SERONEGATIVE CELIAC DISEASE IN BRAZILIAN PATIENTS: A SERIES OF CASES.

BACKGROUND: Celiac disease (CD) is an autoimmune disease characterized by immune reaction mostly to wheat gluten. The diagnosis is based on clinical, serological and histological findings in patients ingesting gluten. Cases that the clinical profile indicates CD and the autoantibodies are negative bring so a dilemma for the professional, as the risk of missed the diagnosis or a delay at the same. OBJECTIVE: To show the importance of correct diagnosis of cases with seronegative celiac disease (SNCD). METHODS: Ten cases of SNCD Brazilian patients were retrospectively studied (2013 to 2019). Data of clinical complaints, autoantibodies, IgA serum levels, histological findings and HLA-DQ2/DQ-8 were compiled. Dual-X densitometry, delay at diagnosis, previous autoimmune diseases and family history of CD were also checked. RESULTS: All SNCD patients presented clinical symptoms of CD, with confirmed diagnosis by histological findings of the duodenal mucosa and HLA-DQ2 and/or HLA-DQ8 positivity. All patients had normal IgA levels and negative autoantibodies (IgA-anti-transglutaminase and anti-endomysial). Dual-X densitometry detected osteopenia in two women and osteoporosis in two males, all with low levels of vitamin D. Delay diagnostic ranged from 1 to 19 years. Familiar occurrence of CD was reported in 40% of the cases. After one year of gluten-free diet, eight patients refer improve of symptoms, while duodenal biopsies, done in five cases, showed histological improvement. CONCLUSION: Patients who demonstrate the clinical profile of celiac disease with negative serology and normal levels of IgA, especially those who have family members with celiac disease, should be submitted to duodenal biopsies to look for histological findings.

Doença celíaca soronegativa em pacientes brasileiros: uma série de casos / Seronegative celiac disease in brazilian patients: a series of cases

ABSTRACT BACKGROUND: Celiac disease (CD) is an autoimmune disease characterized by immune reaction mostly to wheat gluten. The diagnosis is based on clinical, serological and histological findings in patients ingesting gluten. Cases that the clinical profile indicates CD and the autoantibodies are negative bring so a dilemma for the professional, as the risk of missed the diagnosis or a delay at the same. OBJECTIVE: To show the importance of correct diagnosis of cases with seronegative celiac disease (SNCD). METHODS: Ten cases of SNCD Brazilian patients were retrospectively studied (2013 to 2019). Data of clinical complaints, autoantibodies, IgA serum levels, histological findings and HLA-DQ2/DQ-8 were compiled. Dual-X densitometry, delay at diagnosis, previous autoimmune diseases and family history of CD were also checked. RESULTS: All SNCD patients presented clinical symptoms of CD, with confirmed diagnosis by histological findings of the duodenal mucosa and HLA-DQ2 and/or HLA-DQ8 positivity. All patients had normal IgA levels and negative autoantibodies (IgA-anti-transglutaminase and anti-endomysial). Dual-X densitometry detected osteopenia in two women and osteoporosis in two males, all with low levels of vitamin D. Delay diagnostic ranged from 1 to 19 years. Familiar occurrence of CD was reported in 40% of the cases. After one year of gluten-free diet, eight patients refer improve of symptoms, while duodenal biopsies, done in five cases, showed histological improvement. CONCLUSION: Patients who demonstrate the clinical profile of celiac disease with negative serology and normal levels of IgA, especially those who have family members with celiac disease, should be submitted to duodenal biopsies to look for histological findings.

