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The interaction between lifestyle--defined more specifically in health care as the personal exposome--and its implications on obesity and breast cancer development highlights the critical role of body composition and inflammation in these patients. There is clear evidence that the personal and internal exposome triggers biochemical, inflammatory, and metabolic reprogramming, which might favor ectopic lipid accumulation within the body, such as muscles. Additionally, the presence of excessive adipose tissue exacerbates these alterations in the internal exposome, resulting in cell damage and modifying body composition. Understanding the nexus between these lifestyle-induced exposome modifications, such as inflammation, and the resultant changes in body composition is crucial to assess the association with breast cancer progression and treatment responses. Various techniques can be used to evaluate body composition; one of those most used currently is bioelectrical impedance analysis. This analysis provides parameters, including phase angle (PhA), by which cellular health and metabolic activity can be assessed. In addition, PhA is a potential indicator of nutritional status and disease prognosis, as it has been linked to survival and quality of life in patients with cancer. Therefore, PhA might be used in daily oncology practice to implement an accurate nutritional intervention, reducing side effects and complications of oncology management, and improving quality of life during treatment and survival, even in patients with breast cancer with obesity or overweight. The aim of this review is to analyze the existing information on the current application of PhA in patients with breast cancer and its potential use as a tool to assess inflammatory response, identify malnutrition, and predict the deterioration of quality of life so that it could be proposed as an early indicator for nutritional interventions in this group of patients.
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Composição Corporal , Neoplasias da Mama , Inflamação , Estado Nutricional , Obesidade , Qualidade de Vida , Humanos , Neoplasias da Mama/complicações , Obesidade/complicações , Feminino , Impedância Elétrica , Estilo de Vida , Prognóstico , Tecido Adiposo/metabolismoRESUMO
Around 30-60% of patients with rheumatoid arthritis (RA) present treatment failure to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Chitinase-like proteins (CLPs) (YKL-40, YKL-39, SI-CLP) might play a role, as they are associated with the inflammatory process. This study aimed to evaluate CLP utility as a biomarker in the treatment failure of csDMARDs. A case-control study included 175 RA patients classified into two groups based on therapeutic response according to DAS28-ESR: responders (DAS28 < 3.2); non-responders (DAS28 ≥ 3.2). CLP serum levels were determined by ELISA. Multivariable logistic regression and receiver operating characteristic (ROC) curves were used to evaluate CLPs' utility as biomarkers of treatment failure. Non-responders presented higher levels of YKL-40, YKL-39, and SI-CLP compared with responders (all: p < 0.001). YKL-40 correlated positively with YKL-39 (rho = 0.39, p < 0.001) and SI-CLP (rho = 0.23, p = 0.011) and YKL-39 with SI-CLP (rho = 0.34, p < 0.001). The addition of CLPs to the regression models improves diagnostic accuracy (AUC 0.918) compared to models including only clinical classical variables (AUC 0.806) p < 0.001. Non-responders were positive for all CLPs in 35.86%. Conclusions: CLPs could be considered as a useful biomarker to assess treatment failure, due to their association with clinical variables and improvement to the performance of regression models.
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OBJECTIVES: To describe the response and relapse of severe thrombocytopenia in patients with systemic lupus erythematosus (SLE) with different treatments. METHOD: We performed a retrospective cohort study, which included SLE patients who were hospitalized for thrombocytopenia of less than 30,000/µL platelets, from January 2012 to December 2021. Demographic and clinical information was obtained from clinical records. Kaplan-Meier and logrank test were performed. RESULTS: Forty-seven patients, mostly women (83%) with a median age of 31 years, were included in the study. Eight patients (17%) relapsed within a median period of 35.7 weeks. Initial acute treatment with prednisone at 1 mg/kg/day was as effective as glucocorticoid pulses. However, induction treatment with cyclophosphamide (CYC) had the lowest remission rate (43%, p = 0.034). There was no significant difference in relapse-free survival (RFS) among the acute glucocorticoid treatments. CYC induction was associated with lower RFS compared to rituximab (RTX) (CYC 43.6 weeks vs. RTX 51.8 weeks, p = 0.040) or azathioprine (AZA) (CYC 43.6 weeks vs. AZA 51.2 weeks, p = 0.024). Administration of antimalarials was associated with longer RFS (51.6 weeks vs. 45.0 weeks, p = 0.021). Factors such as antiphospholipid syndrome, IgG anti-ß2 glycoprotein I positivity, renal and additional hematologic SLE activity during follow-up significantly reduced RFS. CONCLUSIONS: Despite similar response of acute glucocorticoid regimens, induction therapy with AZA or RTX resulted in a longer RFS compared to CYC. Adding an antimalarial also improved RFS. Our study provides evidence that may help develop better treatment strategies for severe thrombocytopenia in SLE patients. Key Points ⢠Induction therapy with azathioprine or rituximab provided longer relapse-free survival in SLE thrombocytopenia compared with cyclophosphamide. ⢠Antimalarial administration was associated with longer relapse-free survival in SLE thrombocytopenia. ⢠Antiphospholipid syndrome, IgG anti-ß2 glycoprotein I positivity, as well as renal and additional hematologic SLE activity during follow-up, decreased relapse-free survival.
