The importance of nutritional intervention in the reduction of body weight in patients with the antiphospholipid antibody

OBJETIVO: Avaliar a eficácia da intervenção nutricional na redução do excesso de peso (EP), em pacientes com síndrome do anticorpo antifosfolípide (SAF). MÉTODO: Incluídos 40 pacientes, acima de 18 anos, com diagnóstico de SAF primária ou secundária, acompanhados no Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) e recrutados no período de outubro de 2005 a fevereiro de 2006. Foram coletados dados demográficos e realizados a revisão de prontuários, a mensuração de peso e da altura, o cálculo do índice de massa corpórea (IMC) atual e a adequação da dieta pelo IMC ideal. Foi realizada avaliação na primeira consulta e após intervalo mínimo de dois meses. RESULTADOS: A média de idade dos pacientes foi de 41 anos, sendo 93% de mulheres. Os pacientes com SAF primária perfaziam 25%, com média de dois anos da doença. A trombose venosa ocorreu em 63%, arterial em 48% e manifestações obstétricas em 27%. Na primeira consulta, 68% apresentavam EP, 27% eram eutróficos e 5% estavam com baixo peso (BP). Após três meses de intervenção, os eutróficos mantiveram o peso e os de BP tornaram-se eutróficos, segundo o IMC. Interessantemente, entre os pacientes com EP (n = 27), 82% emagreceram, 14% engordaram e 4% se mantiveram. Especificamente, 11 pacientes apresentaram 1% a 3% de perda ponderal de peso, oito perderam de 4% a 7%, dois reduziram 8% a 9% e um reduziu 13,6% com o acompanhamento nutricional. CONCLUSÃO: Foi demonstrado no presente estudo que a intervenção nutricional conseguiu atingir metas para redução de peso, possibilitando diminuição no risco trombótico num curto período, sendo, portanto, uma modalidade terapêutica inicial e de eleição para corrigir o EP em pacientes com SAF.OBJECTIVE: To evaluate the efficacy of the nutricional intervention in the loss of the weight excess (WE), in patients with the antiphospholipid antibody syndrome (APS). METHODS: Forty patients older than 18 years-old were included, with a diagnosis of either primary or secondary APS, followed at the the Rheumatology Outpatient Clinic from HCFM-USP and were recruited between october/2005 and february/06. Demographic data and patient records were reviewed. Body weight, height and current Body Mass Index (BMI) were recorded as well as diet adjustment according to ideal BMI. Patients were subjected to a first medical and nutritional evaluation and subsequently at least 2 months after baseline. RESULTS: The mean age was 41 years old and 93% of the patients were female. The patients with primary APS were 25%, the mean disease duration was 2 years. Venous thrombosis occurred in 63%, arterial in 48% and obstetric events in 27%. In the first consultation 68% presented WE, 27% were euthrophic and 5% were of low weight (LW). After three months of intervention, the eutrophics maintained body weight while those with LW became eutrophic. Among the patients with WE (n=27), 82% lost weight, 14% had gained weight and 4% kept their weight. Specifically, 11 patients had-3 % of weight loss, 8 lost 4-7%, 2 lost 8-9%, and 1 patient lost 13.6% while under nutritional counseling. CONCLUSION: The data demonstrate that nutritional intervention help achieving reduction in body weight. This may lead to reduction of the thrombotic risk in a short period of time. Nutritional intervention may thus be a valuable initial therapeutic approach to adjust body weight in patients with APS

Still's Disease and Recurrent Complex Regional Pain Syndrome Type-I: The First Description

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder characterized by neuropathic pain associated with local edema and changes suggestive of autonomic involvement such as altered sweating, skin color, and skin temperature of the affected region. CRPS was described associated with several diseases, such as trauma, psychiatric conditions, and cancer. However, no case associated with Still's disease has been previously described. In this paper, the authors describe the first case of CRPS associated with Still's disease

Coronavirus disease 2019 (covid-19) and rheumatic diseases

At the end of December 2019, a new viral infection never before described appeared in the city of Wuhan, Hubei province, China, leading to a percentage of cases of severe respiratory failure. It was very quickly investigated and its etiological agent was discovered, being a new betacoronavirus, called Severe Acute Respiratory Coronavirus 2 Syndrome (SARS-Cov 2), to differentiate it from the SARS-Cov,  reported in the period from 2000 to 2004, and another similar disease also caused by coronavirus, after ten years - Middle East Respiratory Syndrome Coronavirus (MERS-Cov). The disease caused by the virus came to be called Coronavirus Disease 2019 (Covid-19). After leaving China, this disease spread to several countries in the world, culminating in March, when the World Health Organization (WHO) declared a state of pandemic (1). The coronavirus is characterized by presenting RNA with a single helix and on its viral surface presents, to electron microscope, a structure that look like a crown, hence the name corona. A probable mutation happened from wild sources, which could be the origin of bats or snakes. Eating meat from the wild animal market, a tradition in China, was once again responsible for a major epidemic (1)

Seizures in Primary Antiphospholipid Syndrome: The Relevance of Smoking to Stroke

