Resveratrol in Rheumatological Diseases: A Systematic Review.

Resveratrol is an antioxidant with anti-inflammatory and cell-protective properties. The aim of our article is to review the use of resveratrol in rheumatic diseases. PubMed/Medline, Embase, and Scielo were screened for articles on resveratrol and rheumatic diseases in the period between of January 1966 and March 2023. Five articles were depicted, including 481 patients. The included diseases were osteoarthritis (n=3), rheumatoid arthritis (n=1), and Takayasu arteritis (n=1). The age varied from 32 to 58.2 years, and the female gender ranged from 62% to 74% in the studies. Disease duration ranged from 3.5 ± 3.2 to 9.4 ± 5.8 years. The resveratrol dosage went from 250 mg to 1000 mg/day. All those articles demonstrated improvements in the diverse rheumatic diseases, including pain intensity, function, disease activity (DAS 28), swelling joints, and reduced inflammation markers (erythrocyte sedimentation rate, C-reactive protein, interleukinIL-1, IL-6, and tumor necrosis factor). No side effects were detected in all studies. In conclusion, resveratrol seems to be a safe therapy for various rheumatic diseases, although the evidence is very limited. The improved subjective and objective complaints and laboratory parameters are promising. However, there is a need to reconfirm, reproduce, and investigate the topic in more extensive, well-controlled, double-blind, cross-over studies.

Successful Treatment of a Fibromyalgia Patient Using a Homeopathic Preparation of Cannabis sativa.

BACKGROUND: Homeopathy has been used in observational and controlled studies to treat patients with fibromyalgia (FM), but none has previously used the remedy Cannabis sativa. CASE HISTORY: A 51-year-old female patient presenting with diffuse pain and sleep disorder was diagnosed with FM using the relevant American College of Rheumatology criteria. She reported having 18 tender points, a pain score (visual analog scale, VAS) of 9.0, and a well-being VAS of 5.0. She was prescribed Cannabis sativa 6 cH, five drops sublingually thrice a day. RESULTS: After 2 months, she returned asymptomatic, with 0 tender points, pain VAS of 0, and well-being VAS of 9.0. The Modified Naranjo Criteria for Homeopathy score was equal to +9, suggesting the clinical outcome was causally attributable to the medicine prescribed. CONCLUSION: This case study reveals the positive role of homeopathic treatment in FM. Studies using a randomized controlled design, including pragmatic trials to determine treatment effectiveness in real-world clinical practice, are indicated in this field.

Avaliação da transferência materno-infantil de anticorpos em pacientes com síndrome antifosfolípide / Evaluation of maternal-child antibody transfer of patients with antiphospholipid syndrome

Introdução: a síndrome antifosfolípide (SAF) é caracterizada por eventos trombóticos e perdas gestacionais de repetição sendo considerada a trombofilia adquirida mais comum. Objetivo: realizar uma revisão narrativa da passagem transplacentária de anticorpos em pacientes com SAF. Metodologia: revisão narrativa da literatura. Resultados: quando não está associada a alguma doença do tecido conectivo é dita primária e quando em associação com lúpus eritematosos sistêmico é dita secundária. A morbidade gestacional é frequente e torna-se de importância avaliar a passagem desses anticorpos transplacentariamente, desde que existem modelos animais da síndrome com transferência passiva desses anticorpos. A passagem transplacentária de anticorpos específicos já foi determinada em estudos, os quais demonstraram baixos níveis destes anticorpos no soro materno, porém uma eficiente passagem transplacentária para o neonato. Conclusão: existem poucos estudos sobre essa passagem materno-infantil em pacientes com SAF, que são aqui revisados.

