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1.
Scand J Rheumatol ; : 1-9, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38314784

RESUMO

OBJECTIVE: Inflammation markers, e.g. C- reactive protein (CRP) and sedimentation rate, can be normal despite active vasculitis. Von Willebrand factor (vWF) is secreted from endothelial cells in response to vascular damage. Some reports suggest increased vWF levels in vasculitis. This study aimed to evaluate vWF serum concentration in vasculitis patients as a possible biomarker of disease activity and to review the current literature. METHOD: Adult patients with systemic vasculitis were prospectively enrolled. Disease activity was recorded using the Birmingham Vasculitis Activity Score (BVAS) version 3. Blood group-adjusted vWF antigen serum level was evaluated at diagnosis and, when available, after treatment. RESULTS: Twenty-five vasculitis patients were compared to 15 healthy controls. The mean age of patients was 56 ± 17 years and 56% were women. Forty percent had anti-neutrophil cytoplasmic autoantibody-associated vasculitis, 20% giant cell arteritis, 16% polyarteritis nodosa, 8% Takayasu arteritis, and the rest had other vasculitides. The mean disease duration was 3.4 ± 4.8 years. Mean vWF was higher in patients with active vasculitis than in healthy controls (212 ± 81% vs 106 ± 26%, p < 0.001). vWF levels directly correlated with BVAS. In 13 patients with active vasculitis who reached remission or low disease activity after treatment, vWF level at follow-up decreased significantly. In three out of five patients who were treated with interleukin-6 inhibitors, vWF was elevated despite normal CRP levels, while vasculitis was clinically active. CONCLUSION: vWF antigen serum level is increased in active vasculitis and could potentially serve as a biomarker for active disease.

2.
Actas Urol Esp (Engl Ed) ; 47(9): 588-597, 2023 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37355207

RESUMO

INTRODUCTION: Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. MATERIALS AND METHODS: We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up. RESULTS: No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. DISCUSSION AND CONCLUSIONS: The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.


Assuntos
Incontinência Urinária por Estresse , Incontinência Urinária , Coelhos , Humanos , Masculino , Animais , Incontinência Urinária por Estresse/cirurgia , Uretra/cirurgia , Uretra/patologia , Mioblastos/patologia , Engenharia Tecidual
3.
BMC Cancer ; 18(1): 262, 2018 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514651

RESUMO

BACKGROUND: The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands. METHODS: Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable). RESULTS: The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion. CONCLUSIONS: This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands.


Assuntos
Neoplasias da Mama/epidemiologia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Intraductal não Infiltrante/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/economia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/economia , Carcinoma Intraductal não Infiltrante/patologia , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Prognóstico , Sistema de Registros , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
4.
Eur J Clin Microbiol Infect Dis ; 32(3): 305-16, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23242464

RESUMO

The primary objective of this meta-analysis was to estimate the prevalence of adult community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae in Europe, adjusted for possible independent covariates. Two reviewers conducted a systematic literature search using PubMed on English-language articles that involved human subjects with CAP during the period from January 1990 to November 2011 across European countries. A mixed-effects meta-regression model was developed and populated with 24,410 patients obtained from 77 articles that met the inclusion criteria. The model showed that the observed prevalence of S. pneumoniae in CAP significantly varies between European regions, even after adjusting for explanatory covariates, including patient characteristics, diagnostic tests, antibiotic resistance, and health-care setting. The probability of detecting S. pneumoniae was substantially higher in studies that performed more frequently a diagnostic polymerase chain reaction assay compared to all the other diagnostic tests included. Furthermore, S. pneumoniae was more likely to be confirmed as the cause of a CAP in studies with intensive care unit patients as compared to those with hospital- or community-treated patients. This study provides estimates of the average observed prevalence of S. pneumoniae, which could be used for projecting the health and economic benefits of pneumococcal immunization.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Adulto , Infecções Comunitárias Adquiridas/microbiologia , Europa (Continente)/epidemiologia , Humanos , Pneumonia Pneumocócica/microbiologia , Prevalência
6.
Vaccine ; 30(31): 4691-700, 2012 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-22561315

