Comparação entre os scores SLICC-2012 e EULAR-ACR 2019 no diagnóstico de lúpus eritematoso sistêmico em pacientes do sexo masculino

Orientador: Prof. Dr. Eduardo dos Santos PaivaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde. Defesa : Curitiba, 28/02/2024Inclui referênciasResumo: O Lúpus Eritematoso SIstêmico (LES) é uma doença autoimune do tecido conjuntivo que afeta predominantemente mulheres. É heterogêneo, tanto biológica quanto imunologicamente, com diversas apresentações clínicas. Devido à extensa gama de manifestações, critérios envolvendo aspectos clínicos e imunológicos têm sido utilizados para classificação da doença. Pouco se sabe sobre as diferenças nos critérios diagnósticos quando se comparam indivíduos do sexo masculino e feminino. Métodos: Em estudo retrospectivo, utilizando coorte histórica com dados de pacientes do Ambulatório de Reumatologia do Hospital de Clínicas da Universidade Federal do Paraná, buscamos informações a respeito da utilização dos critérios SLICC 2012 e ACR-EULAR 2019 para LES em homens.Resultados: Pacientes do sexo masculino apresentam maior frequência de derrame pleural (37,9% p 0,002) e derrame pericárdico (27,6% p 0,02), além de manifestações neurológicas (3,7% p < 0,001), principalmente convulsões (22,4% p 0,003), e febre (60,3% p < 0,001). Em relação ao sexo feminino, há predomínio de alopecia (55,2% p < 0,001), artralgia (91,4% p 0,014) e predomínio de anticorpo anti-Ro (51% p 0,044). Discussão: Na comparação entre os escores SLICC e ACR-EULAR não foram encontradas diferenças, pois 98,3% dos pacientes do sexo masculino atingiram o SLICC e 94,8% os critérios ACR-EULAR, apoiando a hipótese de que os critérios podem ser utilizados independentemente do gênero do paciente.Abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease of the connective tissue that predominantly affects women. It is heterogeneous both biologically and immunologically, with various clinical presentations. Due to the extensive range of manifestations, criteria involving clinical and immunological aspects have been used for disease classification. Little is known about the differences in diagnostic criteria when comparing male and female individuals. Methods: In a retrospective study, using a historical cohort with data from patients at the Rheumatology Clinic of the Hospital de Clínicas at the Federal University of Paraná, we searched for information regarding the use of SLICC 2012 and ACR-EULAR 2019 criteria for SLE in men. Results: Male patients have a higher frequency of pleural effusion (37.9% p 0.002) and pericardial effusion (27.6% p 0.02), as well as neurological manifestations (3.7% p <0.001), mainly seizures (22.4% p 0.003), and fever (60.3% p < 0.001). Regarding females, there is a predominance of alopecia (55.2% p <0.001), arthralgia (91.4% p 0.014), and the predominance of anti-Ro antibody (51% p 0.044). Discussion: In the comparison between the SLICC and ACR-EULAR scores, no differences were found since 98.3% of male patients reached SLICC, and 94.8%, the ACR-EULAR criteria, supporting the hypothesis that the criteria can be used regardless of the patient's gender

Comparação entre os scores SLICC-2012 e EULAR-ACR 2019 no diagnóstico de lúpus eritematoso sistêmico em pacientes do sexo masculino

