Autoinflammatory diseases: a Latin American multicenter study according to age and sex / Doenças autoinflamatórias: um estudo multicêntrico latino-americano de acordo com o sexo e a idade

ABSTRACT Objective: To evaluate autoinflammatory diseases (AID) according to age at diagnosis and sex, and response to therapy in a large population. Methods: This is a cross-sectional observational study of a Latin American registry using a designed web system for data storage, collected between 2015 and 2018. Any altered findings during follow-up were recorded. The forms were translated into Portuguese and Spanish, including demographic, clinical, laboratory, genetic and treatment characteristics. Results: We included 152 patients, 51.3% male and 75% Caucasian. The median age at disease onset was 2.1 years (0-15.6 years) and median age at diagnosis 6.9 years (0-21.9 years); 111 (73%) were children (0-9 years old), and 41 (27%) were adolescents and young adults (AYA) (10-21 years old). Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) occurred in 46/152 (30%), chronic non-bacterial osteomyelitis (CNO) in 32/152 (21%), and familial Mediterranean fever (FMF) in 24/152 (15.7%). PFAPA was significantly higher in young children than in AYA (38.7% vs. 7.3%, p<0.001), while CNO were lower (13.5% vs. 41.5%, p<0.001). The frequency of females was significantly higher in CNO (28.4% vs. 14.1%, p=0.031) and lower in FMF (8.1% vs. 23.1%, p=0.011). The most used drugs were glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), and colchicine. Glucocorticoids and colchicine treatment were used in all AID with good to moderate response. However, cryopyrin-associated periodic syndromes (CAPS) seemed unresponsive to glucocorticoids. NSAIDs and methotrexate were the main medications used to treat CNO. Conclusions: Differences among AID patients were observed in the LA population regarding sex and age at disease diagnosis.

RESUMO Objetivo: Avaliar as doenças autoinflamatórias (DAI) de acordo com sexo e idade no momento do diagnóstico e a resposta terapêutica em uma grande população. Métodos: Este é um estudo observacional transversal de um registro latino-americano que usou um sistema de dados coletados entre 2015 e 2018. Quaisquer achados alterados ao longo do acompanhamento foram registrados. Os formulários foram traduzidos para os idiomas português e espanhol, incluindo características demográficas, clínicas, laboratoriais, genéticas e de tratamento. Resultados: Incluímos 152 pacientes, sendo 51,3% do sexo masculino e 75% da raça branca. A média de idade de início da doença foi de 2,1 anos (0-15,6 anos) e a média de idade de diagnóstico 6,9 anos (0-21,9 anos); 111 (73%) eram crianças (0-9 anos) e 41 (27%) adolescentes/adultos jovens (10-21 anos). A síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA) ocorreu em 46/152 (30%), osteomielite não bacteriana crônica (CNO) em 32/152 (21%) e febre familiar do Mediterrâneo (FMF) em 24/152 (15,7%). A PFAPA foi significativamente maior em crianças pequenas (38,7 vs. 7,3%, p<0,001), e a CNO, em adolescentes/adultos jovens (13,5 vs. 41,5%, p<0,001). A frequência do sexo feminino foi significativamente maior na CNO (28,4 vs. 14,1%, p=0,031) e menor na FMF (8,1 vs. 23,1%, p=0,011). Os medicamentos mais utilizados foram glicocorticoides, anti-inflamatórios não esteroidais (AINE) e colchicina. O tratamento com glicocorticoides e colchicina foi usado em todas as DAI com resposta boa a moderada. No entanto, as síndromes periódicas associadas à criopirina (CAPS) pareciam não responder aos glicocorticoides. AINE e metotrexato foram os principais medicamentos utilizados no tratamento da CNO. Conclusões: Diferenças de pacientes com DAI foram observadas na população latino-americana em pacientes agrupados por sexo e idade ao diagnóstico da doença.

Teleenfermería en salud mental: efecto sobre los síntomas de ansiedad y el consumo de alcohol durante la pandemia de COVID-19 / Telenursing in mental health: effect on anxiety symptoms and alcohol consumption during the COVID-19 pandemic / Telenfermagem em saúde mental: efeito em sintomas de ansiedade e consumo de álcool durante a pandemia COVID-19

Objetivo: investigar el efecto de una intervención a distancia sobre los síntomas de ansiedad y el consumo de alcohol en usuarios del servicio de Atención Primaria de Salud. Método: estudio cuasiexperimental, realizado con 1270 participantes que respondieron al Alcohol Use Disorders Identification Test y al State-Trait Anxiety Inventory 6. De estos, 1033 encuestados obtuvieron puntajes de síntomas de ansiedad moderada/grave (STAI-6 > 3) y consumo de alcohol de riesgo moderado/grave (AUDIT-C>3), y recibieron las intervenciones mediante llamada telefónica con un seguimiento de siete y 180 días. Para analizar los datos se utilizó un modelo de regresión de efectos mixtos. Resultados: el efecto de la intervención realizada fue positivo para reducir los síntomas de ansiedad entre T0 y T1 (µ=1,6 p<0,001) y para reducir el patrón de consumo de alcohol entre t1 y t3 (µ=1,57 p< 0,001). Conclusión: los resultados del seguimiento sugieren que la intervención tuvo un efecto positivo en la reducción de la ansiedad y el patrón de consumo de alcohol que tiende a mantenerse en el tiempo. Existe evidencia de que la intervención propuesta puede ser una alternativa para la atención preventiva en salud mental, en situaciones donde se comprometa la accesibilidad del usuario o del profesional.

Objective: to investigate the effect of a remote intervention on anxiety symptoms and alcohol use in users of the Primary Health Care service. Method: a quasi-experimental study conducted with 1,270 participants who answered the Alcohol Use Disorders Identification Test and the State-Trait Anxiety Inventory-6. Of these, 1,033 interviewees scored for moderate/severe anxiety symptoms (STAI-6 > 3) and moderate/severe risk alcohol use (AUDIT-C > 3), and received the interventions via telephone calls with follow-up periods lasting seven and 180 days. For data analysis, a mixed-effects regression model was used. Results: the effect of the intervention performed was positive in reducing anxiety symptoms between T0 and T1 (µ=1.6, p<0.001) and in reducing the alcohol use pattern between T1 and T3 (µ=1.57, p<0.001) Conclusion: the follow-up results suggest a positive effect of the intervention in reducing anxiety and the alcohol use pattern, which tends to be maintained over time. There is diverse evidence that the intervention proposed can be an alternative for preventive care in mental health, in situations where accessibility of the user or the professional is compromised.

