Myocardial perfusion study and coronary artery angiography in systemic lupus erythematosus patients

OBJECTIVE: To evaluate coronary artery findings using coronary artery angiography in systemic lupus erythematosus (SLE) patients with myocardial perfusion abnormalities. METHODS: Ninety female SLE patients, ages from 18 to 55 years old, more than 5 years of disease duration, without current or previous confirmed coronary artery disease (CAD), and who were either in use or had used steroid treatment for at least 1 year were evaluated. Myocardial perfusion scintigraphy was performed using a singlephoton emission computed tomography employing Technetium 99m-sestamibi. Images were captured at resting and after dipyridamole-induced stress. The CAD risk factors (RF) considered were the traditional ones in general population and SLE-related factors. All patients who had abnormal findings on myocardial perfusion tests were invited to undergo coronary angiography. RESULTS: The mean age was 38 ± 10 years old, with mean disease duration of 128 ± 59 months, American College of Rheumatology (ACR) number 7 ± 1, Disease Activity Index for SLE (SLE-DAI) score 6 ± 5 and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC/ACR-DI) score 2 ± 2. Thirty-three percent of patients presented myocardial perfusion scintigraphy abnormalities. Regression logistic analysis was performed considering the traditional CAD-RF and SLE-related variables in 48 SLE patients on regular follow-up. Current vasculitis was associated with abnormal myocardial perfusion. There was no association between other clinical and/or serologic features, cumulative dose or duration of prednisone use and myocardial perfusion scintigraphy results. Twenty-one patients with abnormal myocardial scintigraphy agreed to undergo coronary angiography. Atherosclerotic plaques were identified by angiography in eight patients (38%). Abnormal angiography subgroup presented higher number of traditional CAD-RF (p = 0.006). Arterial hypertension, postmenopausal status and higher triglyceride level showed a significant association with abnormal angiography (p = 0.046, 0.024 and 0.043, respectively). The number of ACR criteria, SLE-DAI and SLICC/ACR-DI scores were also higher in the sub-group with coronary abnormalities (p = 0.018, 0.010 and 0.003, respectively). CONCLUSIONS: Current vasculitis was an important variable associated with abnormal myocardial scintigraphy. This study suggests that myocardial scintigraphy can be used as a screening test for CAD in SLE patients with high-risk of cardiovascular disease, even in the absence of ischemic heart symptoms. Patients with abnormal myocardial perfusion results and at least four CAD-RF had higher risk of presenting coronary stenosis on coronary angiography.OBJETIVO: avaliar as artérias coronárias por meio da cineangiocoronariografia de pacientes com lúpus eritematoso sistêmico (LES) e anormalidades de perfusão miocárdica. MÉTODO: participaram do estudo 90 pacientes do sexo feminino, idades entre 18 e 55 anos, com diagnóstico de LES há mais de cinco anos, sem antecedentes pessoais de doença arterial coronária (DAC) manifesta e em uso atual ou pregresso de corticosteróide por, pelo menos, um ano. A cintilografia cardíaca, com aquisição de imagens tomográficas utilizando Tecnécio 99m-sestamibi, foi executada nas fases de repouso e de estresse induzido por dipiridamol. Os fatores de risco (FR) considerados foram os tradicionais para DAC e os relacionados ao LES. As pacientes com alterações cintilográficas foram convidadas a submeterem-se à cineangiocoronariografia. RESULTADOS: as pacientes apresentaram média de idade de 38 ± 10 anos, diagnóstico de LES há 128 ± 59 meses, número de critérios do American College of Rheumatology (ACR) 7 ± 1, escores do Disease Activity Index for Systemic Lupus Erythematosus (SLE-DAI) 6 ± 5 e do Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC/ACR-DI) 2 ± 2. Anormalidades de perfusão miocárdica foram observadas em 33% das pacientes. A análise de regressão logística considerando-se os FR-DAC tradicionais e as variáveis relacionadas ao LES foi realizada com 48 pacientes em seguimento regular. Vasculite atual foi associada à anormalidade de perfusão miocárdica. Não houve associação entre outras manifestações clínicas e/ou sorológicas de LES, dose cumulativa ou tempo de uso de prednisona e o resultado da cintilografia miocárdica. Vinte e uma pacientes com alterações cintilográficas foram submetidas à cineangiocoronariografia. Placas ateroscleróticas em artérias coronárias foram observadas em 8 pacientes (38%). O subgrupo das pacientes com cateterismo cardíaco anormal apresentou maior número de FR clássicos para DAC (p = 0,006). Hipertensão arterial sistêmica, menopausa e hipertrigliceridemia foram os FR-DAC associados à presença de lesões coronárias (p = 0,046; 0,024 e 0,043, respectivamente). Número de critérios do ACR e escores do SLE-DAI e do SLICC/ ACR-DI também foram significativamente maiores no subgrupo de pacientes com cateterismo alterado (p = 0,018; 0,010 e 0,003, respectivamente). CONCLUSÕES: vasculite atual foi importante variável associada à anormalidade cintilográfica. Este estudo sugere que a cintilografia miocárdica pode ser usada como rastreamento de DAC em pacientes com LES e risco aumentado para doença cardiovascular, mesmo na ausência de sintomas de isquemia cardíaca. Pacientes com anormalidades de perfusão miocárdica e, pelo menos, 4 FR-DAC têm maior chance de apresentar estenoses coronárias à cineangiocoronariografia.UNIFESP-EPMUNIFESP, EPMSciEL

