Sobreposição de esclerose sistêmica e artrite reumatoide: uma entidade clínica distinta?

ResumoIntroduçãoA esclerose sistêmica (ES) é uma enfermidade do tecido conjuntivo de caráter autoimune caracterizada pela tríade de injúria vascular, autoimunidade (celular e humoral) e fibrose tecidual. Estima‐se que a dor musculoesquelética seja uma queixa frequente dos pacientes com ES, que oscila entre 40% e 80%, e principalmente em pacientes com doença difusa precoce. A artrite, clinicamente observada, pode ser uma característica observada na apresentação da ES, frequentemente leva a erros diagnósticos iniciais com artrite reumatoide (AR). No curso da enfermidade, a artrite é observada em 24% a 97% dos pacientes com ES.ObjetivosCorrelacionar a ocorrência ou não de artrite em pacientes com ES da região Centro‐Oeste do Brasil com possíveis manifestações clínicas e laboratoriais distintas observadas em três grupos de pacientes. Relatar a frequência de verdadeira associação entre esclerose sistêmica e artrite reumatoide em pacientes com sinovite clínica e radiologicamente observada.MétodosForam avaliados 61 pacientes portadores de ES subsequentemente a cada três meses durante um ano, para fins de se constatar clinicamente a ocorrência de sinovite e padrões de evolução. Os pacientes foram divididos em três grupos: 41 com ES sem artrite, 16 com ES com artrite e quatro com sobreposição entre ES e AR. Todos os pacientes foram submetidos a exame radiológicos das mãos no fim do estudo.ResultadosDentre todos os pacientes avaliados, encontrou‐se predomínio feminino (98,7%), idade média de 50,94 anos, cor branca (49,2%), forma limitada da doença (47,6%), tempo de diagnóstico entre cinco e 10 anos (47,6%) e tempo de evolução da doença de 8,30 anos. Entre todos os pacientes, 14 (22,9%) apresentavam fator reumatoide (FR) positivo, embora entre aqueles com FR positivo apenas 10 apresentaram artrite durante o seguimento de um ano. O anticorpo anticitrulina (anti‐ CCP) foi feito em 24 pacientes, com positividade em quatro deles (16,7%), observada somente nos pacientes com sobreposição ES/AR. Na comparação das manifestações clínicas entre os grupos de pacientes, observou‐se a maior ocorrência de gastrite e valvulopatia cardíaca em pacientes com ES e artrite, mas não nos demais grupos. No grupo de pacientes com overlap ES/AR e nos pacientes com ES e artrite observou‐se redução importante de qualidade de vida, medida pelo índice HAQ, sobretudo nos pacientes com artrite presente no momento da avaliação clínica. Encontramos alterações radiográficas em 42,6% dos pacientes com ES. Contudo, nos pacientes com sinovite, encontraram‐se alterações radiológicas compatíveis com artrite reumatoide em 50%.ConclusõesEnquanto a frequência de artrite clínica observada em pacientes com esclerose sistêmica foi de 32,8%, a verdadeira sobreposição entre ES e AR foi de 6,6% neste estudo. Observou‐se ainda a frequência de anti‐CCP positivo em 20% dos pacientes com artrite contra nenhum paciente com ES sem artrite.AbstractIntroductionSystemic sclerosis (SSc) is an autoimmune disease of the connective tissue characterized by the triad of vascular injury, autoimmunity (cellular and humoral) and tissue fibrosis. It is estimated that musculoskeletal pain is a common complaint of patients with SSc, ranging from 40 to 80%, and mainly in patients with early diffuse disease. Arthritis, clinically observed, may be a feature seen in the presentation of SSc, often leading to early diagnostic errors with rheumatoid arthritis (RA). In the course of the disease, arthritis is observed in 24 to 97% of patients with SSc.ObjectivesTo correlate the occurrence or nonoccurrence of arthritis in patients with SSc of the Midwest region of Brazil with possible distinct clinical and laboratory manifestations observed in three groups of patients. To report the frequency of true association between systemic sclerosis and rheumatoid arthritis in patients with clinically and radiologically observed synovitis.MethodsSixty‐one SSc patients were subsequently assessed every 3 months within 1 year, in order to clinically observe the occurrence of synovitis and its patterns of progression. Patients were divided into 3 groups: 41 patients with SSc without arthritis, 16 SSc patients with arthritis and 4 patients with overlap of SSc and RA. All patients underwent a radiological examination of the hands at the end of the study.ResultsAmong all patients evaluated, we found a female predominance (98.7%), mean age of 50.94 years, white color (49.2%), limited form of the disease (47.6%), time of diagnosis between 5 to 10 years (47.6%) and duration of the disease of 8.30 years. Among all patients, 14 (22.9%) had positive rheumatoid factor (RF), while among those with positive RF, only 10 patients had arthritis during one‐year follow‐up. The antibody anticitrulline (anti‐CCP) test was performed in 24 patients, being positive in 4 of them (16.7%), with positivity being observed only in patients with SSc/RA overlap. Comparing the clinical manifestations among the groups of patients, there was a higher incidence of gastritis and cardiac valvulopathy in patients with SSc and arthritis, but not in the others. In the group of patients with SSc/RA overlap and in patients with SSc and arthritis a significant reduction in quality of life was observed, measured by HAQ index, especially in patients with arthritis present during clinical evaluation. We found radiographic changes in 42.6% of patients with SSc. However, in patients with synovitis, radiological changes consistent with rheumatoid arthritis were found in 50% of patients.ConclusionsWhile the frequency of clinical arthritis observed in patients with systemic sclerosis was 32.8%, the true overlap between of SSc and RA was 6.6% in this study. We also observed the frequency of positive anti‐CCP in 20% of patients with arthritis versus no patients with SSc without arthritis

