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1.
Mol Biotechnol ; 61(6): 461-468, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30997667

RESUMO

Synthetic biology and genetic engineering in algae offer an unprecedented opportunity to develop species with traits that can help solve the problems associated with food and energy supply in the 21st century. In the green alga Chlamydomonas reinhardtii, foreign genes can be expressed from the chloroplast genome for molecular farming and metabolic engineering to obtain commodities and high-value molecules. To introduce these genes, selectable markers, which rely mostly on the use of antibiotics, are needed. This has risen social concern associated with the potential risk of horizontal gene transfer across life kingdoms, which has led to a quest for antibiotic-free selectable markers. Phosphorus (P) is a scarce nutrient element that most organisms can only assimilate in its most oxidized form as phosphate (Pi); however, some organisms are able to oxidize phosphite (Phi) to Pi prior to incorporation into the central metabolism of P. As an alternative to the use of the two positive selectable makers already available for chloroplast transformation in C. reinhardtii, the aadA and the aphA-6 genes, that require the use of antibiotics, we investigated if a phosphite-based selection method could be used for the direct recovery of chloroplast transformed lines in this alga. Here we show that following bombardment with a vector carrying the ptxD gene from Pseudomonas stutzeri WM88, only cells that integrate and express the gene proliferate and form colonies using Phi as the sole P source. Our results demonstrate that a selectable marker based on the assimilation of Phi can be used for chloroplasts transformation in a biotechnologically relevant organism. The portable selectable marker we have developed is, in more than 18 years, the latest addition to the markers available for selection of chloroplast transformed cells in C. reinhardtii. The ptxD gene will contribute to the repertoire of tools available for synthetic biology and genetic engineering in the chloroplast of C. reinhardtii.


Assuntos
Proteínas de Bactérias/genética , Chlamydomonas reinhardtii/genética , Cloroplastos/genética , NADH NADPH Oxirredutases/genética , Fosfitos/metabolismo , Fósforo/metabolismo , Proteínas de Algas/genética , Proteínas de Algas/metabolismo , Proteínas de Bactérias/metabolismo , Chlamydomonas reinhardtii/metabolismo , Cloroplastos/metabolismo , Engenharia Genética/métodos , Marcadores Genéticos , Vetores Genéticos/química , Vetores Genéticos/metabolismo , NADH NADPH Oxirredutases/metabolismo , Fosfitos/farmacologia , Pseudomonas stutzeri/química , Pseudomonas stutzeri/genética , Seleção Genética , Transformação Genética
2.
Am J Ophthalmol ; 200: 85-94, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30660771

RESUMO

PURPOSE: Cystoid macular edema (CME) is a leading cause of blindness. This study assessed the efficacy and safety of tocilizumab (TCZ) in refractory CME. DESIGN: Retrospective case series. METHODS: Patients with CME secondary to noninfectious uveitis who had inadequate response to corticosteroids and at least 1 conventional immunosuppressive drug, and in most cases to other biological agents, were studied. CME was defined as central retinal thickness greater than 300 µm. The primary outcome measure was macular thickness. Intraocular inflammation, best-corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS: A total of 25 patients (mean ± standard deviation age 33.6 ± 18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n = 9), Behçet disease (n = 7), birdshot retinochoroidopathy (n = 4), idiopathic (n = 4), and sarcoidosis (n = 1). The ocular patterns were panuveitis (n = 9), anterior uveitis (n = 7), posterior uveitis (n = 5), and intermediate uveitis (n = 4). Most patients had CME in both eyes (n = 24). TCZ was used in monotherapy (n = 11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7 ± 177.2 vs 259.1 ± 499.5 µm; P = .00009) and BCVA (0.39 ± 0.31 vs 0.54 ± 0.33; P = .0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9 ± 13.6 mg/day vs 3.1 ± 2.3 mg/day; P = .002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow-up of 12.7 ± 8.34 months. CONCLUSION: Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.