RESUMO

INTRODUCTION: Respiratory syncytial virus (RSV) infection is one of the major causes of respiratory illness in infants, infecting virtually every child before the age of 2 years. Currently, several Phase 1 trials with RSV vaccines in infants are ongoing or have been completed. As yet, no efficacy estimates are available for these vaccine candidates. Nevertheless, cost-effectiveness estimates might be informative to enable preliminary positioning of an RSV vaccine. METHODS: A decision analysis model was developed in which a Dutch birth cohort was followed for 12 months. A number of potential vaccination strategies were reviewed such as vaccination at specific ages, a two- or three-dosing scheme and seasonal vaccination versus year-round vaccination. The impact of the assumptions made was explored in various sensitivity analyses, including probabilistic analysis. Outcome measures included the number of GP visits, hospitalizations and deaths, costs, quality-adjusted life years and incremental cost-effectiveness ratios (ICERs). RESULTS: Currently, without vaccination, an annual number of 28,738 of RSV-related GP visits, 1623 hospitalizations, and 4.5 deaths are estimated in children in the age of 0-1 year. The total annual cost to society of RSV in the non-vaccination scenario is €7.7 million (95%CI: 1.7-16.7) and the annual disease burden is estimated at 597 QALYs (95%CI: 133-1319). In case all infants would be offered a potentially safe and effective 3-dose RSV vaccination scheme at the age of 0, 1 and 3 months, the total annual net costs were estimated to increase to €21.2 million, but 544 hospitalizations and 1.5 deaths would be averted. The ICER was estimated at €34,142 (95%CI: € 21,652-€ 87,766) per QALY gained. A reduced dose schedule, seasonal vaccination, and consideration of out-of-pocket expenses all resulted in more favorable ICER values, whereas a reduced vaccine efficacy or a delay in the timing of vaccination resulted in less favorable ICERs. DISCUSSION: Our model used recently updated estimates on the burden of RSV disease in children and it included plausible utilities. However, due to the absence of clinical trial data, a number of crucial assumptions had to be made related to the characteristics of potential RSV vaccine. The outcomes of our modeling exercise show that vaccination of infants against RSV might be cost-effective. However, clinical trial data are warranted.


Assuntos
Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vacinas contra Vírus Sincicial Respiratório/economia , Vacinação/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Humanos , Lactente , Modelos Econômicos , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida
7.
Clin Rheumatol ; 31(5): 885-8, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22234494

RESUMO

The role of regulatory T cells (T-regs) in familial Mediterranean fever (FMF) was never evaluated. Preliminary studies that we have conducted suggested a rise in the number of regulatory T cells after FMF attacks reaching a maximal level at 7 days. The aim of this study was to evaluate the percentage and activity of regulatory T cells in FMF. Six patients with refractory FMF and six healthy controls were evaluated. The percentage of T-reg cells and forkhead box protein 3 (Foxp3) expression was evaluated and compared between four states: FMF in remission, FMF at the first day of an attack, FMF 7 days after the start of the attack, and healthy controls. Four females and two males were included. All patients had FMF with high severity score, 2.8 ± 0.4 (0-3). The mean age was 31.6 ± 6.2. The mean age at onset was 9.3 ± 9.3. The mean colchicine dose was 2.6 mg ± 0.4. The expression of Foxp3 7 days after the attacks was significantly higher than in FMF at the first day of the attack, FMF in remission, and healthy controls 10.08 ± 2.36 vs. 7.005 ± 0.3 vs. 5.3 ± 1.06 vs. 4.44 ± 1.8; p < 0.05 (Fig.1). The percentage of T-regs in peripheral blood was not statistically different between the four groups. Theexpression of Foxp3 by T-regs increases 7 days after attacks of FMF. Anti-inflammatory cytokines interleukin-10 and TGF-ß are known to activate T-regs and have been reported to increase in FMF attacks in line with the present findings. It is suggested that T-regs may have a role in terminating FMF attacks.


