Intestinal histological findings in patients with spondyloarthritis: a study of the relationship with disease activity.

The role of intestinal microbioma and subclinical bowel inflammation in the etiology of sponsyloarthritis (SpA) has gained a lot of attention recently. Almost 65% of SpA patients will have asymptomatic bowel inflammation if assessed by ileocolonoscopy. The connection between intestinal inflammation and SpA originated the gut-joint axis hypothesis in which monocytes and T cells found in the joint would have origin in the gut.

Intestinal histological findings in patients with spondyloarthritis: a study of the relationship with disease activity

The role of intestinal microbioma and subclinical bowel inflammation in the etiology of sponsyloarthritis (SpA) has gained a lot of attention recently. Almost 65% of SpA patients will have asymptomatic bowel inflammation if assessed by ileocolonoscopy. The connection between intestinal inflammation and SpA originated the gut-joint axis hypothesis in which monocytes and T cells found in the joint would have origin in the gut (AU)

Tiossulfato de sódio 10% intralesional para tratamento da calcinose em pacientes com esclerose sistêmica e dermatomiosite: série de casos / 10% intralesional sodium thiosulphate for calcinosis treatment in patients with systemic sclerosis and dermatomyositis: case series

INTRODUÇÃO: A calcinose é uma complicação frequente da esclerose sistêmica e da dermatomiosite, resultando em dor local, contraturas, ulcerações, infecções secundárias e limitação funcional. Não há tratamento eficaz para calcinose mas o tiossulfato de sódio tem se mostrado promissor. OBJETIVOS: Analisar a resposta terapêutica ao tiossulfato de sódio 10% intralesional nas calcinoses de pacientes com dermatomiosite e esclerose sistêmica. MÉTODOS: Estudo prospectivo, não controlado, incluindo 7 pacientes, totalizando 10 calcinoses, sendo um paciente com dermatomiosite e 6 com esclerose sistêmica. Desfechos primários: melhora da dor pela escala visual analógica e diminuição do maior e menor diâmetros das calcinoses ao raio-x. Desfechos secundários: melhora da qualidade de vida pelo SF12 (Medical Outcomes Study Short Form 12) e da função pelo HAQ (Health Assesment Questionnaire). Resultados foram expressos em médias e as variáveis contínuas comparadas pelo teste t-Student ou pelo teste de Wilcoxon. RESULTADOS: Foram realizadas 2 a 8 aplicações intralesionais (média de 3,7), com média de 8,9mg de tiossulfato por injeção a intervalos de 13 a 56 dias, com intervalo médio de 19 dias. Todos os pacientes relataram melhora da dor, porém esse resultado não foi significativamente estatístico. Não houve redução do diâmetro das calcinoses, nem melhora da qualidade de vida ou funcional. CONCLUSÃO: Baixas doses de tiossulfato de sódio administradas por injeções intralesionais, em intervalos médios de 19 dias, em número limitado de aplicações, não foram efetivas para o tratamento da calcinose

BACKGROUND: Calcinosis is a frequent complication of systemic sclerosis and dermatomyositis, resulting in local pain, contractures, ulcerations, secondary infections and functional limitations. There is no effective treatment for calcinosis, but sodium thiosulphate has shown to be promising. OBJECTIVE: To analyze the therapeutic response to 10% intralesional sodium thiosulphate on calcinosis of patients with dermatomyositis and systemic sclerosis. METHODS: Non-controlled prospective study, with 7 patients and 10 calcinoses, of which one had dermatomyositis and six had scleroderma. Primary outcomes: improvement in the pain by the visual analogue scale, and a decrease in both diameters (biggest and smallest) of calcinoses on X-ray. Secondary outcomes: improvement in quality of life by SF12 (Medical Outcomes Study Short Form 12), and of function by HAQ (Health Assessment Questionnaire). Results were expressed as means; continuous variables were compared by the t-Sudent test or by the Wilcoxon test. RESULTS: Two to 8 intralesional applications were performed (mean of 3.7), with mean of 8.9mg of thiosulphate per injection, at 13-56 days intervals (mean of 19 days). All patients reported improvement in pain, albeit such result was not statistically significant. There was no reduction in the diameters of calcinoses, nor there were quality of life or functional improvements. CONCLUSION: Low doses of sodium thiosulphate, administered through intralesional injections, in mean intervals of 19 days, in a limited number of applications, were not effective for calcinosis treatment

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients.