Orientador: Prof. Dr. Eduardo dos Santos PaivaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde. Defesa : Curitiba, 28/02/2024Inclui referênciasResumo: O Lúpus Eritematoso SIstêmico (LES) é uma doença autoimune do tecido conjuntivo que afeta predominantemente mulheres. É heterogêneo, tanto biológica quanto imunologicamente, com diversas apresentações clínicas. Devido à extensa gama de manifestações, critérios envolvendo aspectos clínicos e imunológicos têm sido utilizados para classificação da doença. Pouco se sabe sobre as diferenças nos critérios diagnósticos quando se comparam indivíduos do sexo masculino e feminino. Métodos: Em estudo retrospectivo, utilizando coorte histórica com dados de pacientes do Ambulatório de Reumatologia do Hospital de Clínicas da Universidade Federal do Paraná, buscamos informações a respeito da utilização dos critérios SLICC 2012 e ACR-EULAR 2019 para LES em homens.Resultados: Pacientes do sexo masculino apresentam maior frequência de derrame pleural (37,9% p 0,002) e derrame pericárdico (27,6% p 0,02), além de manifestações neurológicas (3,7% p < 0,001), principalmente convulsões (22,4% p 0,003), e febre (60,3% p < 0,001). Em relação ao sexo feminino, há predomínio de alopecia (55,2% p < 0,001), artralgia (91,4% p 0,014) e predomínio de anticorpo anti-Ro (51% p 0,044). Discussão: Na comparação entre os escores SLICC e ACR-EULAR não foram encontradas diferenças, pois 98,3% dos pacientes do sexo masculino atingiram o SLICC e 94,8% os critérios ACR-EULAR, apoiando a hipótese de que os critérios podem ser utilizados independentemente do gênero do paciente.Abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease of the connective tissue that predominantly affects women. It is heterogeneous both biologically and immunologically, with various clinical presentations. Due to the extensive range of manifestations, criteria involving clinical and immunological aspects have been used for disease classification. Little is known about the differences in diagnostic criteria when comparing male and female individuals. Methods: In a retrospective study, using a historical cohort with data from patients at the Rheumatology Clinic of the Hospital de Clínicas at the Federal University of Paraná, we searched for information regarding the use of SLICC 2012 and ACR-EULAR 2019 criteria for SLE in men. Results: Male patients have a higher frequency of pleural effusion (37.9% p 0.002) and pericardial effusion (27.6% p 0.02), as well as neurological manifestations (3.7% p <0.001), mainly seizures (22.4% p 0.003), and fever (60.3% p < 0.001). Regarding females, there is a predominance of alopecia (55.2% p <0.001), arthralgia (91.4% p 0.014), and the predominance of anti-Ro antibody (51% p 0.044). Discussion: In the comparison between the SLICC and ACR-EULAR scores, no differences were found since 98.3% of male patients reached SLICC, and 94.8%, the ACR-EULAR criteria, supporting the hypothesis that the criteria can be used regardless of the patient's gender

Comparação entre os scores SLICC-2012 e EULAR-ACR 2019 no diagnóstico de lúpus eritematoso sistêmico em pacientes do sexo masculino