Objetivo: investigar o efeito de uma intervenção remota nos sintomas de ansiedade e no uso de álcool em usuários do serviço de Atenção Primária à Saúde. Método: estudo quase experimental, realizado com 1270 participantes que responderam o Alcohol Use Disorders Identification Test e a State-Trait Anxiety Inventory 6. Desses, 1033 entrevistados pontuaram para sintomas de ansiedade moderada/severa (STAI-6>3) e uso de risco de álcool moderado/severo (AUDIT-C>3), e receberam as intervenções via chamada telefônica com follow-up de sete e 180 dias. Para análise dos dados utilizou-se um modelo de regressão de efeitos mistos. Resultados: o efeito da intervenção realizada foi positivo na redução dos sintomas de ansiedade entre T0 e T1 (µ=1,6 p<0.001) e na redução do padrão de uso de álcool entre t1 e t3 (µ=1,57 p<0.001). Conclusão: os resultados do follow-up sugerem efeito positivo da intervenção na redução da ansiedade e no padrão de uso de álcool, o qual tende a se manter ao longo do tempo. Há evidências de que a intervenção proposta pode ser uma alternativa para o cuidado preventivo em saúde mental, em situações nas quais a acessibilidade do usuário ou do profissional encontram-se comprometidas.

Intervenção Breve para uso de Substâncias Psicoativas no Brasil: revisão sistemática / Brief Intervention for Psychoactive Substance use in Brazil: a systematic review

RESUMO As Intervenções Breves têm sido preconizadas há mais de 20 anos pela Organização Mundial da Saúde como uma estratégia de prevenção aos problemas relacionados ao uso de Substâncias Psicoativas, tendo como prioridade a aplicação nos serviços de atenção primária à saúde visando a diminuição dos riscos relacionados a esse fenômeno. Diante disso, o objetivo do presente estudo foi mapear e descrever as evidências científicas existentes na literatura sobre o uso de Intervenção Breve para o uso de Substâncias Psicoativas desenvolvidas no Brasil. Trata-se de revisão sistemática. As buscas foram realizadas em sete fontes de informações, em agosto de 2021. Todos os estudos foram desenvolvidos com abordagem quantitativa. O álcool esteve presente na maioria dos estudos, seguido da maconha e nicotina. O cenário predominante foi a unidade básica de saúde, com público de adultos de ambos os sexos e universitários. A maioria apresentou como proposta a Intervenção Breve grupal presencial e somente dez indicaram o referencial norteador da Intervenção Breve utilizada. No Brasil, as Intervenções Breves são incipientes e os estudos apresentados não destacam com exatidão o referencial norteador da intervenção utilizada.

ABSTRACT Brief Interventions have been recommended for more than 20 years by the World Health Organization as a strategy to prevent problems related to the use of Psychoactive Substances, with priority being applied in primary health care services in order to reduce the risks related to this substance. phenomenon. Therefore, the objective of the present study was to map and describe the existing scientific evidence in the literature on the use of Brief Intervention for the use of Psychoactive Substances developed in Brazil. This is a systematic review. Searches were carried out in seven sources of information in August 2021. All studies were developed with a quantitative approach. Alcohol was present in most studies, followed by marijuana and nicotine. The predominant scenario was the basic health unit, with a public of adults of both sexes and university students. The majority presented a brief face-to-face group intervention as a proposal and only ten indicated the guiding reference of the Brief Intervention used. In Brazil, Brief Interventions are incipient and the studies presented do not accurately highlight the guiding reference for the intervention used.

Estratégias preventivas ao suicídio para equipe de enfermagem na COVID-19: uma revisão de escopo / Estrategias preventivas al suicidio para un equipo de enfermería durante el COVID-19: una revisión de alcance / Suicide preventive strategies for the nursing team in the COVID-19: a scoping review

Resumo Objetivo Identificar as estratégias de prevenção da ideação suicida e do suicídio durante a pandemia de COVID-19 para a equipe de enfermagem. Métodos Revisão de escopo realizada nas bases de dados PubMed, BVS, SCOPUS, Web of Science, LILACS, CINAHL, Embase, PsycINFO e na literatura cinzenta como Google Acadêmico. Resultados Compõem esta revisão 11 artigos, todos publicados em inglês, a maioria publicada no ano de 2021, nos Estados Unidos da América. As estratégias identificadas perpassam a psicoeducação; espaços para acolhimento das demandas dos profissionais, escuta, apoio e promoção de bem-estar; avaliação e rastreio da saúde mental; encaminhamento para serviços de apoio especializados; intervenção psicológica e aconselhamento; estratégias para reconhecer e lidar com gatilhos, emoções e pensamentos negativos; ações de autocuidado; escuta; apoio e promoção de bem-estar; dentre outras. Conclusão As estratégias que resultaram em impacto positivo na saúde mental das equipes de enfermagem foram a criação de espaços para acolhimento das demandas dos profissionais, escuta, apoio e promoção de bem-estar, além da avaliação e do rastreio da saúde mental como formas de prevenção às ações e às ideações suicidas. Destaca-se a importância de estudos que avaliem o efeito das estratégias na saúde mental das equipes de enfermagem para que protocolos possam ser criados na mitigação do problema.

Resumen Objetivo Identificar las estrategias de prevención de la ideación suicida y del suicidio durante la pandemia de COVID-19 para el equipo de enfermería. Métodos Revisión de alcance realizada en las bases de datos PubMed, BVS, SCOPUS, Web of Science, LILACS, CINAHL, Embase, PsycINFO y en la literatura gris, como Google Académico. Resultados Integran esta revisión 11 artículos, todos publicados en inglés, la mayoría publicada en el año 2021, en Estados Unidos de América. Las estrategias identificadas abarcan la psicoeducación; espacios para la acogida de las demandas de los profesionales, escucha, apoyo y promoción del bienestar; evaluación y rastreo de la salud mental; derivación para servicios de apoyo especializados; intervención psicológica y orientación; estrategias para reconocer y lidiar con disparadores, emociones y pensamientos negativos; acciones de autocuidado; escucha; apoyo y promoción del bienestar; entre otras. Conclusión Las estrategias que tuvieron un impacto positivo en la salud mental de los equipos de enfermería fueron la creación de espacios para acoger las demandas de los profesionales, escucha, apoyo y para la promoción del bienestar, además de la evaluación y el rastreo de la salud mental como formas de prevención de las acciones y de las ideaciones suicidas. Se destaca la importancia de estudios que evalúen el efecto de las estrategias en la salud mental de los equipos de enfermería para que se puedan crear protocolos para mitigar el problema.

Abstract Objective To identify strategies for the prevention of suicidal ideation and suicide during the COVID-19 pandemic for the nursing team. Methods Scoping review performed in PubMed, VHL, SCOPUS, Web of Science, LILACS, CINAHL, Embase, PsycINFO databases and in the gray literature, such as Google Scholar. Results This review comprises 11 articles, all published in English, mostly in year 2021 in the United States of America. The identified strategies include psychoeducation; spaces for embracement of professionals' demands, listening, support and promotion of wellbeing; mental health assessment and screening; referral to specialized support services; psychological intervention and counseling; strategies for recognizing and dealing with triggers, emotions and negative thoughts; self-care actions, among others. Conclusion Strategies that had a positive impact on the mental health of nursing teams were the creation of spaces for embracement of professionals' demands, listening, support and promotion of wellbeing, and the assessment and screening of mental health as ways of preventing suicidal actions and ideations. The importance of studies that evaluate the effect of strategies on the mental health of nursing teams stands out, so that protocols can be created to mitigate the problem.

IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Infecções de sítio cirúrgico em cirurgias ortopédicas de um hospital do estado do Pará, Brasil / Infecciones del sitio quirúrgico de cirugía ortopédica en un hospital del estado de Pará, Brasil / Infections at the surgical site for orthopedic surgery in a hospital in the state of Pará, Brazil

Objetivo: avaliar as infecções de sítio cirúrgico em cirurgias ortopédicas de um hospital público de referência. Materiais e método: estudo descritivo, quantitativo e retrospectivo, com dados de 2.870 pacientes que realizaram cirurgia ortopédica e 60 prontuários de pacientes que desenvolveram infecção de sítio cirúrgico. A coleta ocorreu de janeiro de 2015 a dezembro de 2019 em um hospital de referência localizado no município de Santarém, Pará, Brasil. Os dados foram analisados por estatística descritiva e inferencial. Resultados: o sexo masculino predominou na amostra (65,7%) e nos pacientes com infecções de sítio cirúrgico (70%). A idade média da amostra foi de 44,6 ± 19,1 anos e dos pacientes com infecções de sítio cirúrgico de 46,2 ± 19,7 anos. Foi identificada frequência de infecções de sítio cirúrgico de 2,1%. Os fatores de risco associados às infecções de sítio cirúrgico foram duração da cirurgia, uso de implante, número de fraturas e uso de prótese de quadril ou outras. O perfil microbiológico foi composto de Staphylococcus aureus (35,1%), Klebsiella pneumoniae (13,5%) e Pseudomonas aeruginosa (13,5%). Conclusões: nas cirurgias ortopédicas, a equipe de saúde deve ficar atenta com as infecções de sítio cirúrgico em pacientes do sexo masculino, idosos, solteiros, com o ensino fundamental, bem como em cirurgias com longo tempo de duração, na presença de implante, com elevado número de fraturas e com o uso de próteses.

Objetivo: evaluar las infecciones del sitio quirúrgico para cirugías ortopédicas en un hospital público de referencia. Materiales y método: estudio descriptivo, cuantitativo y retrospectivo, con datos de 2.870 pacientes que se sometieron a cirugía ortopédica, donde 60 registros muestran que los pacientes desarrollaron infección del sitio quirúrgico. La recolección de datos ocurrió de enero de 2015 a diciembre de 2019 en un hospital de referencia en la ciudad de Santarém, Pará, Brasil. Los datos fueron analizados mediante estadística descriptiva e inferencial. Resultados: el sexo masculino predominó en la muestra (65,7 %) y en pacientes con infecciones del sitio quirúrgico (70 %). La edad media de la muestra fue de 44,6 ± 19,1 años, mientras que para los pacientes con infecciones del sitio quirúrgico fue de 46,2 ± 19,7 años. Se identificó una frecuencia de 2,1 % de infecciones del sitio quirúrgico. Los factores de riesgo asociados con esta afectación son: duración de la cirugía, el uso de un implante, el número de fracturas y el uso de prótesis de cadera (u otras). El perfil microbiológico estuvo compuesto por Staphylococcus aureus (35,1 %), Klebsiella pneumoniae (13,5 %) y Pseudomonas aeruginosa (13,5 %). Conclusiones: en cirugías ortopédicas, el equipo de salud debe estar atento a las infecciones del sitio quirúrgico en pacientes de sexo masculino, adultos mayores, solteros y con educación básica. Así mismo, deben monitorear este tipo de infecciones en cirugías de larga duración, en presencia de implante, con un alto número de fracturas en el paciente y el uso de prótesis.

Objective: To assess surgical site infections in orthopedic surgeries at a public reference hospital. Materials and method: Descriptive, quantitative and retrospective study, with data from 2,870 patients who underwent orthopedic surgery, where 60 patient records showed the development of surgical site infection. Data collection took place from January 2015 to December 2019 in a reference hospital in the city of Santarém, Pará, Brazil. Data were analyzed using descriptive and inferential statistics. Results: The male gender prevailed among the individuals in the sample (65.7%) and in the patients with surgical site infections (70%). The mean age of the sample was 44.6 ± 19.1 years and for patients with surgical site infections 46.2 ± 19.7 years. A 2.1% frequency of surgical site infection was identified. The risk factors associated with surgical site infection were: surgery duration, the use of an implant, the number of fractures, and the use of hip prostheses or others. The microbiological profile was composed by Staphylococcus aureus (35.1%), Klebsiella pneumoniae (13.5%), and Pseudomonas aeruginosa (13.5%). Conclusions: In orthopedic surgeries, the health team must be aware of surgical site infections in male, elderly and single patients, with elementary education, as well as in surgeries with a long duration, in the presence of an implant, a high number of fractures, and with the use of prostheses.