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Azatioprina , Ciclofosfamida , Glucocorticoides , Imunossupressores , Lúpus Eritematoso Sistêmico , Recidiva , Rituximab , Humanos , Feminino , Estudos Retrospectivos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adulto , Masculino , Ciclofosfamida/uso terapêutico , Rituximab/uso terapêutico , Glucocorticoides/uso terapêutico , Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Antimaláricos/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Adulto Jovem , Resultado do Tratamento , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/complicações , Trombocitopenia/tratamento farmacológico , Trombocitopenia/etiologiaRESUMO
INTRODUCTION/OBJECTIVES: The heterodimer exostosin-1/exostosin-2 (EXO-1/2) is a novel antigen observed in membranous nephropathy associated with systemic lupus erythematosus. This study aimed to evaluate the association between EXO-1/2 positivity in kidney biopsy and kidney outcomes. METHODS: The kidney biopsy tissue from 50 class 5 lupus nephritis (LN) and 55 mixed class 3/4 + 5 LN patients was stained for EXO-1/2. Baseline clinical and histological characteristics were compared between EXO-1/2 positive and EXO-1/2 negative patients. Time-to-event analyses were performed to compare rates of response to therapy, kidney flares, and progression to a 40% decline of the glomerular filtration rate (eGFR), doubling of serum creatinine, and kidney failure. RESULTS: Fourteen out of 50 (28%) of class 5 and 5 out of 55 (9%) of mixed class 3/4 + 5 LN stained positive for EXO-1/2. Patients with class 5 LN and EXO-1/2 positive stain were younger, with better kidney function at presentation, and lower scarring in the kidney biopsy analysis. Over a median follow-up of 100 months, patients with positive EXO-1/2 staining had significantly lower rates of progression in the full cohort. When analyzed separately in class 5 and mixed class LN subgroups, there were significantly lower rates of progression to a 40% decline of the eGFR and non-statistically significant trends for doubling of serum creatinine and kidney failure. CONCLUSION: EXO-1/2 is a novel antigen detected in class 5 LN and associated with a good prognosis of kidney function. The incorporation of EXO-1/2 staining in clinical practice can potentially modify the management of LN due to its prognostic implications. Key Points ⢠Exostosin-1/exostosin-2 antigen has been found in cases of membranous nephropathy associated with autoimmune diseases such as systemic lupus erythematosus. ⢠Exostosin-1/exostosin-2 staining in the kidney biopsy of class 5 or mixed class 3/4 + 5 lupus nephritis is associated with a good long-term prognosis of kidney function. ⢠The incorporation of exostosin-1/exostosin-2 staining into clinical practice can potentially modify management due to its prognostic implications.
