Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)

Abstract Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

Anafilaxia e reações anafilactóides / Anaphylaxis and anaphylactoid reactions

A Terapia Nutricional tem tido grande impacto na evolução do paciente grave. Sua escolha e manuseio, no entanto, têm sido alvo de dúvidas e erros freqüentes, principalmente no paciente crítico. A escolha da terapia nutricional a ser realizada, bem como sua via de administração deve levar em conta o quadro clínico e as condições gerais do paciente. A via oral/enteral de oferta de nutrientes, mais fisiológica, é a preferível. Portanto, sempre que possível, deve-se utilizar o trato gastrintestinal. Quando este não puder ser utilizado, a via parenteral está indicada, tanto no sentido de suplementar a nutrição enteral, como quando esta não consegue suprir toda a demanda de nutrientes, de que o paciente necessita. Esta revisão tem por objetivo apresentar e difundir a condução da terapia nutricional no paciente crítico, de forma prática e adequada. De maneira geral, a oferta calórica deverá atender às necessidades basais do paciente e a protéica fornecer material plástico para síntese protéica. Minerais, vitaminas e água deverão ser ajustados às necessidades e ao quadro clínico do paciente em questão

Asma: manejo da crise / Asthma: management asthma exacerbations

A asma é uma doença inflamatória, crônica, das vias aéreas, que se tornam hiper-responsivas e obstruídas, causando tosse, sibilância, dispnéia e desconforto torácico, de modo recorrente. Pode ser classificada como leve, moderada ou grave. Crises asmáticas são caracterizadas por períodos de piora dos sintomas clínicos e da função pulmonar, de maneira reversível, resultando em prejuízo para as atividades usuais do doente e de sua qualidade de vida. A inflamação das vias aéreas, contudo, permanece cronicamente, mesmo nos períodos intercríticos. As agudizações também devem ser classificadas de acordo com sua gravidade, para que a melhor opção terapêutica e os cuidados com o paciente sejam instituídos

Hipogamaglobulinemia como fator de risco para infecçäo por Cryptococcus neoformans: a propósito de dois casos / Hypogammaglobulinemia as predisposing factor for Cryptococcus neofarmans infection: regarding two cases

Dois pacientes HIV-soronegativos com doenca criptocacica refrataria a terapia antifungica convencional foram submetidos a estudo do sistema imune. Hipogamaglobulinemia foi evidenciada em ambos e associada a alteracao funcional da imunidade mediada por celulas. Hipogamaglobulinemia Ú considerada como um possivel fator predisponente para infeccao criptocacica. A importancia dos anticorpos no controle da infeccao por Cryptococcus neoformans e discutida