3.
Bioresour Technol ; 274: 252-260, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30529329

RESUMO

A Chlorella vulgaris UTEX 26 semicontinuous culture was implemented in 2000 L raceways with M medium during spring season at greenhouse conditions. Areal biomass productivities between 20 and 26 g m-2 d-1 were reached on the third day. The maximal areal lipid productivity obtained was 6.1 g m-2 d-1 and an increment in the saturated fatty acids (SFA) proportion (C14-C18) was favored in comparison with the fatty acids obtained with M medium in photobioreactors of 1 L and photoperiod light:darkness 12:12 h. After the eighth day of the culture or biomass concentrations above 0.25 g L-1, the microalgal cultures were prone to contamination by ciliates and amoebae, due to the sugars excreted by C. vulgaris UTEX 26. The periodical addition of NH4HCO3 to the microalgal culture maintained the ammonium concentration between 25 and 50 mg L-1, which contributed to diminish the contamination risks by protozoa.


Assuntos
Biomassa , Chlorella vulgaris/metabolismo , Lipídeos/biossíntese , Microalgas , Fotobiorreatores , Tanques , Estações do Ano
4.
Reumatol. clín. (Barc.) ; 14(3): 155-159, mayo-jun. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-174100

RESUMO

Objetivo. Estandarizar la evaluación clínica de pacientes con espondiloartritis (EspA) axial y artritis psoriásica (APs). Métodos. Estudio cualitativo que incluyó: 1) grupo nominal (18 expertos); 2) revisión de la literatura sobre variables empleadas en la evaluación de los pacientes con EspA axial o APs, y 3) grupo focal con reumatólogos y otro con pacientes con EspA axial o APs para analizar la evaluación de las EspA en las consultas de reumatología. Los expertos seleccionaron las variables a incluir en el cuadro de actuación con base en su relevancia, factibilidad en consulta y método/s de medición. Resultados. El cuadro de actuación incluye las variables para valorar antecedentes personales, exploración física, actividad y función, pruebas complementarias y tratamientos. Detalla factores de riesgo de progresión radiográfica, factores predictores de respuesta a terapia biológica, e incluye variables de excelencia. Conclusiones. Este cuadro de actuación para pacientes con EspA axial y APs podrá ayudar a homogeneizar la práctica clínica diaria y a mejorar el manejo y el pronóstico de estos pacientes


Objective. To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist. Methods. Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type. Results. The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence. Conclusions. This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis


Assuntos
Humanos , Literatura de Revisão como Assunto , Espondilartrite/diagnóstico , Artrite Psoriásica/diagnóstico , Exame Físico/métodos , Fatores de Risco , Prognóstico , Avaliação de Programas e Projetos de Saúde , Análise Qualitativa , Projetos , Espondilartrite/terapia , Artrite Psoriásica/terapia , Epidemiologia Descritiva , Análise Estatística
5.
Clin Exp Rheumatol ; 2018 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-29745878

RESUMO

OBJECTIVES: To study whether disease status at treatment initiation has changed after the issue of the ASAS classification criteria. METHODS: REGISPONSERBIO registers patients with axial spondyloarthritis (axSpA) on biological treatment since 2013. It includes patients starting biological treatment (incident) or already on biological therapies (prevalent). Patients in both groups were compared in terms of: age at disease onset and at treatment start, disease duration, gender, HLA-B27, body mass index (BMI), BASDAI, BASFI, C-reactive protein, ESR, metrological data, ASQoL, WAPAI, extra-articular manifestations, comorbidities, radiological study, type of biological treatment and concomitant treatments. RESULTS: 256 patients were included, of whom 174 (65%) were already on biologic therapy. Compared to incident patients, prevalent patients started treatment with longer disease duration (15 vs. 8.6 years; p<0.001), a higher proportion of them were men (83% vs. 67%; p=0.01), a smaller proportion of them showed non-radiographic axial spondylarthritis (nr-axSpA)(17% vs. 32%; p<0.01), and a higher proportion had HLAB27 (85% vs. 73%; p=0.02). There were no statistically significant differences in terms of disease activity, degree of disability, quality of life, or prevalence of extra-articular manifestations. CONCLUSIONS: Data suggest that, after the issue of the new classification criteria for SpA, biological therapy is being administered earlier than previously in SpA patients and in a higher proportion of patients with nr-axSpA. However, this change in prescribing profile, apparently, has not caused an over-treatment, as patients do not seem to have a lower disease burden than prior to the issue of the criteria.

