Persistence of antiphospholipid antibodies over time and its association with recurrence of clinical manifestations: A longitudinal study from a single centre.

PURPOSE: To analyze the antiphospholipid antibody (aPL) persistence over time in patients with antiphospholipid syndrome (APS) and its association with clinical recurrence and to identify predictors of aPL persistence over time. PATIENTS AND METHODS: 200 patients with a diagnosis of APS and at least three follow-up aPL determinations were included. Persistent aPL profile was defined as the presence of lupus anticoagulant (LAC) and/or IgG/IgM anticardiolipin (aCL) and/or IgG/IgM anti-ß2 glycoprotein-I (aß2GPI) (> 99th percentile) antibodies in at least 66% of follow-up measurements. Multilevel mixed-effect generalized linear models with logit link were used. RESULTS: 112 (56%) patients maintained persistent aPL profiles over time, while 88 (44%) were transient. Median follow-up time was 172.5 months. Follow-up time did not affect the odds of aPL persistence in multivariate analysis (p = 1.00). Baseline triple aPL positivity [OR 78 (95%CI 16.9-359.7, p < 0.001)] and double aPL positivity [OR = 7.6 (95%CI 3.7-15.7, p < 0.001)] correlated with persistent aPLs over time, while isolated LAC [OR = 0.26 (95% CI 0.08-0.49, p = 0.002)] or isolated IgG/IgM aCL [OR = 0.20 (95% CI 0.11-0.59, p = 0.004)] positivity, were predictors of transient aPL profile. Patients with persistent aPLs had higher rate of clinical recurrence in comparison to patients with transient aPLs [OR = 2.48 (95%CI 1.34-4.58, p = 0.003)]. CONCLUSIONS: More than half of patients with baseline medium-high titer aPL positivity had persistent positive aPLs over time. Patients with persistent aPLs were more prone to present recurrence of clinical manifestations. Multiple aPL positivity increased the odds of a persistent aPL profile over time, while isolated LAC and aCL positivity decreased it.

El ingreso urgente de los pacientes con enfermedad pulmonar obstructiva crónica: situación actual / Urgent hospitalization of patients with chronic obstructive pulmonary disease: the current situation

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The growing role of precision medicine for the treatment of autoimmune diseases; results of a systematic review of literature and Experts' Consensus.

Autoimmune diseases (AIDs) share similar serological, clinical, and radiological findings, but, behind these common features, there are different pathogenic mechanisms, immune cells dysfunctions, and targeted organs. In this context, multiple lines of evidence suggest the application of precision medicine principles to AIDs to reduce the treatment failure. Precision medicine refers to the tailoring of therapeutic strategies to the individual characteristics of each patient, thus it could be a new approach for management of AIDS which considers individual variability in genes, environmental exposure, and lifestyle. Precision medicine would also assist physicians in choosing the right treatment, the best timing of administration, consequently trying to maximize drug efficacy, and, possibly, reducing adverse events. In this work, the growing body of evidence is summarized regarding the predictive factors for drug response in patients with AIDs, applying the precision medicine principles to provide high-quality evidence for therapeutic opportunities in improving the management of these patients.

Profundidade do sulco gengival em pacientes de faixa etária de 18-25 anos / Depth of gingival sulcus in patients aged between 18 to 25 years

Gingival probing performed in periodontal normal condition brings important results for the definition of health and diseases of the periodontal tissues. The aim was to evaluate the depth probing of the gingival sulcus in permanent dentition of young adults. It was carried out a transversal study with 120 volunteers aged 18 to 25 years and with healthy gum. It was used a manual periodontal probe Williams model. The evaluation was performed on all four sides, with a total of four measurements per tooth. The collected data were first tabulated and submitted to Kruskal-Wallis test with Dunn's post test.The mean and standard deviation of the upper teeth were: incisor (1.1343 ± 0.33665); canine (1.1819 ± 0.369); premolar ratio (1.3677 ± 0.3752); molar(1.8030 ± 0.4116). The mean of the lower teeth was: incisor (1.1260 ± 0.3272); canine (1.2106 ± 0.3390); premolar ratio (1.4580 ± 0.3778); molar (1.9068 ± 0.4497).It concludes that the average depth of the gingival sulcus, between the group of teeth was higher in the lower arch relative to the upper; except for faces: incisive distal, buccal molar and the lingual incisor and canine; in which the result related to the average depth is less than the upper arch. (AU)

