Portuguese multidisciplinary recommendations for non-pharmacological and non-surgical interventions in patients with rheumatoid arthritis

BACKGROUND: Patients with rheumatoid arthritis (RA) report significant levels of disease impact, which are improved, but not fully abrogated by immunosuppressive therapy, even when remission is achieved. This imposes the need for adjuvant interventions targeting the uncontrolled domains of disease impact. Non-pharmacological interventions are widely used for this purpose, but they have not been the object of professional recommendations or guidelines. OBJECTIVE: To propose multidisciplinary recommendations to inform clinical care providers regarding the employment of non-pharmacological and non-surgical interventions in the management of patients with RA. METHODS: The EULAR standardized operating procedures for the development of recommendations were followed. First, a systematic literature review was performed. Then, a multidisciplinary Technical Expert Panel (TEP) met to develop and discuss the recommendations and research agenda. For each developed recommendation i) the level of evidence and grade of recommendation were determined, and ii) the level of agreement among TEP members was set. A recommendation was adopted if approved by ≥75% of the TEP members, and the level of agreement was considered high when ≥8. All relevant national societies were included in this construction process to attain their endorsement. RESULTS: Based on evidence and expert opinion, the TEP developed and agreed on five overarching principles and 12 recommendations for non-pharmacological and non-surgical interventions in patients with RA. The mean level of agreement between the TEP members ranged between 8.5 and 9.9. The recommendations include a broad spectrum of intervention areas, such as exercise, hydrokinesiotherapy, psychological interventions, orthoses, education, general management of comorbidities, among others; and they set the requirements for their application. CONCLUSIONS: These recommendations are based on the consensus judgment of clinical experts from a wide range of disciplines and patients' representatives from Portugal. Given the evidence for effectiveness, feasibility and safety, non-pharmacological and non-surgical interventions should be an integral part of standard care for people with RA. It is hoped that these recommendations should be widely implemented in clinical practice. The target audience for these recommendations includes all health professionals involved in the care of patients with RA. The target patient population includes adult Portuguese people with RA.publishersversionpublishe

Divergência genética entre cultivares locais e cultivares melhoradas de feijão.

A grande variabilidade genética presente no germoplasma de feijão (Phaseolus vulgaris L.) em uso na agricultura familiar no Brasil tem sido plenamente reconhecida. A eficiência da conservação e o aproveitamento desta variabilidade aumentam quando esta é devidamente caracterizada. O objetivo deste trabalho foi caracterizar a variabilidade genética de parte do germoplasma existente em poder de produtores de feijão no Rio Grande do Sul, e de cultivares produzidas pela pesquisa, e reuni-las em grupos de similaridade genética. Foi avaliada a divergência genética de 37 cultivares locais (land races) e 14 cultivares indicadas pela pesquisa no Estado, utilizando 40 descritores morfológicos; a grande maioria desses descritores são necessários à proteção legal. Empregou-se análise multivariada, por intermédio de componentes principais e método de agrupamento. O uso destas técnicas possibilitou identificar descritores ineficientes ou redundantes no estudo da variabilidade genética e reunir as cultivares estudadas em quatro grupos distintos de similaridade genética. As cultivares locais revelaram variabilidade superior à encontrada nas cultivares oriundas da pesquisa, o que sugere a importância da sua inclusão em programas de melhoramento

Avaliação de queijos Minas artesanais da região de Campo das Vertentes fabricados com prensagens manual e mecânica.

A etapa de prensagem do queijo Minas artesanal (QMA) tradicionalmente é feita manualmente, podendo predispor o queijeiro a lesões por esforço repetitivo (LER). O objetivo deste trabalho foi avaliar as características do QMA produzido na região de Campos das Vertentes - MG, utilizando-se prensagens manual e mecânica. Os queijos foram fabricados em quatro repetições e maturados por 22 dias, conforme a legislação vigente para a região. Foi empregada a mesma matéria-prima e a mesma tecnologia, exceto pelo tipo de prensagem, representando os dois tratamentos. Após a maturação, os queijos foram submetidos às análises físico-químicas, microbiológicas, de textura e de cor. Não houve diferença estatística entre os tratamentos (p > 0,05) para os aspectos físico-químicos, exceto para os teores de umidade e proteínas (p 0,05). Foram verificadas diferenças significativas (p 0,05) nos resultados das análises microbiológicas entre os tratamentos. Novas pesquisas ainda precisam ser realizadas para elucidar os efeitos da utilização da prensa mecânica na produção do QMA

Design, synthesis, and biological evaluation of new thalidomide–donepezil hybrids as neuroprotective agents targeting cholinesterases and neuroinflammation

A new series of eight multifunctional thalidomide–donepezil hybrids were synthesized based on the multi target-directed ligand strategy and evaluated as potential neuroprotective, cholinesterase inhibitors and anti neuroinflammatory agents against neurodegenerative diseases. A molecular hybridization approach was used for structural design by combining the N-benzylpiperidine pharmacophore of donepezil and the isoindoline 1,3-dione fragment from the thalidomide structure. The most promising compound, PQM-189 (3g), showed good AChE inhibitory activity with an IC50 value of 3.15 μM, which was predicted by docking studies as interacting with the enzyme in the same orientation observed in the AChE–donepezil complex and a similar profile of interaction. Additionally, compound 3g significantly decreased iNOS and IL-1β levels by 43% and 39%, respectively, after 24 h of incubation with lipopolysaccharide. In vivo data confirmed the ability of 3g to prevent locomotor impairment and changes in feeding behavior elicited by lipopolysaccharide. Moreover, the PAMPA assay evidenced adequate blood–brain barrier and gastrointestinal tract permeabilities with an Fa value of 69.8%. Altogether, these biological data suggest that compound 3g can treat the inflammatory process and oxidative stress resulting from the overexpression of iNOS and therefore the increase in reactive nitrogen species, and regulate the release of pro-inflammatory cytokines such as IL-1β. In this regard, compound PQM-189 (3g) was revealed to be a promising neuroprotective and anti-neuroinflammatory agent with an innovative thalidomide–donepezil-based hybrid molecular architectur