Assuntos
Febre Familiar do Mediterrâneo/patologia , Linfócitos T Reguladores/patologia , Adulto , Biomarcadores/metabolismo , Colchicina/uso terapêutico , Febre Familiar do Mediterrâneo/tratamento farmacológico , Febre Familiar do Mediterrâneo/imunologia , Febre Familiar do Mediterrâneo/metabolismo , Feminino , Fatores de Transcrição Forkhead/metabolismo , Humanos , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Contagem de Linfócitos , Masculino , Indução de Remissão , Índice de Gravidade de Doença , Linfócitos T Reguladores/imunologia , Linfócitos T Reguladores/metabolismo
8.
Epidemiol Infect ; 140(8): 1503-14, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22115361

RESUMO

The aim of this study was to investigate the optimal pertussis booster vaccination strategy for The Netherlands. A realistic age-structured deterministic model was designed. Assuming a steady-state situation and correcting for underreporting, the model was calibrated using notification data from the period 1996-2000. Several sensitivity analyses were performed to explore the impact of different assumptions for parameters surrounded by uncertainty (e.g. duration of protection after natural infection, underreporting factors, and transmission probabilities). The optimal age of an additional booster dose is in the range of 10-15 years, and implementation of this booster dose will reduce both symptomatic and asymptomatic infections, although the incidence of symptomatic infections in older age groups will increase. The impact of the different assumptions used in the model was in general limited. We conclude that over a wide range of assumptions, an additional booster dose can reduce the incidence of pertussis in the population.


Assuntos
Esquemas de Imunização , Imunização Secundária , Modelos Biológicos , Vacina contra Coqueluche/imunologia , Coqueluche/epidemiologia , Coqueluche/prevenção & controle , Adolescente , Adulto , Idoso , Algoritmos , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vacina contra Coqueluche/administração & dosagem , Vacinação , Adulto Jovem
9.
Lik Sprava ; (1-2): 80-94, 2009.
Artigo em Russo | MEDLINE | ID: mdl-19957399

RESUMO

The article presents results of studies. These results show dependence of life expectancy from the social status and intellectual activity. Quality of life of scientists of advanced age in comparison with other pensioners has been analyzed. Continuation of scientific activity became guarantee of their health and longevity.


Assuntos
Emigrantes e Imigrantes , Inteligência/fisiologia , Longevidade/fisiologia , Idoso , Idoso de 80 Anos ou mais , Emigrantes e Imigrantes/psicologia , Humanos , Qualidade de Vida , Classe Social , Inquéritos e Questionários , Estados Unidos
11.
Vaccine ; 27(7): 1119-26, 2009 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-19071185

RESUMO

Influenza and respiratory syncytial virus (RSV) infections are responsible for considerable morbidity, mortality and health-care resource use. For the Netherlands, we estimated age and risk-group specific numbers of antibiotics, otologicals and cardiovascular prescriptions per 10,000 person-years during periods with elevated activity of influenza or RSV, and compared these with peri-season rates. Data were taken from the University of Groningen in-house prescription database (www.iadb.nl) and virological surveillance for the period 1998-2006. During influenza and RSV periods excess antibiotic prescriptions were estimated for all age groups. In the age groups 0-1 and 2-4 years, excess antibiotic prescriptions during periods with elevated RSV activity (65% and 59% of peri-seasonal rates) exceeded the surpluses estimated during the influenza-activity periods (24% and 34% of peri-seasonal rates) while for otologicals excess prescriptions were higher for influenza (22% and 27%) than for RSV (14% and 17%). Among persons of 50 years and older, notably those without medical high-risk conditions, excess prescriptions for cardiovascular medications were estimated during the influenza periods at approximately 10% (this was also already seen in persons aged 45-49). Our results may have implications for influenza vaccination policies. In particular, extension of influenza vaccination to groups of non-elderly adults and young children may lower excess prescriptions during these influenza periods for all three types of drug prescriptions investigated.


