Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Recommendations on cutaneous and hematological manifestations of Sjögren's disease by the Brazilian Society of Rheumatology.

Sjogren's disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal).

Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic).

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Role of the renin-angiotensin system in the nandrolone-decanoate-induced attenuation of the Bezold-Jarisch reflex.

The androgen nandrolone decanoate (ND) is known to cause cardiovascular abnormalities, such as attenuation of the Bezold-Jarisch Reflex (BJR), cardiac hypertrophy, and elevation of mean arterial pressure (MAP). Futhermore, a relationship between androgens and the renin-angiotensin system (RAS) has been reported. The purpose of this study was to evaluate the influence of RAS on the BJR, cardiac and prostatic hypertrophy, and MAP evoked by ND. For this, male Wistar rats were treated with ND (10 mg·(kg body mass)(-1) for 8 weeks; DECA), or vehicle (control animals; CON), or enalapril (10 mg·(kg body mass)(-1), daily; CONE), or ND and enalapril (10 mg ND + 10 mg enalapril per kilogram of body mass; DECAE). After 8 weeks of treatment, the BJR was evaluated by bradycardia and hypotensive responses that were elicited by serotonin administration (2-32 µg·(kg body mass)(-1)). MAP was assessed; cardiac and prostate hypertrophy were determined by the ratio of the tissue mass:body mass, and by histological analysis of the heart. Animals from the DECA group showed prostatic and cardiac hypertrophy, elevation in mean arterial pressure, and an impairment of BJR. Co-treatment with enalapril inhibited these changes. The data from the present study suggest that RAS has an impact on BJR attenuation, cardiac and prostatic hypertrophy, and the elevation in MAP evoked by ND.

Giant lactating adenoma.

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.

[Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors]. / Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados.

The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome.

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review).

BACKGROUND: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. CONCLUSION: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

Demonstration of epithelial-mesenchymal transition in kidney. The contribution of a coupled histochemical and immunohistochemical staining with Periodic Acid-thionin Schiff.

Traditional Periodic Acid Schiff has been extensively used, coupled with immunohistochemistry for epithelia or mesenchymal cells, to highlight renal tubular basement membrane (TBM). We recently tried to perform such technique in a 5/6 nephrectomy model of progressive renal fibrosis to demonstrate TBM disruption as an evidence for epithelial-mesenchymal transdifferentiation. Despite excellent basement membrane staining with traditional fuchsin-Periodic Acid Schiff, the interface between epithelial and mesenchymal cells was frequently blurred when revealed with 3'3 diaminobenzidine tetrachloride-peroxidase. Also, it was inadequate when revealed with alkaline phosphatase-fast red. We devised a triple staining method with Periodic Acid-Thionin Schiff to highlight basement membrane in blue, after double immunostaining for epithelium and mesenchymal cells. Blue basement membrane rendered a brisk contrast and highlighted boundaries between epithelial-mesenchymal interfaces. This method was easy to perform and useful to demonstrate the TBM, yield a clear demonstration of the very focal TBM disruption found in this model of progressive renal fibrosis.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)

Abstract Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Infecções sexualmente transmissíveis em mulheres afrodescendentes de comunidades quilombolas no Brasil: prevalência e fatores associados / Sexually transmissible infections in African-descendant women in maroon communities in Brazil: prevalence and associated factors / Enfermedades de transmisión sexual en mujeres afrodescendientes de comunidades quilombolas en Brasil: prevalencia y factores asociados

Resumo: O objetivo do estudo foi estimar a prevalência de infecções sexualmente transmissíveis (IST) e fatores associados sobre mulheres quilombolas no Brasil. Trata-se de estudo transversal de base populacional com mulheres quilombolas no período de março de 2017 a janeiro de 2019. Utilizou-se um questionário com informações sociodemográficas, comportamentais e clínicas. Foi realizado exame ginecológico para coleta de células cervicais para citologia oncótica e para detecção de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e papilomavírus humano (HPV), por meio de teste de reação em cadeia pela polimerase. Foi realizado teste rápido para HIV e sífilis. O desfecho principal foi definido como a infecção por um ou mais agentes infecciosos de transmissão sexual. Para a análise, utilizou-se o teste do qui-quadrado e regressão logística hierárquica. De um total de 380 mulheres, 352 (92,6%) foram incluídas no estudo. A prevalência de, pelo menos, uma IST foi de 18,5% (IC95%: 14,76-22,85). A maior prevalência foi de 11,1% por HPV, seguido de 6,3% por T. vaginalis e de 4,3% por C. trachomatis. Não houve nenhum caso de N. gonorrhoeae. Para o HIV, a prevalência foi de 0,3%, e de sífilis foi de 4,3%. A citologia cervicovaginal estava alterada em 7,7%. A detecção de uma ou mais IST foi significativamente associada a idade entre 25 e 44 anos (OR = 2,33; IC95%: 1,05-5,18), a consumo de álcool (OR = 1,96; IC95%: 1,06-3,64), a resultado alterado da citologia (OR = 3,96; IC95%: 1,65-9,48) e a vaginose bacteriana (OR = 3,61; IC95%: 2,01-6,47). Em mulheres quilombolas houve elevada prevalência de uma ou mais IST, o que torna importante a elaboração de estratégias de prevenção direcionadas a essas mulheres.