Ensino de Arquivologia: diagnóstico das metodologias adotadas no ensino das disciplinas técnicas na formação arquivística

Aimed to analyze the technical training of the Archivist from the curricular proposal of the undergraduate UFPB course, through the disciplines that make up the technicalities formation of the Archivist, prioritizing the analysis of the methodologies adopted by the teacher and express the body in each program. The results show that it is necessary to reassess the methodological procedures adopted mainly due to the use of outdated strategies, such as the DVD and overhead projector.Objetivou analisar a formação técnica do Arquivista a partir da proposta curricular do Curso de Graduação da UFPB, por meio das disciplinas que compõem a formação tecnicista do Arquivista, priorizando a análise das metodologias adotadas pelo corpo docente e expressa em cada programa. Os resultados apontam que faz-se necessário reavaliar os procedimentos metodológicos adotados, sobretudo em razão do uso de estratégias já ultrapassadas, a exemplo do DVD e retroprojetor

Multiple comparison and clustering statistical tests in the software RBio for lettuce and maize crops

The present study had as objective to evaluate the efficiency and uniformity of the tests of multiple comparisons in relation to the agglomerative test applied in the RBio software. In the evaluations we used data from agricultural experiments conducted by the authors themselves, in the experimental field of the Federal University of Goiás. The data analyzed came from three experiments: the first one was a completely randomized design, the second was a randomized complete block design third in DBC in subdivided parcel scheme. In the evaluation of the data he used the Rbio software. The data were submitted to analysis of variance by the F test at 5% probability. The averages were compared using the multiple comparison tests (Tukey test, Duncan and Student-Newman-Keuls) and the agglomerate test (Scott-Knott). In relation to the Tukey, Student-Newman-Keuls and Duncan tests, the lower accuracy of these tests increases the incidence of type I error, and the ambiguity allowed by them generates difficulties in the interpretation of the results. Because the Scott-Knott test does not allow a mean to belong to more than one group and due to its greater rigor, which generates a lower incidence of type I error, this is the most indicatedThe objective of this study was to evaluate the efficiency and uniformity of multiple comparison tests when compared to clustering test applied in the software RBio. The evaluations were carried out using data of agricultural experiments conducted by the authors, in the experimental field of the Federal University of Goiás. The data analyzed were from three experiments conducted for lettuce and maize crops: the first was conducted in a completely randomized design; the second in a randomized block design; and the third in a randomized block design with split-plot arrangement. The evaluation of the data collected in the lettuce and maize crops was carried out using the software Rbio. The data were subjected to analysis of variance by the F test at 5% probability. The means were compared by multiple comparison (Tukey, Duncan, and Student-Newman-Keuls), and clustering (Scott-Knott) tests. The lower rigor of the Tukey, Student-Newman-Keuls, and Duncan tests results in higher incidence of type I error, and the ambiguity allowed by them generates difficulties in the interpretation of results. Considering that the Scott-Knott test does not allow for a mean to belong to more than one group and it has higher rigor, which generates a lower incidence of type I error, it is the recommended test for the studies evaluated

Thermal body patterns for healthy Brazilian adults (male and female)

The aim of this study was to establish the skin temperature (Tsk) thermal profile for the Brazilian population and to compare the differences between female and male Brazilian adults. A total of 117 female and 103 male were examined with a thermographic camera. The Tsk of 24 body regions of interest (ROI) were recorded and analyzed. Male Tsk results were compared to female and 10 ROI were evaluated with respect to the opposite side of the body (right vs. left) to identify the existence of significant contralateral Tsk differences (?Tsk). When compared right to left, the largest contralateral ?Tsk was 0.3 °C. The female vs. male analysis yielded significant differences (p menor que0.05) in 13 of the 24 ROI. Thigh regions, both ventral and dorsal, had the highest ?Tsk by sex (? 1.0 °C). Tsk percentile below P5 or P10 and over P9o or P95 may be used to characterize hypothermia and hyperthermia states, respectively. Thermal patterns and Tsk tables 2 were established for Brazilian adult men and women for each ROI. There is a low Tsk variation between sides of the body and gender differences were only significant for some ROIs

