Social impact of disease parameters and damage accrual in adult Brazilian patients with childhood-onset Systemic Lupus Erythematosus.

OBJECTIVES: To describe the frequency and investigate potential associations of unemployment, need of financial assistance and health-related quality of life in adult patients with childhood-onset Systemic Lupus Erythematosus (cSLE). METHODS: In this multicenter cross-sectional retrospective cohort study including cSLE adult patients, questionnaires were applied evaluating demographic characteristics, medical history, treatment, receipt of government financial assistance, work status, quality of life, economic classification, disease activity, and damage accrual. Disease activity and disease damage were measured at the study visit. RESULTS: Sixty-nine cSLE patients with a median age of 21 years from two Brazilian tertiary centers were included (median disease duration 9 years). Twenty-eight (40.6%) patients were unemployed and 16 (23.2%) were receiving financial assistance or retirement pension. Work unemployment was associated with higher damage scores (OR 1.83, 95% CI 1.08 to 3.09, p = 0.024), and the need of financial assistance was associated with longer disease duration (OR 1.15, 95% CI 1.00 to 1.31, p = 0.045) and worse economic score (OR 0.87, 95% CI 0.77 to 0.99, p = 0.038). Emotional health and body image perception were the most compromised domains of quality of life but showed no association with disease parameters. Disease activity, on the other hand, was inversely associated with symptoms scores (ß = -1.377, p = 0.014) and scores of adverse effects of medications (ß = -1.286, p = 0.020). CONCLUSION: cSLE is a disease with severe outcomes and high social burden that profoundly impacts patients. Damage accrual is a major contributor to unemployment during adulthood and its prevention must be central in the management of cSLE.

Use of synthetic and biologic DMARDs during pregnancy.

Introduction: Since most of the autoimmune diseases (AID) affect mostly women in their fertile years, and fertility is in general preserved, the use of disease-modifying antirheumatic drugs (DMARDs) during conception, pregnancy, and lactation has been a matter of concern in the treatment of women affected by AID. Areas covered: We performed a comprehensive review of the latest and most relevant research papers published in the field and discussed different aspects related to the use of synthetic and biologic DMARDs and immunosuppressants in the preconceptional period, during pregnancy and lactation in AID patients, both in males and females. Expert commentary: Active AID impose an increased risk for adverse maternal and fetal outcomes, such as preeclampsia, miscarriage, intrauterine growth restriction, prematurity, low birth weight, and stillbirth. Family planning with proper contraception and shared decision-making on the ideal time to conceive with treatment adjustment must be a rule. One of the main challenges when counseling and/or adjusting treatment of patients that are planning a pregnancy is to provide a medication that is at the same time efficacious and safe at the conceptional period and to developing the fetus.

Pseudotumor cerebri in childhood and adolescence: data from a specialized service.

OBJECTIVE: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. METHODS: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. RESULTS: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. CONCLUSION: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.

Pseudotumor cerebri in childhood and adolescence: data from a specialized service / Pseudotumor cerebral na infância e adolescência: dados de um serviço especializado

ABSTRACT Objective: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. Methods: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. Results: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. Conclusion: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.

RESUMO Relatar os casos de crianças e adolescentes com diagnóstico de pseudotumor cerebral com ou sem doença reumática. Métodos: Estudo retrospectivo através de revisão de prontuários, 29 pacientes com idade até 18 anos e diagnóstico de pseudotumor, atendidos nos ambulatórios de Reumatologia Pediátrica e Neurologia de um hospital terciário, registrados até dezembro de 2016. Resultados: Dentre os 29 pacientes com diagnóstico de pseudotumor cerebral, 51,7% eram meninas. A média de idade de aparecimento dos sintomas foi de 12,3 anos. Em relação à etiologia do pseudotumor cerebral, em 18 pacientes (62%) foi possível identificar uma causa, sendo o diagnóstico de doença reumática associada em quatro desses casos. Cefaléia foi o sintoma mais frequente (69%), e a medicação mais utilizada foi a acetazolamida (69%). Dois pacientes evoluíram para cegueira e 10 ainda se encontram em seguimento ambulatorial. Conclusão: Concluímos que, apesar de raro, o diagnóstico de pseudotumor cerebral deve ser considerado em crianças com cefaleia, principalmente nos pacientes com doença reumática.

Fontes de estudo e pesquisa entre os estudantes de medicina / Sources of study and research among medical students

Introdução: Fontes de estudo são os recursos didáticos físicos que auxiliam o educando a realizar sua aprendizagem, constituindo-se em meio para facilitar, incentivar ou possibilitar o processo ensino-aprendizagem. A seleção dessas fontes é feita em função do objetivo a ser cumprido, que varia desde atividades curriculares a atualização científica. Objetivo: Identificar as fontes de estudo e pesquisa utilizadas pelos estudantes de medicina e o critério de uso. Método: Foi desenvolvido um estudo transversal com 262 participantes. Os dados foram coletados por meio de questionário estruturado, com 12 perguntas de múltipla escolha. Foi utilizado o programa Microsoft Access® para a montagem do banco de dados e o programa Microsoft Excel® para a análise dos dados colhidos. A análise estatística foi quantitativa utilizando o programa Statistical Package for the Social Sciences® (SPSS). Resultados: Como fonte de estudo para uma prova: 70,6% utilizam livro, 52,7% dos alunos usam as aulas ministradas pelos professores, e as anotações próprias das aulas são utilizadas por 43,9%; 26,7% dos estudantes se julgam aptos a identificar uma fonte de estudo confiável; os principais critérios de seleção dessas fontes foram: a complexidade do conteúdo e o tempo. Observou-se que 23,5% dos alunos do segundo e quarto períodos consideravam possuir autonomia, valor que praticamente dobrou (45,8%) no sexto e oitavo períodos (p=0,002). Conclusões: Apesar de se sentirem cada vez mais confiantes no uso das ferramentas disponíveis para a realização das provas à medida que o curso avança, não há unanimidade no reconhecimento de sua adequação para este fim; e a maioria dos estudantes busca sites confiáveis para a atualização científica, como o da Bireme.

Introduction: Sources of study are physical teaching resources that help the student to perform his learning process, being the means to facilitate, encourage or enable the teaching-learning process. The selection of these sources is made according to the goal to be achieved, ranging from the scientific update to curricular activities. Objective: The aim of this study was to identify the sources of study and research used by medical students and the criteria used for their selection. Methods: A cross-sectional study was developed with 262 participants. Results: The following sources of study for a test were identified: 70.6% use books, 52.7% of the students interviewed use lessons taught in class, and the students' own notes from the lessons are used by 43.9%; 26.7% of the students feel able to identify a reliable source of study. The main criteria for selection of these sources were: the complexity of the content and time. Conclusion: overall, it is possible to realize that students feel a deficiency in their education in the instruction for seeking information but nevertheless, they still learn during graduation how to select reliable information.