Abstract: The study aimed to estimate the prevalence of sexually transmissible infections (STIs) and associated factors in women in quilombola (maroon) communities in Brazil. This was a population-based cross-sectional study of quilombola women from March 2017 to January 2019. A questionnaire was used with sociodemographic, behavioral, and clinical information. A gynecological examination was performed for the collection of uterine cervical cells for oncotic cytology and the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and human papillomavirus (HPV) via polymerase chain reaction. Rapid tests for HIV and syphilis were performed. The main outcome was defined as infection with one or more sexually transmissible pathogens. The analysis used chi-square test and hierarchical logistic regression. From a total of 380 women, 352 (92.6%) were included in the study. Prevalence of at least one STI was 18.5% (95%CI: 14.76-22.85). The highest prevalence was for HPV, with 11.1%, followed by 6.3% for T. vaginalis and 4.3% for C. trachomatis. There were no cases of N. gonorrhoeae. Prevalence was 0.3% for HIV and 4.3% for syphilis. Cervical-vaginal cytology was altered in 7.7% of the women. Detection of one or more STIs was significantly associated with age 25 to 44 years (OR = 2.33; 95%CI: 1.05-5.18), alcohol consumption (OR = 1.96; 95%CI: 1.06-3.64), altered cervical cytology (OR = 3.96; 95%CI: 1.65-9.48), and bacterial vaginosis (OR = 3.61; 95%CI: 2.01-6.47). Quilombola women showed high prevalence of one or more STIs, emphasizing the importance of organizing prevention strategies targeted to these women.

Resumen: El objetivo del estudio fue estimar la prevalencia de enfermedades de transmisión sexual (ETS) y sus factores asociados en mujeres quilombolas en Brasil. Estudio transversal de base poblacional con mujeres quilombolas durante el período de marzo de 2017 a enero de 2019. Se utilizó un cuestionario con información sociodemográfica, comportamental y clínica. Se realizó un examen ginecológico, a fin de recoger células cervicales para la citología oncótica, así como para la detección de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, y virus del papiloma humano (VPH) mediante un test de reacción en cadena de la polimerasa. Se realizó un test rápido para VIH y sífilis. El resultado principal, se definió como infección por uno o más agentes infecciosos de transmisión sexual. Para el análisis, se utilizó el test de chi-cuadrado y regresión logística jerárquica. De un total de 380 mujeres, 352 (92,6%) se incluyeron en el estudio. La prevalencia de por lo menos una ETS fue de 18,5% (IC95%: 14,76-22,85). La mayor prevalencia fue por VPH 11,1%, seguida de 6,3% por T. vaginalis y 4,3% por C. trachomatis. No hubo casos de N. gonorrhoeae. Para el VIH, la prevalencia fue de 0,3% y de sífilis fue de 4,3%. La citología cérvico-vaginal estaba alterada en un 7,7%. La detección de una o más ETS estuvo significativamente asociada con la edad entre 25 a 44 años (OR = 2,33; IC95%: 1,05-5,18), el consumo de alcohol (OR = 1,96; IC95%: 1,06-3,64), resultado alterado de la citología (OR = 3,96; IC95%: 1,65-9,48) y vaginosis bacteriana (OR = 3,61; IC95%: 2,01-6,47). Las mujeres quilombolas presentaron una elevada prevalencia por una o más ETS, por lo que es importante la elaboración de estrategias de prevención dirigidas a estas mujeres.

Giant lactating adenoma

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

Validation and psychometric properties of the Eular Sjögren's Syndrome Patient Reported Index (ESSPRI) into Brazilian Portuguese.

