The Risk of Obstetric Complications and the Effects of Treatment in Women with Low Titer and Medium-High Titer Anti-Phospholipid Antibodies

Background/Purpose: The association of low titer anti-phospholipid antibodies (aPL) with obstetric anti-phospholipid syndrome (APS) is increasingly acknowledged, even though some studies have showed conflicting results. To raise further evidence on the relevance of low titer aPL in pregnancy morbidity (PM), we retrospectively reviewed the clinical records of pregnant women attending a joint obstetric/rheumatology clinic over the years 2009-2016. Methods: Patients were included when positive in at least one criteria aPL assay, at any titer, in two occasions minimum 12 weeks apart. Statistical analysis was performed using R package. Results: 111 women (338 pregnancies) were identified. 51 women displayed low-titer aPL, with 160 pregnancies. 60 patients carried aPL at medium-high titers, with 178 pregnancies. 4 patients (4%) had thrombotic APS, 27 (24%) obstetric APS, 7 (6%) thrombotic and obstetric APS, 15 (14%) medium-high titer aPL and non criteria PM, 7 (6%) medium-high titer aPL and no PM, 18 (16%) low titer aPL and non criteria PM and 15 (14%) low titer aPL and no PM. Low-titer aPL were significantly associated with pregnancy complications (c2=8.82, p=0.003). Considering 245 untreated pregnancies, a significant difference in PM distribution was noted for low titer and medium-high titer aPL (p=0.003, Table 1). Among patients with low titer aPL, treatment with low molecular weight heparin [LMWH] + low-dose aspirin [LDASA] significantly improved pregnancy outcomes (p<<0.001, odds ratio [OR]=0.07, 95% CI=0.007\u20130.300), leading to a 14.3-fold reduction of obstetric complications. Hydroxychloroquine [HCQ] was not associated with a significant improvement in live birth rate (p=0.079). Among women with medium-high titer aPL, the standard therapeutic approach with LMWH+LDASA resulted in a significant improvement of obstetric outcome (p<<0.001, OR=0.20, 95% CI=0.100\u20130.400). HCQ treatment significantly improved obstetric outcome, carrying a 3-fold increase in the live birth rate (p=0.025, OR=0.34, 95% CI=0.117\u20130.894). Conclusion: According to our data, low titer aPL are significantly associated with aPL-associated obstetric complications, with a lower prevalence of premature birth compared to medium-high titer aPL. Treatment with LDASA+LMWH led to a higher increase of live birth rate in women with low titer aPL compared to those with medium-high titer aPL. Additional treatment such as HCQ were effective in women with medium-high titer aPL but not those with low titer aPL. Table 1. Obstetric outcomes (defined according to Miyakis et al, 2006) in 245 untreated pregnancies in women with low titer and medium-high titer anti-phospholipid antibodies

Le metatarsalgie negli atleti praticanti il mezzofondo : patogenesi e trattamento fisioterapico

The authors report the cases of fifty athletes with unilateral metatarsalgia due overload or trauma. This disease was treated with conservative therapy which allowed to obtain highly satisfactory results. The authors agree in considering physiotherapy as an effective treatment to reash a quick rehabilation and speedy return to athletic activity

Reconfigurable quantum photonic circuits based on nano-electro-mechanical systems

We present recent progress on the development of nano-opto-electromechanical systems (NOEMS) for solid-state quantum photonics and discuss the application of optical switching networks for de-multiplexing single photons generated by semiconductor quantum dots

Physicochemical characteristics and sensory profile of honey samples from stingless bees (Apidae: Meliponinae) submitted to a dehumidification process

This study was conducted to evaluate the effect of a dehumidification process on the physicochemical and sensory characteristics of stingless-bee honey. Melipona scutellaris and M. quadrifasciata honey samples were submitted to a dehumidification process and to physicochemical (reducing sugars, apparent sucrose, moisture, diastatic activity, hydroxymethylfurfural, ash, pH, acidity, and electric conductivity) and sensory evaluations (fluidity, color, aroma, crystallization,flavor,and acceptability). The results indicated that the dehumidification process does not interfere with honey quality and acceptability.<br>Este estudo foi conduzido com o objetivo de avaliar o efeito do processo de desumidificação sobre as características físico-químicas e sensoriais do mel das abelhas sem ferrão. Amostras de méis de Melipona scutellaris e M. quadrifasciata foram submetidas ao processo de desumidificação, passando em seguida por avaliações físico-químicas (açúcares redutores, sacarose aparente, umidade, atividade diastásica, hidroximetilfurfural, cinzas, pH, acidez e condutividade elétrica) e sensoriais (fluidez, cor, aroma, cristalização, sabor e aceitabilidade). Os resultados indicaram que o processo de desumidificação não interfere na qualidade e aceitabilidade do mel

Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: Data from the UK Juvenile-onset systemic lupus erythematosus cohort study

Funder: Versus Arthritis UKFunder: LUPUS UK; FundRef: https://doi.org/10.13039/501100018817Introduction: Juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune/inflammatory disease with significant morbidity and mortality. Neuropsychiatric (NP) involvement is a severe complication, encompassing a heterogeneous range of neurological and psychiatric manifestations. Methods: Demographic, clinical, and laboratory features of NP-SLE were assessed in participants of the UK JSLE Cohort Study, and compared to patients in the same cohort without NP manifestations. Results: A total of 428 JSLE patients were included in this study, 25% of which exhibited NP features, half of them at first visit. Most common neurological symptoms among NP-JSLE patients included headaches (78.5%), mood disorders (48.6%), cognitive impairment (42%), anxiety (23.3%), seizures (19.6%), movement disorders (17.7%), and cerebrovascular disease (14.9%). Peripheral nervous system involvement was recorded in 7% of NP-SLE patients. NP-JSLE patients more frequently exhibited thrombocytopenia (<100 × 109/L) (p = 0.04), higher C-reactive protein levels (p = 0.01), higher global pBILAG score at first visit (p < 0.001), and higher SLICC damage index score at first (p = 0.02) and last (p < 0.001) visit when compared to JSLE patients without NP involvement. Conclusions: A significant proportion of JSLE patients experience NP involvement (25%). Juvenile-onset NP-SLE most commonly affects the CNS and is associated with increased overall disease activity and damage

Monitoring the sardine (Sardinella brasiliensis) fermentation process to obtain anchovies Monitoramento do processo de fermentação da sardinha, Sardinella brasiliensis, para obtenção de anchovas

Anchovies are traditional fish preserves, prepared from fermented fish of the engraulidae family, mainly in European countries. In Brazil, sardines (Sardinella brasiliensis) are an alternative fish for preparing these types of preserves, provided that the preservation process results in a high quality product. In this research, sardines were prepared for preservation and physicochemical, microbiological and sensory analyses were carried out during the preservation process. Whole or eviscerated sardines, with or without condiments/preservatives and with 20% of salt (w/w) were used. Sardines were analyzed fresh, and at 1, 15, 30, 45 and 60 days along the preservation process. The use of whole sardines, with or without condiments/preservatives, presented best results, with increased non-proteic nitrogen in the dry matter, higher levels of total volatile bases and higher contents of lactic acid and sodium chloride. The higher acidity observed in the whole sardine treatments resulted in better control of halophylic mesophilic microorganisms, which were kept under 1.4 x 10³ CFU g-1 in both treatments. Total coliforms and Staphylococcus aureus reached 21 and 3.0 x 10² CFU g-1, respectively. Escherichia coli and Salmonella spp were not present in the fresh sardines or in any of the four treatments, indicating that the concentration of salt used was appropriate to maintain the product under adequate microbiological control. Both whole or eviscerated sardines under the conditions of this experiment were appropriate in terms of the microbiological safety of the preserves. Treatments using whole fish, either with or without condiments/preservatives, also presented better sensorial properties such as color, flavor, taste and texture, as compared to the eviscerated fish treatments. Whole sardines produced good quality, anchovy-type preserves, which can be used for consumption and marketing purposes.<br>As sardinhas brasileiras podem ser utilizadas para o preparo de pescado fermentado, à semelhança do que é feito com as anchovas na Europa, desde que o processamento permita a obtenção de um produto com qualidade. O objetivo desta pesquisa foi monitorar o processamento de fermentação de sardinhas, Sardinella brasiliensis, utilizando 4 tratamentos, a saber: peixes inteiros e eviscerados, ambos com ou sem condimentos, e 20% de sal. As sardinhas foram analisadas in natura e nos períodos de 1; 15; 30; 45 e 60 dias de fermentação. O pescado mantido com vísceras apresentou maior facilidade para fermentação e revelou maiores teores de bases voláteis, nitrogênio não protéico e acidez em ácido lático (19,82 mg 100 g-1). A contagem total de mesófilos se manteve na faixa de 10³ UFC g-1. Coliformes totais e Staphilococcus aureus apresentaram baixas contagens. Escherichia coli e Salmonella não foram detectadas. O processamento do pescado com vísceras, não interferiu na segurança microbiológica e propiciou os melhores resultados para cor, aroma, sabor e textura do produto final