RESUMO CONTEXTO: A doença celíaca (DC) é uma doença autoimune caracterizada por reação imune principalmente ao glúten do trigo. O diagnóstico é baseado em achados clínicos, sorológicos e histológicos em pacientes que ingerem glúten. Casos em que o perfil clínico indica DC e os autoanticorpos são negativos trazem um dilema para o profissional, como o risco de não realizar ou atrasar o diagnóstico da DC. OBJETIVO: Mostrar a importância do diagnóstico correto de casos com doença celíaca soronegativa (DCSN). MÉTODOS: Dez casos de pacientes brasileiros com DCSN foram estudados retrospectivamente (2013 a 2019). Foram compilados dados de queixas clínicas, autoanticorpos, níveis séricos de IgA, achados histológicos e HLA-DQ2 / DQ-8. Densitometria, atraso no diagnóstico, doenças autoimunes prévias e histórico familiar de DC também foram verificados. RESULTADOS: Todos os pacientes com DCSN apresentaram sintomas clínicos de DC, com diagnóstico confirmado por achados histológicos da mucosa duodenal e positividade para HLA-DQ2 e/ou HLA-DQ8. Todos os pacientes apresentavam níveis normais de IgA e autoanticorpos negativos (IgA-anti-transglutaminase e anti-endomisial). A densitometria detectou osteopenia em duas mulheres e osteoporose em dois homens, todos com baixos níveis de vitamina D. O atraso no diagnóstico variou de 1 a 19 anos. A ocorrência familiar de DC foi relatada em 40% dos casos. Após 1 ano de dieta isenta em glúten, oito pacientes referem melhora dos sintomas, enquanto as biópsias duodenais, realizadas em cinco casos, mostraram melhora histológica. CONCLUSÃO: Pacientes que apresentam quadro clínico de doença celíaca com sorologia negativa e níveis normais de IgA, principalmente aqueles que possuem familiares com doença celíaca, devem ser submetidos à biópsia duodenal para pesquisa de achados histológicos.

Growth performance and gastrointestinal responses in heavy Tom turkeys fed antibiotic free corn-soybean meal diets supplemented with multiple doses of a single strain Bacillus subtilis probiotic (DSM29784)1.

Growth performance and gastrointestinal (GIT) responses to a single-strain of Bacillus subtilis (SSB) were investigated using 960 Hybrid Converter Toms. A total of 4 iso-caloric and iso-nitrogenous corn-soybean meal-based diets were allocated to 12 replicate cages/pens and fed (ad libitum) in a four-phase feeding program (starter; days 0 to 28, grower-1; days 29 to 56, grower-2; days 57 to 84, and finisher; days 85 to 126). The diets had either 0 (control), 1E+08 (low), 2E+08 (mid) or 1E+09 (high) cfu B. subtilis/kg. Feed intake (FI) and BW were recorded by phase. Excreta samples were collected towards the end of starter and grower-1 phases for apparent retention (AR) of components by marker method and litter moisture, respectively. Selected birds were necropsied on days 28 and 56 for GIT weight and samples for jejunal histomorphology and ceca digesta short chain fatty acids (SCFA). Supplemental SSB had linear and non-linear (P < 0.05) response on BW gain (BWG). Specifically, relative to the control, birds fed low SSB had higher BWG in starter and grower-1 phases whereas bird fed mid and high SSB had lower BWG in grower-2 and birds fed low and mid SSB had higher BWG in finisher phase. Consequently, birds fed low and mid SSB doses were heavier (P < 0.05) than control fed birds at the end of trial. The FCR response to SSB was linear and non-linear (P < 0.05) with birds fed low SSB showing lower FCR than control fed birds in starter, grower-1 and finisher phases. Supplemental SSB had linear and non-linear (P < 0.05) effects on AR of components (DM, ash, crude protein, crude fat, neutral detergent fiber, and gross energy), litter moisture, GIT weight, jejunal histomorphology, and SCFA. Relative to control, birds fed high SSB showed higher AR of components, villi height, day 56 ceca digesta total SCFA concentration, and lower litter moisture. In conclusions, under condition of the current study, growth performance was optimized by low to mid SSB. Improved nutrient retention and indices of gut health suggested higher SSB doses may optimize growth performance under challenging farm conditions.

Effect of dietary supplementation of Bacillus subtilis DSM29784 on hen performance, egg quality indices, and apparent retention of dietary components in laying hens from 19 to 48 weeks of age.

The aim of the current study was to evaluate egg production, quality, and apparent retention (AR) of components in response to a multi-dose application of a single strain Bacillus subtilis (SSB; DSM29784) in a corn-soybean meal basal diet fed to hens (19 to 48 wk of age). The treatments consisted of a basal diet with either no probiotic (control, CON), 1.1E+08 (low, LSSB), 2.2E+08 (medium, MSSB) or 1.1E+09 (high, HSSB) CFU/kg of diet. A total of 336, 19-wk old Shaver White layers were used at a stocking density of 7 and 6 hens/replicate-cage in layer I (week-19 to 28) and layer II (week-29 to 48) phases, respectively. Evaluated variables included feed intake (FI), body weight (BW), feed conversion ratio (FCR), egg production, weight, mass, and egg quality (shell thickness, shell breaking strength, albumen height (AH), and Haugh unit (HU)). Excreta was collected at the end of week-28 for AR of components and apparent metabolizable energy (AME). Supplementation of SSB increased (P = 0.008) FI during peak egg-lay (week-24) and BW increased linearly (P = 0.019) in early layer II (week-32). In layer I, LSSB compared with CON increased EM (g/egg) by 3.3% (P = 0.049). In layer II, SSB inclusion tended to improve FCR (linear, P = 0.094; g FI: g EM). Although shell breaking strength was lowest at week-20 with HSSB (4.518 vs. 4.889 kgf for HSSB vs. CON; P = 0.045), AH and HU were improved at higher dose of SSB, in both phases (P ≤ 0.005). Apparent retention of dry matter, AME, and minerals were improved (P < 0.0001) in a dose response. Hence, while the low dose of B. subtilis DSM29784 improved hen performance and maintained egg quality in both phases, a higher dose of SSB improved the interior protein quality of eggs (AH and HU).