Assuntos
Anti-Infecciosos/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
12.
Int J STD AIDS ; 19(10): 668-75, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18824618

RESUMO

This paper provides an estimation of the lifetime health-care cost of HIV-infected children and an update of the cost-effectiveness of universal HIV-screening of pregnant women in Amsterdam (The Netherlands). During 2003-2005, we collected data concerning the prevalence of newly diagnosed HIV-infected pregnant women in Amsterdam. Also, data on resource utilization and HAART regimen for HIV-infected children was gathered from a national registry. Using Kaplan-Meier survival analysis, we estimated the life-expectancy of a vertically HIV-infected child at 19 years, with the corresponding lifetime health-care costs of 179,974 Euros. HIV-screening of pregnant women could prevent 2.4 HIV transmissions annually in Amsterdam, based on an estimated prevalence of nine yet undiagnosed HIV-positive pregnant women per 10,000 pregnancies. We show that universal HIV screening during pregnancy generates significant net cost savings and health benefits in most situations. Universal antenatal HIV screening is justified in Amsterdam from a health-economic point of view.


Assuntos
Sorodiagnóstico da AIDS/economia , Infecções por HIV/diagnóstico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Programas de Rastreamento/economia , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Terapia Antirretroviral de Alta Atividade/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Custos de Cuidados de Saúde , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/economia , Países Baixos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Anos de Vida Ajustados por Qualidade de Vida
13.
Lik Sprava ; (3-4): 123-35, 2008.
Artigo em Russo | MEDLINE | ID: mdl-19145833

RESUMO

The article presents experience of the assessment of labour quality and professionalism of medical personnel (physicians and nurses) after the study conducted in 20 medical institutions in Kiev and 20 in Moscow. Expert-points method of assessment was used, correlation analysis of finalized qualifying assessment and social status of staff in each department was the mechanism of check of obtained results. Quality of life of population depends a lot on professionalism of specialists (physicians, teachers, scientists and others). The article presents results of four year (2003-2006) study of quality of life of four generations of Ukrainians aged from 11 to 85 years. Regularity was revealed in different sides of life of four group of responders, including personal, behavioral and psychological aspects.


Assuntos
Competência Clínica , Pessoal de Saúde/psicologia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade de Vida/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Moscou , Testes Psicológicos , Fatores Socioeconômicos , Ucrânia , Adulto Jovem
15.
J Clin Rheumatol ; 13(3): 124-7, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17551376

RESUMO

BACKGROUND: Behcet's disease (BD) is known to vary in severity and manifestations in different populations. OBJECTIVE: In an attempt to sort out genetic and environmental influences on disease expression, we carried out a study to assess the clinical features of BD in the adult Druze and Arab populations in north Israel, comparing 2 disparate ethnic groups of similar genetic background inhabiting the same geographic region. METHODS: We compared 23 Druze and 30 Arab patients with BD. All patients fulfilled the classification criteria of the International Study Group for BD. RESULTS: Manifestations were similar in 2 groups. The most frequent BD manifestations among the Druzes were recurrent oral aphthae (100%) and genital aphthae (61%) versus 100% and 53% in Arab patients, followed by inflammatory ocular involvement, 65% versus 53%, respectively. Arthritis was noted in 39% of Druze, with 27% in Arabs. Anterior uveitis occurred in 9 Druze patients (48%) and panuveitis in 4, with no case of blindness when compared with 30% with anterior uveitis, 4 with panuveitis, and 4 cases of blindness (P < 0.04) among the Arabs. One Druze BD patient had deep vein thrombosis versus 8 Arab patients (P < 0.017). No pulmonary embolism, aortic aneurysm, nor valvular involvement was documented in the Druze versus 1 case of each in Arabs. No case of neuro-Behcet was reported in Druzes versus 6 cases of neuro-Behcet among Arabs (P < 0.023). The severity score was 4.0 (SD, 1.2) in Druze and 5.8 (SD, 1.9) in Arabs (P = 0.0004). The prevalence of HLA B51 did not differ significantly between the groups. CONCLUSION: Druze BD patients in Israel have a milder disease than do Arabs, similar to observations in familial Mediterranean fever. Druze BD patients had significantly less severe ocular disease and neurologic manifestations. Our results suggest an ethnic influence on expression of BD not related to HLA B 51.


