Assessment by doppler ultrasound of entheseal lesions in spondyloarthritis : a longitudial study to determine structural damage and disease activity lesions

RESUMO: Enthesitis is the hallmark of spondyloarthritis (SpA), and is observed in all subtypes. Wide information on SpA abnormalities, including synovitis, tendinitis and enthesitis, can be efficiently perceived by Doppler ultrasound. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect enthesis alterations; and vascularized enthesitis detected by Doppler ultrasound appears to be a valuable diagnostic tool to confirm SpA diagnosis. However, data published until now concerning entheseal elementary alterations that characterize SpA enthesitis (enthesis inflammatory activity) or enthesopathy (permanent structural changes) reflect rather the authors’ empiric opinion than a methodological validation process. In this sense it seems crucial to identify elementary entheseal lesions associated with activity or damage, in order to improve monitoring and treatment response in SpA patients. The development of better assessment tools is today a challenge and a need in SpA. The first study of this thesis focused on the analysis of the reliability of inter-lector and inter-ultrasonography equipment of Madrid sonography enthesitis index (MASEI). Fundamental data for the remaining unrolling project validity. In the second and third studies we concerned about two entheseal elemental lesions: erosions and bursa. In literature erosions represent a permanent structural damage, being useful for monitoring joint injury, disease activity and therapeutic response in many rheumatic diseases; and to date, this concept has been mostly applied in rheumatoid arthritis (RA). Unquestionably, erosion is a tissue-related damage and a structural change. However, the hypothesis that we decided to test was if erosions represent a permanent structural change that can only grow and worsen over time, as occurs in RA, or a transitory alteration. A longitudinal study of early SpA patients was undertaken, and the Achilles enthesis was used as a model. Our results strongly suggested that previously detected erosions could disappear during the course of the disease, being consistent with the dynamic behavior of erosion over time. Based on these striking results it seems reasonable to suggest that the new-bone formation process in SpA could be associated with the resolution of cortical entheseal erosion over time. These results could also be in agreement with the apparent failure of anti-tumor necrosis factor (TNF) therapies to control bone proliferation in SpA; and with the relation of TNF-α, Dickkopf-related protein 1 (Dkk-1) and the regulatory molecule of the Wnt signaling pathway in the bone proliferation in SpA. In the same model, we then proceeded to study the enthesis bursa. Interestingly, the Outcome Measures in Rheumatology Clinical Trials (OMERACT) enthesopathy definition does not include bursa as an elementary entheseal lesion. Nonetheless, bursa was included in 46% of the enthesis studies in a recently systematic literature review, being in agreement with the concept of “synovio-entheseal complex” that includes the link between enthesitis and osteitis in SpA. It has been clarified in recent data that there is not only a close functional integration of the enthesis with the neighboring bone, but also a connection between enthesitis and synovitis. Therefore, we tried to assess the prevalence and relevance of the bursa-synovial lesion in SpA. Our findings showed a significant increase of Achilles bursa presence and thickness in SpA patients compared to controls (healthy/mechanical controls and RA controls). These results raise awareness to the need to improve the enthesopathy ultrasonographic definition. In the final work of this thesis, we have explored new perspectives, not previously reported, about construct validity of enthesis ultrasound as a possible activity outcome in SpA. We performed a longitudinal Achilles enthesis ultrasound study in patients with early SpA. Achilles ultrasound examinations were performed at baseline, six- and twelve-month time periods and compared with clinical outcome measures collected at basal visit. Our results showed that basal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are higher in patients with Doppler signal in enthesis, and even that higher basal ESR, CRP and Ankylosing Spondylitis Disease Activity Score (ASDAS) predicted a higher Doppler signal (an ultrasound alteration accepted as representative of inflammation) six months later. Patients with very high disease activity assessed by ASDAS (>3.5) at baseline had significantly higher Achilles total ultrasound score verified at the same time; and ASDAS <1.3 predicted no Doppler signal at six and twelve months. This seems to represent a connection between classical biomarkers and clinical outcomes associated with SpA activity and Doppler signal, not only at the same time, but also for the following months. Remarkably, patients with inactive disease (ASDAS < 1.3) at baseline had no Doppler signal at six and twelve months. These findings reinforce the potential use of ultrasound related techniques for disease progression assessment and prognosis purposes. Intriguingly, Ankylosing Spondylitis Disease Activity Index (BASDAI) didn’t show significant differences between different cut-offs concerning ultrasound lesions or Doppler signal, while verified with ASDAS. These results seem to indicate that ASDAS reflects better than BASDAI what happens in the enthesis. The work herein discussed clearly shows the potential utility of ultrasound in enthesis assessment in SpA patients, and can be important for the development of ultrasound activity and structural damage scores for diagnosis and monitoring purposes. Therefore, local promotion of this technique constitutes a medical intervention that is worth being tested in SpA patients for diagnosis, monitoring and prognosis purposes

state of practice and training

Over the last years, musculoskeletal ultrasound (MSUS) has been increasingly integrated by rheumatologists into clinical practice. Nowadays, it is considered an important imaging modality for the diagnosis, monitoring, and prognosis of various rheumatic diseases, along with its role in the guidance of interventional procedures. Formal training is needed to ensure a skilled and safe MSUS practice. Data regarding the use of MSUS by Portuguese rheumatologists is, however, lacking. Herein, we present a study on the current state of practice and training of MSUS in Portugal.publishersversionpublishe

