Transverse Myelitis in Systemic Lupus Erythematosus: Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients.

BACKGROUND: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. METHODS: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). RESULTS: Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. CONCLUSIONS: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.

Moedas complementares digitais e políticas públicas durante a crise da COVID-19 / Monedas complementarias digitales y políticas públicas durante la crisis de COVID-19 / Digital complementary currencies and public policies during the COVID-19 pandemic

Resumo Programas de renda básica têm sido utilizados em todo o mundo como uma ferramenta para mitigar os efeitos adversos da crise da COVID-19. No Brasil, a implementação de iniciativas federais de renda básica emergencial (RBE) enfrenta um duplo desafio: a logística de distribuição de dinheiro e os critérios de elegibilidade dos cidadãos. No entanto, iniciativas de moedas complementares existem há muitos anos no Brasil, estando associadas especialmente aos bancos comunitários, os quais operam no nível local e possuem conhecimento mais aprofundado sobre as necessidades dos moradores. Este artigo analisa o uso de moedas digitais complementares no enfrentamento de desafios de distribuição de renda. Apresentamos o caso da moeda complementar digital Mumbuca E-Dinheiro, adotada pelo município de Maricá (RJ). Discutimos como esta iniciativa permitiu a distribuição de renda de forma rápida e segura com o objetivo de mitigar os efeitos da pandemia da COVID-19 no Brasil. Sugerimos que, no momento atual, a RBE poderia ser paga através do E-dinheiro, começando pelos municípios nos quais ele já atua e depois se expandindo para os demais. A interoperabilidade com outros atores do ecossistema de pagamentos e articulações com governos locais são medidas adicionais para dar escala ao uso das moedas complementares digitais no combate à crise do coronavírus.

Resumen Los programas de ingresos básicos se han utilizado en todo el mundo como una herramienta para mitigar los efectos adversos de la crisis de COVID-19. En Brasil, la implementación de iniciativas federales de ingresos básicos de emergencia enfrenta un doble desafío: la logística de distribución de dinero y los criterios de elegibilidad de los ciudadanos. Las iniciativas monetarias complementarias han existido en Brasil durante muchos años y están asociadas especialmente con bancos comunitarios, instituciones que operan a nivel local y tienen un conocimiento más profundo sobre las necesidades de los residentes. Este artículo examina el uso de monedas complementarias digitales para enfrentar los desafíos de distribución de ingresos. Presentamos el caso de la moneda complementaria digital Mumbuca E-Dinheiro adoptada por el municipio de Maricá (RJ) y discutimos cómo esta iniciativa permitió la distribución de ingresos de manera rápida y segura para mitigar los efectos de la pandemia de COVID-19 en Brasil. Sugerimos que, en el momento actual, los ingresos básicos de emergencia podrían pagarse a través de la plataforma E-Dinheiro, comenzando por los municipios en que esta plataforma ya opera y luego expandiéndose a los demás. La interoperabilidad con otros actores del ecosistema de pagos y los vínculos con los gobiernos locales son medidas adicionales para ampliar el uso de monedas complementarias digitales en la lucha contra la crisis del coronavirus.

Abstract Basic income programs have been used worldwide as a tool to mitigate the adverse effects of the COVID-19 pandemic. In Brazil, the implementation of federal emergency basic income initiatives faces a twofold challenge: money distribution logistics and eligibility criteria. This paper analyses the use of digital complementary currencies (DCC) to face these challenges. Complementary currencies have long existed in Brazil as part of community banks. The latter are institutions that operate at the local level and have better information regarding residents' needs. We present the case of Mumbuca E-Dinheiro, a DCC adopted by the municipality of Maricá (RJ), and discuss how this initiative has enabled quick and safe cash distribution aimed at mitigating the effects of the COVID-19 pandemic in Brazil. We suggest that, at present, basic emergency income could be distributed through the E-Dinheiro platform, starting with the municipalities in which it already operates and then expanding to others. Interoperability with other actors in the payment ecosystem and connections with local governments are additional actions to scale up the use of digital complementary currencies to combat the coronavirus crisis.

Construção da agenda de inclusão financeira à luz da Teoria Ator-Rede / Construcción de la agenda de inclusión financiera a la luz de la teoría actor-red / Construction of the financial inclusion agenda in light of the actor-network theory

Resumo Este artigo procurou compreender a atuação dos atores no processo de construção social da agenda de inclusão financeira no Brasil, utilizando a Teoria Ator-Rede (TAR) como lente teórica, visto que a formação da agenda pode ser compreendida como um contínuo processo de associações que envolve diferentes mediadores. Os dados foram coletados por meio de entrevistas semiestruturadas com representantes das instituições envolvidas no processo de construção da agenda em tela, bem como de fontes documentais. A dinâmica do processo de construção da agenda de inclusão financeira foi analisada considerando os quatro momentos da translação (problematização, atração de interesses, recrutamento e mobilização) apresentados na literatura pertinente. Verificou-se que a agenda de inclusão financeira no Brasil é fruto de um processo incremental, que contou com a atuação de uma ampla gama de atores (do governo, do mercado, fomentadores e estudiosos e internacionais) e que foi influenciada por alguns elementos não humanos, destacando-se o Banco Central do Brasil (BCB) como ator focal do processo.

Resumen Este artículo se propuso comprender el papel de los actores en el proceso de construcción social de la agenda de inclusión financiera en Brasil, utilizando la teoría del actor-red (TAR) como lente teórica, ya que la formación de la agenda puede entenderse como un proceso continuo de asociaciones que involucra a diferentes mediadores. Los datos se recolectaron a través de entrevistas semiestructuradas con representantes de las instituciones involucradas en el proceso de construcción de la agenda en cuestión, así como de fuentes documentales. Se analizó la dinámica del proceso de construcción de la agenda de inclusión financiera considerando los cuatro momentos de la traducción (problematización, participación, enrolamiento y movilización) presentados en la literatura relevante. Se comprobó que la agenda de inclusión financiera en Brasil es el resultado de un proceso incremental, al que asistieron una amplia gama de actores (gobierno, mercado, desarrolladores y académicos, así como internacionales) y que fue influenciada por algunos elementos no humanos, entre los que se destaca el Banco Central do Brasil (BCB) como el actor central del proceso.

Abstract This article adopts the perspective of the actor-network theory to understand the role of the actors in the process of social construction of the financial inclusion agenda, considering that agenda-setting can be seen as a continuous process of associations that involves different mediators. Data were collected through semi-structured interviews with representatives of the institutions involved in the process of agenda-setting examined, as well as from documentary sources. The dynamics of the process of developing the financial inclusion agenda were analyzed considering the four moments (problematization, interessement, enrolment, and mobilization) presented in the relevant literature. The research found out that the financial inclusion agenda in Brazil is the result of an incremental process, which was attended by a wide range of actors (government, market, developers and scholars, and also international actors) and it was influenced by some non-human elements, among which the Central Bank of Brazil (BCB) stands out as the focal actor of the process.

Physician's Experience and Disease Activity Affect the Impact of Ultrasound on the Treatment Decision in Rheumatoid Arthritis.

BACKGROUND/OBJECTIVE: The aim of this cross-sectional study was to explore which factors affect the impact of musculoskeletal ultrasound (MUS) on the treatment proposal among rheumatologists with different degree of experience. METHODS: Sixteen clinical vignettes summarized data from rheumatoid arthritis (RA) outpatients; vignettes included clinical evaluation and a blank section for a first treatment proposal; MUS information was then added, based on German Ultrasound score, followed by a blank section for treatment re-consideration, if applicable. During a 6 months period, each vignette was concomitantly presented to six trainees and six senior rheumatologists (SR); three SR had ≥15 years of experience. Participants were blinded to colleagues' responses. Appropriated statistics were used. RESULTS: Vignettes included data from female patients, who had a mean ± SD age of 43.3 ± 9 years, 7.6 ± 3.5 years of disease duration and comorbidities (68.8%). MUS induced treatment modification in 24% of evaluations, with similar percentage among SR and trainees. Within SR, more experienced rheumatologists (≥15 years) never translated MUS findings in a different treatment proposal, compared to 34% of those with lesser experience, p ≤ 0.0001. There were 60 clinical scenarios each, with remission and moderate disease activity, and 36 clinical scenarios each, with low and high disease activity. MUS-induced treatment modifications were more frequent in scenarios with low and moderate disease activity, compared to remission and high disease activity, p = 0.008. CONCLUSIONS: Physician's experience and disease activity level affect the impact of MUS on the treatment decision in RA outpatients. RA patients with intermediate disease activity may benefit from MUS incorporation to standard assessments.

Early outcomes in kidney transplant recipients with systemic lupus erythematosus.