Incidence of systemic lupus erythematosus in Natal, RN, Brazil

OBJECTIVE: To study the incidence of Systemic Lupus Erythematosus (SLE) in the city of Natal, Brazil. METHODS: Only patients living in the city of Natal, older than 15 years old, who fulfilled at least 4 of ACR criteria between January 1st, 2000 and December 31st, 2000, were included. Four sources were used to identify new cases of SLE: 1) the University Hospital; 2) health units and hospitals of the public health network; 3) specialists at private hospitals and outpatient clinics; 4) three laboratories performing antinuclear antibody (ANA) determination. Physicians were contacted by mail, receiving explanations about the study and directions on how to collaborate. Brazilian population census data (2000) was used to calculate incidence rate. The Standardized Mortality Ratio (SMR) was used to compare the incidence rates. The 95% confidence intervals (95% CI) were calculated and a P value 15 anos, com pelo menos, quatro critérios do ACR, entre 1/1/ 2000 e 31/12/2000, excluindo lúpus droga-induzido. Foram utilizadas quatro fontes para identificação de pacientes: 1) hospital universitário; 2) postos de saúde de hospitais da rede pública; 3) especialistas (reumatologistas, dermatologistas, nefrologistas e hematologistas) em clínicas e hospitais privados e 4) resultados positivos de FAN (> 1:80) de três principais laboratórios da cidade. Médicos foram informados, por cartas, dos procedimentos para notificação. Dados do Censo 2000 foram utilizados para o cálculo das taxas de incidência. Standardized Mortality Ratio (SMR) foi aplicado para comparação das taxas de incidência. O valor de p < 0,05 foi considerado significativo. RESULTADOS: foram identificados 43 novos casos de LES, com uma incidência calculada de 8,7 por 100.000/ano (95% IC 6,3-11,7/100.000). Trinta e oito mulheres 14,1:100.000/ano (95% IC 10,0-19,3) e 5 homens 2,2 por 100.000/ano (95% IC 0,7-5,2). A média de idade dos pacientes foi de 31,8 anos (95% IC 27,8-35,8), sendo de 31,4 anos (95% CI 27,2-34,7) nas mulheres e de 35 anos (95% CI 27,8-52,2) nos homens. A mediana de duração da doença (tempo entre a primeira manifestação clínica de LES e o diagnóstico ) foi de 10 meses (1 a 72 meses). CONCLUSÕES: a incidência de LES em Natal, RN, parece ser maior que a relatada em outras regiões do mundo. Fatores étnicos e ambientais, como maior exposição à radiação ultravioleta, parecem contribuir para essas diferenças observadas.Universidade Federal do Rio Grande do Norte Departamento de Medicina ClínicaUFRN Hospital Universitário Onofre LopesUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Anticuerpos antifosfatidilserina en pacientes con síndrome antifosfolipido primario y en individuos sanos