Assuntos
Síndrome de Behçet/etnologia , Etnicidade , Índice de Gravidade de Doença , Adulto , Árabes , Artrite/etnologia , Artrite/etiologia , Síndrome de Behçet/complicações , Cegueira/etnologia , Cegueira/etiologia , Feminino , Doenças dos Genitais Femininos/etnologia , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Masculinos/etnologia , Doenças dos Genitais Masculinos/etiologia , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Úlcera Cutânea/etnologia , Úlcera Cutânea/etiologia , Estomatite Aftosa/etnologia , Estomatite Aftosa/etiologia , Uveíte/etnologia , Uveíte/etiologia , Trombose Venosa/etnologia , Trombose Venosa/etiologia
16.
Ann Rheum Dis ; 66(6): 818-20, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17148544

RESUMO

OBJECTIVE: To assess changes in macrophage phenotype and function after rituximab-induced B cell depletion in patients with rheumatoid arthritis (RA). METHODS: 10 patients with RA were treated with rituximab, achieving significant B cell depletion 4 months later. Clinical improvement, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, mRNA of B cell activating factor (BAFF), interleukin (IL) 10 and CD86 in human monocyte-derived macrophages (HMDMs) and tumour necrosis factor alpha (TNFalpha) secretion from cultured HMDMs were assessed at baseline and after the depletion. RESULTS: A clinical response of American College of Rheumatology (ACR) 50% improvement was noted in six patients, and another two patients responded with moderate improvement, equivalent to ACR 20-50% improvements. RF and anti-CCP antibodies were positive at baseline in seven of ten patients. RF disappeared or declined in six patients 4 months after treatment, correlating with clinical improvement. By contrast, anti-CCP remained unchanged in six patients. After rituximab treatment, and in association with clinical improvement, BAFF, IL10 and CD86 mRNA expression in HMDM were significantly upregulated compared with values at baseline. A significant decrease in TNFalpha in the supernatant of cultured HMDM was also noted. CONCLUSIONS: In addition to B cell depletion and attenuation in some of the specific autoantibodies, clinical improvement in rituximab-treated patients with RA occurred in association with changes in macrophage function.


Assuntos
Anticorpos Monoclonais/farmacologia , Antirreumáticos/farmacologia , Artrite Reumatoide/tratamento farmacológico , Macrófagos/efeitos dos fármacos , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Fator Ativador de Células B/biossíntese , Linfócitos B/efeitos dos fármacos , Antígeno B7-2/biossíntese , Células Cultivadas , Feminino , Humanos , Interleucina-10/biossíntese , Contagem de Linfócitos , Depleção Linfocítica , Macrófagos/imunologia , Masculino , Pessoa de Meia-Idade , Peptídeos Cíclicos/imunologia , Fator Reumatoide/sangue , Rituximab , Índice de Gravidade de Doença , Resultado do Tratamento , Fator de Necrose Tumoral alfa/biossíntese
18.
J Autoimmun ; 27(2): 134-9, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17029886

RESUMO

In this study we aimed to determine whether serum B-lymphocyte activating factor (BAFF) level is increased in patients with chronic hepatitis C virus (HCV) infection, and to assess its association with HCV-related autoimmunity. Sixty-five patients with chronic HCV infection were compared with two disease control groups [57 patients with systemic lupus erythematosus (SLE) and 15 with chronic hepatitis B virus (HBV) infection] and a healthy control group of 35 individuals. A special attention was given to HCV-related arthralgia and or vasculitis. Serum BAFF was assessed in all studied individuals, whereas rheumatoid factor (RF), anti-cardiolipin antibodies (aCL), and cryoglobulins were determined in HCV and HBV infected patients, and anti-dsDNA antibodies and aCL were assessed in patients with SLE. Mean serum BAFF was increased in patients with HCV infection and SLE (2.4+/-0.8 ng/ml and 3.1+/-1.34 ng/ml respectively) compared to 1.1+/-0.14 ng/ml in patients with HBV; and to 1.1+/-0.27 in healthy controls (all, p<0.0001). The elevation in serum BAFF was associated with HCV-related arthralgia and or vasculitis (p<0.0001), and with the presence of aCL and of cryoglobulins. HBV patients lacked features suggestive of autoimmunity. In SLE patients, elevated serum BAFF was in association with the presence of anti-dsDNA (p=0.002). As in other autoimmune diseases, increased serum BAFF was also found in patients with chronic HCV infection. Elevated serum BAFF levels were associated with clinical and laboratory features of autoimmunity, suggesting that BAFF may play a role in HCV-related autoimmunity.