Effects of Paullinia cupana extract on lamotrigine pharmacokinetics in rats: A herb-drug interaction on the gastrointestinal tract with potential clinical impact.

Paullinia cupana-containing preparations are being consumed worldwide for weight reduction. As obesity and epilepsy are common comorbidities and lamotrigine (LTG) is a broad-spectrum antiepileptic drug, it is likely to find epilepsy patients taking P. cupana and LTG simultaneously. Thus, this work aimed to investigate the potential interaction between P. cupana extract and LTG in rats. In a study, rats were orally co-administered with a single-dose of P. cupana extract (821 mg/kg) and LTG (10 mg/kg). In another study, rats were orally pre-treated for 14 days with P. cupana extract (821 mg/kg/day) receiving LTG (10 mg/kg, p.o.) on the 15th day. Rats of the respective control groups received the corresponding volume of the extract vehicle. LTG concentrations were determined at several post-dose time-points and submitted to a non-compartmental pharmacokinetic analysis. The co-administration of P. cupana and LTG induced a significant reduction of LTG Cmax and AUC0-24 and prolonged the mean residence time. However, no significant effects were observed on LTG pharmacokinetics following a 14-day pre-treatment period with the extract. In this study changes in the body weight of rats and in some biochemical parameters were also evaluated. Overall, the results revealed a pharmacokinetic-based herb-drug interaction between P. cupana extract and LTG, mainly after their co-administration

Intervenção psicológica na infância e adolescência em ambiente hospitalar

O presente relatório reflete o trabalho de estágio académico desenvolvido no ano letivo de 2010 com vista à obtenção do grau de Mestre em Psicologia Clínica e de Aconselhamento. O estágio decorreu num hospital público no âmbito da pediatria e desenvolvimento com a duração de 14 meses perfazendo um total de 617 horas. A revisão de literatura compreende a intervenção e avaliação psicológica com crianças e adolescentes, e contextualiza as atividades desenvolvidas assistenciais e formativas, assim como os casos clínicos acompanhados e apresentados em maior profundidade. A intervenção surge no âmbito da psicologia clínica na infância e adolescência em contexto hospitalar ambulatório, em equipas multidisciplinares que permitiram integrar diferentes perspetivas clínicas sobre uma realidade, a criança e família em sofrimento. Permitiu ainda, alargar os conhecimentos ao nível do psicodiagnóstico, terapêutica, prevenção e prognóstico das principais perturbações pedopsiquiátricas, assim como de compreender a importância do psicólogo clínico numa equipa multidisciplinar de saúde mental infantil. As problemáticas mais prevalentes foram: hiperatividade com défice de atenção e as dificuldades de aprendizagem. Na intervenção psicológica realizada foram utilizadas várias ferramentas e metodologias, avaliação psicológica (entrevista, observação clínica, e aplicação de testes psicológicos) e o acompanhamento psicológico inspirado na ludoterapia centrada na criança. Os casos apresentados são discutidos salientando a nossa perspetiva, sendo necessário estar com e “centrado no cliente”, nas suas idiossincrasias, reconhecendo que a fonte de todo o conhecimento reside na vivência intersubjetiva entre o cliente e o psicólogo (Rogers, 2004/1951)

Determination of lamotrigine in human plasma and saliva using microextraction by packed sorbent and high performance liquid chromatography–diode array detection: An innovative bioanalytical tool for therapeutic drug monitoring

A ground-breaking high-performance liquid chromatography-diode array detection method based on microextraction by packed sorbent (MEPS) as sample preparation approach is described herein for determination of lamotrigine (LTG), a narrow therapeutic index drug, in human plasma and saliva. MEPS variables and chromatographic conditions were optimized to achieve appropriate selectivity and sensitivity using small sample volumes (100 μL). The chromatographic separation of LTG and chloramphenicol [internal standard (IS)] was accomplished in < 5 min on a C18-column, at 35 °C, using a mobile phase composed by acetonitrile/methanol/water-triethylamine 0.3% at pH 6.0 (13:13:74, v/v/v) pumped isocratically at 1 mL/min. LTG and IS were detected at 215 nm. A good linearity was obtained for LTG (r² ≥ 0.9936) in the range of 0.1–20 μg/mL in plasma and saliva, with the limit of quantification of 0.1 μg/mL. The method was shown to be precise (RSD ≤ 14.5%) and accurate (bias ± 13.4%), and the absolute recovery ranged from 64.9% to 73.6%. The stability of LTG was demonstrated in plasma and saliva samples in all studied conditions. The proposed assay was applied to the analysis of real human plasma and saliva samples from epilepsy patients under LTG therapy and the results support its usefulness for therapeutic drug monitoring