OBJECTIVE: To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. METHODS: Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. RESULTS: Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. CONCLUSION: Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

Use of infliximab in patient with chronic non-bacterial osteomyelitis, case report / Uso de infliximab en paciente con osteomielitis crónica no bacteriana, reporte de caso

Introduction: chronic non-bacterial osteomyelitis (CNO) is a non-infectious inflammatory of unknown etiology. Case description: ABA, female, 16 years old, was admitted with a pain in her left thigh. At the time, it was suspected to be caused by a tumor, and a bone scintigraphy was requested, which evidenced a focal area of increased uptake in the distal metadiaphyseal area of the left femur. A bone biopsy was performed, and its result was compatible with chronic osteomyelitis. The patient started taking pamidronate (withdrawn due to treatment failure) and methotrexate (subsequently suspended due to urticarial reaction). After some years of clinical stability, a new focal area of osteomyelitis appeared, in the distal right femur. The use of anti-TNF (infliximab) was chosen, resulting in an improvement of the algic state. Discussion: the diagnosis of CNO is made by process of elimination and is based on clinical, laboratorial, radiological, bacteriological and histological data. Non-hormonal anti-inflammatory and bisphosphonate drugs are recommended as initial therapy. Disease-modifying drugs, steroids and anti-TNFα have been used in severe and recurring cases. Conclusion: the authors present a CNO case with good response to anti-TNFα after treatment failure with bisphosphonates..(AU)

Introducción: la osteomielitis crónica no bacteriana (OMNB) es una enfermedad inflamatoria no infecciosa de etiología desconocida. Descripción del caso: ABA, mujer,16 años, ingresó con dolor en muslo izquierdo. En ese momento, se sospechaba que era causado por un tumor, y se solicitó una gammagrafía ósea, que evidenció un área focal de captación aumentada en el área metadiafisaria distal del fémur izquierdo. Se realizó una biopsia de hueso, y su resultado fue compatible con osteomielitis crónica. El paciente comenzó a tomar pamidronato (retirado debido a una falla en el tratamiento) y metotrexato (posteriormente suspendido debido a una reacción urticarial).Después de algunos años de estabilidad clínica, apareció una nueva área focal de osteomielitis en el fémur derecho distal. Se eligió el uso de anti-TNF (infliximab), lo que resultó en una mejora del estado álgico. Discusión: el diagnóstico de CNO se realiza por proceso de eliminación y se basa en datos clínicos, de laboratorio, radiológicos,bacteriológicos e histológicos. Se recomiendan los fármacos antiinflamatorios y bifosfonatos no hormonales como terapia inicial. Se han usado fármacos modificadores de la enfermedad, esteroides y anti-TNFα en casos graves y recurrentes. Conclusión: los autores presentan un caso de CNO con buena respuesta a anti-TNFα después del fracaso del tratamiento con bisfosfonatos..(AU)

Balance and falls in axial Spondyloarthritis: a cross sectional study.

BACKGROUND: Spondyloarthritis (SpA) patients may suffer from balance loss predisposing them to falls. AIM: To study balance impairment and falls in axial SpA patients and its association with clinical and epidemiological variables, disease activity, functional and metrology indexes. METHODS: Cross-sectional study of 55 SpA patients with axial disease. Clinical and epidemiological data were collected from the charts. Balance was accessed by Berg Balance Scale (BBS). The following instruments were applied: ASDAS (Ankylosing Spondylitis Disease Activity Score)-ESR, ASDAS-CRP, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), BASMI (Bath Ankylosing Spondylitis Metrology Index) and ASQoL (Ankylosing spondylitis quality of life questionnaire). The number of falls in the last year was obtained through direct questioning. RESULTS: In this sample, 30.9% had high risk of falls by the BBS and 25.4% recalled having at least one fall in the last years. The BBS values were lower in those with white ethnic background (p=0.01), smokers (p=0.03) and with HLA-B27 (p=0.03) and correlated inversely with BASDAI (rho=-0.28), ASDAS-ESR (rho=-0.32) and ASDAS-CRP (rho=-0.33), BASFI (rho=-0.71; p < 0.0001), BASMI (rho=-0.80; p < 0.0001), ASQoL (rho=-0.57; p < 0.001) and age (rho=-0.50; p < 0.001). Linear multivariable analysis showed that BASFI and BASMI were independently associated with BBS (p=0.01 and < 0.0001 respectively). Patients with falls had lower BBS (p=0.03) and loss of balance correlated with impairment of the quality of life (rho=-0.56; p < 0.001). CONCLUSIONS: Balance is impaired in 1/3 of axial SpA patients and the BBS is associated mainly with functional and metrology indexes, showing that patients with severe cumulative damage are more affected.