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Progressão da Doença , Taxa de Filtração Glomerular , Rim , Nefrite Lúpica , Humanos , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/metabolismo , Nefrite Lúpica/patologia , Feminino , Masculino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Rim/patologia , Rim/fisiopatologia , Biópsia , Adulto Jovem , N-AcetilglucosaminiltransferasesRESUMO
Patients with immune-mediated inflammatory diseases are prone to steatotic liver disease (SLD), which has been observed in patients with psoriasis and hidradenitis suppurativa. We aimed to assess whether systemic lupus erythematosus (SLE) was associated with SLD and to define factors associated with SLD in SLE. This was a cross-sectional study, we included 106 consecutive patients with SLE who were seen in the rheumatology clinic between June 2021 and March 2022 and we chose two sex-paired controls for each SLE. All the participants underwent FibroScan and anthropometric assessments. SLD was defined as a controlled attenuation parameter ≥ 275dB/m. Prevalence of SLD was lower in patients with SLE (21.7% vs 41.5%, p < 0.001). Patients with SLE and SLD had a lower frequency of hydroxychloroquine use (65% vs 84%, p = 0.04), and higher C3 levels [123mg/dl (IQR 102-136) vs 99mg/dl (IQR 78-121), p = 0.004]. Factors associated with SLD in SLE were body mass index (BMI), waist circumference, glucose, and C3; hydroxychloroquine use was a protective factor. On univariate analysis, SLE was associated with a reduced risk of SLD (OR 0.39, 95%CI 0.23-0.67); however, after adjusting for age, BMI, waist, glucose, triglycerides, high-density cholesterol, low-density cholesterol, leukocytes, and hydroxychloroquine, it was no longer associated (OR 0.43, 95%CI 0.10-1.91). In conclusion, the prevalence of SLD in patients with SLE was not higher than that in the general population, and SLE was not associated with SLD. The factors associated with SLD were anthropometric data, glucose, hydroxychloroquine, and C3 levels.
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Hidroxicloroquina , Lúpus Eritematoso Sistêmico , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Feminino , Masculino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Hidroxicloroquina/uso terapêutico , Fígado Gorduroso/epidemiologia , Fígado Gorduroso/complicações , Índice de Massa Corporal , Prevalência , Fatores de Risco , Circunferência da Cintura , Complemento C3/metabolismo , Complemento C3/análiseRESUMO
INTRODUCTION: Sexual dysfunction (SD) is highly prevalent and multifactorial; nevertheless, recent research has shed light on a notable phenomenon: male patients with systemic lupus erythematosus (SLE) exhibit an elevated prevalence of sexual function disorders compared with the general population. Despite this recognition, the precise nature and extent of this association remain incompletely understood. OBJECTIVES: This comprehensive review aims to clarify the link by providing an overview of the fundamental components of normal male sexual function, delving into the pathogenesis of male SD and exploring the primary factors predisposing male SLE patients to SD. Additionally, the review offers insights into potential screening, diagnostic, and treatment strategies based on the current body of literature. METHODS: A meticulous search of relevant literature was conducted using the PubMed and Google Scholar databases. RESULTS: Studies exploring the correlation between SLE and SD in both genders have revealed a nearly 2-fold increased risk of SD among individuals with SLE compared with healthy counterparts. Moreover, these studies suggest that male SLE patients may have a higher susceptibility to SD, with reported prevalence ranging from 12% to 68%, compared with 0% to 22% in healthy individuals. Male patients with SLE are influenced by a spectrum of pathological factors, including pharmacological, psychological, and disease-related determinants, which, through their intricate interplay, elevate the likelihood of developing SD. CONCLUSION: Healthcare professionals must remain vigilant in understanding the intricacies of human sexuality and its dysfunction, particularly in males with SLE. The objective is to establish effective and potentially standardized methods for promptly diagnosing and optimally managing SD, recognizing its significant impact on the quality of life for males living with SLE. The pivotal role of rheumatologists in initiating discussions about sexual health, diagnosing SD, investigating causes, and implementing tailored strategies is underscored as crucial in addressing this multifaceted issue.
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Lúpus Eritematoso Sistêmico , Disfunções Sexuais Fisiológicas , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Disfunções Sexuais Fisiológicas/etiologia , Reumatologistas , PrevalênciaRESUMO
OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.