Growth performance, apparent retention of components, and excreta dry matter content in Shaver White pullets (5 to 16 week of age) in response to dietary supplementation of graded levels of a single strain Bacillus subtilis probiotic.

Administered in adequate amounts, probiotics can be an alternative to antibiotic growth promoters in poultry production. This study evaluated dose response of a single strain of Bacillus subtilis (SSB, DSM29784) on growth performance, apparent retention (AR) of components, and excreta DM content in pullets. A basal corn-soybean meal diet was formulated to meet the specifications for grower (week 5 to 10) and developer (week 11 to 16) phases. In each phase, SSB was added to the basal diet to create 4 test diets: 0 (control, CON), 1.1E+08 (low; LSSB), 2.2E+08 (medium; MSSB), or 1.1E+09 (high; HSSB) CFU of SSB/kg of feed. All diets had TiO2 (0.5%) as a digestibility marker. A total of 720 day-old Shaver White chicks were placed in 48 cages (15 pullets per cage) and reared on a commercial antibiotic free diet for a 4-wk period. At the beginning of week 5, treatments were allocated based on cage BW (n = 12). Birds had free access to feed and water throughout. The BW, BW uniformity, feed intake (FI) and FCR were obtained weekly. Excreta was collected at the end of each phase for AR of DM, organic matter, CP, neutral detergent fiber, minerals, and AME, as well as excreta DM content. In response to SSB inclusion, BW improved in a linear (P < 0.005) and quadratic (P < 0.0001) manner in grower. FI decreased in a linear and quadratic pattern (P < 0.05, week 8 to 10) in grower, and linearly (P < 0.05) across the developer phase. Overall FCR improved in linear and quadratic pattern (P < 0.01) in the grower phase. In both the phases, AME improved in a quadratic pattern (P < 0.05). Inclusion of SSB had a linear reduction (P < 0.0001) in excreta moisture content in the grower phase. In summary, these results demonstrate that B. subtilis probiotic improved performance through enhanced nutrient utilization and reduced excreta moisture content indicating improved pullet gut health.

Cardiovascular risk and mannose binding lectin in patients with rheumatoid arthritis from southern Brazil.

BACKGROUND: Mannose binding lectin (MBL) appears to be involved in susceptibility to rheumatoid arthritis (RA), in the inflammatory process and in the genesis of atherosclerotic disease. OBJECTIVE: To study the association of MBL serum levels and its genotypic variation with carotid arteries intimal thickness (IMT) in RA patients from Southern Brazil. METHODS: MBL serum levels, MBL2 genotyping and IMT were investigated in 90 RA patients along with their demographic, clinical and laboratory profile. MBL levels and MBL2 genotyping were evaluated in 90 healthy controls. RESULTS: A significant lower MBL serum concentration was observed in patients with RA in relation to controls (528 ng/mL vs 937.5 ng/mL, p = 0.05, respectively). The median IMT in RA patients was 0.59 mm (0.51 to 0.85 mm). There was no correlation between levels of MBL with disease activity, erythrocyte sedimentation rate, autoantibodies presence or IMT (p = NS). A weak and negative correlation was found between MBL and CRP levels (Rho = -0.24; p = 0.02;). The MBL2 variant at codon 54 (variant B) and HYPA haplotype were the most frequently observed in the RA sample (67.5% and 31.7%). MBL2 wild type (A/A) were associated with lower IMT when compared with heterozygotes (A/O; p = 0.04) and low producers (O/O; p = 0.05). In addition, high producers genotypes had lower levels of CRP when compared with medium (p = 0.04) or with low producers (p = 0.05). CONCLUSION: RA patients had lower MBL levels than controls. MBL were negatively associated with CRP serum levels; low MBL genotypes producers increased thickness of the IMT than high producers.