Objective: To investigate the prevalence of IgM, IgG and IgA anti-phosphatidylserine (aPS) antibodies in patients with primary antiphospholipid syndrome (PAPS) and in healthy controls; to analyze sensitivity, and specificity of aPS antibodies for the diagnosis of APS and finally to assess associations between aPS antibodies with specific APS manifestations. Methods: A cross-sectional study was performed in 36 female PAPS patients and in 200 blood donors. IgM, IgG, and IgA antiphosphatidylserine (aPS) antibodies were tested in PAPS patients and controls using an in house technique and a commercial kit. PAPS patients were also tested for lupus anticoagulant (LAC), IgM and IgG anticardiolipin (aCL) antibodies, and for anti-β2 glycoprotein I (anti-β2GPI) antibodies. Results: The prevalence of IgM, IgG, and IgA aPS antibodies in PAPS patients was as follows: 10.8-16.7%, 32.4-35.7%, and 16.1%, respectively. Although a relatively low sensitivity was found for aPS antibodies in PAPS, the specificity of IgM, IgG, and IgA aPS antibodies for PAPS was 94.7-98.9%, 95.3-96.3%, and 97.9%, respectively. All aPS isotypes were significantly associated with obstetric manifestations of APS. IgM aPS antibodies were associated with an increased risk of venous and arterial thrombosis. IgA aPS antibodies were associated with arterial thrombosis whereas IgG aPS antibodies were associated with an increased risk of venous thrombotic events. IgM and IgG aPS antibodies were frequently found in association with anti-β2GPI antibodies. Conclusions: The prevalence of aPS antibodies is low in PAPS but these antibodies are highly specific for PAPS and are associated with specific PAPS manifestations.Objetivo: Investigar la prevalencia de anticuerpos anti-fosfatidilserina (aFS) de tipo IgM, IgG e IgA en pacientes con síndrome antifosfolípido primario (SAFP) y en controles sanos; analizar la sensibilidad y la especificidad de los anticuerpos aFS para el diagnóstico de aFS y finalmente, evaluar las asociaciones entre los anticuerpos específicos aFS y las manifestaciones clínicas del SAF. Métodos: Estudio transversal de 36 pacientes mujeres con SAFP y 200 donantes de sangre. Se determinaron anticuerpos antifosfatidilserina de tipo IgM, IgG e IgA en pacientes y controles con SAFP utilizando una técnica propia y un kit comercial. A los pacientes com SAFP también se les determinó el anticoagulante lúpico (ACL), los anticuerpos anticardiolipina IgM e IgG (aCL), y los anticuerpos anti-β2 glucoproteína I (anti-β2GPI). Resultados: La prevalencia de los anticuerpos AFS IgM, IgG, IgA en pacientes con SAFP fue la siguiente: 10,8-16,7%, 32,4-35,7%, y 16,1%, respectivamente. Aunque se encontro una sensibilidad relativamente baja para los anticuerpos AFS en el SAFP, la especificidad de los anticuerpos AFS IgM, IgG, IgA para el SAFP fue 94,7-98,9%, 95,3-96,3% y 97,9%, respectivamente. Todos los isotipos de AFS se asociaron significativamente con las manifestaciones obstétricas. Los anticuerpos AFS IgM se asociaron con un riesgo aumentado de trombosis venosa y arterial. Los anticuerpos AFS IgA se asociaron con la trombosis arterial mientras que los anticuerpos AFS IgG se asociaron con un mayor riesgo de eventos trombóticos venosos. Los anticuerpos AFS IgM e IgG se encuentran con frecuencia em asociación con anticuerpos anti-β2GPI. Conclusiones: La prevalencia de anticuerpos AFS es baja en SAFS pero estos anticuerpos son altamente específicos para SAFP y se asocian con manifestaciones SAFP específicos

