing this article. ReferencesFormats: Share , 8600 Rockville Pike, Bethesda MD, 20894 USA

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