Orientador: Prof. Dr. Eduardo dos Santos PaivaDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde. Defesa : Curitiba, 28/02/2024Inclui referênciasResumo: O Lúpus Eritematoso SIstêmico (LES) é uma doença autoimune do tecido conjuntivo que afeta predominantemente mulheres. É heterogêneo, tanto biológica quanto imunologicamente, com diversas apresentações clínicas. Devido à extensa gama de manifestações, critérios envolvendo aspectos clínicos e imunológicos têm sido utilizados para classificação da doença. Pouco se sabe sobre as diferenças nos critérios diagnósticos quando se comparam indivíduos do sexo masculino e feminino. Métodos: Em estudo retrospectivo, utilizando coorte histórica com dados de pacientes do Ambulatório de Reumatologia do Hospital de Clínicas da Universidade Federal do Paraná, buscamos informações a respeito da utilização dos critérios SLICC 2012 e ACR-EULAR 2019 para LES em homens.Resultados: Pacientes do sexo masculino apresentam maior frequência de derrame pleural (37,9% p 0,002) e derrame pericárdico (27,6% p 0,02), além de manifestações neurológicas (3,7% p < 0,001), principalmente convulsões (22,4% p 0,003), e febre (60,3% p < 0,001). Em relação ao sexo feminino, há predomínio de alopecia (55,2% p < 0,001), artralgia (91,4% p 0,014) e predomínio de anticorpo anti-Ro (51% p 0,044). Discussão: Na comparação entre os escores SLICC e ACR-EULAR não foram encontradas diferenças, pois 98,3% dos pacientes do sexo masculino atingiram o SLICC e 94,8% os critérios ACR-EULAR, apoiando a hipótese de que os critérios podem ser utilizados independentemente do gênero do paciente.Abstract: Systemic lupus erythematosus (SLE) is an autoimmune disease of the connective tissue that predominantly affects women. It is heterogeneous both biologically and immunologically, with various clinical presentations. Due to the extensive range of manifestations, criteria involving clinical and immunological aspects have been used for disease classification. Little is known about the differences in diagnostic criteria when comparing male and female individuals. Methods: In a retrospective study, using a historical cohort with data from patients at the Rheumatology Clinic of the Hospital de Clínicas at the Federal University of Paraná, we searched for information regarding the use of SLICC 2012 and ACR-EULAR 2019 criteria for SLE in men. Results: Male patients have a higher frequency of pleural effusion (37.9% p 0.002) and pericardial effusion (27.6% p 0.02), as well as neurological manifestations (3.7% p <0.001), mainly seizures (22.4% p 0.003), and fever (60.3% p < 0.001). Regarding females, there is a predominance of alopecia (55.2% p <0.001), arthralgia (91.4% p 0.014), and the predominance of anti-Ro antibody (51% p 0.044). Discussion: In the comparison between the SLICC and ACR-EULAR scores, no differences were found since 98.3% of male patients reached SLICC, and 94.8%, the ACR-EULAR criteria, supporting the hypothesis that the criteria can be used regardless of the patient's gender

SEIZURE AS INSULINOMA APRESENTATION: A CASE REPORT

Introdução: O insulinoma é um tumor neuroendócrino com prevalência de 4:1.000.000 habitantes, sem predominância por sexo ou idade, e representa cerca de 1-2% das neoplasias pancreáticas. Portadores da doença apresentam sintomas de hipoglicemia que são manifestados devido à hipersecreção de insulina. Objetivo: Relatar um caso de insulinoma diagnosticado após crise convulsiva. Relato de caso: Paciente feminina, 31 anos, interna por crises convulsivas causadas por hipoglicemia com início há 3 anos. Durante a internação iniciou-se investigação sendo constatado hiperinsulinemia, porém, apesar da suspeição, exames de imagem disponíveis não detectaram a presença de insulinoma. Foi submetida a intervenção cirúrgica com USG intraoperatório sem sucesso. No pós operatório, necessitou de uso de análogos de somatostatina para controle da doença e evoluiu sem presença de novos episódios de hipoglicemia. Conclusão: Insulinoma é um raro tumor que secreta insulina, levando a sinais e sintomas de hipoglicemia. A excisão cirúrgica do tumor, quando possível, leva a cura da maioria dos pacientes. Naqueles não curados pela cirurgia, o uso de análogos de somatostatina representam uma segunda opção de tratamento.Introduction: Insulinoma is a neuroendocrine tumor with an incidence of 4 per million, with no difference of prevalence by sex or age, and represents about 1-2% of the pancreatic neoplasia. This patient has hypoglycemic symptoms, manifested due to insulin hypersecretion. Objective: Report an insulinoma case. Case report: A female patient, 31 years old, admitted in 2011 due to convulsions that began three years ago, caused by hypoglycemia. In the hospital, it was found hyperinsulinism. However, the image exams were negative to insulinoma. After undergoing surgical procedure, the patient continued with hypoglycemia. Using longacting somatostatin analog, therefore, the patient had no further episodes of hypoglycemia. Conclusion: Insulinoma is a rare tumor which leads to elevated insulin levels. The surgery is favorable and leads to healing in most cases. The use of long-acting somatostatin analog is the second treatment option

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted