Axial Spondyloarthritis after bariatric surgery: a 7-year retrospective analysis

Abstract Background: In recent decades, obesity has become a public health problem in many countries. The objective of this study was to evaluate the main joint and extra-articular manifestations related to spondyloarthritis (SpA) after bariatric surgery (BS) in a retrospective cohort. Methods: Demographic, clinical, laboratory and imaging data from nine patients whose SpA symptoms started after a BS have been described. Modified New York (mNY) criteria for ankylosing spondylitis (AS) and the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial (ax-SpA) and peripheral (p-SpA) spondyloarthritis were applied. Results: The mean weight reduction after BS was 49.3 ±21.9 kg. The BS techniques were Roux-en-Y gastric bypass (n =8; 88.9%) and biliopancreatic diversion with duodenal switch (n = 1; 11.1%). Four (44.4%) patients had no axial or peripheral pain complaints before BS, while the other four (44.4%) had sporadic non-inflammatory back pain that had been attributed to obesity. One patient (11.1%) had persistent chronic back pain. In all nine cases, patients reported back pain onset or pattern (intensity or night pain) change after BS (mean time 14.7 ± 18 months). In addition, 8 of them (88.9%) were human leukocyte antigen (HLA)-B27 positive. All nine patients could be classified according to ASAS criteria as ax-SpA and five (55.6%) patients were classified as AS, according to the mNY criteria. Conclusion: Our data highlight a temporal link between SpA onset symptoms and the BS, suggesting a possible causal plausibility between the two events.

Prevalência de sintomas respiratórios e fatores associados: estudo de base populacional em adultos de Lages, Santa Catarina, Brasil / Prevalence of respiratory symptoms and associated factors: a population-based study in adults from Lages, Santa Catarina State, Brazil

Realizou-se estudo transversal de base populacional em Lages, Santa Catarina, Brasil, para estimar a prevalência de sintomas de bronquite crônica, falta de ar e chiado no peito e os fatores associados em adultos de 20-59 anos de idade (n = 2.051). Processo de amostragem através de conglomerados e análise de regressão de Poisson foram realizados. As prevalências de bronquite crônica, falta de ar e chiado no peito foram de 5 por cento, 35,7 por cento e 20,2 por cento, respectivamente. Análises ajustadas mostraram presença de bronquite crônica associada à baixa escolaridade, fumar dez ou mais pacotes de cigarros ao ano e internação por problemas de pulmão na infância. Falta de ar associou-se ao sexo feminino, baixa escolaridade e renda familiar, pardos e amarelos, história de internação por problemas de pulmão na infância, ser fumante e trabalhar com poeira ou pó. Presença de chiado no peito associou-se ao sexo feminino, baixa escolaridade e renda familiar, pardos e pretos, história de internação por problemas de pulmão na infância, ser fumante e trabalhar com poeira ou pó. Particularidades do clima e das atividades laborais devem ser consideradas no planejamento das ações em saúde.

A cross-sectional population-based study was conducted in Lages, Santa Catarina State, Brazil, in order to estimate the prevalence of symptoms of chronic bronchitis, breathlessness, and wheezing and associated factors in a sample of adults 20 to 59 years of age (n = 2,051). The study employed a cluster sample design and Poisson regression analyses. Prevalence rates for chronic bronchitis, breathlessness, and wheezing were 5 percent, 35.7 percent, and 20.2 percent, respectively. The adjusted analysis showed chronic bronchitis associated with low schooling, smoking, and hospital admissions due to respiratory illness during childhood. Breathlessness was associated with female gender, low schooling and family income, non-white race, hospital admissions due to respiratory illness during childhood, smoking, and occupational exposure to dust. Wheezing was associated with female gender, low schooling and family income, non-white race, hospital admissions due to respiratory illness during childhood, smoking, and occupational exposure to dust. Public health planners should consider climatic factors and work activities when developing activities to prevent respiratory diseases.

Manifestações respiratórias e doenças de vias aéreas: prevalência e fatores de risco em suinocultores de Braço do Norte, Santa Catarina / Respiratory manifestations and respiratory diseases: prevalence and risk factors among pig farmers in Braço do Norte, Brazil

OBJETIVO: Descrever a prevalência de sinais e sintomas de doença respiratória, avaliar as características do confinamento e identificar potenciais fatores de risco nos suinocultores do município de Braço do Norte, Santa Catarina. MÉTODOS: Um estudo do tipo observacional, de caráter exploratório, com delineamento transversal, em que a coleta de dados foi através de entrevistas e realização de espirometrias. Foram investigados o histórico laborativo, as condições do ambiente e trabalho, a saúde respiratória e o hábito tabágico. Como medida de risco foi utilizada a razão de chances da exposição, ao comparar suinocultores expostos e não expostos aos fatores de interesse de acordo com presença de sinais e sintomas de doença respiratória. RESULTADOS: A prevalência das manifestações de sintomas e sinais respiratórios foi de 84,3 por cento, de asma brônquica foi de 5,6 por cento e de bronquite crônica naqueles acima de 40 anos foi 5,1 por cento. Apenas 2,6 por cento dos suinocultores utilizavam equipamentos de proteção específica para o aparelho respiratório. Manifestações respiratórias entre os suinocultores mostraram-se associadas ao baixo nível socioeconômico, baixa escolaridade, tabagismo, uso de fogão a lenha e uso de desinfetantes. Havia uma aparente associação entre tempo e intensidade de trabalho e os achados de uma menor prevalência de manifestações respiratórias. CONCLUSÃO: O 'fenômeno saúde do trabalhador' pode explicar a associação entre tempo/intensidade de trabalho e a menor prevalência de manifestações respiratórias. Entretanto, o evidente comprometimento do aparelho respiratório entre os suinocultores e a baixa adoção de medidas de proteção específica nesta população apontam para a necessidade de um programa de controle da exposição e regulamentação dos fatores ambientais.

OBJECTIVE: To describe the prevalence of signs and symptoms of respiratory disease among pig farmers in Braço do Norte, Santa Catarina, Brazil, evaluating the characteristics of swine confinement buildings and identifying potential risk factors. METHODS: An exploratory, cross-sectional, observational study involving interviews and pulmonary function tests (spirometry). Aspects related to job history, work conditions, and environment, as well as to respiratory status and smoking, were evaluated. Odds ratios were used to estimate the chances of exposure when comparing pig farmers according to the signs and symptoms of respiratory disease. RESULTS: The prevalence of clinical signs and symptoms of respiratory disease was 84.3 percent, clinical manifestations of bronchial asthma were detected in 5.6 percent of the farmers evaluated, and chronic bronchitis was diagnosed in 5.1 percent of the workers over the age of 40. Only 2.6 percent used specific individual respiratory protection devices. Respiratory disease was positively associated with low socioeconomic level, low level of education, smoking, the use of wood stoves, and the use of disinfectants. Work load and length of employment were both apparently associated with a lower prevalence of respiratory disease. CONCLUSION: The association between duration of employment and lower prevalence of respiratory disease can be attributed to the healthy worker effect. However, the evident respiratory impairment among pig farmers and the limited use of personal protective equipment draw attention to the need to implement a program to monitor exposure and regulate environmental factors.

A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure.

INTRODUCTION: Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology. METHODS: Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more. RESULTS: Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone. CONCLUSIONS: Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.