Introduction: a antiphospholipid syndrome (APS) is characterized by thrombotic events and recurrent pregnancy losses and is considered the most common acquired thrombophilia. Objective: to carry out a narrative review of the transplacental passage and antibodies in patients with APS. Methodology: narrative literature review Results: when it is not associated with any connective tissue disease, it is said to be primary and when in association with systemic lupus erythematosus it is said to be secondary. Gestational morbidity is frequent and it is important to evaluate the passage of these antibodies transplacentally, since there are animal models of the syndrome with passive transfer of these antibodies. The transplacental passage of specific antibodies has already been determined in studies, which demonstrated low levels of these antibodies in the maternal serum, but an efficient transplacental passage for the newborn. Conclusion: there are few studies on this maternal-infant passage in patients with APS, which are reviewed here.

Clinical and therapeutical features of patients with systemic lupus erythematosus associated with gastroparesis: A systematic review.

This paper aims to analyze the clinical, therapeutic, and evolutionary characteristics of patients with systemic lupus erythematosus (SLE) that is associated with gastroparesis. We have systematically researched articles published in Pubmed, MEDLINE, LILACS, and Scielo dating from 1966 to April 2020. All the researched articles are based on gastroparesis and SLE in the following literature: English, Chinese, and Japanese. We obtained five cases of SLE associated with gastroparesis. There are three case reports included and two retrospective epidemiological studies where the clinical data are not detailed. Of the case reports, all of them were females aged between 27 and 58 years. All of them showed symptoms of nausea and vomiting. Abdominal pain and weight loss were reported in the only two-third of the cases. Only one case showed early satiety. All the cases were tested positive for antinuclear antibodies and anti-dsDNA antibodies at the time of gastroparesis. In all the cases, scintigraphy was performed to check gastric emptying. This is the gold standard for diagnosing gastroparesis. Concerning therapy used, three-third of the cases received glucocorticoids 1 mg/kg daily. In two-third of the cases, azathioprine was used. Before starting the corticosteroids therapy, all the cases received antibiotics and motility stimulants with poor outcomes. The early diagnosis of gastroparesis with SLE must be rapid so that the therapy can be initiated promptly. Due to the severity of the condition that may result in nausea, abdominal pains, and satiety, using endoscopy and gastric emptying scintigraphy is fundamental.

Factors related to the performance of elderly people in temporal ordering tests. / Fatores associados ao desempenho de idosos nos testes de ordenação temporal.

PURPOSE: To describe the performance of elderly individuals in Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS) tests and research related factors. METHODS: An observational, cross-sectional study conducted with elderly people aged 60 to 79 years. The participants underwent cognitive screening tests, interviews containing socio-demographic data and general health, as well as audiologic evaluation and temporal auditory processing (PPS and DPS) evaluation tests. A descriptive analysis of the association between the performance in temporal processing and the variables gender, age, level of education and audiometric alterations was conducted through multiple linear regression. RESULTS: 86 elderly people participated in the study, most of them female, with ages between 60 and 69. Male participants performed better in both tests as well as the participants with higher education, whereas no difference in performance was observed across the different age ranges. In the DPS, the participants with auditory alteration performed worse in relation to the ones with average frequencies of 0.5 to 4 kHz. CONCLUSION: The male gender and higher level of education were associated with better results in the temporal ordering tests, whereas auditory alteration was associated with worse performance only in the pitch pattern sequence test.

OBJETIVO: Investigar os fatores associados e descrever o desempenho no teste padrão de frequência e teste padrão de duração em idosos. MÉTODO: Estudo observacional, seccional, conduzido com idosos de 60 a 79 anos. Os participantes realizaram teste de rastreio cognitivo, entrevista contendo dados sociodemográficos e de saúde geral, avaliação audiológica e testes de avaliação do processamento auditivo temporal (padrão de frequência e padrão de duração). Foi conduzida análise descritiva da associação entre o desempenho nos testes de processamento temporal e as variáveis: sexo, idade, nível de escolaridade e alterações audiométricas, por meio da regressão linear múltipla. RESULTADOS: Participaram do estudo 86 idosos, sendo a maioria do sexo feminino, com idade entre 60 e 69 anos. O desempenho para ambos os testes foi melhor nos homens e nos idosos com maior nível de escolaridade e similar nas diferentes faixas etárias. No teste padrão de frequência, idosos com alteração auditiva apresentaram pior desempenho do que aqueles com média nas frequências de 0.5 a 4 kHz normal. CONCLUSÃO: O sexo masculino e maior nível de escolaridade estão associados ao melhor desempenho nos testes de ordenação temporal, enquanto a alteração audiométrica apresenta associação com o pior desempenho apenas no teste padrão de frequência.