Electrocardiographic changes in spondyloarthritis and use of anti-TNF-α drugs: a retrospective study with 100 patients / Alterações eletrocardiográficas em espondiloartrites e uso de anti-TNF-α: estudo retrospectivo em 100 pacientes

ABSTRACT Objective To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. Methods Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. Results Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. Conclusion Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.

RESUMO Objetivo Avaliar a prevalência de alterações eletrocardiográficas em pacientes com espondiloartrites, correlacionando-as com o uso de medicações antifator de necrose tumoral alfa (TNF-α) e presença do HLA-B27. Métodos Estudo retrospectivo com 100 pacientes com diagnóstico de espondiloartrites pelo critério Assessment of SpondyloArthritis International Society (ASAS) e 50 controles. Foram coletados nos prontuários dos pacientes, dados epidemiológicos, clínicos, exames de atividade inflamatória, presença do HLA-B27, e uso de medicamentos. A atividade de doença foi avaliada pelo Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Todos foram submetidos a eletrocardiograma realizado com aparelho de 12 derivações, sendo analisados ritmo, frequência cardíaca, distúrbios de condução e intervalo QT corrigido pela fórmula de Bazett. Resultados Dos 100 pacientes com espondiloartrites, 49 não usavam anti-TNF-α e 51 utilizavam este medicamento. O HLA-B27 estava presente em 53,1% da amostra. A frequência cardíaca foi mais baixa (p=0,06), o intervalo QT foi mais prolongado (p<0,0001) e existia mais perturbação de condução do ramo direito (p=0,014) nos pacientes com espondiloartrites do que nos controles. Uma modesta correlação de tempo de doença com frequência cardíaca foi encontrada (Rho=0,26; IC95%: 0,06-0,44; p=0,008). A presença do HLA-B27 aumentou a prevalência de perturbação de condução do ramo direito. Nenhum dos parâmetros eletrocardiográficos analisados alterou-se com uso de anti-TNF-α. Conclusão Pacientes com espondiloartrites tiveram frequência cardíaca menor, maior intervalo QT e prevalência maior de perturbação de condução do ramo direito do que controles. O HLA-B27 influi no aparecimento de perturbação de condução do ramo direito. O uso de anti-TNF-α não influiu nos achados eletrocardiográficos.

Avaliação da qualidade de atendimento através dos escores de risco TIMI e GRACE em serviço especializado no manejo de emergências cardiológicas do município de Curitiba (PR) / Quality evaluation of service through the scores TIMI risk and GRACE in a specialized service on cardiologic emergency at Curitiba

As síndromes coronarianas agudas (SCA) são uma das principais causas de morte e internamento da população mundial. Sua mortalidade vem decrescendo, muito dependente de ferramentas utilizadas no atendimento pré e intra-hospitalar. Traçar um perfil da SCA e comparar a taxa de mortalidade de um serviço especializado no atendimento de emergências cardiológicas com as taxas de mortalidade da literatura. Estudo observacional, prospectivo e consecutivo em formato de registro em 180 pacientes no Hospital da Santa Casa de Misericórdia de Curitiba. Média de idade 61,8 anos ±11,3 e 65,2% do sexo masculino. A incidência de infarto agudo do miocárdio com supra de ST foi 33,5%, infarto agudo do miocárdio sem supra ST45% e angina instável 20,5%. A mortalidade total foi 8,9% em 1 e 12% em 6 meses. O escore TIMI médio foi 3,1±1,3 (6% de risco de morte, novo IAM ou nova revascularização em 1 mês) e escore GRACE 99±27,9 (4,4% de risco de morte em 6 meses).Conclusão:a mortalidade em pacientes com menos de 70 anos esteve acima do esperado em relação a literatura

Acute coronary syndromes (ACS) are a leading cause of death and hospitalization in the world. Its mortality has been decreasing dependent in the tools used pre and in-hospital. Delineate a ACS profile and compare the mortality rate between a specialized service on cardiologic emergency and the rates from the literature. Observational, prospective and consecutive trial registered 180 patients in Santa Casa de Misericordia Hospital at Curitiba. The average age was 61,8 years ±11,3 and 65,2% were men. The incidence of ST-segment elevation myocardial infarction was 33,5%, non-ST-elevation myocardial infarction 45% and unstable angina 20,5%. Total mortality was 8,9% in one month and 12% in 6 months. TIMI score average was 3,1±1,3 (6% risk of death, new MI or new revascularization in 1 month) and GRACE score 99±27,9 (4,4% risk of death in 6 months). The mortality in patients younger than 70 years old was higher than expected in relation to the literature

Perfil epidemiológico dos casos de sífilis congênita notificados em hospital maternidade de nível secundário no município de Colombo - PR / Epidemiological profile of congenital syphilis cases notified in a secondary complexity maternity hospital at Colombo - PR