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Antirreumáticos , Artrite Reumatoide , Artrite Reumatoide/tratamento farmacológico , Humanos , México , Antirreumáticos/uso terapêutico , Glucocorticoides/uso terapêutico , Feminino , Anti-Inflamatórios não Esteroides/uso terapêutico , Gravidez , Analgésicos/uso terapêuticoRESUMO
Carcinomatosis of the bone marrow is a rare clinical condition characterized by diffuse tumor infiltration of the bone marrow accompanied by hematological abnormalities, including thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). In patients with gastric carcinoma, this association is infrequent. Below we present a case of a 19-year-old female patient with no known pathological history who presented with upper digestive tract bleeding. Upon examination, anemia and thrombocytopenia were documented, with schistocytes in the peripheral blood smear and prolonged coagulation times. Endoscopic studies indicated a lesion in the Borrmann IV gastric body, and the bone marrow biopsy showed the presence of signet ring cells. Because there was no possibility of systemic therapy, the patient died during hospitalization. This case contributes to the medical literature by describing an unusual presentation of a very frequent pathology.
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Adenocarcinoma , Carcinoma , Coagulação Intravascular Disseminada , Neoplasias Gástricas , Microangiopatias Trombóticas , Feminino , Humanos , Adulto Jovem , Adulto , Coagulação Intravascular Disseminada/etiologia , Medula Óssea/patologia , Adenocarcinoma/complicações , Microangiopatias Trombóticas/complicações , Microangiopatias Trombóticas/diagnóstico , Carcinoma/complicações , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Neoplasias Gástricas/complicaçõesRESUMO
To evaluate associations between the domains of the ANCA-associated vasculitis patient-reported outcome (AAV-PRO) instrument and clinical variables. Patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA), or renal-limited vasculitis (RLV) were recruited from a tertiary care center in Mexico City. Demographic, clinical, serological, and treatment-related data were retrieved. Disease activity, damage, patient and physician global assessments (PtGA and PhGA) were evaluated. All patients completed the AAV-PRO questionnaire, male patients also completed the International Index of Erectile Function (IIEF-5) questionnaire. Seventy patients (44 women and 26 men) were included, with a median age of 53.5 years (43-61), and a disease duration of 82 months (34-135). Moderate correlations were identified between the PtGA and the AAV-PRO domains: social and emotional impact, treatment side effects, organ-specific symptoms, and physical function. The PhGA correlated with the PtGA and prednisone doses. Subanalyses of the AAV-PRO domains according to sex, age, and disease duration showed significant differences in the treatment side effects domain, with higher scores in women, in patients < 50 years, and in patients with disease duration < 5 years. The domain of concerns about the future showed a higher score in patients with disease duration < 5 years. A total of 17/24 (70.8%) of men who completed the IIEF-5 questionnaire were classified as having some degree of erectile dysfunction. The domains of AAV-PRO correlated with other outcome measures, while differences were found between some of the domains according to sex, age, and disease duration.
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss , Granulomatose com Poliangiite , Nefropatias , Poliangiite Microscópica , Médicos , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Granulomatose com Poliangiite/diagnóstico , Estudos Transversais , Medidas de Resultados Relatados pelo Paciente , Anticorpos Anticitoplasma de NeutrófilosRESUMO
Background and aim: With an ever-increasing population of patients recovering form severe coronavirus disease 2019 (COVID-19), recognizing long-standing and delayed neurologic manifestations is crucial. Here, we present a patient developing posterior reversible encephalopathy syndrome (PRES) in the convalescence form severe coronavirus disease 2019 (COVID-19).Case presentation: A 61-year-old woman with severe (COVID-19) confirmed by nasopharyngeal real-time reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) required invasive mechanical ventilation 24-hours after admission. During her intensive care unit stay, she developed transient acute kidney injury and septic shock. She was extubated after 22 days. On day 25, she developed generalized tonic-clonic seizures. Magnetic resonance imaging (MRI) of the brain showed bilateral subcortical lesions on the parietal and occipital lobes and multiple micro-and macro-bleeds, consistent with PRES. At this point, RT-PCR for SARS-CoV-2 in a respiratory specimen and cerebrospinal fluid was negative. She was discharged home 35 days after admission on oral levetiracetam. Control MRI five months after discharge showed bilateral focal gliosis. On follow-up, she remains seizure-free on levetiracetam.Conclusions: PRES has been observed before as a neurological manifestation of acute COVID-19; to our knowledge, this is the first PRES case occurring in a hospitalized patient already recovered from COVID-19. A persistent proinflammatory/prothrombotic state triggered by SARS-CoV-2 infection may lead to long-standing endothelial dysfunction, resulting in delayed PRES in patients recovering from COVID-19. With a rapid and exponential increase in survivors of acute COVID-19, clinicians should be aware of delayed (post-acute) neurological damage, including PRES.
