RESUMO
IgA Nephropathy (IgAN) is the commonest primary glomerular disease around the world and represents a significant cause of end-stage renal disease. IgAN is characterized by mesangial deposition of IgA-immune complexes and mesangial expansion. The pathophysiological process includes an abnormally glycosylated IgA1, which is an antigenic target. Autoantibodies specifically recognize galactose-deficient IgA1 forming immune complexes that are amplified in size by the soluble IgA Fc receptor CD89 leading to deposition in the mesangium through interaction with non-classical IgA receptors. The local production of cytokines promotes local inflammation and complement system activation, besides the stimulation of mesangial proliferation. The spectrum of clinical manifestations is quite variable from asymptomatic microscopic hematuria to rapidly progressive glomerulonephritis. Despite all the advances, the pathophysiology of the disease is still not fully elucidated. The mucosal immune system is quoted to be a factor in triggering IgAN and a "gut-kidney axis" is proposed in its development. Furthermore, many recent studies have demonstrated that food intake interferes directly with disease prognosis. In this review, we will discuss how mucosal immunity, microbiota, and nutritional status could be interfering directly with the activation of intrinsic pathways of the mesangial cells, directly resulting in changes in their function, inflammation and development of IgAN.
RESUMO
A contaminação por agrotóxicos gera discussão pelos impactos no meio ambiente e saúde. Os períodos natal e neonatal constituem janelas com susceptibilidade às consequências dos agrotóxicos. O estudo possui um desenho ecológico descritivo com o objetivo de verificar a existência de associação entre o consumo per capta dos agrotóxicos e eventos da gravidez e nascimento, através da quantidade consumida em 1997 e 2001 nos estados brasileiros. Os dados são do Instituto Brasileiro de Geografia e Estatística e do Sistema de Informações sobre Nascidos Vivos. O estudo não recebeu financiamento, utilizou bases de dados populacionais públicas sem análises individuais. Nos cálculos foi utilizado o consumo per capta de agrotóxicos classificados em três grupos com os tercis de distribuição em ordem crescente. O banco de dados do Departamento de Informática do SUS foi utilizado na análise das variáveis de desfecho de gravidez. Os resultados evidenciam associação entre praguicida e prematuridade, bem como uma relação com baixo o peso ao nascer, porém, que pode ser também um efeito confundidor.
Contamination with pesticides has generated discussion about their impacts on the environment and health. Natal and neonatal periods represent windows of susceptibility to the effects of pesticides. In this study we used a descriptive ecological design with the aim of verifying a possible association between the per capita consumption of pesticides and events of pregnancy and birth, using the amount of pesticides consumed in 1997 and 2001 in Brazilian states. The data was obtained from the Brazilian Institute of Geography and Statistics and the Live Birth Information System. The study received no funding, and thus employed public databases of populations without individual analysis. For the calculations we used the per capita consumption of pesticides classified into three groups with the distribution of the tertiles in ascending order. The database of the Information Department at the SUS (Unified Health System) was used to analyze the pregnancy outcome variables. The results show an association between pesticide consumption and premature births, and pesticide consumption and low birth weight, although the latter could also be a confounding effect.
RESUMO
INTRODUCTION: Data is scarce regarding adverse events (AE) of biological therapy used in the management of Crohn's Disease (CD) among Brazilian patients. OBJECTIVES: To analyse AE prevalence and profile in patients with CD treated with Infliximab (IFX) or Adalimumab (ADA) and to verify whether there are differences between the two drugs. METHOD: Retrospective observational single-centre study of CD patients on biological therapy. Variables analysed: Demographic data, Montreal classification, biological agent administered, treatment duration, presence and type of AE and the need for treatment interruption. RESULTS: Forty-nine patients were analysed, 25 treated with ADA and 24 with IFX. The groups were homogeneous in relation to the variables studied. The average follow-up period for the group treated with ADA was 19.3 months and 21.8 months for the IFX group (p = 0.585). Overall, 40% (n = 10) of patients taking ADA had AE compared with 50% (n = 12) of IFX users (p = 0.571). There was a tendency towards higher incidence of cutaneous and infusion reactions in the IFX group and higher incidence of infections in the ADA treated group, although without significant difference. CONCLUSIONS: No difference was found in the AE prevalence and profile between ADA and IFX CD patients in the population studied. (AU)
INTRODUÇÃO: Há poucos dados sobre os eventos adversos (EA) da terapia biológica usada no tratamento da doença de Crohn (DC) entre os pacientes brasileiros. OBJETIVOS: Analisar a prevalência dos EA e o perfil dos pacientes com DC tratados com Infliximabe (IFX) ou Adalimumabe (ADA) e verificar se há diferenças entre esses dois fármacos. MÉTODO: Estudo observacional e retrospectivo de pacientes com DC em terapia biológica, realizado em centro único. As variáveis analisadas foram: dados demográficos, classificação de Montreal, agente biológico administrado, duração do tratamento, presença e tipo de EA e necessidade de interrupção do tratamento. RESULTADOS: Quarenta e nove pacientes foram analisados, 25 tratados com ADA e 24 com IFX. Os grupos eram homogêneos em relação às variáveis estudadas. O período médio de acompanhamento foi de 19,3 meses para o grupo tratado com ADA e de 21,8 meses para o grupo tratado com IFX (p = 0,585). No total, 40% dos pacientes (n = 10) que receberam ADA tiveram AE, em comparação com 50% dos pacientes (n = 12) que receberam IFX (p = 0,571). Houve uma maior incidência de reação cutânea e à infusão no grupo IFX e de infecções no grupo ADA, embora sem diferença significativa. CONCLUSÃO: Não houve diferença na prevalência de EA e no perfil dos pacientes com DC que receberam ADA e IFX. (AU)