Traçar um perfil epidemiológico dos casos de sífilis congênita (SC), ocorridos no Hospital Maternidade Alto Maracanã (HMAM), em Colombo-PR; e fazer uma revisão da literatura sobre SC. Revisão das fichas de notificação/sífilis congênita do período de março 2012 a outubro 2013 do HMAM. Os dados foram colocados em uma planilha no Microsoft Excel e analisados com o programa computacional spss v.20.0. A amostra continha 44 mulheres. O diagnóstico da sífilis foi feito durante o pré-natal em 33 gestantes, na internação para parto ou cesárea em 8 mulheres, e em 3 casos o RN recebeu diagnóstico da doença congênita após nascimento. Dos recém nascidos, 77,3% eram assintomáticos; 65,2% não realizaram pesquisa de antígeno não treponêmico no líquido cefalorraquidiano; e 34,9% não fizeram radiografia de ossos longos. O tratamento com penicilina G cristalina 100.000 a 150.000 ui/kg/dia por 10 dias foi administrado em 75% deles. O sistema de notificação da SC permitiu maior número de diagnósticos da doença. Associado a isso há também um aumento no número de casos, indicando uma falha no atendimento pré-natal. A conduta no RN nem sempre é a preconizada pelos manuais, tanto que alguns recebem alta hospitalar sem avaliação de todas as complicações da doença. Ainda há falha no preenchimento das fichas de notificação, algumas mal preenchidas e com dados não condizentes com as indicações de diretrizes

To define the epidemiological profile of cases of Congenital Syphilis (CS), held in Hospital Maternidade Alto Maracanã (HMAM) in Colombo-PR, and to make a literature review on CS. Review of the Notification Forms/ Congenital Syphilis from March 2012 to October 2013 from the HMAM. Data were transferred to a worksheet in Microsoft Excel and analyzed with the computer program SPSS v.20.0. The sample contained 44 women. The diagnosis of syphilis was made during the prenatal in 33 patients, 8 women at admission during childbirth both normal delivery and surgical, and in 3 cases the newborn (NB) received a diagnosis of congenital disease after birth. 77.3% of the NBs were asymptomatic; 65.2% didn't perform non-treponemal antigen in cerebrospinal fluid; and 34.9% didn't had long bones X-ray. Treatment with penicillin G crystalline 100,000 to 150,000 IU/kg/day was administered for 10 days in 75% of the NBs. The system of notification of CS allowed greater number of diagnoses of the disease. Associated with this there is also an increase in the number of cases, indicating a failure in prenatal care. The conduct in NBs is not always as recommended in the manuals and some are discharged without evaluating all the complications of the disease. There still fails in completing reporting forms, some filled with poor and inconsistent data with indications of guidelines

Uso da membrana amniótica humana acelular na cicatrização de queimaduras térmicas de terceiro grau em ratos / The use of human's acelular amniotic membrane to heal third degree burns in rats

Há muito tempo, procura-se uma alternativa para cobrir as feridas causadas por injúria térmica. Alguns autores consideram a membrana amniótica (MA) o elemento mais adequado para substituir a epiderme. O objetivo deste trabalho é utilizar a MA acelular como um substituto definitivo da derme em queimaduras. 24 ratos Wistar foram submetidos a um processo de injúria térmica. Dividiram-se os animais em dois grupos: controle e experimental. No último, foi aplicada MA sobre a ferida. Semanalmente, realizou-se a análise planimétrica das áreas da injúria. No 26º dia foram coletados quatro segmentos da lesão para a avaliação histológica de dois tipos de colágeno. Foi encontrada diferença significativa entre as médias das 4 áreas (p<0,001) nos grupos A e B. Em relação à porcentagem de colágeno tipo I e III não houve diferença significativa entre os grupos (p=0,598). Não ocorreu diferença significativa com o uso da MA acelular

Long time an alternative to cover the wounds caused by thermal injury has been searched. Some authors consider the amniotic membrane (AM) is the best element to replace the epidermis. The objective of this study is to use the acellular amniotic membrane as a permanent replacement to dermis in burns. 24 male Wistar rats were submitted to a process of thermal injury. The animals were divided in two groups: control and experimental. In the experimental group, the AM has been applied to the wound. Every week was made the planimetric analysis of the areas of injury. On the 26th day, four segments of the lesion were collected to a histological rating of two types of collagen. The study showed significant difference between the average of the four areas (p <0.001) in A and B groups. About the percentage of type I and III collagen there was no significant difference between the groups (p = 0.598). The use of acellular amniotic membrane was not effective