Rheumatic Disease Autoantibodies in Patients with Autoimmune Thyroid Diseases.

BACKGROUND: Patients with autoimmune thyroid diseases (ATD) such as Graves' disease (GD) and Hashimoto thyroiditis (HT) may have non-organ specific autoantibodies such as antinuclear antibodies (ANA) and rheumatoid factor (RF). AIM: To study the prevalence of rheumatic autoantibodies in a group of ATD patients without known rheumatic diseases and to evaluate its association with the patients' epidemiological and treatment profiles. To follow positive non-organ specific autoantibody-positive ATD individuals to investigate whether they will develop a rheumatic disorder. METHODS: A sample of 154 ATD patients (70 HT and 84 GD; mean age 45.3 ± 14.2) had determination of ANA by immunofluorescence, using hep-2 cells as substrate, extractable nuclear antigen profile by ELISA kits and RF by latex agglutination. Epidemiological and treatment profiles were obtained through chart review. These patients were followed for the mean period of 5 years, between 2010 and 2015. RESULTS: Positive ANA was found in 17.5% (27/154) of the patients: anti-Ro/SS-A in 4/154 (2.5%); anti-RNP in 4/154 (2.5%), and anti-La/SS-B in 3/154 (1.9%). None had anti-Sm antibodies. RF was detected in 12/154 (7.7%) of ATD patients and was more common in older individuals (p = 0.007). There was a positive association between the presence of RF and ANA (p = 0.03; OR 3.89; 95% CI 1.1-13.3). None of the patients with positive autoantibodies developed clinical rheumatic diseases during the period of observation. CONCLUSION: We found rheumatic autoantibodies in 17.5% of ATD patients without rheumatic diseases. None of them were associated with the appearance of clinical rheumatic disorder during the period of 5 years.

Evaluation of different dietary alterations in their ability to mitigate the incidence and severity of woody breast and white striping in commercial male broilers.

The following study was conducted to define how multiple nutritional strategies affect broiler performance, meat yield, and the presence and severity of white striping (WS) and woody breast (WB) in high-yielding broilers. Relative to a commercial set of reference broiler diets (Commercial reference diet; Trt 1) that were fed in a 4-phase program, the following nutritional strategies were investigated: increasing the ratio of digestible arginine: digestible lysine (dArg: dLys ranged from 113 to 126; Trt 2), supplementing Trt 1 with 94.4 mg vitamin C/kg feed (Trt 3), doubling the vitamin pack inclusion rate (Trt 4), reducing the digestible amino acid density (dAA) of only the grower phase by 15% and feeding the same Trt 1 starter, finisher, and withdraw diets (Trt 5), and combining the 4 strategies just mentioned (Trt 6). There was no difference in performance at the end of the starter phase (P = 0.066); however, at the end of the grower and finisher phases, feeding lower dAA grower diets suppressed BW (Trts 5 and 6; P < 0.001) and increased FCR. Differences in performance amongst all treatments disappeared at day 49 (P = 0.220). No differences were observed in average breast weight (P = 0.188); however, breast yield (as a % of live weight) was greatest for Trt 1 and least for Trt 6 (P = 0.041). The WB score dropped from 1.83 in Trt 1 to 1.49, 1.27, 1.74, 1.53, and 1.43 in treatments 2 to 6, respectively (P = 0.018). These changes were the result of a shift in WB score, where the WB class that contained scores of 2 and 3 shifted from 61.3% in Trt 1 to 49.3, 35.9, 60.0, 50.8, and 38.7 in treatments 2 to 6, respectively. Given the FCR, breast weight data and the fact that high WB scores result in a devaluation of breast meat, feeding a higher ratio of dArg: dLys, higher vitamin C, or lower dAA in the grower phase results in better breast meat quality and value.

Abuse, cancer and sexual dysfunction in women: A potentially vicious cycle.

More than 30% of women have a history of abuse. Women with cancer may be at substantially increased risk for abuse, but this issue is rarely discussed in the course of oncology care. Women with a history of abuse who present for cancer care commonly have a high prevalence of co-morbid illness. Sexual dysfunction, a highly prevalent but under-recognized condition among women of all ages, is also more common among both women with a history of abuse and women with cancer. Although common after cancer, sexual dysfunction, like abuse, can be stigmatizing and often goes undiagnosed and untreated. This review first examines the literature for evidence of a relationship between any history of abuse and cancer among women, addressing two questions: 1) How does abuse promote or create risk for developing cancer? 2) How does cancer increase a woman's susceptibility to abuse? We then examine evidence for a relationship between abuse and female sexual dysfunction, followed by an investigation of the complex relationship between all three factors: abuse, sexual dysfunction and cancer. The literature is limited by a lack of harmonization of measures across studies, retrospective designs, and small and idiosyncratic samples. Despite these limitations, it is imperative that providers integrate the knowledge of this complex relationship into the care of women with cancer.