Fatores de risco para osteoporose em uma amostra da população de atenção primária em São Paulo, Brasil / Risk factors for osteoporosis in a sample of the primary attention population in São Paulo, Brazil

Objetivo: esse estudo teve como objetivo avaliar a instrução sobre osteoporose de uma amostra da população que frequenta o Centro de Saúde Butantã (CSE), visando incentivar a forma mais adequada de prevenção e/ou tratamento. Metodologia: Foi elaborado e aplicado, durante um mês, um questionário para identificar os fatores de risco de 101 pacientes, de ambos os sexos. Resultados: do total desses pacientes, 49% tinham idade inferior a 45 anos, 33% entre 45 e 65 anos e 18% acima de 65 anos. A cor branca prevaleceu em 66%, sendo que 36% do total possuíam hipertensão, 10% diabetes e 7% outras doenças crônicas. Em relação ao índice de massa corpórea (IMC), 4% estavam abaixo de 20Kg/m2, 37% eutróficos, 30% com sobrepeso, 24% com obesidade grau I e 5% com IMC superior a 35Kg/m2. Foi verificado que 76% da população era sedentária, 35% fumantes, 32% com consumo alcoólico inferior a 3 vezes na semana, 3% superior a 3 vezes e 65% sem consumo de álcool. Quanto a ingestão de leite, 37% não o consumiam e 40% apenas 1 vez ao dia. Não houve diferença estatística entre as pessoas que conheciam ou não a osteoporose, sendo que 60% tinham conhecimento sobre a doença, porém esse grau de instrução não implicou em diferenças nos hábitos de vida. Discussão: em 100% da amostra estudada foi encontrado pelo menos 1 fator de risco para o seu desenvolvimento, principalmente a baixa ingestão de cálcio e a falta de atividade física, confirmando a importância da intervenção nesses fatores preveníveis.

Objective: this study aimed to evaluate the education on osteoporosis in a sample of the population who attends the Center for Health Butantã (CSE), to encourage the most appropriate way of preventing and / or treatment. Methodology: was developed and implemented over a month, a questionnaire to identify risk factors of 101 patients of both sexes. Results: of the total of these patients, 49% were below 45 years, 33% between 45 and 65 and 18% over 65 years. The white prevailed in 66% and 36% of the total had hypertension, diabetes 10% and 7% other chronic diseases. In relation to body mass index (BMI), 4% were below 20Kg/ m2, 37% normal, 30% overweight, 24% with obesity grade I and 5% with BMI greater than 35kg/m2. It was found that 76% of the population was sedentary, 35% smokers, 32% with alcohol consumption less than 3 times a week, 3% more than 3 times and 65% with no consumption of alcohol. As the intake of milk, not the 37% and 40% consumed only 1 day. There was no statistical difference between people who knew or not osteoporosis, while 60% had knowledge about the disease, but this level of education did not lead to differences in living habits. Discussion: in 100% of the studied sample was found at least 1 risk factor for its development, especially the low calcium intake and lack of physical activity, confirming the importance of intervention in those preventable factors.

Pediatric catastrophic antiphospholipid syndrome patient evolving to systemic lupus erythematosus.