6.
Clin Exp Rheumatol ; 36(5): 879-883, 2018 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29745883

RESUMO

OBJECTIVES: Dactylitis is a typical feature of psoriatic arthritis. However, dactylitis was included as a spondyloarthritis (SpA) feature for both (axial and peripheral) of the ASAS classification criteria, but data about its prevalence are scarce, especially in patients with a recent onset of the disease. Our objective was to determine the prevalence and characteristics associated with dactylitis in patients with early SpA. METHODS: A baseline dataset from the ESPeranza cohort was used. This programme included patients who were suspected of having SpA (age <45 years, symptoms duration of 3-24 months and with inflammatory back pain, or asymmetrical arthritis, or spinal/joint pain plus ≥1 of the SpA features). For this study, 609 patients who were diagnosed with SpA by their physician were included. Descriptive, univariable and multivariable logistic regression analyses were employed to investigate the association between the presence of dactylitis and the characteristics associated with SpA. RESULTS: Fifty-eight (9.5%) patients currently or previously had dactylitis. In the multivariable analysis, dactylitis was independently associated with peripheral arthritis (OR= 4.83; p<0.001), enthesitis (OR= 2.49; p=0.01), psoriasis (OR= 3.62; p<0.01) and the physician's visual analogue scale (OR= 0.82; p=0.01). However, 67% of the patients who had dactylitis did not have peripheral arthritis or psoriasis and 15% had predominantly axial disease. CONCLUSIONS: Dactylitis is a frequent manifestation in patients with SpA, even during the early stages of the disease. Its presence is mainly associated with peripheral manifestations and psoriasis. Nevertheless, dactylitis is not exclusive of patients with PsA or peripheral manifestations.

7.
Rheumatol Int ; 38(7): 1277-1284, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29786781

RESUMO

To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.

8.
Reumatol Clin ; 14(3): 155-159, 2018 May - Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28284772

RESUMO

OBJECTIVE: To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist. METHODS: Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type. RESULTS: The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence. CONCLUSIONS: This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis.

10.
Bioresour Technol ; 244(Pt 1): 400-406, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28783567

RESUMO

The aim of the present work was to evaluate the feasibility of microalgae cultivation using secondary treated domestic wastewater. Two Chlorella vulgaris strains (CICESE and UTEX) and an indigenous consortium, were cultivated on treated wastewater enriched with and without the fertilizer Bayfolan®. Biomass production for C. vulgaris UTEX, CICESE and the indigenous consortium grown in treated wastewater was 1.167±0.057, 1.575±0.434 and 1.125±0.250g/L, with a total lipid content of 25.70±1.24, 23.35±3.01and 20.54±1.23% dw, respectively. The fatty acids profiles were mainly composed of C16 and C18. Regardless of the media used, in all three strains unsaturated fatty acids were the main FAME (fatty acids methyl esters) accumulated in a range of 45-62%. An enrichment of treated wastewater with Bayfolan® significantly increased the production of biomass along with an increase in pigments and proteins of ten and threefold, respectively.


Assuntos
Biomassa , Chlorella vulgaris , Águas Residuárias , Chlorella , Ácidos Graxos , Microalgas
11.
Rheumatol Int ; 37(8): 1239-1248, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28389856

RESUMO

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.


Assuntos
Artrite Psoriásica/terapia , Doenças Cardiovasculares/diagnóstico , Gerenciamento Clínico , Medicina Baseada em Evidências , Tomada de Decisões , Técnica Delfos , Humanos , Reumatologia/métodos , Fatores de Risco , Espanha
13.
Environ Sci Pollut Res Int ; 24(33): 25618-25626, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27272702

RESUMO

The effect of sequential batch cultures of the marine microalgae Nannochloropsis oculata on lipid and biomass production was studied in 200-L raceway ponds for 167 days (nine harvesting cycles) during winter and spring seasons under greenhouse conditions. The highest biomass concentration and productivity were 1.2 g/L and 49.8 mg/L/day on days 73 (5th cycle) and 167 (9th cycle), respectively. The overall interval of lipid production was between 131 and 530 mg/L. Despite the daily and seasonal variations of light irradiance (0-1099 µmol photon/m2 s), greenhouse temperature (2.1-50.7 °C), and culture temperature (12.5-31.4 °C), ANOVA analysis showed no statistical difference (p value > 0.01) on the fatty acid methyl ester (FAMES) composition over the nine harvesting cycles evaluated. The most abundant FAMES were palmitic (C16:0), stearic (C18:0) and palmitoleic (C16:1∆9) acids with 37.1, 28.6, and 8.4 %, respectively. The sequential batch cultures of N. oculata in raceway ponds showed an increasing biomass production in each new cycle while keeping the quality of the fatty acid mixture under daily and seasonal variations of light irradiance and temperature.