Manifestações reumáticas da hanseníase

The classical manifestations of leprosy are cutaneous and neurological involvement; however, rheumatic manifestations are relatively common during the course of the disease and can be the initial manifestation. Herein are reviewed the clinical features of leprosy, particularly those that may mimic rheumatic diseases.Univ Fed Amazonas, Hosp Univ Getulio Vargas, Manaus, Amazonas, BrazilUniv Fed Sao Paulo, Dept Med, Disciplina Reumatol, Sao Paulo, BrazilUniv Fed Amazonas, Dept Clin Med, Disciplina Reumatol, Fac Ciencias Saude, Manaus, Amazonas, BrazilUniv Fed Sao Paulo, Dept Med, Disciplina Reumatol, Sao Paulo, BrazilWeb of Scienc

Cultural Differences between University Students in Online Learning Quality and Psychological Profile during COVID-19

During the COVID-19 pandemic, educational systems had to adapt to the social and health situation immediately. This led to the appearance of the asynchronous teaching model. Throughout the pandemic at an educational level, we can distinguish three phases, eminently online, hybrid, and face-to-face. However, the perception of educational quality in these three educational moments, considering the psychometric profile and cultural differences comparing Ibero-American countries, has not been studied. The study aims to analyze the psychological profile, and perception of quality in the teaching–learning processes at the university stage, during the three processes of educational transition during COVID-19: online, hybrid, and face-to-face. Thus, 1093 university students from Ibero-American countries were studied. Through a questionnaire, demographic, academic, and psychological variables were analyzed during three phases of the pandemic. Data suggest that Latin American students had higher levels of trait anxiety and stress perception, as well as higher levels of loneliness, during the online teaching phase (lockdown), but higher grades and higher levels of motivation compared to Europeans. Indeed, Latin Americans showed greater convenience, and preference for online learning methods. However, during the face-to-face teaching phase, European students presented greater motivation and grades, showing a greater preference for this method of learning than Latin American students. Factors such as resilience, a more unfavorable and pronounced pandemic evolution, and greater social inequities, may explain the present results. Furthermore, the present study suggests that despite the effect of the pandemic on mental health, online education is postulated as an effective teaching–learning alternative. Indeed, online teaching models have come to stay, not as a substitute, but as a tool, an essential focus of attention on these models should be conducted in European countries, while the governments of Latin American countries ensure that the infrastructures and resources are equitable to be able to correctly implement this teaching model

Gender Differences of University Students in the Online Teaching Quality and Psychological Profile during the COVID-19 Pandemic

With the arrival of COVID-19, educational systems have had to adapt to the social and health situation immediately. This led to the appearance of the asynchronous teaching model. Throughout the pandemic, at the educational level, we can distinguish three phases, eminently online, hybrid, and finally, face-to-face. However, the perception of educational quality in these three educational moments, taking into account the psychometric profile and gender, has not been studied. Thus, 1093 university students from Ibero-American countries were analyzed. Through a questionnaire, demographic, academic, and psychological variables were analyzed at three moments during the evolution of the pandemic. Data suggest that, during the lockdown phase, while teaching was eminently online, students presented higher levels of stress and higher difficulty of learning; class attendance, convenience, preferred method of learning, grading score, and motivation were lower, compared to other phases of teaching (hybrid and face-to-face). During this period, females presented higher stress levels than males, as well as higher levels of anxiety and loneliness, without gender differences among the other studied variables. During the hybrid and face-to-face phases, male students presented higher values in the results of difficulty learning and demanding activities. No differences were seen regarding motivation, synchronous class attendance, learning level, grades, convenience, or preferred learning method. The results from the present study suggest that, despite the effect of the pandemic on mental health, asynchronous education is postulated as an effective teaching–learning alternative. Yet, a special focus should be given to female students