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COVID-19 , Síndrome da Leucoencefalopatia Posterior , Humanos , Feminino , Pessoa de Meia-Idade , COVID-19/complicações , SARS-CoV-2 , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/etiologia , Síndrome da Leucoencefalopatia Posterior/patologia , Convalescença , LevetiracetamRESUMO
BACKGROUND: Splenectomy is a therapy for patients with treatment-refractory autoimmune cytopenias. Antiphospholipid antibodies (aPL) can be identified in 25%-85% of these patients. In this study, we sought to identify whether the presence of aPL was associated with worse outcomes in autoimmune cytopenia's patients who had undergone splenectomy. METHODS: We conducted a retrospective cohort study of patients who underwent splenectomy from 2000 to 2018. We describe clinical characteristics and outcomes in patients with autoimmune cytopenia's diagnosis with positive determinations of aPL. Additionally, we performed a case-control sub-analysis 1:1 of the cases with autoimmune cytopenia's matched control patients with negative aPL determination. RESULTS: A splenectomy was performed in 707 patients, of which we included 34 for the analysis. The median age at the time of splenectomy was 37 years (range 19-61), 53% corresponded to immune thrombocytopenia (ITP) and 47% to autoimmune hemolytic anemia (AIHA). Compared with controls (n = 34), patients had more treatment lines in addition to steroids (p = .02). There were no differences in complete response rate, 65% in cases and 80% in controls (p = .17). However, there was numerically a higher incidence of early infections (21% of cases vs. 3% controls, p = .05). During the entire follow-up, 15% of aPL patients compared with 9% of control patients had a thrombotic event (p = .70). DISCUSSION: Splenectomy for treatment-refractory autoimmune cytopenia's patients with persistent aPL is an effective treatment despite some safety concerns related to early infections. These results suggest that the presence of aPL should not impact the decision to undergo splenectomy.
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Anticorpos Antifosfolipídeos , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Objective.To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). Methods. The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations. Results.Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%. Conclusion.This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.
Objetivo.Desarrollar recomendaciones prácticas, basadas en la mejor evidencia y experiencia disponible, sobre el manejo de enfermería de los pacientes con artritis reumatoide (AR) y enfermedad pulmonar intersticial (EPI). Métodos. Se utilizó la metodología de consenso en la que un panel de expertos (formado por enfermeras de reumatología, reumatólogos, una psicóloga, una fisioterapeuta y una paciente) definió el ámbito, los usuarios, los temas sobre los que explorar la evidencia y sobre los que emitir recomendaciones. Tres preguntas PICO evaluaron la eficacia y seguridad de la rehabilitación pulmonar y las medidas no farmacológicas para el tratamiento de la tos crónica y el reflujo gastroesofágico mediante la búsqueda de revisiones sistemáticas, excluyendo aquellas cuya calidad era baja, muy baja o críticamente baja, según la herramienta AMSTAR-2. Posteriormente, se hizo una reunión para la formulación de recomendaciones que se presentaron con un resumen de la evidencia a la encuesta Delphi. Resultados.Con los resultados de las revisiones se establecieron 15 recomendaciones cuyo grado de acuerdo osciló entre el 77% y el 100% en la una encuesta Delphi. Tres recomendaciones fueron rechazadas en la segunda ronda: una por la evidencia disponible y los dos restantes se basaron en la opinión de expertos. Las 12 recomendaciones restantes aprobadas se referían a la evaluación del paciente (n=4), a la educación del paciente (n=4) y a la gestión del riesgo (n=4). Conclusión. El conocimiento del consenso Openreumapor parte de enfermería y la aplicación sus 12 recomendaciones basadas en la mejor evidencia y experiencia puede mejorar el seguimiento y el pronóstico de los pacientes con AR que presentan EPI.
