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1.
T2-hyperintensity in the internal globus pallidus in Machado-Joseph disease T2hyperintensity Thyperintensity T2 hyperintensity T MachadoJoseph Machado Joseph
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Meira, Alex T.
; Araruna, Jorge E. D.
; Araujo, Lais Vieira
; Leite, Raíssa N. L. F.
; Franklin, Gustavo L.
; Nepomuceno, Adriana M. T.
; Teive, Hélio A. G.
.
2.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
3.
COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro
; Uchôa, Caroline Louise Mesquita
; Mazzoco, Marina Flaborea
; Cruz, Isabella D'Andrea Garcia da
; Echegaray, Mariana V.F.
; Humes, Eduardo de Castro
; Silveira, Júlia Belizário
; Santi, Talita Di
; Miguel, Euripedes Constantino
; Corchs, Felipe
; Fatori, Daniel
; Campello, Guilherme
; Oliveira, Gabriel M. de
; Argolo, Felipe C.
; Ferreira, Felipe de M.
; Machado, Gustavo
; Argeu, Adriana
; Oliveira, Graça Maria Ramos de
; Serafim, Antônio de Pádua
; Siqueira, Luciana de Lima
; Rossi, Luciane de
; Rios, Izabel Cristina
; Oliveira, Talita Rodrigues de
; Antoniazzi, Leilane C. K.
; Gagliotti, Daniel Augusto Mori
; Abelama Neto, Emílio
; Oliveira Junior, Paulo Novais de
; Correia, Aline Villalobo
; Gonçalves, Luca Schilling
; Tortato, Liana Silva
; Busato, Wagner Machado Moraes
; Guimarães-Fernandes, Flávio
; Alves, Marcos
; Leite Netto, Oswaldo Ferreira
; Schoueri, Patrícia de Campos Lindenberg
; Roque, Márcio de Assis
; Merlin, Silvia Stahl
; Boer, Giovana Cardoso Machado
; Sallet, Paulo Clemente
; Malbergier, André
; Spedo, Mariana Abrahão
; Kamitsuji, Carla Satie
; Faria, Elizabeth de
; Moreira, Moacyr Vergara de Godoy
; Kaufman, Arthur
; Abdo, Carmita
; Scanavino, Marco de Tubino
; Lancman, Selma
; Tavares, Hermano
; Polanczyk, Guilherme
; Brunoni, André R.
; Forlenza, Orestes V.
; Barros-Filho, Tarcísio Eloy Pessoa de
.
OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.
4.
Unwrapping the long-term impacts of COVID-19 pandemic on Brazilian academic mothers: the urgency of short, medium, and long-term measures
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HIPÓLITO, JULIANA
; DIELE-VIEGAS, LUISA M.
; CORDEIRO, TÁBATA E.F.
; SALES, LILIAN P.
; MEDEIROS, ADRIANA
; DEEGAN, KATHLEEN R.
; LEITE, LUCIANA
.
Abstract Since the beginning of the COVID-19 pandemic, publications have highlighted the disproportionate impact of the COVID-19 pandemic on academic mothers, mostly focusing on the impact of social distancing and quarantine. A few months later, despite the lack of effective vaccines or therapeutics in sight, many economic activities are being resumed. Nurseries and schools are expected to be among the latest to reopen, which will amplify the impacts of the pandemic on academic mothers. In this letter, we unwrap the pandemic impacts on academic mothers and describe a set of specific short-, medium- and long-term policies that, if implemented, could reduce setbacks for gender equality during the pandemic and can help to level the playing field for academic mothers.
https://doi.org/10.1590/0001-3765202020201292
1664 downloads
5.
Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.
; Ho, Yeh-Li
; Besen, Bruno A.M.P.
; Malbuisson, Luiz M.S.
; Taniguchi, Leandro U.
; Mendes, Pedro V.
; Costa, Eduardo L.V.
; Park, Marcelo
; Daltro-Oliveira, Renato
; Roepke, Roberta M.L.
; Silva Jr, João M.
; Carmona, Maria José C.