Anticoagulant Choices Affect the Mean Platelet Volume Measurement by Impedance.

BACKGROUND: Mean platelet volume (MPV) is a parameter that evaluates the platelet size. Clinical applications of MPV are limited because of its poor standardization in routine laboratories. This study analyzed the effect of anticoagulants on MPV measurements by impedance technology. METHODS: Blood from 36 healthy volunteers was collected in vacuum tubes filled with K2EDTA and sodium citrate, analyzed immediately (basal) and at 1, 2, and 3 hours after venipuncture. RESULTS: Comparisons between the anticoagulants demonstrated a significant difference (p < 0.05) after 1 hour of exposure with K2EDTA, causing a time-dependent increase on MPV measured. No significant changes in MPV were observed with sodium citrate with 3 hours of exposure (p > 0.05). CONCLUSIONS: The use of sodium citrate is highly indicated for assessment of MPV when the measurement time after blood collection is estimated to be more than 1 hour.

Mannose-binding lectin deficiency and miscarriages in rheumatoid arthritis.

OBJECTIVE: To investigate the association between mannose-binding lectin (MBL) serum level and MBL2 polymorphisms, and the frequency of spontaneous miscarriages in rheumatoid arthritis (RA) patients. METHODS: One hundred seventy seven women (mean age 50 years) with RA from Southern Brazil were studied and 4.5% had a history of abortion (8/177). The MBL levels were determined by ELISA. MBL2 polymorphisms in the promoter (-550H/L, -221X/Y), 5' untranslated region (4 P/Q) and exon 1 (p.Gly54Asp: B allele, p.Arg52Cys: D allele and p.Gly57Glu: C allele; collectively labelled O) were genotyped by sequencing. RESULTS: Mannose-binding lectin levels of RA patients ranged from ≤100 ng/mL to 6640 ng/mL (median 541.5 ng/mL). There was a significant difference in MBL median levels (100 ng/mL vs. 625 ng/mL, respectively, p = .001) and frequency of MBL deficiency (75.0% vs. 24.1%, p = .007, OR = 10.3, 95%CI = 1.9-55.4), in patients with a history of miscarriage vs those without it. Patients with RA and miscarriage had more frequently haplotypes related with low MBL levels (p = .007, OR = 10.5, 95%CI = 1.3-84) than high producers. Moreover, LYPB haplotype and O allele were significantly associated with the occurrence of miscarriage (p = .001, OR = 9.7, 95%CI = 2.4-39.1 and p = .009, OR = 5.9, 95%CI = 1.4-23.4, respectively). CONCLUSIONS: The results suggest that MBL deficiency and the presence of MBL2 gene polymorphisms that lead to MBL deficiency are risk factors for the occurrence of miscarriage in patients with RA.

Analysis of four serum biomarkers in rheumatoid arthritis: association with extra articular manifestations in patients and arthralgia in relatives / Análise de quatro marcadores sorológicos na artrite reumatoide: associação com manifestações extra-articulares no paciente e artralgia em familiares

ABSTRACT Objectives: To evaluate the frequency of four serum biomarkers in RA patients and their relatives and identify possible associations with clinical findings of the disease. Methods: This was a transversal analytical study. Anti-cyclic citrullinated peptide (anti-CCP), anti-mutated citrullinated vimentin (anti-MCV) and IgA-rheumatoid factor (RF) were determined by ELISA and IgM-RF by latex agglutination in 210 RA patients, 198 relatives and 92 healthy controls from Southern Brazil. Clinical and demographic data were obtained through charts review and questionnaires. Results: A higher positivity for all antibodies was observed in RA patients when compared to relatives and controls (p < 0.0001). IgA-RF was more frequent in relatives compared to controls (14.6% vs. 5.4%, p = 0.03, OR = 2.98; 95% CI = 1.11-7.98) whereas anti-CCP was the most common biomarker among RA patients (75.6%). Concomitant positivity for the four biomarkers was more common in patients (46.2%, p < 0.0001). Relatives and controls were mostly positive for just one biomarker (20.2%, p < 0.0001 and 15.2%, p = 0.016, respectively). No association was observed between the number of positive biomarkers and age of disease onset, functional class or tobacco exposure. In seronegative patients predominate absence of extra articular manifestations (EAMs) (p = 0.01; OR = 3.25; 95% CI = 1.16-10.66). Arthralgia was present in positive relatives, regardless the type of biomarker. Conclusions: A higher number of biomarkers was present in RA patients with EAMs. Positivity of biomarkers was related to arthralgia in relatives. These findings reinforce the link between distinct biomarkers and the pathophysiologic mechanisms of AR.

RESUMO Objetivos: Avaliar a frequência de quatro marcadores sorológicos em pacientes com AR e seus familiares e identificar possíveis associações com achados clínicos da doença. Métodos: Estudo analítico transversal. Determinaram-se os níveis de anticorpos antipeptídeo citrulinado cíclico (anti-CCP), anticorpos antivimentina citrulinada-mutada (anti-MCV) e fator reumatoide (FR) IgA por Elisa e de FR-IgM por aglutinação em látex em 210 pacientes com AR, 198 familiares e 92 controles saudáveis do sul do Brasil. Coletaram-se dados clínicos e demográficos por meio da revisão de prontuários e questionários. Resultados: Observou-se maior positividade para todos os anticorpos em pacientes com AR em comparação com os familiares e controles (p < 0,0001). O FR-IgA era mais frequente em familiares quando comparados com os controles (14,6% versus 5,4%, p = 0,03, OR = 2,98; IC95% = 1,11 a 7,98). O anti-CCP foi o biomarcador mais comum entre pacientes com AR (75,6%). A positividade concomitante para os quatro biomarcadores foi mais comum nos pacientes (46,2%, p < 0,0001). Familiares e controles eram positivos em sua maioria para apenas um biomarcador (20,2%, p < 0,0001 e 15,2%, p = 0,016, respectivamente). Não foi observada associação entre o número de biomarcadores positivos e a idade de início da doença, classe funcional ou exposição ao fumo. Em pacientes soronegativos, predominou a ausência de manifestações extra-articulares (MEA) (p = 0,01; OR = 3,25; IC95% = 1,16 a 10,66). A artralgia estava presente em familiares positivos, independentemente do tipo de biomarcador. Conclusões: Um maior número de biomarcadores estava presente em pacientes com AR com MEA. A positividade dos biomarcadores estava relacionada com a artralgia em familiares. Esses achados reforçam a ligação entre os diferentes biomarcadores e os mecanismos fisiopatológicos da AR.

Calidad de vida en adultos mayores en Cartagena, Colombia / Quality of life in the senior population of Cartagena, Colombia

RESUMEN Objetivo Determinar factores asociados a la calidad de vida de los adultos mayores en Cartagena, 2015. Método Estudio transversal, con una población de 107 604 adultos mayores y se estimó una muestra de 660 personas. Se adelantó un muestreo bietapico. Se tomó como referente la teoría de calidad de vida relacionada con salud y para medir los conceptos planteados por esta teoría se emplearon los test de Pfeiffer, encuesta socio-demográfica, escala de depresión de Yesavage, cuestionario de salud auto percibida, escala de Barthel, Lawton y Brody, Índice Multicultural de Calidad de Vida, cuestionario Duke- UNC-11. Se usó la estadística descriptiva y un modelo de regresión logística multivariada. Se consideraron los aspectos éticos de estudios con humanos. Resultados Participaron 657 personas, edad promedio de 71 años, predominó el sexo femenino (55,7 %), tener pareja estable (62,6 %), escolaridad primaria (49,6 %), ocupación hogar (52,8%), residir en estratos 2 y 3 (66,7 %) y vivir con 4 personas, promedio, en el hogar. Se observó alta prevalencia de apoyo social adecuado (89,5 %), no presentar síntomas depresivos con significancia clínica (86.9 %), independencia para realizar actividades básicas (86,3 %) e instrumentales de la vida diaria (60,8 %), percibir su salud como buena (51,4 %), percibir la calidad de vida relacionada con salud como excelente (87,4 %). Las patologías más frecuentes fueron las cardiovasculares (26,1 %). Conclusiones La calidad de vida se asoció positivamente a percibir apoyo social adecuado y a la independencia para realizar actividades instrumentales de la vida diaria y neg(AU)

ABSTRACT Objective To determine factors associated with the quality of life of the elderly in Cartagena in 2015. Method Cross-sectional study on a population of 107 604 senior adults, with a sample of 660 people. Two-stage sampling was carried out using the Pfeiffer test, socio-demographic survey, Yesavage depression scale, self-perceived health questionnaire, Barthel Lawton and Brody scale, Multicultural Quality of Life Index, and Duke Questionnaire. Descriptive statistics and a multivariate logistic regression model were used. The ethical aspects of human studies were considered. Results 657 people participated, with an average age of 71 years, predominantly female (55.7 %), with a stable partner (62.6 %), primary schooling (49.6 %), household occupation (52.8 %), residing in strata 2 and 3 (66.7 %), and living with an average of 4 people in the same household. Findings include high prevalence of adequate social support (89.5 %), no depressive symptoms of clinical significance (86.9 %), independence to perform basic activities (86.3 %) and instrumental activities of daily living (60.8%). Additionally, their health was perceived as good (51.4 %), and the quality of life related to health as excellent (87.4 %). The most frequent pathologies were cardiovascular (26.1 %). Conclusions Quality of life was positively associated to the perception of adequate social support and independence to perform instrumental activities of daily living, and negatively to working or having a pension.(AU)

Analysis of four serum biomarkers in rheumatoid arthritis: association with extra articular manifestations in patients and arthralgia in relatives.

OBJECTIVES: To evaluate the frequency of four serum biomarkers in RA patients and their relatives and identify possible associations with clinical findings of the disease. METHODS: This was a transversal analytical study. Anti-cyclic citrullinated peptide (anti-CCP), anti-mutated citrullinated vimentin (anti-MCV) and IgA-rheumatoid factor (RF) were determined by ELISA and IgM-RF by latex agglutination in 210 RA patients, 198 relatives and 92 healthy controls from Southern Brazil. Clinical and demographic data were obtained through charts review and questionnaires. RESULTS: A higher positivity for all antibodies was observed in RA patients when compared to relatives and controls (p<0.0001). IgA-RF was more frequent in relatives compared to controls (14.6% vs. 5.4%, p=0.03, OR=2.98; 95% CI=1.11-7.98) whereas anti-CCP was the most common biomarker among RA patients (75.6%). Concomitant positivity for the four biomarkers was more common in patients (46.2%, p<0.0001). Relatives and controls were mostly positive for just one biomarker (20.2%, p<0.0001 and 15.2%, p=0.016, respectively). No association was observed between the number of positive biomarkers and age of disease onset, functional class or tobacco exposure. In seronegative patients predominate absence of extra articular manifestations (EAMs) (p=0.01; OR=3.25; 95% CI=1.16-10.66). Arthralgia was present in positive relatives, regardless the type of biomarker. CONCLUSIONS: A higher number of biomarkers was present in RA patients with EAMs. Positivity of biomarkers was related to arthralgia in relatives. These findings reinforce the link between distinct biomarkers and the pathophysiologic mechanisms of AR.

[Quality of life in the senior population of Cartagena, Colombia]. / Calidad de vida en adultos mayores en Cartagena, Colombia.

OBJECTIVE: To determine factors associated with the quality of life of the elderly in Cartagena in 2015. METHOD: Cross-sectional study on a population of 107 604 senior adults, with a sample of 660 people. Two-stage sampling was carried out using the Pfeiffer test, socio-demographic survey, Yesavage depression scale, self-perceived health questionnaire, Barthel Lawton and Brody scale, Multicultural Quality of Life Index, and Duke Questionnaire. Descriptive statistics and a multivariate logistic regression model were used. The ethical aspects of human studies were considered. RESULTS: 657 people participated, with an average age of 71 years, predominantly female (55.7 %), with a stable partner (62.6 %), primary schooling (49.6 %), household occupation (52.8 %), residing in strata 2 and 3 (66.7 %), and living with an average of 4 people in the same household. Findings include high prevalence of adequate social support (89.5 %), no depressive symptoms of clinical significance (86.9 %), independence to perform basic activities (86.3 %) and instrumental activities of daily living (60.8%). Additionally, their health was perceived as good (51.4 %), and the quality of life related to health as excellent (87.4 %). The most frequent pathologies were cardiovascular (26.1 %). CONCLUSIONS: Quality of life was positively associated to the perception of adequate social support and independence to perform instrumental activities of daily living, and negatively to working or having a pension.

OBJETIVO: Determinar factores asociados a la calidad de vida de los adultos mayores en Cartagena, 2015. MÉTODO: Estudio transversal, con una población de 107 604 adultos mayores y se estimó una muestra de 660 personas. Se adelantó un muestreo bietapico. Se tomó como referente la teoría de calidad de vida relacionada con salud y para medir los conceptos planteados por esta teoría se emplearon los test de Pfeiffer, encuesta socio-demográfica, escala de depresión de Yesavage, cuestionario de salud auto percibida, escala de Barthel, Lawton y Brody, Índice Multicultural de Calidad de Vida, cuestionario Duke- UNC-11. Se usó la estadística descriptiva y un modelo de regresión logística multivariada. Se consideraron los aspectos éticos de estudios con humanos. RESULTADOS: Participaron 657 personas, edad promedio de 71 años, predominó el sexo femenino (55,7 %), tener pareja estable (62,6 %), escolaridad primaria (49,6 %), ocupación hogar (52,8%), residir en estratos 2 y 3 (66,7 %) y vivir con 4 personas, promedio, en el hogar. Se observó alta prevalencia de apoyo social adecuado (89,5 %), no presentar síntomas depresivos con significancia clínica (86.9 %), independencia para realizar actividades básicas (86,3 %) e instrumentales de la vida diaria (60,8 %), percibir su salud como buena (51,4 %), percibir la calidad de vida relacionada con salud como excelente (87,4 %). Las patologías más frecuentes fueron las cardiovasculares (26,1 %). CONCLUSIONES: La calidad de vida se asoció positivamente a percibir apoyo social adecuado y a la independencia para realizar actividades instrumentales de la vida diaria y negativamente al hecho de trabajar o tener pensión.

Mannose-Binding Lectin Deficiency in Brazilian Patients with Spondyloarthritis.

BACKGROUND: Infections are usually involved in the pathogenesis of spondyloarthritis (SpA). Mannose-binding lectin (MBL) is a component of the innate immune system with an important role in microbial defense. OBJECTIVE: To study the prevalence of MBL deficiency in SpA patients as well as its influence in the clinical profile of these diseases. METHODS: We studied 89 SpA patients and 89 healthy individuals, paired for age and gender. MBL serum levels were measured by ELISA test. Individuals with levels ≤100 ng/mL were considered deficient. SpA patients had determination of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, Bath Ankylosing Spondylitis Functional Index (BASFI), C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and review of their clinical profile. RESULTS: SpA patients had MBL levels ranging from 100 to 4100 ng/mL (median = 375 ng/mL); controls levels ranged from 100 to 4703 ng/mL (median = 1204 ng/mL; p < 0.0001). The prevalence of MBL deficiency was 27/89 (30.3%) in SpA patients and 12/89 (13.5%) in controls, with p = 0.01; OR = 2.5 (95% IC = 1.2-5.3). No association/correlation was found between MBL levels with BASDAI, BASFI, age at disease onset, ASDAS-CRP, ESR, CRP, presence of uveitis, HLAB27, peripheral arthritis, or SpA subtype (all p = NS). CONCLUSION: MBL levels may be linked with the occurrence of SpA but do not influence its phenotype.

Rheumatic Disease Autoantibodies in Autoimmune Liver Diseases.

BACKGROUND: Autoimmune liver diseases (ALDs) are known to be associated with systemic autoimmune rheumatic diseases (SARDs) and their autoantibodies. We aimed to study the prevalence of SARDs and related autoantibodies, as well as their prognostic implications in a group of patients with ALDs. METHODS: This was a cross-sectional study. Sixty patients with ALDs (38.3% with autoimmune hepatitis; 11.7% with primary biliary cirrhosis; 25% with primary sclerosing cholangitis and 25% with overlap syndrome) were studied for the presence of SARDs and their autoantibodies. RESULTS: There was autoimmune rheumatic disease in 20% of the studied sample. Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) were the commonest (11.6% and 5%, respectively). Antinuclear antibodies (ANAs) were present in 35% of the patients, followed by anti-Ro (20.0%); anti-nucleosome (18.3%); rheumatoid factor (10%) anti-CCP (8.3%); anti-RNP (8.3%); anti-ds-DNA (6.6%); anti-La (3.3%); anti-Sm (3.3%), anti-ribosomal P (3.3%). Anti-Ro (p = 0.0004), anti-La (p = 0.03), anti-RNP (p = 0.04) and anti-Sm (p = 0.03) were commonly found in patients with SARD, but not anti-DNA, anti-nucleosome and anti-ribosomal P. No differences were found in liver function tests regarding to the presence of autoantibodies. CONCLUSIONS: There was a high prevalence of SARD and their autoantibodies in ALD patients. Anti-Ro, anti-La, anti-RNP and anti-Sm positivity points to an association with systemic autoimmune rheumatic diseases. The presence of autoantibodies was not related to liver function tests.