Remote Communication and Education in a Pandemic Context

In this article, we reflect on the implications/choices/contingencies of confrontation involving social actors in communicative-educational interaction from the spread of Covid-19 around the globe. Therefore, we built a theoretical approach around the subject-technologies-disruptive moment relationship and examined five articles written by Brazilian researchers/educators from different regions, published in 2020, in search of notes on emergency education in the pandemic. This is an exploratory study in which we investigate epistemic interfaces and practices of Communication/Education linked to the possibility of rescue/reinforcement of qualified listening as a reducing element of the concerns that mark our historical period.Trata-se de estudo exploratório no qual averiguamos interfaces epistêmicas e práticas da Comunicação/Educação ligadas à possibilidade de resgate/reforço da observação e escuta qualificadas como elementos redutores das inquietações que marcam o advento pandêmico, em especial no atinente ao ensino básico. Refletimos, pois, sobre implicações/escolhas/contingências de enfrentamento envolvendo atores sociais em interação comunicativo-educativa a partir do alastramento da Covid-19 em nossa quadra histórica, com ênfase nas preocupações epistêmico-praxiológicas (a)típicas da educação naquele nível de ensino. Para tanto, construímos abordagem teórica em torno da relação sujeito-tecnologiasmomento disruptivo, cotizando-a com o exame de cinco artigos escritos por pesquisadores/educadores brasileiros originários de regiões distintas, publicados em 2020, em busca de apontamentos sobre o ensino emergencial no Brasil durante a pandemia.

Communication and Education: A Contribution to Think About Environmental Education

We analyse the interface between communication and education as a key element to build proactive environmental sense among urban citizens. Through multi-referenced theoretical ballast and with support on field data, we seek to understand how environmental communication is handled in the dynamics of the city. These findings suggest the need to generate, potentialize and allow circulation/interpretation — in a feedback system — (of) links to make the citizens of human conglomerates reflect and act facing the circumstances that reduce their life quality.Analisamos a interface comunicação-educação como elemento central na construção de sentidos ambientais proativos entre habitantes urbanos. Por meio de lastro teórico multirreferenciado e com apoio em dados de campo, buscamos compreender como a comunicação socioambiental é tratada na dinâmica da urbe. Os achados sinalizam a necessidade de gerar, potencializar e fazer circular/interpretar, em sistema de retroalimentação, elos que facultem aos moradores de conglomerados humanos refletirem e agirem frente às circunstâncias que reduzam a sua qualidade de vida.

Cantrell Syndrome. Case report of an adult

Cantrell syndrome is characterized by defects that involve the diaphragm, abdominal wall, pericardium, heart, and lower region of the sternum. It is a rare entity, usually diagnosed at birth and accompanied by high mortality due to the complexity and gravity of the anomalies. In this report, we present a 32-year-old male patient, who was diagnosed in infancy but who reached adult age asymptomatic.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Sodium butyrate in growing and fattening diets for early-weaned rabbits

[EN] To study the effect of adding coated sodium butyrate (SB) to growing-fattening rabbit diets, 2 trials were conducted. In trial 1, 180 rabbits were housed in pairs and fattened from 23 (weaning) to 63 d of age to evaluate their zootechnical performance. Trial 2 involved 30 rabbits, from 23 to 37 d of age and housed individually in digestibility cages, to evaluate digestibility, caecal fermentative activity and morphology of the intestinal mucosa. In both trials rabbits were randomly divided into 2 groups, each receiving one of the following diets: control diet [CTR, 360 g neutral detergent fibre (NDF) and 170 g crude protein (CP)/kg dry matter (DM)] and SB diet. The SB diet, similar to CTR diet, included coated SB at 5 g/kg by replacement of an identical quantity of wheat. In trial 1, after the first 2 wk, the SB content was reduced from 5 to 3 g/kg. In trial 2, faeces were collected over the last 6 d (32-37 d of age), with rabbits being slaughtered at 37 d of age. Gastric and caecal pH were measured and fermentative activity was determined in caecal contents. Three sections of the small intestine were excised from 20 rabbits (10 per treatment) for microscopic examination of intestinal villi and crypts in the proximal region, central region and distal region. In the first 2 wk after weaning, SB rabbits grew 8% less than their counterparts (P=0.002), but had a better feed conversion ratio (1.58 vs. 1.61; P=0.036). During the whole trial 1 period, SB improved feed conversion (P=0.005) and decreased feed intake (104.1 CTR vs. 98.8 g/d SB; P=0.017). No difference was recorded in daily weight gain (42.7 vs. 42.9 g/d). In both diets, the digestibility of DM, organic matter, energy, CP and NDF were similar. In the 3 intestinal regions of rabbits fed SB diet, crypts were deeper (P<0.05). There were no significant differences in villus height and width between treatments. Pectinase activity was higher (P=0.054) with SB diet, but cellulase and xylanase activity remained unaffected by diet. In our experimental conditions, the addition of SB allowed an improvement in feed conversion.Ribeiro, J.; Gaspar, S.; Pinho, M.; Freire, JPB.; Falcão-E-Cunha, L. (2012). Sodium butyrate in growing and fattening diets for early-weaned rabbits. World Rabbit Science. 20(4):199-207. doi:10.4995/wrs.2012.1233SWORD19920720