; Carvalho, Carlos Roberto Ribeiro
; Hirota, Adriana
; Kanasiro, Alberto Kendy
; Crescenzi, Alessandra
; Fernandes, Amanda Coelho
; Miethke-Morais, Anna
; Bellintani, Arthur Petrillo
; Canasiro, Artur Ribeiro
; Carneiro, Bárbara Vieira
; Zanbon, Beatriz Keiko
; Batista, Bernardo Pinheiro De Senna Nogueira
; Nicolao, Bianca Ruiz
; Besen, Bruno Adler Maccagnan Pinheiro
; Biselli, Bruno
; Macedo, Bruno Rocha De
; Toledo, Caio Machado Gomes De
; Pompilio, Carlos Eduardo
; Carvalho, Carlos Roberto Ribeiro De
; Mol, Caroline Gomes
; Stipanich, Cassio
; Bueno, Caue Gasparotto
; Garzillo, Cibele
; Tanaka, Clarice
; Forte, Daniel Neves
; Joelsons, Daniel
; Robira, Daniele
; Costa, Eduardo Leite Vieira
; Silva Júnior, Elson Mendes Da
; Regalio, Fabiane Aliotti
; Segura, Gabriela Cardoso
; Marcelino, Gustavo Brasil
; Louro, Giulia Sefrin
; Ho, Yeh-Li
; Ferreira, Isabela Argollo
; Gois, Jeison de Oliveira
; Silva Junior, Joao Manoel Da
; Reusing Junior, Jose Otto
; Ribeiro, Julia Fray
; Ferreira, Juliana Carvalho
; Galleti, Karine Vusberg
; Silva, Katia Regina
; Isensee, Larissa Padrao
; Oliveira, Larissa dos Santos
; Taniguchi, Leandro Utino
; Letaif, Leila Suemi
; Lima, Lígia Trombetta
; Park, Lucas Yongsoo
; Chaves Netto, Lucas
; Nobrega, Luciana Cassimiro
; Haddad, Luciana
; Hajjar, Ludhmila
; Malbouisson, Luiz Marcelo
; Pandolfi, Manuela Cristina Adsuara
; Park, Marcelo
; Carmona, Maria José Carvalho
; Andrade, Maria Castilho Prandini H De
; Santos, Mariana Moreira
; Bateloche, Matheus Pereira
; Suiama, Mayra Akimi
; Oliveira, Mayron Faria de
; Sousa, Mayson Laercio
; Louvaes, Michelle
; Huemer, Natassja
; Mendes, Pedro
; Lins, Paulo Ricardo Gessolo
; Santos, Pedro Gaspar Dos
; Moreira, Pedro Ferreira Paiva
; Guazzelli, Renata Mello
; Reis, Renato Batista Dos
; Oliveira, Renato Daltro De
; Roepke, Roberta Muriel Longo
; Pedro, Rodolpho Augusto De Moura
; Kondo, Rodrigo
; Rached, Samia Zahi
; Fonseca, Sergio Roberto Silveira Da
; Borges, Thais Sousa
; Ferreira, Thalissa
; Cobello Junior, Vilson
; Sales, Vivian Vieira Tenório
; Ferreira, Willaby Serafim Cassa
.
OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
https://doi.org/10.6061/clinics/2020/e2294
1957 downloads
6.
TUNING OF THE METAHEURISTIC VARIABLE NEIGHBORHOOD SEARCH FOR A FOREST PLANNING PROBLEM
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Araújo Júnior, Carlos Alberto
; Mendes, João Batista
; Assis, Adriana Leandra de
; Cabacinha, Christian Dias
; Stocks, Jonathan James
; Silva, Liniker Fernandes da
; Leite, Helio Garcia
.
ABSTRACT In forest science it is important evaluate new technologies from computational science. This work aimed to test a different kind of metaheuristic called Variable Neighborhood Search in a forest planning problem. The management total area has 4.210 ha distributed in 120 stands in ages between 1 and 6 years old and site index since 22 m to 31 m. The problem was modelled considering the maximization of the net present value subject to the restrictions: annual cut volume between 140.000 m³ and 160.000 m³, harvester ages equal to 5, 6 or 7 years, and the impossibility of division of the management unity at harvester time. It was evaluated different settings for the Variable Neighborhood Search, varying the quantity of neighbours, the neighbourhood structure and number or generations. 30 repetitions were performed for each setting. The results were compared to the one obtained from integer linear programming and linear programming. The integer linear programming considered the best solution obtained after 1 hour of processing. The best setting to the Variable Neighborhood Search was 100 neighbours, a neighbourhood structure with changes in 1%, 2%, 3% and 4% of prescriptions and 500 iterations. The results shown by the Variable Neighborhood Search was 2,77% worse than one obtained by the integer linear programming with 1 hours of processing, and 2,84% worse than the linear programming. It is possible to conclude that the presented metaheuristic can be used satisfactorily in a resolution of forest scheduling problem when the best parameters are chosen.
https://doi.org/10.1590/01047760201824032538
1147 downloads
7.
