36 research outputs found

    2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis

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    The objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission

    Nanolimes doped with quantum dots for stone consolidation assessment.

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    Currently, the application of consolidation treatments based on nanolimes (Ca(OH)2 nanoparticles) has become a common practice during the restoration of historical buildings. However, recent studies have showed that their effectiveness on stone materials is lower than expected. This result is due to the accumulation of nanolimes near the surface, which decreases their penetration depth into stone matrix and, consequently, results in a low restoration effectiveness. This research is focused on a new nanocomposite based on Ca(OH)2 nanoparticles doped with ZnO quantum dots whose fluorescence shows the real penetration of the nanomaterial into the stone matrices and allows us to study the affinity between nanolimes and the solvent used in the application in order to improve the penetration of the treatment into stones. Different mixtures of solvents have been probed to improve the penetration depth by analysing their kinetic stabilities and using thin-layer chromatography to evaluate their capacity to transport the nanolimes. Furthermore, a new support for thin-layer chromatography based on mortar has been designed, which has the advantage of having the same chemical composition as the limestones. Moreover, the effectiveness of the treatments was studied on limestones from Puerto de Santa María and Espera (Spain), which have been widely used in historical and contemporary buildings in the southwest of Spain. Nanolimes doped with ZnO quantum dots allow one to choose the optimal solvents for each kind of stone based on their fluorescence from UV radiation. Additionally, the fluorescence of the quantum dots could be used as an indicator of the consolidated areas for cultural heritage applications.Departamento de Sistemas Físicos, Químicos y Naturales, Universidad Pablo de OlavidePreprin

    High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19 : first results of ReumaCoV Brasil registry

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    Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process

    Pauliceia em série: kitsch e desvairismo

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    “Minhas reivindicações? Liberdade” (Andrade 2019: 11). Em meio ao processo de modernização de São Paulo, processo repleto de contradições e conflitos, Mário de Andrade publica sua Pauliceia desvairada, obra complexa, que articula elementos da cultura de massa e da cultura popular para elaborar uma arte de vanguarda brasileira. Neste trabalho, propomos que o livro de 1922, tão próximo da lógica e da estética da reprodutibilidade técnica, pode ser entendido como uma via de estudo da emergência do kitsch no Brasil. Essa proposição se sustenta pela leitura de alguns poemas e do Prefácio interessantíssimo, mas também se ampara na elaboração teórica feita em A escrava que não é Isaura (1925) e no lançamento de Klaxon (1922). O que sobressai é a ambivalência das posições em jogo: em Mário de Andrade encontramos o desvairismo como defesa vanguardista e aristocrática de uma arte genuína; mas também notamos a emergência do kitsch, marcada pela sedução dos clichês e pelo mascaramento performático que, diante das massas, esvazia qualquer essência, dos sujeitos e dos objetos

    Measuring and modelling biodiversity from space

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    Abstract: The Earth is undergoing an accelerated rate of native ecosystem conversion and degradation and there is increased interest in measuring and modelling biodiversity from space. Biogeographers have a long-standing interest in measuring patterns of species occurrence and distributional movements and an interest in modelling species distributions and patterns of diversity. Much progress has been made in identifying plant species from space using high-resolution satellites (QuickBird, IKONOS), while the measurement of species movements has become commonplace with the ARGOS satellite tracking system which has been used to track the movements of thousands of individual animals. There have been significant advances in land-cover classifications by combining data from multi-passive and active sensors, and new classification techniques. Species distribution modelling has been growing at a striking rate and the incorporation of spaceborne data on climate, topography, land cover, and vegetation structure has great potential to improve models. There have been significant advances in modelling species richness, alpha diversity, and beta diversity using multisensors to quantify land-cover classifications and landscape metrics, measures of productivity, and measures of heterogeneity. Remote sensing of nature reserves can provide natural resources managers with near real-time data within and around reserves that can be used to support conservation efforts anywhere in the world. Future research should focus on incorporating recent spaceborne sensors, more extensive integration of available spaceborne imagery, and the collection and dissemination of high-quality field data. This will improve our understanding of the distribution of life on earth
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