Objectives. To evaluate the frequency of seizures in primary antiphospholipid syndrome (PAPS) and their possible clinical and laboratory associations. Methods. Eighty-eight PAPS patients (Sydney's criteria) were analyzed by a standard interview, physical examination and review of medical charts. Risk factors for seizures, clinical manifestations, associated comorbidities, and antiphospholipid antibodies were evaluated. Results. Nine (10.2%) patients with seizures were identified, 77.8% had convulsions onset after PAPS diagnosis. Mean age, gender, and race were comparable in groups with or without seizures. Interestingly, a higher frequency of current smoking (44.4 versus 10.1%, P = 0.019) was observed in the first group. Stroke, Sneddon's syndrome, and livedo reticularis were more frequent in PAPS patients with seizures than those without seizures, although not statistically significant (P > 0.05). Comparison between patients with seizures onset after PAPS diagnosis (n = 7) and those without convulsions (n = 79) demonstrated a higher frequency of current smoking (42.9 versus 10%, P = 0.042) and stroke in the first group (71.4 versus 30.4%, P = 0.041). Regression analysis confirmed that smoking (P = 0.030) and stroke (P = 0.042) were independently associated to seizures. Conclusion. About 10.2% of PAPS patients had convulsions, predominantly after PAPS diagnosis, and seizures were associated to current smoking and stroke

Seizures in Primary Antiphospholipid Syndrome: The Relevance of Smoking to Stroke

Objectives. To evaluate the frequency of seizures in primary antiphospholipid syndrome (PAPS) and their possible clinical and laboratory associations. Methods. Eighty-eight PAPS patients (Sydney's criteria) were analyzed by a standard interview, physical examination and review of medical charts. Risk factors for seizures, clinical manifestations, associated comorbidities, and antiphospholipid antibodies were evaluated. Results. Nine (10.2%) patients with seizures were identified, 77.8% had convulsions onset after PAPS diagnosis. Mean age, gender, and race were comparable in groups with or without seizures. Interestingly, a higher frequency of current smoking (44.4 versus 10.1%, P = 0.019) was observed in the first group. Stroke, Sneddon's syndrome, and livedo reticularis were more frequent in PAPS patients with seizures than those without seizures, although not statistically significant (P > 0.05). Comparison between patients with seizures onset after PAPS diagnosis (n = 7) and those without convulsions (n = 79) demonstrated a higher frequency of current smoking (42.9 versus 10%, P = 0.042) and stroke in the first group (71.4 versus 30.4%, P = 0.041). Regression analysis confirmed that smoking (P = 0.030) and stroke (P = 0.042) were independently associated to seizures. Conclusion. About 10.2% of PAPS patients had convulsions, predominantly after PAPS diagnosis, and seizures were associated to current smoking and stroke

Effects of vitamin D supplementation on mortality in critically ill patients: a systematic review and meta-analysis

Objective: This study aimed to use a meta-analysis to evaluate whether vitamin D supplementation can improve critically ill patients' parameters.Materials and Methods: A systematic review of the literature and meta-analysis was performed using the electronic databases PubMed, Cochrane, Medline, and Scielo. The selected studies are randomized controlled trials (RCTs) that evaluate the effect of vitamin D supplementation in critically ill patients over 18 years of age and are available in full. All of the articles involved randomized clinical trials that analyzed the effects of vitamin supplementation on mortality, length of ICU stay, length of hospital stay, and use of mechanical ventilation. Results: The meta-analysis revealed that vitamin D supplementation in critically ill patients can reduce mortality in 28-30 days [RR =0.76 (95%CI: 0.57-1.00, p=0.05)] (p=0.85), hospital mortality (p=0.14), length of ICU stays (p=0.11), length of hospital stays (p=0.08) and time of mechanical ventilation (p=0.32).Conclusion: This meta-analysis demonstrated that vitamin D supplements in critically ill patients show a reduction in mortality in 28-30 days. Thus, it is suggested that critically ill patients who are 18 years of age or older should receive a dose of vitamin D greater than 150,000IU to obtain this benefit.Introdução: baixos níveis de vitamina D estão associados com fatores prognósticos na unidade de terapia intensiva. A suplementação de vitamina D poderia melhorar o prognóstico de pacientes criticamente doentes. Metodologia: uma revisão sistemática da literatura foi realizada usando os seguintes bancos de dados eletrônicos: PubMed, Cochrane, Medline, usando as seguintes palavras-chave: vitamin D, intensive care unit, critical care, sepsis, critical ill. Resultados: a suplementação de vitamina D em pacientes críticos pode reduzir a mortalidade em 28-30 dias. (RR 0,76 (IC 95%: 0,57-1,00, p = 0,05). Não houve diferença significativa entre os grupos em relação à mortalidade entre 84 e 90 dias (RR 1,09 (IC 95%: 0,45-2,62, p = 0,85 ), mortalidade hospitalar (RR = 0,84 (IC 95%: 0,66-1,06, p = 0,14), duração da internação na UTI (RR -1,44 (IC 95%: -3,19-0,31, p = 0,11), duração da internação ( RR -6,46 (IC 95%: -13,72-0,80, p = 0,08) e tempo de ventilação mecânica (RR -0,91 (IC 95%: -70,70-0,88, p = 0,32). Conclusão: esta metanálise baseada em estudos randomizados controlados anteriores, demonstra que pacientes adultos gravemente doentes receberam pelo menos uma dose de vitamina D de 150.000 UI, por uma das vias (enteral ou parenteral) para reduzir a mortalidade em 28-30 dias. Estudos futuros envolvendo um número mais significativo de participantes são desejáveis. De fato, esse fator se torna essencial para avaliar a suplementação com doses altas e baixas de vitamina D