META-HEURISTIC CLONAL SELECTION ALGORITHM FOR OPTIMIZATION OF FOREST PLANNING
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Araújo Júnior, Carlos Alberto
; Mendes, João Batista
; Cabacinha, Christian Dias
; Assis, Adriana Leandra de
; Matos, Lisandra Maria Alves
; Leite, Helio Garcia
.
RESUMO Dada a importância de se avaliar novas tecnologias para otimização do planejamento florestal, este trabalho objetivou introduzir a metaheurística Clonal Selection Algorithm na resolução de um problema de ordenamento da produção florestal. Considerou-se uma área manejada de tamanho igual a 4.210 ha, contendo 120 talhões com idades entre 1 e 6 anos e índice de sítio variando entre 22 m e 31 m. O problema foi modelado com o objetivo de se maximizar o valor presente líquido global do empreendimento e considerou como restrições uma demanda anual entre 140.000m3 e 160.000 m3, colheita apenas nas idades de 5, 6 e 7 anos e a imposição de não fracionamento dos talhões no momento do corte. Foram avaliados diferentes configurações da metaheurística Clonal Selection Algorithm, variando-se as taxas de seleção, clonagem, hipermutação e substituição, além do tamanho da população inicial. Considerou-se como critério de parada uma quantidade de gerações igual a 100 e para cada parametrização avaliou-se 30 repetições. Os resultados foram comparados com aqueles obtidos utilizando-se programação linear e programação linear inteira. Para a programação inteira considerou-se a melhor solução após 1 hora de processamento. A melhor configuração foi a que considerou 80 células na população inicial, taxas de seleção, clonagem, hipermutação e substituição iguais a 0,20, 0,80, 0,20 e 0,50, respectivamente. Os resultados apresentados pela metaheurística Clonal Selection Algorithm foram 1,69% superiores à programação linear inteira e 4,35% inferior a programação linear. Conclui-se que a metaheurística apresentada pode ser utilizada para resolução de problemas de ordenamento florestal.
ABSTRACT It is important to evaluate the application of new technologies in the field of computational science to forest science. The goal of this study was to test a different kind of metaheuristic, namely Clonal Selection Algorithm, in a forest planning problem. In this problem, the total management area is 4.210 ha that is distributed in 120 stands in ages between 1 and 6 years and site indexes of 22 m to 31 m. The problem was modeled considering the maximization of the net present value subject to the constraints: annual harvested volume between 140,000 m3 and 160,000 m3, harvest ages equal to 5, 6 or 7 years, and the impossibility of division of the management unity at harvest time. Different settings for Clonal Selection Algorithm were evaluated to include: varying selection, cloning, hypermutation, and replacement rates beyond the size of the initial population. A generation value equal to 100 was considered as a stopping criteria and 30 repetitions were performed for each setting. The results were compared to those obtained from integer linear programming and linear programming. The integer linear programming, considered to be the best solution, was obtained after 1 hour of processing. The best setting for Clonal Selection Algorithm was 80 individuals in the initial population and selection. Cloning, hypermutation, and replacement rates equal to 0.20, 0.80, 0.20 and 0.50, respectively, were found. The results obtained by Clonal Selection Algorithm were 1.69% better than the integer linear programming and 4.35% worse than the linear programming. It is possible to conclude that the presented metaheuristic can be used in the resolution of forest scheduling problems.
https://doi.org/10.1590/1806-90882017000600007
1231 downloads
8.
Qualidade de vida nas espondiloartrites: análise de uma grande coorte brasileira
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Ribeiro, Sandra L.E.
; Albuquerque, Elisa N.
; Bortoluzzo, Adriana B.
; Gonçalves, Célio R.
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M.S.
; Costa, Izaias P.
; Duarte, Angela L.B. Pinto
; Kohem, Charles L.
; Leite, Nocy H.
; Lima, Sonia A.L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Resende, Gustavo G.
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L.C.
; Valim, Valéria
; Sampaio-Barros, Percival D.
.
Resumo Objetivo: Analisar as variáveis demográficas e clínicas associadas à diminuição da qualidade de vida em uma grande coorte brasileira de pacientes com espondiloartrite (EpA). Métodos: Foi aplicado um protocolo de pesquisa único a 1.465 pacientes brasileiros classificados como tendo EpA de acordo com os critérios do European Spondyloarthropaties Study Group (ESSG), atendidos em 29 centros de referência em reumatologia do Brasil. Foram registradas as variáveis clínicas e demográficas. A qualidade de vida foi analisada por meio do questionário Ankylosing Spondylitis Quality of Life (ASQoL). Resultados: A pontuação média do ASQoL foi de 7,74 (+ 5,39). Ao analisar doenças específicas no grupo de EpA, as pontuações do ASQoL não apresentaram diferença estatisticamente significativa. Os dados demográficos mostraram piores escores de ASQoL associados ao gênero feminino (p = 0,014) e etnia negra (p < 0,001). Quanto aos sintomas clínicos, a dor na região glútea (p = 0,032), a dor cervical (p < 0,001) e a dor no quadril (p = 0,001), estiveram estatisticamente associadas a piores escores no ASQoL. O uso contínuo de fármacos anti-inflamatórios não esteroides (p < 0,001) e agentes biológicos (p = 0,044) esteve associado a escores mais elevados de ASQoL, enquanto outros medicamentos não interferiram nos escores do ASQoL. Conclusão: Nesta grande série de pacientes com EpA, o sexo feminino e a etnia negra, bem como sintomas predominantemente axiais, estiveram associados a uma qualidade de vida reduzida.
Abstract Objective: To analyze quality of life and demographic and clinical variables associated to its impairment in a large Brazilian cohort of patients with spondyloarthritis (SpA). Methods: A common protocol of investigation was applied to 1465 Brazilian patients classified as SpA according to the European Spondyloarthropaties Study Group (ESSG) criteria, attended at 29 reference centers for Rheumatology in Brazil. Clinical and demographic variables were recorded. Quality of life was analyzed through the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Results: The mean ASQoL score was 7.74 (± 5.39). When analyzing the specific diseases in the SpA group, the ASQoL scores did not present statistical significance. Demographic data showed worse scores of ASQoL associated with female gender (p = 0.014) and African-Brazilian ethnicity (p < 0.001). Regarding clinical symptoms, buttock pain (p = 0.032), cervical pain (p < 0.001) and hip pain (p = 0.001), were statistically associated with worse scores of ASQoL. Continuous use of nonsteroidal anti-inflammatory drugs (p < 0.001) and biologic agents (p = 0.044) were associated with higher scores of ASQoL, while the other medications did not interfere with the ASQoL scores. Conclusion: In this large series of patients with SpA, female gender and African-Brazilian ethnicity, as well as predominant axial symptoms, were associated with impaired quality of life.
https://doi.org/10.1016/j.rbr.2015.03.003
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9.
Avaliação do desempenho do BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) numa coorte brasileira de 1.492 pacientes com espondiloartrites: dados do Registro Brasileiro de Espondiloartrites (RBE)
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Costa, Izaias Pereira da
; Bortoluzzo, Adriana B.
; Gonçalves, Célio R.
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Ribeiro, Sandra L.E.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Albuquerque, Elisa N.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M.S.
; Duarte, Angela L.B. Pinto
; Kohem, Charles L.
; Leite, Nocy H.
; Lima, Sonia A.L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Resende, Gustavo G.
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L.C.
; Valim, Valéria
; Sampaio-Barros, Percival D.
.
Objetivo Avaliar os resultados da aplicação do Índice de Atividade de Doença da Espondilite Anquilosante de Bath (BASDAI) numa série de pacientes brasileiros com EpA e estabelecer suas correlações com as variáveis específicas do grupo. Métodos Um protocolo comum de investigação foi prospectivamente aplicado em 1.492 pacientes brasileiros classificados como EpA pelos critérios do Grupo Europeu de Estudo das Espondiloartropatias (ESSG), acompanhados em 29 centros de referência em reumatologia no Brasil. Variáveis clínicas, demográficas e índices de doença foram colhidos. Os valores totais do BASDAI foram comparados com a presença das diferentes variáveis. Resultados O valor médio do BASDAI foi de 4,20 ± 2,38. Os escores médios do BASDAI foram mais elevados nos pacientes com forma clínica combinada, comparado às formas axiais e periféricas isoladas, nos pacientes do sexo feminino e nos sedentários. Com relação ao componente axial, valores mais altos do BASDAI estiveram significativamente associados à lombalgia inflamatória, à dor alternante em nádegas, à dor cervical e ao acometimento de coxofemorais. Houve associação estatística entre os valores do BASDAI e o comprometimento periférico, relacionado ao número de articulações inflamadas, tanto dos membros inferiores quanto dos membros superiores, e às entesites. A positividade do HLA-B27 e a presença de manifestações extra-articulares não estiveram correlacionadas com os valores médios do BASDAI. Valores mais baixos do BASDAI estiveram associados ao uso de agentes biológicos (p < 0,001). Conclusão Nesta série heterogênea de pacientes brasileiros com EpA, o BASDAI conseguiu demonstrar “atividade de doença” tanto nos pacientes com acometimento axial quanto naqueles com envolvimento periférico.
Objective To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. Methods A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applied. The total values of BASDAI were compared to the presence of the different variables. Results The mean score of BASDAI was 4.20 ± 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 ± 2.38) clinical presentation, compared to the pure axial (3.78 ± 2.27) or pure peripheral (4.00 ± 2.38) clinical presentations (P < 0.001). BASDAI also presented higher scores associated with the female gender (P < 0.001) and patients who did not practice exercises (P < 0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (P < 0.049), alternating buttock pain (P < 0.001), cervical pain (P < 0.001) and hip involvement (P < 0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (P = 0.004) and upper limbs (P = 0.025). The presence of enthesitis was also associated to higher scores of BASDAI (P = 0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (P < 0.001). Conclusion In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate “disease activity” in patients with axial as well as peripheral disease.
https://doi.org/10.1016/j.rbr.2014.05.005
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10.
Cardiac 123I-MIBG uptake in de novo Brazilian patients with Parkinson's disease without clinically defined dysautonomia
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Leite, Marco Antonio Araujo
; Nascimento, Osvaldo J. M.
; Pereira, João Santos
; Amaral, Clayton
; Mesquita, Cláudio T.
; Azevedo, Jader C.
; Brito, Adriana S. X. de
; Pedras, Felipe Villela
.
A cintilografia miocárdica com meta-iodo-benzil-guanidina (123I cMIBG) foi estudada na doença de Parkinson (DP), especialmente nos países asiáticos, mas não na América Latina. A quase totalidade desses estudos inclui indivíduos com DP com disautonomia definida. Nosso objetivo é relatar a neurotransmissão simpática cardíaca em doentes brasileiros com DP de novo esporádica, sem disautonomia clinicamente definida. Foi avaliada retrospectivamente uma série de 21 casos consecutivos com DP sem sintomas ou sinais de disautonomia observáveis pelos testes de beira-de-leito. Com a aplicação dos critérios de exclusão, este número foi reduzido para 14. A captação do 123I MIBG pelo SPECT foi baixa ou ausente em todos os pacientese; a relação coração / mediastino foi baixa em 12 dos 14. Concluímos que a 123c MIBG é capaz de identificar alteração da neurotransmissão simpática cardíaca em doentes com DP de novo sem disautonomia clinicamente definida.
Myocardial scintigraphy with meta-iodo-benzyl-guanidine (123I cMIBG) has been studied in Parkinson's disease (PD), especially in Asian countries, but not in Latin America. Most of these studies include individuals with PD associated to a defined dysautonomia. Our goal is to report the cardiac sympathetic neurotransmission in de novo Brazilian patients with sporadic PD, without clinically defined dysautonomia. We evaluated retrospectively a series of 21 consecutive cases with PD without symptoms or signs of dysautonomia assessed by the standard bedside tests. This number was reduced to 14 with the application of exclusion criteria. 123I cMIBG SPECT up-take was low or absent in all of them and the heart/mediastinum ratio was low in 12 of 14. We concluded that 123I cMIBG has been able to identify cardiac sympathetic neurotransmission disorder in Brazilian de novo PD patients without clinically defined dysautonomia.
https://doi.org/10.1590/0004-282X20140042
3639 downloads
11.
Errata de "Artrite enteropática no Brasil: dados do Registro Brasileiro de Espondiloartrites"
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Resende, Gustavo G.
; Lanna, Cristina C. D.
; Bortoluzzo, Adriana B.
; Gonçalves, Célio R.
; Sampaio-Barros, Percival D.
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Ribeiro, Sandra L.E.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Albuquerque, Elisa N.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M. S.
; Costa, Izaias P.
; Duarte, Angela P.
; Kohem, Charles L.
; Leite, Nocy
; Lima, Sonia A. L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L. C.
; Valim, Valeria
.
https://doi.org/10.1016/j.rbr.2014.03.016
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12.
Perfil do uso de drogas modificadoras de doença no Registro Brasileiro de Espondiloartrites
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Kohem, Charles L
; Bortoluzzo, Adriana B
; Gonçalves, Célio R
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Ribeiro, Sandra L.E.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Albuquerque, Elisa N.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M. S.
; Costa, Izaias Pereira da
; Duarte, Angela L.B. Pinto
; Leite, Nocy H.
; Lima, Sonia A.L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Resende, Gustavo G.
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L.C.
; Valim, Valéria
; Sampaio-Barros, Percival D
.
Introdução: Poucos estudos avaliaram o perfil do uso de drogas modificadoras de doença (DMD) em pacientes brasileiros com diagnóstico de espondiloartrite (EpA). Métodos: Um protocolo comum de investigação foi prospectivamente aplicado em 1505 pacientes classificados como EpA pelos critérios do Grupo Europeu de Estudo das Espondiloartrites (ESSG), acompanhados em 29 centros de referência em Reumatologia no Brasil. Variáveis clínicas e demográficas foram obtidas e avaliadas, analisando-se suas correlações com o uso das DMD metotrexato (MTX) e sulfasalazina (SSZ). Resultados: Pelo menos uma DMD foi utilizada por 73,6% dos pacientes, sendo MTX por 29,2% e SSZ por 21,7%, enquanto 22,7% utilizaram ambas as drogas. O uso do MTX foi significativamente associado ao acometimento periférico, e a SSZ foi associada ao comprometimento axial, sendo que as duas drogas foram mais utilizadas, isoladas ou combinadas, no comprometimento misto (p < 0,001). O uso de uma DMD esteve significativamente associado à etnia branca (MTX; p = 0,014), lombalgia inflamatória (SSZ; p = 0,002), dor em nádegas (SSZ; p = 0,030), cervicalgia (MTX; p = 0,042), artrite de membros inferiores (MTX; p < 0,001), artrite de membros superiores (MTX; p < 0,001), entesite (p = 0,007), dactilite (MTX; p < 0,001), doença inflamatória intestinal (SSZ; p < 0,001) e acometimento ungueal (MTX; p < 0,001). Conclusão: O uso de pelo menos uma DMD foi referido por mais de 70% dos pacientes numa grande coorte brasileira de pacientes com EpA, sendo o uso do MTX mais associado ao acometimento periférico e o uso da SSZ mais associado ao acometimento axial.
Introduction: Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). Methods: A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ). Results: At least one DMD was used by 73.6 % of patients: MTX by 29.2 % and SSZ by 21.7%, while 22.7 % used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX , p = 0.014), inflammatory back pain (SSZ, p = 0.002) , buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001). Conclusion: The use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement.
https://doi.org/10.1016/j.rbr.2013.06.003
2823 downloads
13.
Artrite enteropática no Brasil: dados do registro brasileiro de espondiloartrites
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Resende, Gustavo G.
; Lanna, Cristina C. D.
; Bortoluzzo, Adriana B.
; Gonçalves, Célio R.
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Ribeiro, Sandra L. E.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Vieira, Walber P.
; Albuquerque, Elisa N.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M. S.
; Costa, Izaias P.
; Duarte, Angela P.
; Kohem, Charles L.
; Leite, Nocy
; Lima, Sonia A. L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L. C.
; Valim, Valeria
; Sampaio-Barros, Percival D.
.
As doenças inflamatórias intestinais (doença de Crohn e retocolite ulcerativa) apresentam manifestações extraintestinais em um quarto dos pacientes, sendo a mais comum a artrite enteropática. MÉTODOS: Estudo prospectivo, observacional e multicêntrico, realizado com pacientes de 29 centros de referência participantes do Registro Brasileiro de Espondiloartrites (RBE), que se incorpora ao grupo RESPONDIA (Registro Ibero-americano de Espondiloartrites). Dados demográficos e clínicos de 1472 pacientes foram colhidos, e aplicaram-se questionários padronizados de avaliação de mobilidade axial, de qualidade de vida, de envolvimento entesítico, de atividade de doença e de capacidade funcional. Exames laboratoriais e radiográficos foram realizados. Objetivamos, neste presente artigo, comparar as características clínicas, epidemiológicas, genéticas, imagenológicas, de tratamento e prognóstico de enteroartríticos com os outros espondiloartríticos nesta grande coorte brasileira. RESULTADOS: Foram classificados como enteroartrite 3,2% dos pacientes, sendo que 2,5% tinham espondilite e 0,7%, artrite (predomínio periférico). O subgrupo de indivíduos com enteroartrite apresentava maior prevalência de mulheres (P < 0,001), menor incidência de dor axial inflamatória (P < 0,001) e de entesite (P = 0,004). O HLA-B27 foi menos frequente no grupo de enteroartríticos (P = 0,001), mesmo se considerado apenas aqueles com a forma axial pura. Houve menor prevalência de sacroiliíte radiológica (P = 0,009) e também menor escore radiográfico (BASRI) (P = 0,006) quando comparado aos pacientes com as demais espondiloartrites. Também fizeram mais uso de corticosteroides (P < 0,001) e sulfassalasina (P < 0,001) e menor uso de anti-inflamatórios não hormonais (P < 0,001) e metotrexato (P = 0,001). CONCLUSÃO: Foram encontradas diferenças entre as enteroartrites e as demais espondiloartrites, principalmente maior prevalência do sexo feminino, menor frequência do HLA-B27, associados a uma menor gravidade do acometimento axial.
Inflammatory bowel diseases (Crohn's disease and ulcerative rectocolitis) have extraintestinal manifestations 25% of the patients, with the most common one being the enteropathic arthritis. METHODS: Prospective, observational, multicenter study with patients from 29 reference centers participating in the Brazilian Registry of Spondyloarthritis (RBE), which incorporates the RESPONDIA (Ibero-American Registry of Spondyloarthritis) group. Demographic and clinical data were collected from 1472 patients and standardized questionnaires for the assessment of axial mobility, quality of life, enthesitic involvement, disease activity and functional capacity were applied. Laboratory and radiographic examinations were performed. The aim of this study is to compare the clinical, epidemiological, genetic, imaging, treatment and prognosis characteristics of patients with enteropathic arthritis with other types of spondyloarthritis in a large Brazilian cohort. RESULTS: A total of 3.2% of patients were classified as having enteroarthritis, 2.5% had spondylitis and 0.7%, arthritis (peripheral predominance). The subgroup of individuals with enteroarthritis had a higher prevalence in women (P < 0.001), lower incidence of inflammatory axial pain (P < 0.001) and enthesitis (P = 0.004). HLA-B27 was less frequent in the group with enteroarthritis (P = 0.001), even when considering only those with the pure axial form. There was a lower prevalence of radiographic sacroiliitis (P = 0.009) and lower radiographic score (BASRI) (P = 0.006) when compared to patients with other types of spondyloarthritis. They also used more corticosteroids (P < 0.001) and sulfasalazine (P < 0.001) and less non-steroidal anti-inflammatory drugs (P < 0.001) and methotrexate (P = 0.001). CONCLUSION: There were differences between patients with enteroarthritis and other types of spondyloarthritis, especially higher prevalence of females, lower frequency of HLA-B27, associated with less severe axial involvement.
https://doi.org/10.1016/j.rbr.2013.04.001
6793 downloads
14.
Baixa prevalência das manifestações extra-articulares renais, cardíacas, pulmonares e neurológicas nas espondiloartrites: análise do Registro Brasileiro de Espondiloartrites
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Rodrigues, Carlos Ewerton Maia
; Vieira, Walber Pinto
; Bortoluzzo, Adriana B.
; Gonçalves, Célio Roberto
; Silva, José Antonio Braga da
; Ximenes, Antonio Carlos
; Bértolo, Manoel B.
; Ribeiro, Sandra L. E.
; Keiserman, Mauro
; Menin, Rita
; Skare, Thelma L.
; Carneiro, Sueli
; Azevedo, Valderílio F.
; Albuquerque, Elisa N.
; Bianchi, Washington A.
; Bonfiglioli, Rubens
; Campanholo, Cristiano
; Carvalho, Hellen M. S.
; Costa, Izaias P.