Assuntos
Biomassa , Ácidos Graxos/análise , Metabolismo dos Lipídeos , Microalgas/metabolismo , Estramenópilas/metabolismo , Tanques , Estações do Ano
14.
Bioresour Technol ; 212: 207-216, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27099946

RESUMO

A novel culture medium to enhance the biomass and lipid production simultaneously by Chlorella vulgaris UTEX 26 was designed in three stages of optimization. Initially, a culture medium was inferred applying the response surface method to adjust six factors [NaNO3, NH4HCO3, MgSO4·7H2O, KH2PO4, K2HPO4 and (NH4)2HPO4], which were selected on the basement of BBM (Bold's Basal Medium) and HAMGM (Highly Assimilable Minimal Growth Medium) culture media. Afterwards, the nitrogen source compound was optimized to reduce both, ammonium and nitrate concentrations. As result of the optimization process, the proposed culture medium improved 40% the biomass (0.73gL(-1)) compared with the BBM medium and 85% the lipid concentration (281mgL(-1)), with respect to HAMGM medium. Some culture media components concentrations were reduced up to 50%. Gas chromatography analysis revealed that C16:0, C18:0, C18:1, C18:2 and C18:3 were the major fatty acids produced by C. vulgaris UTEX 26.


Assuntos
Chlorella vulgaris/crescimento & desenvolvimento , Meios de Cultura/química , Lipídeos/biossíntese , Bicarbonatos , Biomassa , Chlorella vulgaris/metabolismo , Cromatografia Gasosa , Ácidos Graxos/biossíntese , Nitratos/metabolismo
15.
Clin Exp Rheumatol ; 34(1): 94-9, 2016 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26812050

RESUMO

OBJECTIVES: To evaluate the efficacy of etoricoxib in patients with axial ankylosing spondyloarthritis (AS) refractory to traditional NSAIDs. METHODS: This was an open label, multicentric, randomised, prospective (4 weeks with and open extension to 6 months), non-controlled study. Consecutive patients with axial AS refractory to traditional NSAID eligible for anti-TNF-α therapy were selected. The primary outcomes were the rate of patients with good clinical response (not eligible for anti-TNF-α therapy after etoricoxib) and the Assessment of Spondyloarthritis International Society response criteria for biologic therapies (ASASBIO) response at 4 weeks. Secondary outcomes included: ASAS20 and 40 responses, ASDAS-CRP response, BASDAI, BASFI, back and night back pain, global patient and physician assessment of the disease, and biologic parameters like C-reactive protein (CRP) at 2, 4 weeks and 6 months. RESULTS: A total of 57 axial AS patients were recruited, 46 men, with mean age of 43 years. After 4 weeks of treatment, 26 patients (46%) achieved a good clinical response and 11 (20%) an ASASBIO response. These results at 24 weeks were 19 (33%) and 13 (23%) respectively. All individual clinical variables improved significantly after 4 weeks of treatment. CRP serum levels decreased after 4 weeks but reached no statistical significance, although 30% of patients showed a normalisation of CRP. CONCLUSIONS: Etoricoxib provided a clear clinical improvement in around a third of patients with axial AS refractory to traditional NSAIDs. Special care should be required when deciding to start anti-TNF-α therapy; it seems reasonable to keep in mind these results of etoricoxib treatment.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Resistência a Medicamentos , Piridinas/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Sulfonas/uso terapêutico , Adulto , Idoso , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Substituição de Medicamentos , Etoricoxib , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piridinas/efeitos adversos , Indução de Remissão , Espanha , Espondilite Anquilosante/diagnóstico , Sulfonas/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Reumatol. clín. (Barc.) ; 11(2): 83-89, mar.-abr. 2015.
Artigo em Espanhol | IBECS | ID: ibc-133343