Spotlight on latent tuberculosis infection screening for juvenile idiopathic arthritis in two countries, comparing high and low risk patients

Abstract Background: Rheumatic diseases are associated with an increase in overall risks of tuberculosis (TB). The aim of this study was to evaluate the frequency of TB and the frequency of latent TB infection (LTBI), in clinical practice, for juvenile idiopathic arthritis (JIA) patients from high and low risk of TB incidence endemic countries. Methods: This is an international, multicenter, cross-sectional, observational study of data collection from Brazil and Registry of Portugal at REUMA.PT. The inclusion criteria were patients with Juvenile Idiopathic Arthritis (JIA) with age ≤ 18 years who underwent screening for Mycobacterium tuberculosis infection [tuberculin skin test (TST) and/or interferon gamma release assay (IGRA)]. Chest X-rays and history of exposure to TB were also assessed. Results: 292 JIA patients were included; mean age 14.3 years, mean disease duration 7.5 years, 194 patients (66.4%) performed only TST, 14 (4.8%) only IGRA and 84 (28.8%) both. The frequency of LTBI (10.6%) and TB was similar between the two countries. The reasons for TB screening were different; in Brazil it was performed more often at JIA onset while in Portugal it was performed when starting Disease Modified Anti-Rheumatic Drugs (DMARD) treatment (p < 0.001). Isoniazid therapy was prescribed in 40 (13.7%) patients (31 with LTBI and 9 with epidemiologic risks and/or due to contact with sick people). Only three patients (1%) developed active TB. Conclusion: We found nearly 10% of patients with LTBI, a small percentage of patients with treatment due to epide-miologic risks and only 1% with active TB. Distinct reasons and screening methods for LTBI were observed between the two countries.

Valuing tonsillitis manifestations in schoolchildren in Rio de Janeiro

ABSTRACT Objective: To evaluate the importance attributed to tonsillitis by guardians and their level of knowledge about the disease, correlating their management with their schooling and socioeconomic profiles. Methods: A quantitative, descriptive and observational cross-sectional study involving students aged 5 to 17 years from state-owned and private schools. A questionnaire was applied on management of tonsillitis and knowledge about rheumatic fever, addressing demographic and socioeconomic data. Results: A total of 323 students were included, predominantly females (61.3%), from state-owned schools (77.1%), with a mean age of 9.7±0.3 years. Among the guardians, 48.6% completed high school. Among the students 75.2% had at least one episode of odynophagia in the previous 12 months. Considering the previous 2 years, 89.8% reported this symptom. There was no collection of bacteriological specimens in 67.8%, and in 83% if taking into account only the last episode, despite the search for medical care in most cases (92.6%). The use of anti-inflammatory drugs was very frequent (43.0% "always" and 42.4% "sometimes"). Among the guardians, 81.7% denied being aware of the relation between rheumatic fever and inappropriate treatment of odynophagia; 85.8% said they wished they had received more information. Conclusion: Although it is quite common in schoolchildren, tonsillitis is neglected by many guardians and health professionals, and the ignorance of its relation with rheumatic fever is practically universal, which may contribute to its high prevalence.

Implicações da COVID-19 para indivíduos com transtornos relacionado ao uso de substâncias psicoativas: revisão overview / Implications of COVID-19 for individuals with psychoactive substance use disorders: an overview / Implicaciones de COVID-19 para individuos con trastornos del consumo de sustancias psicoactivas: revisión general

Objetivo: explorar as implicações biopsicossociais da COVID-19 para indivíduos com transtornos relacionado ao uso de substâncias psicoativas, bem como as estratégias de atenção a essa população durante o surto de SARS-CoV-2. Método: estudo descritivo que incluiu diferentes desenhos de estudos em bases de dados virtuais para mostrar o crescimento do número de publicações na área da saúde mental com ênfase em álcool e outras drogas durante a pandemia de COVID-19. Para isso, foram selecionadas duas bases de dados (Biblioteca Cochrane, via Cochrane Database of Systematic Reviews e Medline, via PubMed). Resultados: pessoas com transtornos relacionados ao uso das substâncias psicoativas geralmente apresentam condições de saúde pré-existentes que podem indicar maior risco a infecção por COVID-19. Por outro lado, indivíduos que já faziam o uso de substâncias, podem se beneficiar do uso para alívio temporário da ansiedade causada por essa situação, aumentando os riscos de uso nocivo. Conclusão: questões biológicas, individuais (cognitivo comportamentais) e sociais afetam sobremaneira indivíduos com transtornos relacionados ao uso de substâncias psicoativas colocando-os em alto risco para o contágio e desenvolvimento da COVID-19.

Objective: to explore the biopsychosocial implications of COVID-19 for individuals with disorders related to the use of psychoactive substances, as well as the strategies to care for this population during the SARS-CoV-2 outbreak. Method: a descriptive study that included different study designs in virtual databases to show the growth in the number of publications in the area of mental health with an emphasis on alcohol and other drugs during the COVID19 pandemic. For this, two databases were selected (Cochrane Library, via Cochrane Database of Systematic Reviews and Medline, via PubMed). Results: people with disorders related to the psychoactive substances use generally have pre-existing health conditions that may indicate a higher risk of COVID-19 infection. On the other hand, individuals who already used substances can benefit from the use for temporary relief of anxiety caused by this situation, increasing the risks of harmful use. Conclusion: biological, individual (cognitive behavioral) and social issues greatly affect individuals with disorders related to the use of psychoactive substances, placing them at high risk for the contagion and development of COVID-19

Objetivo: explorar las implicaciones biopsicósociales del COVID-19 para las personas con trastornos relacionados con el uso de sustancias psicoactivas, así como las estrategias de atención a esta población durante el brote de SARS-CoV-2. Método: estudio descriptivo que incluyó diferentes diseños de estudios en bases de datos virtuales para mostrar el crecimiento en el número de publicaciones en el área de salud mental con énfasis en el alcohol y otras drogas durante la pandemia COVID-19. Se seleccionaron dos bases de datos (Cochrane Library, a través de Cochrane Database of Systematic Reviews y Medline, a través de PubMed). Resultados: Las personas con trastornos del consumo de sustancias psicoactivas generalmente tienen condiciones de salud preexistentes que pueden indicar un mayor riesgo de infección por COVID-19. Por otro lado, individuos que ya utilizaron sustancias pueden beneficiarse del uso para el alivio temporal de la ansiedad causada por esta situación, aumentando los riesgos de uso nocivo. Conclusión: biológicos, individuales (cognitivo-conductuales) y problemas sociales afectan en gran medida a individuos con trastornos relacionados con el uso de sustancias psicoactivas, poniéndolos en alto riesgo de contagio y desarrollo covid-19

Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in patients with juvenile dermatomyositis: a real-world multicentre study.