OBJECTIVES: We aim to describe a rare case of a young patient with a catastrophic antiphospholipid syndrome (cAPS) who evolved to systemic lupus erythematosus (SLE).Methodology: Case report description. CASE REPORT: A 15 years old girl came to the emergency department with acute peritonitis secondary to ischemic perforation of the sigmoid. Angiotomography was suggestive of a thrombotic occlusion of the upper mesenteric artery. Laboratory tests revealed a positive lupus anticoagulant and antinuclear antibodies. A cAPS diagnosis was determined based on more than three different sites of thrombosis (lung, kidney, spleen and sigmoid) in less than one week with a lupus anticoagulant. She was treated with intravenous methylprednisolone 1 mg/kg/day associated with intravenous heparin followed by intravenous immunoglobulin. She had a very good outcome with a total improvement and was discharged from the hospital after 2 months. After 12 weeks, the lupus anticoagulant remained positive. After two months, a systemic lupus erythematosus was diagnosed. She was treated with increasing dose of prednisone and azathioprine 100 mg/day and hydroxychloroquine were added to the treatment. After 2 weeks, she was asymptomatic. She is currently well, asymptomatic using hydroxychloroquine, azathioprine and warfarin. CONCLUSION: This article reports a very unusual presentation which is rarely reported and clinicians should be alert to the possibility that CAPS may be the presenting event for SLE patients, condition known in adults and should also be remembered in pediatric scenario.

uso probiótico no transtorno do espectro autista e na esquizofrenia: revisão narrativa da literatura / Probiotic use in autistic spectrum disorder and schizophrenia: narrative literature review

Introdução: devido à grande prevalência do transtorno do espectro autista (TEA) e da esquizofrenia e o caráter incapacitante dessas patologias, fez-se necessário o desenvolvimento de tratamentos cada vez mais eficientes e com menos efeitos adversos. Sendo a microbiota um regulador da inflamação e tendo esta um papel fundamental na gênese dos transtornos psiquiátricos, o uso de probióticos pode ser uma alternativa segura e com baixo custo para o tratamento complementar das doenças psiquiátricas. Objetivo: realizar uma revisão narrativa sobre a eficácia do uso de probióticos na redução de sintomas clínicos e gastrointestinais, assim como da segurança no tratamento do TEA e da esquizofrenia. Metodologia: revisão dos estudos em humanos que avaliaram os efeitos terapêuticos dos probióticos no TEA e esquizofrenia. Resultados: foram selecionados 13 estudos, sendo 8 sobre TEA e 5 sobre esquizofrenia, com total de 485 pacientes. As evidências apontam melhora dos sintomas gastrintestinais dos pacientes com TEA e esquizofrenia; entretanto, sem mudanças conclusivas dos sintomas psiquiátricos na esquizofrenia, associado a potencial benefício no TEA. Conclusão: essa revisão sugere que o uso de probióticos tem um potencial benefício nos sintomas comportamentais no TEA, associado à melhora dos sintomas gastrointestinais na esquizofrenia e TEA; entretanto, não se observou mudanças nos sintomas psiquiátricos da esquizofrenia.

Introduction: due to the high prevalence of autism spectrum disorder (ASD) and schizophrenia and the disabling nature of these pathologies, it has become necessary to develop increasingly efficient treatments with less adverse effects. As the microbiota is a regulator of inflammation and having a fundamental role in the genesis of psychiatric disorders, the use of probiotics may be a safe and low-cost alternative for the complementary treatment of psychiatric diseases. Objective: to perform a narrative review on the fficacy of probiotics use in reducing clinical and gastrointestinal symptoms, and adverse effects of the use of probiotics in the treatment of ASD and schizophrenia. Methodology: review of studies in humans that evaluated the therapeutic effects of probiotics on ASD and schizophrenia. Results: 13 studies were selected, 8 on TEA and 5 on schizophrenia, with a total of 485 patients. Evidence points to improvement in gastrointestinal symptoms in patients with ASD and schizophrenia; however, there were no conclusive changes in psychiatric symptoms in schizophrenia, associated with a potential benefit in ASD. Conclusion: This review suggests that the use of probiotics has a potential benefit in behavioral symptoms in ASD, associated with the improvement of gastrointestinal symptoms in schizophrenia and ASD; however, there were no changes in the psychiatric symptoms of schizophrenia.

Suicide risk in systemic lupus erythematosus: a narrative review / Risco de suicidio no lúpus eritematoso sistêmico: uma revisão narrativa

Introduction: the restrictions imposed by the disease and the perception of personal and social losses related to its course, despite the medical and scientific advances, reinforce fear and generate intense suffering in lupus patients. Psychiatric comorbidities, especially major depressive episodes, are highly prevailing during the course of systemic lupus erythematosus. Among them, suicide is a behavior that is much more common then we believe. Objective: to perform a narrative review on suicidal behavior associated with systemic erythematosus lupus (SLE). Results: studies have shown an increased risk of suicide among patients with chronic diseases and psychiatric disorder, especially depression. However, suicide occurrence cannot be attributed only to a higher prevalence of depression and other mental illnesses. It is necessary to learn more about the suicide risk factors that can be present in patients with lupus to work on a secondary prevention, and avoid not only the premature loss of lives but also the additional suffering of families and surrounding communities. The coordination between the studies on suicidal behavior and its complex network of individual and sociocultural factors and the studies on this multisystem autoimmune disease with a wide manifestation spectrum, which is lupus, creates a new and important field of research. Conclusion: non-psychiatrist office-based physicians, health clinics, or wards dedicated to the treatment of SLE should be able to recognize and handle the suicide risk factors on their patients in order to reduce the suffering caused by this disease.

Introdução: as restrições impostas pela doença e a percepção de perdas pessoais e sociais relacionadas ao seu curso, apesar dos avanços médicos e científicos, reforçam o medo e geram sofrimento intenso em pacientes com lúpus. As comorbidades psiquiátricas, especialmente os episódios depressivos maiores, são altamente prevalentes durante o curso do lúpus eritematoso sistêmico. Entre eles, o suicídio é um comportamento muito mais comum do que acreditamos. Objetivo: realizar uma revisão narrativa sobre o transtorno do suicídio no campo do lúpus. Resultados: estudos têm mostrado um risco aumentado de suicídio entre pacientes com doenças crônicas e distúrbios psiquiátricos, especialmente a depressão. No entanto, a ocorrência de suicídio não pode ser atribuída apenas a uma maior prevalência de depressão e outras doenças mentais. É necessário aprender mais sobre os fatores de risco de suicídio que podem estar presentes em pacientes com lúpus para trabalhar em uma prevenção secundária e evitar, não apenas a perda prematura de vidas, mas também o sofrimento adicional das famílias e comunidades vizinhas. A coordenação entre os estudos sobre comportamentos suicidas e sua complexa rede de fatores individuais e socioculturais e os estudos sobre esta doença auto imune multissistêmica com um amplo espectro de manifestação, que é lúpus, criam um novo e importante campo de pesquisa. Conclusão: os médicos não psiquiatras que trabalham em consultórios, clínicas e enfermarias dedicadas ao tratamento do lúpus devem ser capazes de pesquisar, identificar e lidar com os fatores de risco suicida em seus pacientes, a fim de reduzir o sofrimento causado por esta doença.

Avaliação de polimorfismo da enzima citocromo P450 em pacientes com síndrome antifosfolípide e seu impacto no controle da anticoagulação / Evaluation of polymorphism of the cytochrome P450 enzyme in patients with antiphospholipid syndrome and its impact on anticoagulation control

Introdução: a Síndrome Antifosfolípide é caracterizada por eventos trombóticos e perdas gestacionais de repetição e é considerada a trombofilia adquirida mais comum. Quando não está associada a alguma doença do tecido conectivo é dita primária e seu tratamento é baseado em anticoagulação por longo período com warfarin. Isso requer controle rigoroso do tempo de protrombina realizada pela monitoração dos valores de INR para que se evite em um extremo o risco de sangramento e em outro o risco de trombose. Objetivo: realizar uma revisão daa literatura sobre polimorfismos genéticos da citocromo P450 na síndrome antifosfolipide. Metodologia: revisão narrativa da literatura. Resultados: embora investigações tenham identificado a influência de vários genes na resposta ao warfarin, a maioria das evidências sugere um papel mais importante para o polimorfismo de dois genes: o gene do citocromo P450(CYP)2C9 (CYP2C9) e o gene do complexo redutase epóxido vitamina K 1 (VKORC1). De fato, o warfarin é administrado como uma mistura racêmica de S ­ e R-warfarin e estes enantiômeros são extensivamente metabolizados no fígado por diferentes enzimas do citocromo P450(CYP), com a CYP2C9 servindo como a principal enzima no metabolismo da S-warfarin. Nesse sentido, a farmacogenética da terapia com warfarin é relevante para melhorar a segurança e a efetividade dessa terapia. Polimorfismos estruturais no gene CYP2C9 criam variantes alélicos que codificam enzimas com diferentes atividades catalíticas. As freqüências alélicas destes variantes diferem entre diferentes grupos étnicos, sem estudos no Brasil em pacientes com SAF. Conclusão: o conhecimento da presença de polimorfismos genéticos da citocromo P450 em usuários de warfarin é de fundamental importância. Desde que sangramentos ou alvos subterapeuticos podem advir da presença dessas alterações genéticas.