RESUMO

Objetivos. Evaluar la prevalencia de enfermedad extraarticular (uveítis, psoriasis y enfermedad inflamatoria intestinal [EII]) en una cohorte de pacientes con espondiloartritis (EsA). Pacientes y métodos. AQUILES es un estudio observacional, prospectivo y multicéntrico, en 3 cohortes de pacientes con una de las siguientes enfermedades inflamatorias mediadas por inmunidad (EIMI): EsA, psoriasis y EII. En la cohorte presente se incluyó a pacientes ≥ 18 años con EsA atendidos en consultas hospitalarias de Reumatología. El objetivo principal fue evaluar la coexistencia de estas enfermedades y de uveítis, valorada sobre la base de la historia clínica del paciente hasta el momento de entrar en el estudio. Resultados. Se incluyó a 601 pacientes con EsA (varones: 63,1%, mujeres: 36,9%). Los diagnósticos fueron: espondilitis anquilosante (55,1%); artritis psoriásica (25,2%); espondiloartritis indiferenciada (16,1%); artritis enteropática (2,5%), y otros (1,3%). En el 43,6% (IC del 95%, 39,7-47,6) coexistió al menos una de las 3 enfermedades mencionadas, predominando psoriasis (prevalencia: 27,8%, IC del 95%, 24,4-31,5), uveítis (13,6%, IC del 95%m 11,1-16,6) y EII (5,1%, IC del 95%, 3,7-7,2). En pacientes con espondilitis anquilosante, la prevalencia fue del 25,3% (EII: 3,9%, psoriasis: 5,4%, uveítis: 19,0%) y en pacientes con artritis psoriásica fue del 94,7%, debido a la presencia de psoriasis (94,0%). La coexistencia de estas manifestaciones se asoció a mayor edad, sexo femenino y presencia de otras manifestaciones extraarticulares de las EsA distintas de las estudiadas. Conclusiones. La enfermedad extraarticular en pacientes con EsA es frecuente y en este estudio se asoció a la edad, el sexo femenino y la presencia de otras manifestaciones extraarticulares de EsA (AU)


Objectives. To describe the prevalence of extra-articular disease (uveitis, psoriasis and inflammatory bowel disease [IBD]), in a cohort of patients with spondyloarthritis (SpA). Patients and methods. AQUILES is an observational, prospective and multicentric study of three cohorts of patients with one of the following immune-mediated inflammatory diseases (IMID): SpA, psoriasis, or IBD. In the present cohort, patients ≥18 years of age with SpA were enrolled from Rheumatology clinics. The main objective was to assess the coexistence of these diseases and of uveitis, based on the patients’ clinical history up to the study entry. Results. A total of 601 patients with SpA (men: 63.1%; women: 36.9%) were enrolled. The specific diagnoses were: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated spondyloarthritis (16.1%), enteropathic arthritis (2.5%), and others (1.3%). In 43.6% (95% CI: 39.7-47.6) of the patients, at least one of the three abovementioned diseases was encountered, predominantly psoriasis (prevalence 27.8%, 95% CI: 24.4-31.5), uveitis (13.6%, CI 95%: 11.1-16.6) and IBD (5.1%, 95% CI: 3.7-7.2). In patients with ankylosing spondylitis the proportion of other disease was 25.3% (IBD: 3.9%, psoriasis: 5.4%, uveitis: 19.0%) whilst it was 94.7% in psoriatic arthritis, due to the presence of psoriasis (94.0%). The coexistence of these diseases was associated with age, female gender and the presence of other extra-articular manifestations associated with SpA. Conclusions. Extra-articular disease in patients with SpA is common and, in this study, it was associated to age, female gender and the presence of other SpA-related extra-articular manifestations (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Espondilartrite/epidemiologia , Espondilartrite/prevenção & controle , Psoríase/complicações , Psoríase/imunologia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/imunologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/imunologia , Espondilartrite/complicações , Espondilartrite/fisiopatologia , Estudos de Coortes , Artrite Psoriásica/complicações , Artrite Psoriásica/imunologia , Uveíte/complicações , Estudos Prospectivos , Análise Multivariada
17.
Reumatol Clin ; 11(2): 83-9, 2015 Mar-Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25441489