Objetivo.Desenvolver recomendações práticas, baseadas na melhor evidência e experiência disponíveis, sobre o manejo de enfermagem de pacientes com artrite reumatoide (AR) e doença pulmonar intersticial (DPI). Métodos.Foi utilizada a metodologia de consenso, com grupo nominal, revisões sistemáticas e levantamento Delphi. O painel de especialistas, formado por enfermeiros reumatologistas, reumatologistas, psicólogo, fisioterapeuta e paciente, definiu o escopo, os usuários, os tópicos sobre os quais explorar as evidências e sobre os quais emitir recomendações. Três questões do PICO avaliaram a eficácia e segurança da reabilitação pulmonar e medidas não farmacológicas para o tratamento da tosse crônica e refluxo gastroesofágico por meio de RS. Aqueles cuja qualidade era baixa, muito baixa ou criticamente baixa, de acordo com a ferramenta AMSTAR-2, foram excluídos. Posteriormente, realizou-se uma reunião para formular recomendações que foram apresentadas com um resumo das evidências ao inquérito Delphi. Resultados. Com os resultados das revisões, foram estabelecidas 15 recomendações cujo grau de concordância entre 77% e 100% foi obtido com uma pesquisa Delphi. Três recomendações foram rejeitadas na segunda rodada. As 12 recomendações referiam-se à avaliação do paciente (n=4); à educação do paciente (n=4); e ao gerenciamento de risco (n=4). Apenas uma recomendação foi baseada nas evidências disponíveis, enquanto as demais foram baseadas na opinião de especialistas. Conclusão. Este documento apresenta uma série de recomendações com o objetivo de melhorar o prognóstico e a qualidade de vida dos pacientes com AR-ILD. O conhecimento da enfermagem e a aplicação dessas recomendações podem melhorar o acompanhamento e o prognóstico de pacientes com AR com DPI.
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Artrite Reumatoide , Segurança , Eficácia , Enfermagem , Doenças Pulmonares Intersticiais , ConsensoRESUMO
Background: Asymptomatic subjects, the lack of diagnostic tests and, in countries like Mexico, the epidemiological surveillance method does not allow to establish the real number of infections in the COVID-19 pandemic. Frontline health personnel, as well as other groups related to priority activities are considered of high risk. We included administrative workers in contact with health personnel in the hospital units of the Mexican Institute for Social Security (IMSS, according to its initials in Spanish). Objective: To identify the seroprevalence of antibodies to SARS-CoV-2 in IMSS' administrative staff who does not treat patients. Material and methods: 76 volunteer participating individuals were incluided; IgG antibodies against the SARS-CoV-2 nucleoprotein were measured. A questionnaire was administered to the participants in order to identify possible risk factors. Results: 76 participants were included (39 men, 51.7%), with a median age of 42 years. 29 out of 76 subjects (38.2%), whose median age was 38 years (range 18-69 years); 15 men (51.7%), and 14 women (48.3%). A higher percentage of positive subjects under 45 years of age (n = 20, 84.2%) was observed than those aged 45 or over (n = 9, 25%), with an OR of 3 (95% CI 1.13-7.96, p = 0.03). No statistically significant difference was found regarding the type of comorbidity. Conclusions: The prevalence identified shows an important circulation of the virus in the administrative staff.
Introducción: los sujetos asintomáticos, la falta de pruebas diagnósticas y, en países como México, el método de vigilancia epidemiológica no permiten establecer el número real de contagios en la pandemia de COVID-19. El personal de salud de primera línea y otros grupos con actividades prioritarias son de alto riesgo. Se incluyeron trabajadores administrativos en contacto con personal de salud en las unidades hospitalarias del Instituto Mexicano del Seguro Social (IMSS). Objetivo: identificar la seroprevalencia de anticuerpos contra SARS-CoV-2 en personal administrativo del IMSS que no atiende a enfermos. Material y métodos: se incluyeron 76 individuos a los cuales se les midieron los anticuerpos IgG contra la nucleoproteína del SARS-CoV-2. También se les aplicó un cuestionario para identificar factores de riesgo. Resultados: se incluyeron 76 participantes (39 hombres, 51.7%), con una mediana de 42 años de edad. Fueron positivos 29 de 76 sujetos (38.2%), cuya mediana de edad fue de 38 años (rango 18-69 años); 15 hombres y 14 mujeres. Hubo mayor porcentaje de sujetos positivos menores de 45 años (n = 20, 84.2%) que aquellos de edad ≥ 45 años (n = 9, 25%), con una RM de 3 (IC 95% 1.13-7.96, p = 0.03). No hubo diferencia estadísticamente significativa respecto al tipo de comorbilidad. Conclusiones: la prevalencia identificada muestra una circulación importante del virus en el personal administrativo.