OBJECTIVE: To carry out the cross-cultural adaptation of Eular Sjögren's Syndrome Patient Reported Index (ESSPRI) for Portuguese language and evaluate its psychometric properties. METHOD: Cross-sectional study of patients with primary Sjögren's syndrome (SS). The psychometric properties (intraobserver reproducibility and construct validity) were studied. In construct validity, ESSPRI was compared with the Patient's Global Assessment (PGA), Profile of Fatigue and Discomfort (Profad), Sicca Symptoms Inventory (SSI) and Functional Assessment of Chronic Illness Therapy (Facit-F). Statistical tests used were:Cronbach's alpha, intraclass correlation coefficient (ICC), Bland-Altman method and Spearman coefficient. A value of p ≤ 0.05 was considered significant. RESULTS: There was no difference between versions in both languages; thus, a Brazilian consensual version was obtained. All subjects were women aged 49.4 ± 11.6 years, with onset of symptoms of 7.2 ± 5.4 years, and time of diagnosis of 3.0 ± 3.3 years. The mean ESSPRI was 6.87 ± 1.97. The intraobserver reproducibility was high and significant (0.911) and, with Bland-Altman method, there was no systematic bias in the agreement of measures among evaluations. A moderate correlation of ESSPRI with all tested instruments was observed. CONCLUSION: The Brazilian Portuguese version of ESSPRI is a valid and reproducible version.

Syphilis among HIV serodiscordant partners associated with Human Papillomavirus Infection in a bisexual man / Sífilis entre parceiros sorodiscordantes para HIV associada à infecção por papilomavírus humano em um homem bissexual

Introduction: Syphilis and HIV infections are sexually transmitted infections whose diagnosis and treatment contribute toward preventing congenital transmission. Objective: To report a case of three sexually transmitted infections detected in a male partner during Couple Consultation and syphilis in the female partner during prenatal care. Case report: A 34-year-old black female G2P1 pregnant woman was referred to an outpatient clinic of sexually transmitted infections in Vitória, Brazil, reporting a 30-day evolution of painless papular lesions in the external genitalia, suggestive of condylomata lata. Nontreponemal tests were positive for syphilis and negative for HIV. The husband reported unprotected receptive anal intercourse and possessed anal condylomatous lesions and perianal condylomata lata. He was positive for both HIV and syphilis. Histopathological findings showed low-grade HPV lesions and the PCR test found 16, 39, and 53 HPV subtypes. Treatment with benzathine penicillin G was successful for both partners. Conclusion: This study emphasizes the need for Couple Consultation during pregnancy to identify and treat possible sexually transmitted infections.

Introdução: As infecções por sífilis e HIV são infecções sexualmente transmissíveis cujo diagnóstico e tratamento contribuem para a prevenção da transmissão congênita. Objetivo: Relatar um caso de três infecções sexualmente transmissíveis detectadas em um parceiro masculino durante a consulta do casal e sífilis na parceira durante o pré-natal. Relato de caso: Uma gestante, negra, G2P1, 34 anos, foi encaminhada a um ambulatório de infecções sexualmente transmissíveis em Vitória, Brasil, relatando uma evolução de 30 dias de lesões papulares indolores na genitália externa, sugestivas de condiloma lata. Os testes não treponêmicos foram positivos para sífilis e negativos para HIV. O marido relatou relação sexual anal receptiva desprotegida e possuía lesões condilomatosas anais e condiloma lata perianal. Ele testou positivo tanto para HIV quanto para sífilis. Os achados histopatológicos mostraram lesão de HPV de baixo grau e o teste de PCR encontrou subtipos de HPV 16, 39 e 53. O tratamento com penicilina benzatina G foi bem­sucedido em ambos os parceiros. Conclusão: Este estudo enfatiza a necessidade de consultas de casal durante a gravidez para identificar e tratar possíveis infecções sexualmente transmissíveis.

Recommendations for the treatment of Sjögren's syndrome.

The recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.

[Correlation between iodine urinary levels and pathological changes in thyroid glands]. / Correlação entre níveis de iodo na urina e alterações anatomopatológicas em tireoide.

OBJECTIVES: To determine iodine nutrition in the population and to correlate levels of iodine found in random samples of urine with pathological changes observed in thyroids collected in this population. MATERIALS AND METHODS: Urinary iodine was determined in 30 random samples of urine and the pathological study was carried out in 55 thyroid glands from corpses received by the Department of Forensic Medicine of Vitória, Espírito Santo, Brazil from May to August 2011. RESULTS: In 29 urine samples (96.7%) urinary iodine was above the maximum limit recommended by the World Health Organization (WHO), of 300 mg/L. Fourteen thyroids (25.5%) showed the presence of histological changes compatible with thyroiditis. Higher levels of iodine in urine were observed in females and in of thyroid that showed inflammation (thyroiditis). CONCLUSIONS: We conclude that, in this population, there is excess iodine intake, and greater incidence of inflammatory thyroid disease.