BACKGROUND: Concerns about the safety and efficacy of vaccines in patients with autoimmune diseases (AID) have led to contradictions and low vaccination coverage in this population, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccines have been recommended for immunocompromised patients, there is still a lack of data to support its use for AID patients, such as juvenile dermatomyositis (JDM) patients. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV (qHPV) vaccine in a cohort of JDM patients. METHODS: JDM patients aged from 9 to 20 years and healthy controls (HC) were enrolled to receive a 3-dose schedule of qHPV vaccine from March/2014 to March/2016. Study visits were performed before the first dose, 1 month after the second and third doses, and 6 months after the third dose. Participants completed a diary of possible adverse events for 14 days following each dose of vaccination (AEFV). Disease activity and current therapy were analyzed at each visit for JDM patients. In addition, serum samples from all participants were collected to test antibody concentrations against HPV16 and 18 at each visit. Participant recruitment was conducted in ten Brazilian centres. From 47 eligible JDM patients and 41 HC, 42 and 35, respectively, completed the 3-dose schedule of the vaccine, given that five JDM patients and two HC had received doses prior to their inclusion in the study. RESULTS: The AEFVs presented by the participants were mild and in general did not differ between JDM and HC groups. No severe AEFVs were related to the vaccination. Disease activity was stable, or even improved during the follow-up. One month after the third dose of the vaccine the JDM group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the HC group, who presented 100% for both serotypes (p = 1.000). Six months after the third dose the seropositivity for the patient group was 94% for both HPV types. CONCLUSIONS: The HPV vaccination in this cohort of JDM patients was safe and immunogenic. Since the seropositivity against HPV16 and 18 was very high after the 3-dose schedule, this regimen should be recommended for JDM patients. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, number: RBR-9ypbtf . Registered 20 March 2018 - Retrospectively registered.

Oral and maxillofacial conditions, dietary aspects, and nutritional status of children with congenital Zika syndrome.

OBJECTIVE: The aim of this study was to investigate oral and maxillofacial outcomes in children with congenital Zika syndrome (CZS) and the presence of nonnutritive sucking habits, functional habits, and features related to breastfeeding and nutrition of these children. STUDY DESIGN: We conducted a cross-sectional study with 45 children with CZS and 50 healthy controls in Sergipe state, Brazil, from February 2018 to June 2018. Demographic and clinical data, including breastfeeding and feeding data, were obtained for each child. Additionally, oral and maxillofacial evaluation was performed. RESULTS: Low weight (prevalence rate [PR] 8.33; 95% confidence interval [CI] 2.02-34.45), nonexclusive breastfeeding up to 6 months (PR 1.56; 95% CI 1.18-2.08); mouth breathing (PR 3.46; 95% CI 1.83-6.52); difficulty in swallowing (PR 6.00; 95% CI 2.53-14.25); and excessive salivation (PR 4.81; 95% CI 2.18-10.62) were more frequent in children with CZS. Children with CZS were more likely to have abnormal insertion of the upper labial frenulum (PR 7.04; 95% CI 2.23-22.20); ogival palate (PR 3.70; 95% CI 1.63-8.40), dental enamel defects (PR 2.22; 95% CI 1.05-4.69); and delayed dental eruption (PR 8.89; 95% CI 1.16-68.32) compared with healthy children. CONCLUSIONS: Children with CZS had a higher frequency of problems related to breastfeeding, low weight, and oral and maxillofacial abnormalities compared with healthy children.

Auto da Compadecida em tempos de pandemia: um relato de experiência da produção de uma radionovela durante a maior crise sanitária do século XXI / Auto da Compadecida in Times of Pandemics: an experience report of the production of a radio soap opera during the greatest health crisis of the 21st century / Auto da Compadecida en tiempos de pandemia: un relato de la experiencia de producir una radionovela durante la mayor crisis sanitaria del siglo XXI

O objetivo do trabalho é relatar a experiência de realização da radionovela Auto da Compadecida em tempos de pandemia, produzida por estudantes e professores dos cursos de Comunicação Social e Design da Universidade Federal de Pernambuco, campus Caruaru. A radionovela, dividida em nove episódios, foi adaptada e veiculada entre os meses de maio e junho de 2020, em meio à pandemia do novo coronavírus. Para realizá-la, foi feita uma série de encontros virtuais com a equipe, que adaptou o texto, dirigiu os radioatores, editou, trilhou, montou e veiculou a produção nas redes sociais e em rádios comunitárias e educativas do Brasil. Apesar de trabalhar com uma das obras mais conhecidas do escritor Ariano Suassuna, a coordenação do projeto procurou colocar na adaptação discussões sobre o novo coronavírus (incluindo na história o Capitão Covid), fake news e questões econômicas e políticas que têm comprometido a adoção de medidas necessárias de isolamento social. Junto à produção sonora, foram elaborados conteúdos gráficos para divulgação nas redes sociais; foram também criadas páginas no Instagram e em serviços de streaming de música, podcast e vídeo, a exemplo do Spotify. Dessa forma, a produção do Auto da Compadecida em tempos de pandemia não se resumiu à criação da radionovela, mas acionou conhecimentos de marketing digital, assessoria de imprensa, design e edição, o que contribuiu para ampliar o aprendizado dos estudantes. (AU)

The objective of the work is to report the experience of making the radio soap opera Auto da Compadecida in Times of Pandemics, produced by students and professors of the Social Communication and Design courses at the Federal University of Pernambuco, campus Caruaru. The radio soap opera, divided into nine episodes, was adapted and aired between the months of May and June 2020, amid the pandemic of the new coronavirus. To carry it out, a series of virtual meetings were held with the team, which adapted the text, directed the radio actors, edited, followed and broadcast the production on social networks and on community and educational radio stations in Brazil. Despite working with one of the best-known works of the writer Ariano Suassuna, the project's coordination sought to include in the adaptation discussions about the new coronavirus (including in the story the character Captain Covid), fake news and economic and political issues which have compromised the adoption of necessary measures of social isolation. Along with sound production, graphic content was created for dissemination on social networks, and pages were created on Instagram and music, podcast and video streaming services, such as Spotify. Thus, the production of Auto da Compadecida in Times of Pandemics was not limited to the creation of the radio soap opera, but also triggered knowledge of digital marketing, press relations, design and editing, which contributed to expand student learning. (AU)