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COVID-19 , Previdência Social , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Estudos Soroepidemiológicos , Adulto JovemRESUMO
OBJECTIVES: Our study aims to describe the association between SLE and sexual function, analysing demographic variables, comorbidities and other disease-related factors. As an exploratory objective, the impact of asking about sexual function during outpatient consultation was evaluated. METHODS: From 2018 to 2019, we invited sexually active men diagnosed with SLE to complete questionnaires that evaluated their sexual function and quality of life. Additionally, patients were asked if they believed they had sexual dysfunction, whether they would be interested in receiving specialized sexual care, and if they considered SLE to be detrimental to their sexual function. Epidemiological and disease-related data were retrieved from the patients' clinical records. RESULTS: We included 124 men with SLE. Twenty-two (18%) patients answered positively when asked if they believed they had sexual dysfunction. These patients had lower overall erectile function scores and lower physical function scores than those who did not consider they had sexual dysfunction. In the multivariable analysis, factors that were associated with better sexual function were high physical function (B = 0.126, p = .031), lower BMI (B = 0.53, p = .010) and the patient's perception of normal sexual function (B = 13.0, p < .001). Comorbidities associated with worse sexual function were type 2 diabetes (B = -8.1, p = .017) and a history of thrombosis (B = -5.12, p = .019). CONCLUSION: Sexual function of male patients with SLE is impaired, independently of disease activity, chronic disease damage or pharmacological treatment. A simple question about perception of sexual function in the outpatient clinic can be used to help determine which patients could benefit from a multidisciplinary intervention to improve sexual health.
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Diabetes Mellitus Tipo 2 , Lúpus Eritematoso Sistêmico , Disfunções Sexuais Fisiológicas , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Qualidade de Vida , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologiaRESUMO
Resumen Objetivo: Describir la epidemiología de la tuberculosis infantil en el Departamento de Caldas (2016-2018). Materiales y métodos: Estudio observacional-descriptivo. Resultados: se registraron 41 casos (4%, 41/1.029). La incidencia fue 2,96/100.000 (2016), 6,31/100.000 (2017) y 4,34 /100.000 (2018). La mediana de edad fue 10 años (RI 2-16). El sexo femenino aporto 53,66%, predominó el estrato socioeconómico bajo (90,24%, 37/41), Manizales aportó la mayor carga de casos (43,9%, 18/41). La TB pulmonar se presentó en 39,02% de los casos de tuberculosis infantil. 68,29% (28/41) reportaron haber tenido síntomas alrededor de 15 días de evolución. 70,73% (29/41) presentarón tos con expectoración y 65,85% (27/41) reportaron astenia o disnea. La PPD se midió en 65,85% de la población (27/41) siendo positiva (> 10 mm) en 62,96% (17/27). El diagnóstico radiológico se realizó en 56,1% (23/41). Se reportaron 10 casos de TB extrapulmonar, la presentación más frecuente fue ganglionar (7/10). Se presentaron dos casos fatales. Discusión: La tuberculosis infantil en Caldas refleja la naturaleza de la enfermedad, afectándose principalmente niñas con vulnerabilidades sociales. El síntoma más común es tos húmeda con expectoración, similar a otros estudios desarrollados en Colombia. No se cuenta con una herramienta diagnostica con rendimiento suficiente, por lo que este sigue siendo un desafío clínico.