Introduction: antiphospholipid Syndrome is characterized by thrombotic events and repeated pregnancy losses and is considered the most common acquired thrombophilia. When it is not associated with any connective tissue disease, it is said to be primary and its treatment is based on long-term anticoagulation with warfarin. This requires strict control of the prothrombin time performed by monitoring the INR values to avoid the risk of bleeding at one extreme and the risk of thrombosis at the other. Objective: To perform a review of the literature on genetic polymorphisms of cytochrome P450 in antiphospholipid syndrome. Methods: narrative literature review Results: although investigations have identified the influence of several genes on the response to warfarin, most evidence suggests a more important role for the polymorphism of two genes: the cytochrome P450 (CYP) 2C9 (CYP2C9) gene and the reductase complex gene vitamin K 1 epoxide (VKORC1). In fact, warfarin is administered as a racemic mixture of S ­ and R-warfarin and these enantiomers are extensively metabolized in the liver by different enzymes of cytochrome P450 (CYP), with CYP2C9 serving as the main enzyme in the metabolism of S-warfarin . In this sense, the pharmacogenetics of warfarin therapy is relevant to improve the safety and effectiveness of this therapy. Structural polymorphisms in the CYP2C9 gene create allelic variants that encode enzymes with different catalytic activities. The allele frequencies of these variants differ between different ethnic groups, with no studies in Brazil in patients with APS. Conclusion: knowledge of the presence of genetic polymorphisms of cytochrome P450 in users of warfarin is of fundamental importance. Since bleeding or subtherapeutic targets may result from the presence of these genetic changes.

Manifestações neurológicas da doença de Behçet / Neurological features of Behçet's disease

Introdução: A doença de Behçet (DB), também chamada síndrome de Behçet, é uma doença crônica, multissistêmica com remissões e exacerbações e evolução imprevisível. Objetivo: Descrever as manifestações neurológicas da doença de Behçet. Metodologia: Revisão narrativa da literatura utilizando o Pubmed como banco de dados. Resultados: Envolvimento neurológico em pacientes com DB conhecido como Neuro-Behcet (NB) apresenta uma prevalência variável de 2.2-5%. O diagnóstico de NB e baseado na presença de síndromes neurológicas em pacientes com achados sistêmicos de DB. Achados de neuroimagem e achados de líquor são uteis para excluir diagnósticos diferenciais, principalmente quadros infecciosos. Conclusão: Ainda que a DB seja rara na pratica neurológica rotineira, esta e comumente mencionada no diagnostico diferencial de doenças inflamatórias e/ou desmielinizantes do SNC.

Introductino: Behçet's disease (BD), also called Behçet's syndrome, is a chronic, multisystemic disease with remissions and exacerbations and unpredictable evolution. Objective: To describe neurological manifestations of BD. Metodology: Narrative review of the literature using Pubmed database. Results: Neurological involvement in patients with BD known as Neuro-Behcet (NB) has a variable prevalence of 2.2-5%. The diagnosis of NB is based on the presence of neurological syndromes in patients with systemic BD findings. Neuroimaging findings and cerebrospinal fluid findings are useful to exclude deferential diagnoses, especially infectious conditions. Conclusion: Although BD is rare in routine neurological practice, it is commonly mentioned in the differential diagnosis of inflammatory and / or demyelinating diseases of the CNS.