El objetivo del trabajo es informar la experiencia de hacer la Radionovela Auto da Compadecida en tiempos de pandemia, producida por estudiantes y profesores de los cursos de Comunicación Social y Diseño en la Universidad Federal de Pernambuco, campus Caruaru. La radionovela, dividida en nueve episodios, fue adaptada y transmitida entre los meses de mayo y junio de 2020, en medio de la pandemia del nuevo coronavirus. Para llevarlo a cabo, se realizó una serie de reuniones virtuales con el equipo, que adaptó el texto, dirigió a los radio-actores, editó, siguió y publicó la producción en las redes sociales y en las estaciones de radio comunitarias y educativas en Brasil. A pesar de trabajar con una de las obras más conocidas del escritor Ariano Suassuna, la coordinación del proyecto buscó incluir en la adaptación discusiones sobre el nuevo coronavirus (incluido en la historia el Capitán Covid), noticias falsas y cuestiones económicas y políticas que han comprometido la adopción de medidas necesarias de aislamiento social. Junto con la producción de sonido, se creó contenido gráfico para su difusión en las redes sociales y se crearon páginas en Instagram y servicios de música, podcast y transmisión de video, como Spotify. Por lo tanto, la producción de Auto da Compadecida en tiempos de pandemia no se limitó a la creación de la radio telenovela, sino que desencadenó el conocimiento del marketing digital, las relaciones con la prensa, el diseño y la edición, lo que contribuyó a ampliar el aprendizaje de los estudiantes. (AU)

Prevenção e controle de infecção relacionada à assistência à saúde: um estudo com responsáveis de crianças internadas no setor pediátrico / Prevention and control of specialized healthcare infection: a study of guardians of children in the pediatric sector / Prevención y control de infecciones sanitarias especializadas: estudio de tutores de niños en el sector pediátrico

Justificativa e objetivos: Na hospitalização infantil, a educação em saúde é uma estratégia importante utilizada com acompanhantes, como método de controle das infecções relacionadas à assistência à saúde, uma vez que o conhecimento construído poderá auxiliar na prevenção, possibilitando que familiares e acompanhantes compreendam as medidas de prevenção e as coloquem em prática. Conhecer os saberes e práticas dos responsáveis de pacientes no setor pediátrico, no que concerne à prevenção e controle infecção relacionada à assistência à saúde. Métodos: O estudo foi realizado no setor pediátrico do Hospital Regional do Baixo Amazonas ­ HRBA, na cidade de Santarém ­ Pará. Realizou-se uma pesquisa de campo, com abordagem quantitativa e qualitativa. A pesquisa contou com a participação de 20 (vinte) responsáveis de pacientes pediátricos. Os dados quantitativos foram analisados por meio de estatística descritiva, e os dados qualitativos foram tratados por meio do software IRAMUTEQ. Resultados: A partir das análises qualitativas dos dados pelo software, obteve-se o dendograma denominado Saberes dos Responsáveis sobre infecção relacionada à assistência à saúde , dando origem a duas categorias: uma aborda sobre o conhecimento de infecção relacionada à assistência à saúde e a outra aborda sobre as Práticas de Controle de Infecção. Conclusão: com isso, evidenciou-se que a maioria dos responsáveis pelas crianças, desconheciam sobre a temática abordada, a maioria dos participantes relataram que foram orientadas sobre as medidas de prevenção e controle de infecção relacionada à assistência à saúde durante o período de acompanhamento da criança.(AU)

Background and objective: In children's hospitalization, health education is an important strategy used with caregivers as a method of controlling hospital infections, since the knowledge built may help prevention, enabling family members and caregivers to understand prevention measures and put them In practice. To know the knowledge and practices of the responsible of patients in the pediatric sector, regarding the prevention and control of specialized healthcare infection. Methods: The study was carried out in the pediatric department of the Regional Hospital of Baixo Amazonas - HRBA, in the city of Santarém - Pará. A field study was carried out, with quantitative and qualitative approach. The research was attended by 20 (twenty) responsible pediatric patients. Quantitative data were analyzed using descriptive statistics, and qualitative data were processed using IRAMUTEQ software. Results: Based on the qualitative analysis of the data by the software, a dendogram was obtained called the Knowledge of Persons Responsible for Hospital Infection, giving rise to two categories: one on the Knowledge of Hospital Infection and the other on Infection Control Practices. Conclusion: it was evidenced that most of those responsible for the children were unaware of the issue, most of the participants reported that they were guided about the measures of prevention and control of specialized healthcare infection during the period of follow-up of the child.(AU)

Justificación y objetivos: En la hospitalización infantil, la educación en salud es una estrategia importante utilizada con acompañantes, como método de control de las infecciones hospitalarias, ya que el conocimiento construido podrá auxiliar en la prevención, posibilitando que familiares y acompañantes comprendan las medidas de prevención y las coloquen en la práctica. Conocer los saberes y prácticas de los responsables de pacientes en el sector pediátrico, en lo que concierne a la prevención y control de la infecciones sanitarias especializadas. Métodos: El estudio fue realizado en el sector pediátrico del Hospital Regional del Bajo Amazonas - HRBA, en la ciudad de Santarém - Pará. Se realizó una investigación de campo, con abordaje cuantitativo y cualitativo. La investigación contó con la participación de 20 (veinte) responsables de pacientes pediátricos. Los datos cuantitativos se analizaron mediante una estadística descriptiva, y los datos cualitativos fueron tratados a través del software IRAMUTEQ. Resultados: A partir de los análisis cualitativos de los datos por el software, se obtuvo el dendograma denominado Saberes de los Responsables sobre Infección Hospitalaria, dando origen a dos categorías: una aborda sobre el Conocimiento de Infección Hospitalaria y la otra aborda sobre las Prácticas de Control de Infección. Conclusíon: con ello, se evidenció que la mayoría de los responsables de los niños, desconocían sobre la temática abordada, la mayoría de los participantes relataron que se orientaron sobre las medidas de prevención y control de infecciones sanitarias especializadas durante el período de seguimiento del niño.(AU)

Comparison among ACR1997, SLICC and the new EULAR/ACR classification criteria in childhood-onset systemic lupus erythematosus