A sondagem gengival realizada em condições periodontais normais traz importantes resultados para a definição de saúde e doenças dos tecidos periodontais. O objetivo deste estudo foi avaliar a profundidade clínica do sulco gengival em uma dentição jovem. Um estudo transversal foi realizado com 120 voluntários entre 18 e 25 anos com gengiva saudável. Um modelo de Williams de sonda periodontal manual foi utilizado. A avaliação foi realizada nos quatro lados, com um total de quatro medidas por dente. Os dados coletados foram tabulados e submetidos ao teste de KruskalWallis com pós-teste de Dunn. A média e o desvio padrão dos dentes superiores foram: incisivo (1,1343 ± 0,33665); canino (1,1819 ± 0,369); pré molar (1,3677 ± 0,3752); molar (1,8030 ± 0,4116). A média dos dentes inferiores foi: incisivo (1,1260 ± 0,3272); canino (1,2106 ± 0,3390); pré-molar (1,4580 ± 0,3778); molar (1,9068 ± 0,4497). Concluise que a profundidade média do sulco gengival, entre o grupo de dentes, foi maior no arco inferior em relação ao superior; exceto por faces: incisiva distal, molar vestibular e incisivo lingual e canino; em que o resultado relacionado à profundidade média é menor que o arco superior (AU)

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 247 consecutive cases.

AIM: To analyse the clinical features, laboratory data, foetal-maternal outcomes, and follow-up in a cohort of 247 women with obstetric antiphospholipid syndrome (OAPS). METHODS: The European Registry on APS became a Registry within the framework of the European Forum on Antiphospholipid Antibody projects and placed on a website in June 2010. Cases with obstetric complaints related to aPL who tested positive for aPL prospectively and retrospectively were included. The three-year survey results are reported. RESULTS: 338 women with 1253 pregnancy episodes were included; 915 were historical and 338 were latest episodes. All these women tested positive for aPL. 247 of the 338 fulfilled the Sydney criteria. According to the laboratory categories, 84/247 were in category I, 42 in IIa, 66 in IIb and 55 in IIc. Obstetric complications other than foetal losses, appeared in 129 cases (52.2%). 192 (77.7%) had a live birth and 55 (22.3%) did not. The latter group of only 38 cases (69%) received adequate treatment and 17 (31%) did not. 177/247 (72%) women were put on heparin plus LDA. Thrombosis appeared in two during pregnancy and in 14 during the puerperium. 7 (3%) women evolved to complete SLE. CONCLUSIONS: OAPS shows differential characteristics than classical APS. All laboratory test categories are needed to avoid false-negative diagnoses. In some cases, complement levels could act as a serological marker. OAPS has very good foetal-maternal outcomes when treated. Thrombosis and progression to SLE in mothers with OAPS are scarce compared with "classical APS", suggesting that they have different aPL-mediated pathogenic mechanisms.

Discontinuation of anticoagulation or antiaggregation treatment may be safe in patients with primary antiphospholipid syndrome when antiphospholipid antibodies became persistently negative.

Recommended treatment for patients with primary antiphospholipid syndrome (APS) after a thrombotic event is long-term anticoagulation. Few patients with APS and previously positive antiphospholipid antibodies (aPL) may become negative over time. It is still not exactly known how to treat these patients when aPL become persistently negative. We described the follow-up of 11 primary APS patients whose aPL become persistently negative and in whom thromboprophylaxis was discontinued. The primary end-point was the recurrence of thrombosis in patients with previous thrombotic event and a first thrombotic event in women with previous obstetric APS. Ten (90%) patients were female. Seven (64%) patients had a history of deep venous thrombosis, two of them with pulmonary embolism, and four (36%) women had recurrent miscarriage. Lupus anticoagulant (LAC) was the aPL most frequently detected (82%). Two patients had both LAC and IgG anticardiolipin antibodies. No new thrombotic episode was observed after a median follow-up period of 20 months. Anticoagulation or antiaggregation could be discontinued in some peculiar patients with low-risk primary APS whose aPL become persistently negative. However, studies including a larger number of patients are required to confirm these results.