Assuntos
Autoantígenos/sangue , Fator Ativador de Células B/sangue , Hepatite C Crônica/complicações , Lúpus Eritematoso Sistêmico/complicações , Adulto , Autoanticorpos/sangue , Feminino , Hepatite C Crônica/sangue , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/virologia , Masculino , Pessoa de Meia-Idade
19.
Emerg Med J ; 23(9): 667-71, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16921075

RESUMO

Complications of systemic rheumatic diseases frequently have protean manifestations and may present a diagnostic problem. Patients with connective tissue diseases and vasculitides may have dangerous or life threatening conditions, which must be recognised and treated promptly to prevent rapidly evolving morbidity and mortality. Knowledge of possible emergencies in the context of a defined rheumatic disease may aid in promoting a high index of suspicion and contribute significantly to the timely diagnosis of many potentially dangerous conditions. This review is written for the emergency room physician and discusses the early recognition of selected emergencies in the context of a defined rheumatic disease.


Assuntos
Medicina de Emergência/métodos , Doenças Reumáticas/diagnóstico , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/etiologia , Aortite/diagnóstico , Aortite/etiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Tamponamento Cardíaco/complicações , Tamponamento Cardíaco/etiologia , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Nefropatias/diagnóstico , Nefropatias/etiologia , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Mielite Transversa/diagnóstico , Mielite Transversa/etiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/terapia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Insuficiência Vertebrobasilar/diagnóstico , Insuficiência Vertebrobasilar/etiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
20.
Clin Exp Rheumatol ; 24(2 Suppl 41): S41-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16859596

RESUMO

OBJECTIVE: To review the prevalence, mechanisms, presentations and clinical significance of aortic involvement in rheumatic inflammatory diseases. METHODS: The medical literature, available through a PUBMED search was reviewed and the relevant information was summarized. In addition, selected articles related to aortic involvement in rheumatic diseases were included in this review. RESULTS: Rheumatic disorders may be categorized by their propensity to involve the aorta: conditions with a prevalence of 10% and more (Takayasu's arteritis, temporal arteritis, long-standing ankylosing spondylitis, Cogan's syndrome and relapsing polychondritis), disorders with uncommon but well documented aortic involvement and rheumatic conditions with rare case reports of such involvement. Clinical presentation of aortic disease is dependent on the part of aorta involved and may manifest by aortic pain and/or other symptoms caused by aortic dilatation, narrowing or aneurysm. The histopathology of inflammatory aortitis is characterized by lymphoplasmacytic infiltration with or without giant cells or granulomas. On the other hand, non-inflammatory aortic damage in rheumatic diseases may include Marfan-like cystic disintegration of the aortic media as well as accelerated atherosclerosis. Awareness of rheumatic conditions with a high potential for clinically significant aortic involvement may promote referral of such patients for aortic imaging and sometimes surgery before fatal complications intervene. CONCLUSION: Early diagnosis of aortic involvement can be advanced by informed consideration of such a complication in a rheumatic patient.


Assuntos
Doenças da Aorta/etiologia , Doenças Reumáticas/complicações , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/fisiopatologia , Doenças da Aorta/terapia , Humanos , Inflamação , Doenças Reumáticas/patologia , Doenças Reumáticas/fisiopatologia , Ultrassonografia
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