Habilidades cognitivas e desempenho nos testes de ordenação temporal em idosos / Cognitive abilities and performance in the temporal ordering tests for elderly people

RESUMO Objetivo Investigar a influência dos domínios cognitivos no desempenho do teste padrão de frequência e teste padrão de duração em idosos. Métodos estudo seccional, desenvolvido em indivíduos com idade entre 60 e 79 anos. Realizou-se entrevista, avaliação cognitiva por meio do Montreal Cognitive Assessment, avaliação audiológica periférica (audiometria tonal e vocal) e central (teste padrão de frequência e teste padrão de duração). Resultados Participaram do estudo 58 mulheres com média de idade de 66 anos e 2 meses e 28 homens, com média de idade de 68 anos e 3 meses. Verificou-se que as habilidades visuoespacial, de atenção, concentração e memória de trabalho apresentaram correlação com os testes temporais no sexo feminino e que a habilidade de linguagem apresentou correlação com o teste padrão de frequência. Já entre os homens, houve tendência à significância quanto à capacidade visuoespacial. Ademais, as mulheres apresentaram melhor desempenho na habilidade de memória. Conclusão Os aspectos cognitivos podem influenciar nos testes de ordenação temporal em indivíduos idosos, sobretudo do sexo feminino.

ABSTRACT Purpose To investigate the influence of cognitive domains on the performance of the pitch pattern sequence and duration pattern sequence tests among elderly people. Methods Cross-study realized among individuals aged between 60 to 79 years. We performed an interview, cognitive evaluation through Montreal Cognitive Assessment, peripheral audiologic evaluation (tonal and vocal audiometry) and central (pitch pattern sequence and duration pattern sequence). Results The study involved 58 women with average age of 66.2, and 28 men at an age average of 68.3. On the one hand, we observed that the visual-spatial abilities, attention, concentration and working memory present correlation with temporal tests in females and that language ability correlates with the standard frequency test. Among men, there was a tendency to significance in terms of visual-spatial abilities. Furthermore, women had better performance in memory ability. Conclusion Cognitive aspects may influence the temporal ordering tests among elderly individuals, especially females.

Panniculitides of particular interest to the rheumatologist

Abstract The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment.

Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations.

Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations / Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 1 - Diagnóstico e situações especiais

Abstract Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias. Até 2013, as Américas haviam registrado apenas casos importados quando, em outubro desse mesmo ano, foram notificados os primeiros casos na Ilha de Saint Martin, no Caribe. No Brasil, os primeiros relatos autóctones foram confirmados em setembro de 2014 e até a semana epidemiológica 37 de 2016 já haviam sido registrados 236.287 casos prováveis de infecção pelo chikungunya vírus (CHIKV), 116.523 confirmados sorologicamente. As mudanças ambientais causadas pelo homem, o crescimento urbano desordenado e o número cada vez maior de viagens internacionais têm sido apontados como os fatores responsáveis pela reemergência de epidemias em grande escala. Caracterizada clinicamente por febre e dor articular na fase aguda, em cerca de metade dos casos existe evolução para a fase crônica (além de três meses), com dor persistente e incapacitante. O objetivo deste trabalho foi elaborar recomendações para diagnóstico e tratamento da febre chikungunya no Brasil. Para isso, foi feita revisão da literatura nas bases de dados Medline, SciELO e PubMed, para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Foram geradas 25 recomendações, divididas em três grupos temáticos: (1) diagnóstico clínico, laboratorial e por imagem; (2) situações especiais e (3) tratamento. Na primeira parte estão os dois primeiros temas e o tratamento na segunda.

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment / Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 2 - Tratamento

Abstract Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicações sobre o tratamento das manifestações musculoesqueléticas da febre chikungunya, porém com importantes limitações metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicações empregadas. O objetivo deste trabalho foi elaborar recomendações para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendações da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.