Ultrastructural and biochemical changes of the medial pterygoid muscle induced by unilateral exodontia.

The aim of the present study was to investigate the histological, biochemical and ultrastructural effects of occlusal alteration induced by unilateral exodontia on medial pterygoid muscle in guinea pigs, Cavia porcellus. Thirty (n=30) male guinea pigs (450g) were divided into two groups: experimental-animals submitted to exodontia of the left upper molars, and sham-operated were used as control. The duration of the experimental period was 60 days. Medial pterygoid muscles from ipsilateral and contralateral side were analyzed by histological (n=10), histochemical (n=10), and ultrastructural (n=10) methods. The data were submitted to statistical analysis. When the ipsilateral side was compared to the control group, it showed a significantly shorter neuromuscular spindle length (P<0.05), lower oxidative metabolic activity, and microvessel constriction, in spite of the capillary volume and surface density were not significantly different (P>0.05). In the contralateral side, the neuromuscular spindles showed significantly shorter length (P<0.05), the fibers reflected a higher oxidative capacity, the blood capillaries showed endothelial cell emitting slender sprouting along the pre-existing capillary, and significantly higher blood capillary surface density, and volume density (V(v)=89% Mann-Whitney test, P<0.05). This finding indicated a complex morphological and functional medial pterygoid muscle adaptation to occlusal alteration in this experimental model. Considering that neuromuscular spindles are responsible for the control of mandibular positioning and movements, the professional should consider if these changes interfere in the success of clinical procedures in medical field involving stomatognathic structures.

Alterações morfológicas e angioarquiteturais do músculo pterigóideo medial de cobais Cavia porcellus após a indução de maloclusão, empregando os métodos de macroscopia, microscopia de luz, eletrônica de transmissão, histoenzimologia e morfometria / Morphological and angioarchitectural alterations in guinea pigs Cavia porcellus medial pterygoid muscle after induction of maloclusion by macroscopy, light and transmission electron microscopy, histoenzimology and morphometry

Com o propósito de obter dados morfológicos que favoreçam a compreensão do funcionamento do sistema estomatognático e contribuir, através de dados morfológicos, com pesquisadores que estudam a maloclusão em animais experimentais ou maloclusão geral, o trabalho teve como objetivo estudar a morfologia e a distribuição dos vasos do músculo pterigóideo medial de cobaia Cavia porcellus após indução de maloclusão, empregando os métodos de macroscopia, microscopia de luz, eletrônica de transmissão, histoenzimologia e morfometria. Foram utilizados 40 cobaias Cavia porcellus machos, desmamados, divididos em dois grandes grupos: controle e com maloclusão. Estes foram ainda divididos em 4 subgrupos de 5 animais. O primeiro subgrupo foi destinado ao estudo morfológico macroscópico biometria e angioarquitetural, o segundo subgrupo ao estudo morfológico microscópico através de corte seriado frontal, o terceiro subgrupo ao estudo da tipificação das fibras e microvascularização através da histoenzimologia e o quarto subgrupo ao estudo ultraestrutural através do microscópio eletrônico de transmissão. Sessenta dias após a maloclusão induzida por exodontia dos molares superiores esquerdos, foram analisados os músculos pterigóideo medial nos lados ipsi e contralateral. Os demais animais foram submetidos ao mesmo tipo de estresse porém sem a exodontia e serviram como controle. Macroscópicamente o músculo pterigóideo medial apresentou forma trapezoidal, cujas fibras estavam orientadas no sentido ínfero-Iátero-posterior, à partir de sua origem. As cobaias submetidas à maloclusão apresentaram assimetria muscular macroscópica, onde o músculo pterigóideo medial ipsilateral apresentou dimensões menores em relação ao contralateral. Ao microscópio de luz os músculos do grupo tratado revelaram fusos neuromusculares mais curtos e fibras em degeneração. O estudo histoenzimológico revelou, no lado ipsilateral, alterações adaptativas no tipo de fibra para as de baixa resitência à fadiga e; um aumento significante de vasos no músculo do lado contralateral. Ultraestruturalmente o músculo ipsilateral revelou mitocôndrias com forma e tamanho alterados e cristas mitocondriais reduzidas; e escassas vesículas pinocíticas ou cavéolas no citoplasma das células endoteliais.