RESUMO

OBJECTIVES: To describe the prevalence of extra-articular disease (uveitis, psoriasis and inflammatory bowel disease [IBD]), in a cohort of patients with spondyloarthritis (SpA). PATIENTS AND METHODS: AQUILES is an observational, prospective and multicentric study of three cohorts of patients with one of the following immune-mediated inflammatory diseases (IMID): SpA, psoriasis, or IBD. In the present cohort, patients ≥18 years of age with SpA were enrolled from Rheumatology clinics. The main objective was to assess the coexistence of these diseases and of uveitis, based on the patients' clinical history up to the study entry. RESULTS: A total of 601 patients with SpA (men: 63.1%; women: 36.9%) were enrolled. The specific diagnoses were: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated spondyloarthritis (16.1%), enteropathic arthritis (2.5%), and others (1.3%). In 43.6% (95% CI: 39.7-47.6) of the patients, at least one of the three abovementioned diseases was encountered, predominantly psoriasis (prevalence 27.8%, 95% CI: 24.4-31.5), uveitis (13.6%, CI 95%: 11.1-16.6) and IBD (5.1%, 95% CI: 3.7-7.2). In patients with ankylosing spondylitis the proportion of other disease was 25.3% (IBD: 3.9%, psoriasis: 5.4%, uveitis: 19.0%) whilst it was 94.7% in psoriatic arthritis, due to the presence of psoriasis (94.0%). The coexistence of these diseases was associated with age, female gender and the presence of other extra-articular manifestations associated with SpA. CONCLUSIONS: Extra-articular disease in patients with SpA is common and, in this study, it was associated to age, female gender and the presence of other SpA-related extra-articular manifestations.


Assuntos
Doenças Inflamatórias Intestinais/etiologia , Psoríase/etiologia , Espondilartrite/complicações , Uveíte/etiologia , Adulto , Idoso , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Psoríase/epidemiologia , Uveíte/epidemiologia
18.
Rheumatology (Oxford) ; 53(12): 2223-31, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24996907

RESUMO

OBJECTIVE: The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD). METHODS: We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. RESULTS: Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 µm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 µm) that improved from 420 µm (s.d. 119.5) at baseline to 271 µm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. CONCLUSION: Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte/tratamento farmacológico , Adalimumab , Adolescente , Adulto , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Síndrome de Behçet/complicações , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Criança , Esquema de Medicação , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Resultado do Tratamento , Uveíte/etiologia , Adulto Jovem
19.
Rep Pract Oncol Radiother ; 19(4): 234-8, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25061516

RESUMO

AIM: This study evaluates the acute toxicity outcome in patients treated with RapidArc for localized prostate cancer. BACKGROUND: Modern technologies allow the delivery of high doses to the prostate while lowering the dose to the neighbouring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known. MATERIALS AND METHODS: Between December 2009 and May 2012, 45 patients with primary prostate adenocarcinoma were treated using RapidArc. All patients received 1.8 Gy per fraction, the median dose to the prostate gland, seminal vesicles, pelvic lymph nodes and surgical bed was 80 Gy (range, 77.4-81 Gy), 50.4 Gy, 50.4 Gy and 77.4 Gy (range, 75.6-79.2 Gy), respectively. RESULTS: The time between the last session and the last treatment follow up was a median of 10 months (range, 3-24 months). The incidence of grade 3 acute gastrointestinal (GI) and genitourinary (GU) toxicity was 2.2% and 15.5%, respectively. Grade 2 acute GI and GU toxicity occurred in 30% and 27% of patients, respectively. No grade 4 acute GI and GU toxicity were observed. Older patients (>median) or patients with V60 higher than 35% had significantly higher rates of grade ≥2 acute GI toxicity compared with the younger ones. CONCLUSIONS: RapidArc in the treatment of localized prostate cancer is tolerated well with no Grade >3 GI and GU toxicities. Older patients or patients with higher V60 had significantly higher rates of grade ≥2 acute GI toxicity. Further research is necessary to assess definitive late toxicity and tumour control outcome.

20.
Rheumatol Int ; 34(2): 165-70, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24390635

RESUMO

To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.


Assuntos
Qualidade da Assistência à Saúde/normas , Reumatologia/normas , Espondilartrite/terapia , Padrão de Cuidado/normas , Consenso , Técnica Delfos , Humanos , Melhoria de Qualidade/normas , Espondilartrite/diagnóstico
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