ABSTRACT
Introduction: The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency. Methods: At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output. Results: Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19. Discussion: Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Subject(s)
COVID-19 , Adult , Adolescent , Child , Humans , SARS-CoV-2 , Pandemics , Latin AmericaABSTRACT
OBJECTIVE: To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. METHOD: Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. RESULTS AND CONCLUSIONS: 1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.
Subject(s)
Lupus Nephritis/diagnosis , Lupus Nephritis/therapy , Biopsy , Brazil , Disease Progression , Humans , Remission InductionABSTRACT
Objetivo Elaborar recomendações para o diagnóstico, manejo e tratamento da nefrite lúpica no Brasil. Método Revisão extensa da literatura com seleção dos artigos com base na força de evidência científica e opinião dos membros da Comissão de Lúpus Eritematoso Sistêmico da Sociedade Brasileira de Reumatologia. Resultados e conclusões 1) A biópsia renal deve ser feita sempre que possível e houver indicação e quando não for possível, o tratamento deve ser orientado com base na inferência da clase histológica. 2) Devem ser implementados medidas e cuidados idealmente antes do início do tratamento, com ênfase na atenção ao risco de infecção. 3) Devem-se compartilhar riscos e benefícios do tratamento com pacientes e familiares. 4) O uso da hidroxicloroquina (preferencialmente) ou difosfato de cloroquina é recomendado para todos os pacientes (exceto contraindicação) durante as fases de indução e manutenção. 5) A avaliação da eficácia do tratamento deve ser feita com critérios objetivos de resposta (remissão completa/remissão parcial/refratariedade). 6) Os IECA e/ou BRA são recomendados como antiproteinúricos para todos os pacientes (exceto contraindicação). 7) A identificação de sinais clínicos e/ou laboratoriais sugestivos de GN laboratoriais sugestivos de glomerulonefrite proliferativa ou membranosa deve indicar início imediato de terapia específica incluindo corticosteroides e agente imunossupressor, mesmo que não seja possível comprovação histológica. 8) O tempo de uso dos imunossupressores deve ser no mínimo de 36 meses, mas eles podem ser mantidos por períodos mais longos. A sua suspensão só deve ser feita quando o paciente atingir e mantiver remissão completa sustentada. 9) Deve-se considerar nefrite lúpica refratária quando a remissão completa ou parcial não for alcançada após 12 meses de tratamento adequado, quando uma nova biópsia renal deve ser considerada para auxiliar na identificação da causa da refratariedade e decisão terapêutica. .
Objective To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. Method Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. Results and conclusions (1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. (2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. (3) Risks and benefits of treatment should be shared with the patient and his/her family. (4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. (5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). (6) Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers are recommended as antiproteinuric agents for all patients (unless contraindicated). (7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including corticosteroids and an immunosuppressive agent, even though histological confirmation is not possible. (8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient could achieve and maintain a sustained and complete remission. (9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when ...
Subject(s)
Humans , Lupus Nephritis/diagnosis , Lupus Nephritis/therapy , Biopsy , Brazil , Disease Progression , Remission InductionABSTRACT
PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. METHODS: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4%) were female. The mean age was 39.9 +/- 9.8 years and the disease duration was 13.9 +/- 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9% of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.
Subject(s)
Antimalarials/adverse effects , Chloroquine/analogs & derivatives , Diagnostic Techniques, Ophthalmological/standards , Lupus Erythematosus, Systemic/drug therapy , Retinal Diseases/chemically induced , Adult , Aged , Antimalarials/administration & dosage , Body Weight/physiology , Chi-Square Distribution , Chloroquine/administration & dosage , Chloroquine/adverse effects , Cornea/drug effects , Cornea/pathology , Diagnostic Techniques, Ophthalmological/classification , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Prevalence , Retina/drug effects , Retina/pathology , Retinal Diseases/diagnosis , Retinal Diseases/epidemiology , Risk Factors , Time Factors , Visual Fields/drug effects , Young AdultABSTRACT
OBJETIVOS: Avaliar diferentes métodos diagnósticos para a avaliação de pacientes portadores de lúpus eritematoso sistêmico, usuários crônicos do difosfato de cloroquina (DFC) e, portanto, com alto risco para retinopatia tóxica. MÉTODOS: Foram analisados 72 olhos de 36 pacientes consecutivos, seguidos no Serviço de Reumatologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, de julho de 2007 a abril de 2008. Dados demográficos e clínicos foram avaliados com o intuito de estudar os fatores de alto risco e comparar os seguintes métodos oftalmológicos: acuidade visual, biomicroscopia da córnea, biomicroscopia do fundo, retinografia, angiofluoresceinografia da retina, campo visual macular com mira branca. RESULTADOS: Dos 36 pacientes, 34 (94,4 por cento) eram mulheres. A média de idade foi 39,9 ± 9,8 anos, com tempo de doença igual a 13,9 ± 6,6 anos. Além do uso crônico da cloroquina, os pacientes apresentaram altas doses diárias (>3 mg/kg) e cumulativas. Não foi observada relação entre estes fatores de alto risco e maior prevalência de retinopatia. Foi encontrada prevalência de retinopatia igual a 38,9 por cento, confirmada por alterações bilaterais, centrais ou paracentrais e reprodutíveis no exame de campo visual. Outros exames indicados para seguimento, como acuidade visual, biomicroscopia de fundo e angiofluoresceinografia não foram capazes de diagnosticar a maioria das alterações confirmadas pelo campo visual. CONCLUSÃO: Foi observada alta prevalência de retinopatia por cloroquina entre os pacientes com alto risco, usuários crônicos do DFC, segundo os achados do campo visual. A avaliação desses pacientes deve considerar a realização do exame de campo visual em intervalos menores que os propostos, mesmo quando não há suspeita clínica.