Kidney transplant (KT) is the best treatment for patients who progress to end-stage renal disease. Short-term outcomes in patients with systemic lupus erythematosus (SLE) following KT are not well known. To describe the postoperative outcomes and complications in SLE patients undergoing KT, we conducted a case-control study from 2010 to 2015 including SLE recipients compared to non-SLE controls matched by age and sex. Demographics, comorbidities, donor characteristics, and preoperative tests were retrieved. Main outcomes were 30-day postoperative allograft function, development of infectious or non-infectious complications, and mortality. 68 patients (34 SLE, 34 non-SLE) were included. SLE recipients had median disease duration of 9 years; SLEDAI-2K of 2, and SLICC/ACR damage index of 3; 16 (47%) were taking prednisone (median dose 5 mg daily) before KT. SLE recipients had a lower frequency of diabetes (0 vs. 27%, p = 0.002). No differences were found in the development of any complication (50% SLE vs. 47% non-SLE, p = 1.00); infectious (44% vs. 41%, p = 1.00), or non-infectious (15% vs. 21%, p = 1.00). There were no deaths in either group, and none of the SLE recipients presented lupus disease activity 30 days after the KT. Allograft function determined by serum creatinine, estimated glomerular filtration rate, delayed graft function, and allograft loss was similar in both groups (p > 0.05). There were no differences between SLE recipients with and without complications. Early postoperative outcomes in SLE patients who undergo KT, including allograft function, development of infectious, non-infectious complications, and mortality, are similar to patients without SLE.

Cardiac surgery in systemic lupus erythematosus patients: Clinical characteristics and outcomes. / Cirugía cardiaca en pacientes con lupus eritematoso sistémico: características clínicas y desenlaces.

OBJECTIVES: To study the clinical characteristics and outcomes in systemic lupus erythematosus (SLE) patients who underwent cardiac surgery. METHODS: Retrospective analysis of 30 SLE patients who underwent cardiac surgery at a single center. Demographics, comorbidities, clinical and serologic characteristics, cardiovascular risk scores and treatment were recorded. Type of surgery, postoperative complications, mortality and histology were analyzed. RESULTS: Disease duration at surgery was 2 years. Valve replacement was the procedure most frequently performed (53%), followed by pericardial window (37%). At least one postoperative complication developed in 63% (mainly infections). An aortic cross-clamp time≥76minutes was associated with at least one postoperative complication (OR 6.4, 95% CI 1.1-35.4, p=.03). Early death occurred in 5 patients (17%) and late in 3 (10%); main causes were sepsis and heart failure. Disease activity was associated with pericardial window (OR 12.6, 95% CI 1.9-79, p=.007); lymphopenia≤1.200 (OR 10.1, 95% CI 1.05-97, p=.04); age≤30 years (OR 7.7, 95% CI 1.2-46.3, p=.02); and New York Heart Association class III (OR 7.0, 95% CI 1.1-42, p=.03). Postoperative infection was associated with length of hospital stay≥2 weeks (OR 54.9, 95% CI 5.0-602.1, p=.001); intensive care unit stay≥10 days (OR 20, 95% CI 1.6-171.7, p=.01); duration of mechanical ventilation≥5 days (OR 16.9, 95% CI 1.5-171.7, p=.01); and pulmonary artery systolic pressure≥50mmHg (OR 7.8, 95% CI 1.4-41.2, p=.01). CONCLUSIONS: Cardiac surgery in SLE confers high morbidity and mortality. SLE-specific preoperative risk scores should be designed to identify prognostic factors.

Comunidade e reconhecimento nas relações econômicas / Community and recognition in economic relations

A redução da pobreza exige esforços sociais em vários campos, e entre eles estão aqueles que se referem a políticas públicas, geração de renda e mobilização de (recursos) sociais. A construção de diagnósticos e intervenções para a redução da pobreza exige, também, a colaboração de diferentes saberes sobre a sociedade, em especial gestão pública, psicologia social e finanças. A pesquisa aqui apresentada tem como objetivo investigar a contribuição da comunidade em seus aspetos sociais, organizativos e econômicos, para viabilização e impacto de programas de microcrédito produtivo, com atenção específica aos impactos relativos a redução da pobreza e inclusão social. Foram realizados grupos de discussão, entrevistas fechadas e entrevistas semidirigidas a mulheres moradoras de uma favela na cidade de São Paulo. Os resultados indicam que, para utilizar o microcrédito produtivo, é possível considerar o capital social como garantia, mas a capacidade de sua utilização pelas pessoas envolve complexas mediações entre o capital, a fragilidade relacional e a luta por reconhecimento.

Poverty reduction requires social efforts in several fields, such as those related to public policies, income generation and mobilization of social resources. Building diagnostics and interventions aiming at poverty reduction also requires the collaboration of different knowledge on society, particularly on public administration, social psychology and finances. This research aims at investigating how the community contributes in its social, organizational and economical aspects for making feasible and impacting productive microcredit programs, with particular attention to consequences related to poverty reduction and social inclusion. Discussion groups, closed and semi-structured interviews were conducted with women living in a slum in Sao Paulo. Results indicate that, in order to use a productive microcredit, it is possible to consider the social capital as guarantee, but the ability to use it involves complex mediations between capital, relational fragility and struggle for recognition.