Vivências com os Macuxi da região do baixo São Marcos - Terra Indígena São Marcos (RR)

Ethno-scientific research has contributed to the understanding of the traditional knowledge of the peoples, the present article aims to present information regarding the ethno-cognition of the Macuxi (São Marcos Indigenous Land-TISM) - Roraima. Environmental knowledge reveals information about the practices, use and management of the natural resources of their ethnic group and their habitat. Studies of this nature reinforce the importance of traditional communities in the protection of natural resources and bring visibility to the traditional ecological knowledge, in spaces of dialogue that allow to identify, evaluate, analyze and monitor the conditions of use, management and sustainability of natural resources in the TIs. Indigenous communities have a complex and varied knowledge of biodiversity, and in the case of the Macuxi do Baixo São Marcos, especially since they have not been studied in this regard, it is necessary to understand and respect their knowledge and practices in a broader context, as well as inform them about local potentialities and weaknesses. Studies of this nature reinforce the importance of relations between these indigenous communities and biodiversity, valuing and bringing visibility to the ethno-cognition they possess.. Key-words: Ethnoscience; Ethnicity Macuxi; Traditional knowledgeLas investigaciones etnocientíficas han contribuido a la comprensión del conocimiento tradicional de los pueblos, el presente artículo tiene como objetivo presentar información relacionada con el origen étnico de la etnia macuxi (Tierra Indígena São Marcos-TISM) - Roraima. El conocimiento ambiental revela información sobre las prácticas, el uso y el manejo de los recursos naturales de su grupo étnico y su hábitat. Los estudios de esta naturaleza refuerzan la importancia de las comunidades tradicionales en la protección de los recursos naturales y dan visibilidad al conocimiento ecológico tradicional, en espacios de diálogo que permiten identificar, evaluar, analizar y monitorear las condiciones de uso, gestión y sostenibilidad de los recursos naturales en TI. Las comunidades indígenas tienen un conocimiento complejo y variado sobre la biodiversidad, y en el caso de Macuxi do Baixo São Marcos, en particular porque aún no se han estudiado, es necesario comprender y respetar sus conocimientos y prácticas en un contexto más amplio. así como informarles sobre las potencialidades y debilidades locales. Los estudios de esta naturaleza refuerzan la importancia de las relaciones entre estas comunidades indígenas y la biodiversidad, valorando y dando visibilidad a su etnoconocimiento.Palabras clave: Etnociencia; Etnia macuxi; Conocimiento tradicionalAs pesquisas etnocientíficas têm contribuído para o entendimento dos saberes tradicionais dos povos, o presente artigo tem como objetivo apresentar informações relativas ao etnoconhecimento da etnia macuxi (Terra Indígena São Marcos-TISM) – Roraima. O saber ambiental revela informações sobre as práticas, uso e manejo dos recursos naturais próprios de sua etnia e de seu habitat. Estudos desta natureza reforçam a importância das comunidades tradicionais na proteção dos recursos naturais e trazem visibilidade ao conhecimento ecológico tradicional, em espaços de diálogo que possibilitam identificar, avaliar, analisar e monitorar as condições de uso, manejo e sustentabilidade dos recursos naturais nas TIs. As comunidades indígenas são portadoras de um conhecimento complexo e variado sobre a biodiversidade, e no caso dos Macuxi do Baixo São Marcos, em especial por terem sido ainda pouco estudados neste sentido, é necessário compreender e respeitar seus saberes e práticas num contexto mais amplo, assim como informá-los sobre as potencialidades e fragilidades locais. Estudos desta natureza reforçam a importância das relações entre estas comunidades indígenas e a biodiversidade, valorizando e trazendo visibilidade ao etnoconhecimento que possuem