PURPOSE: To evaluate different diagnostic methods for high risk chloroquine retinopathy due to prolonged use of chloroquine (more than 5 years) by systemic lupus erythematosus patients. Methods: Seventy-two eyes of 36 consecutive patients, followed in the Division of Rheumatology, School of Medicine, University of São Paulo, were analyzed from July 2007 to April 2008. Demographic and clinical data were evaluated in order to study risk factors and to compare the following different ophthalmological methods: visual acuity, biomicroscopy, fundus examination, retinography, fluorescein angiogram, visual field test and, color vision tests. RESULTS: From 36 patients, 34 (94.4 percent) were female. The mean age was 39.9 ± 9.8 years and the disease duration was 13.9 ± 6.6 years. Besides chronic use of chloroquine, patients also showed high daily and cumulative doses. These high risk factors were not related to a higher retinopathy prevalence. Visual field showed 38.9 percent of retinopathy prevalence. Other ophthalmological methods failed in detecting most cases. CONCLUSION: High prevalence of retinopathy in high risk patients was observed by visual field test, but other ophthalmological methods failed in detecting alterations. Ophthalmological assessment of these patients should include visual field, even in the absence of clinical alterations.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Antimalarials/adverse effects , Chloroquine/analogs & derivatives , Diagnostic Techniques, Ophthalmological/standards , Lupus Erythematosus, Systemic/drug therapy , Retinal Diseases/chemically induced , Antimalarials/administration & dosage , Body Weight/physiology , Chi-Square Distribution , Chloroquine/administration & dosage , Chloroquine/adverse effects , Cornea/drug effects , Cornea/pathology , Diagnostic Techniques, Ophthalmological/classification , Fluorescein Angiography , Prevalence , Risk Factors , Retina/drug effects , Retina/pathology , Retinal Diseases/diagnosis , Retinal Diseases/epidemiology , Time Factors , Visual Fields/drug effects , Young AdultABSTRACT
A aterosclerose precoce é uma complicação importante no lúpus eritematoso sistêmico (LES), sendo considerada a principal causa de morbidade e mortalidade na doença. As dislipidemias ocorrem com frequência no seu curso e contribuem para o agravamento desse processo. O objetivo deste artigo é resumir as evidências desta interação, descrever os principais mecanismos de dislipidemias e discutir uma abordagem preventiva deste problema
Subject(s)
Arteriosclerosis , Hyperlipidemias , Lupus Erythematosus, Systemic/complicationsABSTRACT
A síndrome do lúpus neonatal (LN) é uma entidade rara, caracterizada por bloqueio cardíaco congênito (BCC)e/ou lesões cutâneas e, eventualmente, associada a alterações hematológicas e hepáticas. Essa síndrome está estritamente relacionada com a passagem transplacentária de auto-anticorpos maternos, particularmente anti-Ro/SSa e anti-La/SSB, sendo considerada um modelo de auto imunidade adquirida passivamente. Aproximadamente, metade das mães são assintomáticas e o restante apresenta síndrome de Sjögren, lúpus eritematoso sistêmico e outras doenças do sistema conectivo. Essa síndrome é a principal causa de bloqueio cardíaco congênito isolado e determina alto índice de mortalidade. Não existe tratamento preventivo para a síndrome, sendo recomendado que a gestação de mães com anticorpos anti-Ro/SSA ou anti-La/SSB tenha acompanhamento de frequência cardíaca fetal rigoroso. Nos casos em que há evidências de inflamação do miocárdio concomitante está indicado o tratamento com corticóide sistêmico que não seja inativado pela placenta, na tentativa de reverter o quadro
Subject(s)
Humans , Infant, Newborn , Autoantibodies , Autoimmune Diseases/congenital , Autoimmunity , Heart Block/congenital , Heart Block/physiopathology , Lupus Vulgaris/diagnosis , Lupus Vulgaris/physiopathology , Lupus Vulgaris/therapy , Dexamethasone/therapeutic use , Hydrocortisone/therapeutic useABSTRACT
A deteccao de anticorpos contra o citoplasma de neutrofilos e de extrema importancia no diagnostico de certas vasculites sistemicas. A especifidade e a sensibilidade desses anticorpos depende da tecnica utilizada para a sua deteccao. Assim sendo, comparamos os resultados obtidos pela imunofluorescencia (IF), ao ELISA com dois antigenos diferentes: o padrao classico, altamente especifico para a granulomatose de Wegener e o padrao perinuclear, inespecifico, embora fortemente relacionado com o acometimento renal...
Subject(s)
Humans , Enzyme-Linked Immunosorbent Assay , Neutrophils/immunology , Vasculitis/diagnosis , Fluorescent Antibody Technique , Sensitivity and Specificity , Vasculitis/classification , Vasculitis/immunologyABSTRACT
As vasculites sistemicas constituem um grupo de doencas caracterizadas por inflamacao da parede dos vasos sanguineos. Sua etiologia desconhecida, a dificuldade na catalogacao de entidades definidas e o tratamento geralmente empirico, tornam dificil o acompanhamento terapeutico destes pacientes. Entre as dificuldades esta a pobreza de marcadores destas doencas. Nesse particular, o maior avanco na abordagem das vasculites foi a recente descoberta no soro destes pacientes, da presenca de anticorpos dirigidos contra o citoplasma de neutrofilos, que poderiam servir como indicadores diagnosticos e de evolucao da doenca... .
Subject(s)
Humans , Male , Female , Adult , Antibodies , Neutrophils/immunology , Vasculitis/diagnosis , Vasculitis/immunology , Autoantibodies/immunology , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique , Granulomatosis with Polyangiitis/diagnosisABSTRACT
Determinamos neste trabalho a sensibilidade e especificidade da imunofluerescencia, imunodifusao, contraimunoeletroforese (CIE) e "Western blotting" (WB) para a deteccao dos anticorpos anti-Ro/SSA e anti-La/SSB. Todos os soros positivos para estes anticorpos apresentaram imunofluorescencia nuclear positiva, no entanto este teste mostrou totalmente inespecifico. A CIE foi o melhor metodo para a deteccao do anticorpo anti-Ro/SSB. O WB tem sensibilidade inferior mas demonstrou que a resposta ao antigeno Ro/SSA de 50kD predominou no lupus eritematoso sistemico (SLE). Em contraste, o WB e o metodo mais sensivel e especifico para a deteccao do anticorpo anti-La/SSB, seguidos pela CIE e imunodifusao. Os anticorpos anti-Ro/SSA e o anti-La/SSB foram os que estiveram mais frequentemente associados. Apenas 6 soros anti-Ro/SSA possuiam este anticorpo isoladamente e nenhum apresentou a imunofluorescencia nuclear negativa
Subject(s)
Humans , Autoantibodies/blood , Lupus Erythematosus, Systemic/immunology , Biomarkers/blood , Counterimmunoelectrophoresis , Autoimmunity , Blotting, Western , Immunodiffusion , Fluorescent Antibody TechniqueABSTRACT
As caracteristicas clinicas e laboratoriais de 199 pacientes com lupus eritematoso sistemico (LES) foram estudadas. Os pacientes que apresentaram inicio apos 50 anos foram comparados aqueles com inicio mais precoce. O acometimento clinico definiu diferencas importantes entre as duas populacoes. Os pacientes idosos apresentaram maior frequencia de manifestacoes musculares (p<0,05) e menor frequencia de alteracoes cutaneas (p<0,001) e de alopecia (p<0,02). Alem disso a apresentacao clinica mais frequente foi fraqueza muscular, poliartrite e emagrecimento (>10Kg), condicoes estas que podem sugerir o diagnostico de polimialgia reumatica ou doenca neoplasica. A presenca dos diversos auto-anticorpos foi semelhante nos dois grupos. Em contraste com estudos anteriores nao encontramos maior frequencia de anti-La/SSB no LES de inicio tardio. A apresentacao clinica do LES no idoso e menos exuberante e muitas vezes pouco caracteristica, exigindo consideracao especial para este diagnostico no sentido de se evitar retardo na sua terapeutica.