Abstract Background: To date there are no specific classification criteria for childhood-onset systemic lupus erythematosus (cSLE). This study aims to compare the performance among the American College of Rheumatology (ACR) 1997, the Systemic Lupus International Collaborating Clinics criteria (SLICC) and the new European League Against Rheumatism (EULAR)/ACR criteria, in a cSLE cohort. Methods: We conducted a medical chart review study of cSLE cases and controls with defined rheumatic diseases, both ANA positive, to establish each ACR1997, SLICC and EULAR/ACR criterion fulfilled, at first visit and 1-year-follow-up. Results: Study population included 122 cSLE cases and 89 controls. At first visit, SLICC criteria had higher sensitivity than ACR 1997 (89.3% versus 70.5%, p < 0.001), but similar specificity (80.9% versus 83.2%, p = 0.791), however performance was not statistically different at 1-year-follow-up. SLICC better scored in specificity compared to EULAR/ACR score ≥ 10 at first visit (80.9% versus 67.4%, p = 0.008) and at 1-year (76.4% versus 58.4%, p = 0.001), although sensitivities were similar. EULAR/ACR criteria score ≥ 10 exhibited higher sensitivity than ACR 1997 (87.7% versus 70.5%, p < 0.001) at first visit, but comparable at 1-year, whereas specificity was lower at first visit (67.4% versus 83.2%, p = 0.004) and 1-year (58.4% versus 76.4%, p = 0.002). A EULAR/ACR score ≥ 13 against a score ≥ 10, resulted in higher specificity, positive predictive value, and cut-off point accuracy. Compared to SLICC, a EULAR/ACR score ≥ 13 resulted in lower sensitivity at first visit (76.2% versus 89.3%, p < 0.001) and 1-year (91% versus 97.5%, p = 0.008), but similar specificities at both assessments. When compared to ACR 1997, a EULAR/ACR total score ≥ 13, resulted in no differences in sensitivity and specificity at both observation periods. Conclusions: In this cSLE population, SLICC criteria better scored at first visit and 1-year-follow-up. The adoption of a EULAR/ACR total score ≥ 13 in this study, against the initially proposed ≥10 score, was most appropriate to classify cSLE. Further studies are necessary to address if SLICC criteria might allow fulfillment of cSLE classification earlier in disease course and may be more inclusive of cSLE subjects for clinical studies.

Retrato das práticas obstétricas em uma maternidade pública / Retrato de las prácticas obstétricas en una maternidad pública / Picture of midwifery practices at a public maternity hospital

RESUMO Objetivo: identificar as práticas obstétricas adotadas durante a assistência ao parto e nascimento. Método: estudo transversal, analítico, realizado em uma maternidade pública em Aracaju - Sergipe, no período de novembro de 2015 a fevereiro de 2016, com 373 puérperas com idade gestacional ≥ 37 semanas, que permaneciam no mínimo 30 minutos em pré-parto. Foram utilizados os testes qui-quadrado e exato de Fisher. Resultados: as práticas obstétricas de nível "A" ofertadas foram: banho morno 109 (29,2%), massagem 62 (16,6%), bola suíça 50 (13,4%), deambulação 223 (59,8%), contato pele a pele 250 (66,7%) e a presença de acompanhante 89 (23,9%). Foram realizadas práticas nível "B e D" como ocitocina 236 (63,3%), aminiotomia 171 (45,8%), episiotomia 51 (19,8%) e Kristeller 129 (34,6%). Conclusão: este estudo revela a necessidade de adequação da ambiência e implementação irrestrita das boas práticas para garantir assistência segura ao parto e nascimento, assim como contribuir na formação dos novos profissionais.

RESUMEN: Objetivo: identificar las prácticas obstétricas adoptadas durante la atención al parto y nacimiento. Método: estudio trasversal, analítico, desarrollado en una maternidad pública en Aracaju - Sergipe, en el período de noviembre de 2015 a febrero de 2016, con 373 puérperas con edad gestacional ≥ 37 semanas, que permanecían al menos 30 minutos en preparto. Fueron utilizadas las pruebas ji-cuadrado y exacta de Fisher. Resultados: las prácticas obstétricas de nivel "A" ofertadas fueron: baño tibio 109 (29,2%), masaje 62 (16,6%), bola suiza 50 (13,4%), deambulación 223 (59,8%), contacto piel a piel 250 (66,7%) y la presencia de acompañante 89 (23,9%). Fueron aplicadas prácticas nivel "B y D" como oxitocina 236 (63,3%), amniotomía 171 (45,8%), episiotomía 51 (19,8%) y Kristeller 129 (34,6%). Conclusión: este estudio revela la necesidad de adecuación del entorno e implementación irrestricta de las buenas prácticas para garantizar atención segura al parto y nacimiento, y también contribuir a la formación de los nuevos profesionales.

ABSTRACT Objective: identify the midwifery practices adopted during delivery and birth care. Method: cross-sectional, analytic study, undertaken at a public maternity in Aracaju - Sergipe, between November 2015 and February 2016, involving 373 postpartum women with gestational age ≥ 37 weeks, who experienced at least 30 minutes of prepartum. The chi-squared and Fisher's exact test were applied. Results: the following level A midwifery practices were offered: lukewarm bath 109 (29.2%), massage 62 (16.6%), Swiss ball 50 (13.4%), walking 223 (59.8%), skin-to-skin contact 250 (66.7%) and the presence of a companion 89 (23.9%). Level B and D practices were executed, such as oxytocin 236 (63.3%), amniotomy 171 (45.8%), episiotomy 51 (19.8%) and Kristeller's 129 (34.6%). Conclusion: this study reveals the need to adapt the ambience and implement the best practices unrestrictedly in order to guarantee safe delivery and birth care and to contribute to the training of new professionals.

Mycobacteria in Minas cheese commercialized in open fairs in São Paulo, Brazil / Mycobacteria em queijos tipo Minas comercializados em feiras-livres de São Paulo, Brasil

Mycobacterium bovis is the causative agent of bovine tuberculosis, a disease that affects dairy herds throughout the Brazilian territory, constituting a neglected zoonosis transmitted by raw milk and its derivatives. In this study, we evaluated the presence of M. bovis and other mycobacteria in Minas cheese obtained from open fairs in the city of São Paulo between 2012 and 2013. Samples (n = 133) were decontaminated using hexa-cetylpyridinium chloride and seeded on Stonebrink­Leslie medium. The isolates were submitted to molecular identification by TB Multiplex PCR targeting the 16S rRNA gene and amplicon nucleotide sequencing. From 16 cheese samples (12%), we obtained 26 putative colonies of Mycobacterium spp, none of which belonged to any of the Mycobacterium tuberculosis, Mycobacterium avium, or Mycobacterium intracellulare complexes. Phylogenetic analysis showed that sample sequences were grouped in a clade that includes only non-tuberculous mycobacteria with proximity to sequences obtained from Mycobacterium novocastrense (3 sequences), Mycobacterium holsaticum (1 sequence), and Mycobacterium elephantis (2 sequences). Although no epidemiological evidence was found regarding the importance of oral transmission of mycobacteria in healthy people, their importance in the immunosuppressed population remains uncertain.(AU)