Abstract Objective: To describe the epidemiology of childhood TB in the Department of Caldas (2016-2018). Materials and methods: Observational-descriptive study. Results: 41 cases were registered (4%, 41 / 1,029). The incidence was 2.96 / 100,000 (2016), 6.31 / 100,000 (2017) and 4.34 / 100,000 (2018). The median age was 10 years (IR 2-16). The female sex contributed 53.66%, the low socioeconomic status predominated (90.24%, 37/41). Manizales contributed the highest case load (43.9%, 18/41). Pulmonary TB occurred in 39.02% of childhood TB cases. 68.29% (28/41) reported having symptoms around 15 days of evolution. 70.73% (29/41) presented cough with expectoration and 65.85% (27/41) reported asthenia or dyspnea. PPD was measured in 65.85% of the population (27/41), being positive (> 10 mm) in 62.96% (17/27). The radiological diagnosis was made in 56.1% (23/41). 10 cases of extrapulmonary TB were reported, the most frequent presentation was lymph node TB (7/10). Two fatal cases occurred. Discussion: Childhood tuberculosis in Caldas reflects the nature of the disease, mainly affecting girls with social vulnerabilities. The most common symptom is wet cough with expectoration, similar to other studies developed in Colombia. There is not a diagnostic tool with sufficient performance, so this remains a clinical challenge.
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Objetivo: Analisar a inserção do cuidado ao idoso nos cursos de graduação em enfermagem das Instituições de Ensino Superior (IES) públicas e privadas do Paraná. Método: Trata-se de estudo descritivo, exploratório, de abordagem qualitativa, que utilizou a análise documental. Foi realizada a identificação das IES e cursos de graduação por meio do acesso à plataforma online do Ministério da Educação e, posteriormente, às páginas oficiais das IES para identificar conteúdos relacionados ao cuidado gerontológico. As ementas foram analisadas pelo Software Interface R IraMuTeQ® Resultados: Foram identificadas 60 IES e obteve-se informações de 52 cursos. Destes, 53,9% ofertavam disciplinas específicas de saúde do idoso e 46,1% possuíam disciplinas mistas. Na análise de similitude os principais eixos organizadores foram: idoso, enfermagem e processo. Conclusão: Pouco mais da metade dos cursos de enfermagem aborda o cuidado ao idoso em disciplinas específicas. A formação deve estar alinhada às políticas da atenção à pessoa idosa.(AU)
Objetivo: Analizar la inserción del cuidado de ancianos en los cursos de graduación en enfermería de Instituciones de Enseñanza Superior (IES) públicas y privadas de Paraná. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, que utilizó el análisis de documentos. La identificación de las IES y carreras de grado se realizó a través del acceso a la plataforma en línea del Ministerio de Educación y, posteriormente, a las páginas oficiales de las IES para identificar contenidos relacionados con la atención gerontológica. Los menús fueron analizados por el software de interfaz R IraMuTeQ®. Resultados: Se identificaron 60 IES y se obtuvo información de 52 cursos. De estos, 53,9% ofrecieron temas específicos sobre la salud del anciano y 46,1% temas mixtos. En el análisis de similitud, los principales ejes organizadores fueron: anciano, enfermería y proceso. Conclusión: poco más de la mitad de los cursos de enfermería abordan el cuidado de ancianos en disciplinas específicas. La formación debe estar alineada con las políticas de atención a las personas mayores(AU)
Objective: To analyze the insertion of elderly care in undergraduate nursing courses at public and private Higher Education Institutions (HEIs) in Paraná. Method: This is a descriptive, exploratory study, with a qualitative approach, which used document analysis. The identification of HEIs and undergraduate courses was carried out through access to the Ministry of Education's online platform and, later, to the official pages of the HEIs to identify content related to gerontological care. The menus were analyzed by the R IraMuTeQ® Interface Software. Results: 60 HEIs were identified and information was obtained from 52 courses. Of these, 53.9% offered specific subjects on elderly health and 46.1% had mixed subjects. In the similarity analysis, the main organizing axes were: elderly, nursing and process. Conclusion: Just over half of nursing courses address elderly care in specific disciplines. Training must be aligned with care policies for the elderly(AU)
Assuntos
Idoso , Saúde do Idoso , Programas de Graduação em Enfermagem , Enfermagem GeriátricaRESUMO
OBJECTIVES: To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). METHODS: The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations. RESULTS: Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%. CONCLUSIONS: This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.
Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais , Cuidados de Enfermagem , Humanos , Consenso , Qualidade de VidaRESUMO
Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.