; Duarte, Angela P.
; Kohem, Charles L.
; Leite, Nocy H.
; Lima, Sonia A. L.
; Meirelles, Eduardo S.
; Pereira, Ivânio A.
; Pinheiro, Marcelo M.
; Polito, Elizandra
; Resende, Gustavo G.
; Rocha, Francisco Airton C.
; Santiago, Mittermayer B.
; Sauma, Maria de Fátima L. C.
; Valim, Valeria
; Sampaio-Barros, Percival D.
.
OBJETIVO: Descrever as manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas) geralmente não relacionadas às espondiloartrites (EpA) em uma grande coorte de pacientes brasileiros. MÉTODOS: Este estudo retrospectivo analisou 1.472 pacientes com o diagnóstico de EpA atendidos em 29 centros distribuídos pelas cinco principais regiões geográficas do Brasil, integrantes do Registro Brasileiro de Espondiloartrites. Todos os pacientes foram avaliados para a prevalência das principais manifestações extra-articulares (cardíacas, renais, pulmonares e neurológicas), divididas por diagnóstico [espondilite anquilosante (EA), artrite psoriásica (AP), artrite reativa (ARe), artrite associada a doença inflamatória intestinal (DII), EpA indiferenciada (EI) e EpA juvenil] e por forma clínica (axial, periférica, mista e entesítica). RESULTADOS: Dentre os pacientes avaliados com EpA, 963 apresentavam EA, 271 AP, 49 ARe, 48 artrite associada a DII, 98 EI e 43 EpA juvenil. Acometimento cardíaco foi observado em 44 pacientes (3,0%), seguido por acometimento pulmonar em 19 (1,3%), renal em 17 (1,2%) e neurológico em 13 pacientes (0,9%). A maioria dos casos de acometimento visceral ocorreu nos pacientes com EA ou AP e naqueles com forma clínica mista (axial e periférica) e/ou predominantemente axial. CONCLUSÃO: As manifestações extra-articulares cardíacas, renais, pulmonares e neurológicas são muito pouco frequentes nas EpA, variando de 0,9%-3% nesta grande coorte brasileira, estando mais associadas a EA e AP.
OBJECTIVE: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. MATERIALS AND METHODS: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classified according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). RESULTS: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. CONCLUSION: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA.
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15.
Ocorrência simultânea de síndrome de Evans e anemia falciforme em uma criança de 2 anos
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Brito, Adriana Alexandre
; Leite, Luiz Arthur Calheiros
; Martin, Rúbia Maysa
; Ramos, Fernando Wagner da Silva
; Reis, Simone Medeiros Beder
.
Jornal Brasileiro de Patologia e Medicina Laboratorial
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A associação entre anemia falciforme (AF) e síndrome de Evans (SE) parece ser rara. Esse estudo objetivou relatar o caso de uma criança com AF e SE. A paciente R. M. S. S., 2 anos de idade, foi admitida em um centro hematológico apresentando hemorragia de mucosa, leucometria 20,3 × 10(9)/l, hemoglobina 4,6 g/dl e plaquetas 28 × 10(9)/l. Posteriormente, realizou-se mielograma, que evidenciou hipercelularidade eritroide, sugerindo hemólise. Teste positivo da antiglobulina direcionou o diagnóstico para SE. Iniciou-se pulsoterapia com corticoide até regularização da plaquetometria. Hemácias em foice foram visualizadas no esfregaço sanguíneo; eletroforese de hemoglobina revelou fenótipo SS. A associação parece ter sido fortuita e gerou quadro grave, que deve ser reconhecido prontamente.
The association of sickle cell anemia (SCA) and Evans syndrome (ES) seems to be uncommon. This study aimed to report a case of a child with SCA and SE. 2 year-old R. M. S. S. was admitted into a hematologic center with mucosal bleedings. Exam results revealed leucocyte 20.3 × 10(9)/l, hemoglobin 4.6 g/dl, and platelets 28 × 10(9)/l. Subsequently, myelogram was performed and showed erythroid-hypercellularity, which suggested hemolysis. Positive antiglobulin test corroborated the diagnosis of ES. Corticosteroid pulse therapies were conducted until normalization of platelet count. Sickle cells were detected in blood smears and hemoglobin electrophoresis revealed SS phenotype. Despite the fact the association appears to occur randomly, it causes severe clinical symptoms, which must be promptly recognized.
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