Mycobacterium bovis é o agente da tuberculose bovina, doença que acomete o rebanho em todo território brasileiro e é uma negligenciada zoonose transmitida pelo leite e seus derivados. Este trabalho avaliou a presença de M. bovise outras micobactérias, em queijo minas meia-cura, obtidos em feiras-livres na cidade de São Paulo, entre os anos de 2012 e 2013. As amostras (n = 133) foram descontaminadas pelo método HPC (hexa-cetyl-pyridinium chloride) e semeadas em meio Stonebrink Leslie. Os isolados foram submetidos à identificação molecular por PCR TB multiplex, pesquisando-se o gene 16S rRNA, e ao sequenciamento nucleotídico. Dezesseis amostras (12%) possuiam 26 colônias sugestivas de Mycobacterium spp, mas nenhuma delas pertencia aos complexos Mycobacterium tuberculosis, Mycobacterium avium e Mycobacterium intracellulare. A análise filogenética mostrou que todas as amostras estavam agrupadas em clados que incluem apenas micobactérias não tuberculosas (MNT), sendo que algumas possuiam proximidade com sequências obtidas de Mycobacterium novocastrense (3 sequências), Mycobacterium hosaticum(1 sequência) e Mycobacterium elephantis (2 sequências). Embora no momento não haja evidência epidemiológica da importância da transmissão oral das micobactérias pra indivíduos saudáveis, sua importância na população imunossuprimida ainda é incerta.(AU)

Interactive effects of genotype x environment on the live weight of GIFT Nile tilapias

ABSTRACT In this paper, the existence of a genotype x environment interaction for the average daily weight in GIFT Nile tilapia (Oreochromis niloticus) in different regions in the state of Paraná (Brazil) was analyzed. The heritability results were high in the uni-characteristic analysis: 0.71, 0.72 and 0.67 for the cities of Palotina (PL), Floriano (FL) and Diamond North (DN), respectively. Genetic correlations estimated in bivariate analyzes were weak with values between 0.12 for PL-FL, 0.06 for PL and 0.23 for DN-FL-DN. The Spearman correlation values were low, which indicated a change in ranking in the selection of animals in different environments in the study. There was heterogeneity in the phenotypic variance among the three regions and heterogeneity in the residual variance between PL and DN. The direct genetic gain was greater for the region with a DN value gain of 198.24 g/generation, followed by FL (98.73 g/generation) and finally PL (98.73 g/generation). The indirect genetic gains were lower than 0.37 and greater than 0.02 g/generation. The evidence of the genotype x environment interaction was verified, which indicated the phenotypic heterogeneity of the variances among the three regions, weak genetic correlation and modified rankings in the different environments.

Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil).

OBJECTIVES: To assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice. PATIENTS AND METHODS: This cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1552 treatments, including 415 with only synthetic disease-modifying anti-rheumatic drugs, 942 synthetic DMARDs combined with anti-tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. STATISTICAL ANALYSIS: Unpaired t-test and Fisher's two-tailed test; p<0.05. RESULTS: The exposure times were 981 patient-years in the controls, 1744 patient-years in the anti-TNF group (adalimumab=676, infliximab=547 and etanercept=521 patient-years) and 336 patient-years in the other biologics group. The incidence rates of tuberculosis were 1.01/1000 patient-years in the controls and 2.87 patient-years among anti-TNF users (adalimumab=4.43/1000 patient-years; etanercept=1.92/1000 patient-years and infliximab=1.82/1000 patient-years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of tuberculosis was 27(11) months for the anti-TNF group. CONCLUSIONS: The incidence of tuberculosis was higher among users of synthetic DMARDs and anti-TNF than among users of synthetic DMARDs and synthetic DMARDs and non-anti-TNF biologics and also occurred later, suggesting infection during treatment and no screening failure.

Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil) / Incidência de tuberculose em pacientes com artrite reumatoide em uso de bloqueadores do TNF no Brasil: dados do Registro Brasileiro de Monitoração de Terapias Biológicas BiobadaBrasil

Abstract Objectives To assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice. Patients and methods This cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1552 treatments, including 415 with only synthetic disease-modifying anti-rheumatic drugs, 942 synthetic DMARDs combined with anti-tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t-test and Fisher's two-tailed test; p < 0.05. Results The exposure times were 981 patient-years in the controls, 1744 patient-years in the anti-TNF group (adalimumab = 676, infliximab = 547 and etanercept = 521 patient-years) and 336 patient-years in the other biologics group. The incidence rates of tuberculosis were 1.01/1000 patient-years in the controls and 2.87 patient-years among anti-TNF users (adalimumab = 4.43/1000 patient-years; etanercept = 1.92/1000 patient-years and infliximab = 1.82/1000 patient-years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of tuberculosis was 27(11) months for the anti-TNF group. Conclusions The incidence of tuberculosis was higher among users of synthetic DMARDs and anti-TNF than among users of synthetic DMARDs and synthetic DMARDs and non-anti-TNF biologics and also occurred later, suggesting infection during treatment and no screening failure.

Resumo Objetivos Avaliar incidência de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biológicos na prática clinica. Pacientes e métodos Estudo de coorte com dados do Registro Brasileiro de Monitoração de Terapias Biológicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doença (MMCDs) sintéticas, 942 MMCDs sintéticas em associação com anti-TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sintéticas em associação com outros biológicos (abatacepte, rituximabe e tocilizumabe). Avaliaram-se ocorrência de tuberculose, tempo de exposição às drogas e triagem para TB. Análise estatística: teste t não pareado e teste de Fisher bicaudal; p < 0,05. Resultados O tempo de exposição dos controles foi de 981 pacientes-ano, do grupo de anti-TNF foi de 1.744 pacientes-ano (adalimumabe = 676, infliximabe = 547 e etanercepte = 521 pacientes-ano) e o de outros biológicos de 336 pacientes-ano. A incidência de TB foi de 1,01/1.000 pacientes-ano nos controles e de 2,87 pacientes-ano nos usuários de anti-TNF (adalimumabe = 4,43/1.000 pacientes-ano; etanercepte = 1,92/1.000 pacientes-ano e infliximabe = 1,82/1.000 pacientes-ano). Não houve casos de tuberculose no grupo de outros biológicos. O tempo médio de exposição até a ocorrência de tuberculose foi de 27(11) meses para o grupo anti-TNF. Conclusões A incidência de tuberculose foi maior nos usuários de MMCDs sintéticas e anti-TNF do que nos usuários de MMCDs sintéticas e de MMCDs sintéticas e biológicos não anti-TNF, e também mais tardia, sugerindo infecção durante o tratamento, e não falha na triagem.