Measuring skin temperature before, during and after exercise: a comparison of thermocouples and infrared thermography

Measuring skin temperature (TSK) provides important information about the complex thermal control system and could be interesting when carrying out studies about thermoregulation. The most common method to record TSK involves thermocouples at specific locations; however, the use of infrared thermal imaging (IRT) has increased. The two methods use different physical processes to measure TSK, and each has advantages and disadvantages. Therefore, the objective of this study was to compare the mean skin temperature (MTSK) measurements using thermocouples and IRT in three different situations: pre-exercise, exercise and post-exercise. Analysis of the residual scores in Bland-Altman plots showed poor agreement between the MTSK obtained using thermocouples and those using IRT. The averaged error was -0.75 °C during pre-exercise, 1.22 °C during exercise and -1.16 °C during post-exercise, and the reliability between the methods was low in the pre- (ICC = 0.75 [0.12 to 0.93]), during (ICC = 0.49 [-0.80 to 0.85]) and post-exercise (ICC = 0.35 [-1.22 to 0.81] conditions. Thus, there is poor correlation between the values of MTSK measured by thermocouples and IRT pre-exercise, exercise and post-exercise, and low reliability between the two forms of measurement

Time required to stabilize thermographic images at rest

Thermography for scientific research and practical purposes requires a series of procedures to obtain images that should be standardized; one of the most important is the time required for acclimatization in the controlled environment. Thus, the objective of this study was to identify the appropriate acclimatization time in rest to reach a thermal balance on young people skin. Forty-four subjects participated in the study, 18 men (22.3 ± 3.1 years) and 26 women (21.7 ± 2.5 years). Thermographic images were collected using a thermal imager (Fluke ®), totaling 44 images over a period of 20 minutes. The skin temperature (TSK) was measured at the point of examination which included the 0 minute, 2, 4, 6, 8, 10, 12, 14, 16, 18 and 20. The body regions of interest (ROI) analyzed included the hands, forearms, arms, thighs, legs, chest and abdomen. We used the Friedman test with post hoc Dunn?s in order to establish the time at rest required to obtain a TSK balance and the Mann-Whitney test was used to compare age, BMI, body fat percentage and temperature variations between men and women, considering always a significance level of pmenor que0.05. Results showed that women had significantly higher temperature variations than men (pmenor que0.01) along the time. In men, only the body region of the abdomen obtained a significant variance (pmenor que0.05) on the analyzed period, both in the anterior and posterior part. In women, the anterior abdomen and thighs, and the posterior part of the hands, forearms and abdomen showed significant differences (pmenor que0.05). Based on our results, it can be concluded that the time in rest condition required reaching a TSK balance in young men and women is variable, but for whole body analysis it is recommended at least 10 minutes for both sexes

Paisagem e percepção de riscos ambientais: aproximação de conceitos

Paisagem, percepção de risco, vulnerabilidade e resiliência são temas de conferências nacionais e internacionais, sobretudo quando relacionado às mudanças climáticas e seus efeitos sobre os ambientes naturais e sobre a sociedade. A noção de risco está relacionada tanto às ciências naturais quanto às ciências da sociedade. Quando se utiliza o conceito de risco ambiental é necessário compreender a dinâmica de dois componentes que funcionam como sistema, ou seja, o sistema natural e o sistema social, ambos apresentam dinâmica própria, mas nesse nível de interpretação (dimensão da paisagem) devem ser tomados de forma integrada. Este trabalho objetiva fazer uma aproximação entre os conceitos de paisagem e percepção de risco, por meio de revisão de literatura

The International Postal Network and Other Global Flows as Proxies for National Wellbeing.

The digital exhaust left by flows of physical and digital commodities provides a rich measure of the nature, strength and significance of relationships between countries in the global network. With this work, we examine how these traces and the network structure can reveal the socioeconomic profile of different countries. We take into account multiple international networks of physical and digital flows, including the previously unexplored international postal network. By measuring the position of each country in the Trade, Postal, Migration, International Flights, IP and Digital Communications networks, we are able to build proxies for a number of crucial socioeconomic indicators such as GDP per capita and the Human Development Index ranking along with twelve other indicators used as benchmarks of national well-being by the United Nations and other international organisations. In this context, we have also proposed and evaluated a global connectivity degree measure applying multiplex theory across the six networks that accounts for the strength of relationships between countries. We conclude by showing how countries with shared community membership over multiple networks have similar socioeconomic profiles. Combining multiple flow data sources can help understand the forces which drive economic activity on a global level. Such an ability to infer proxy indicators in a context of incomplete information is extremely timely in light of recent discussions on measurement of indicators relevant to the Sustainable Development Goals.Project LASAGNE Contract No. 318132 (STREP) - funded by the European CommissionThis is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.015597