Clinical and laboratory characteristics of Brazilian versus non-Brazilian primary antiphospholipid syndrome patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) clinical database and repository

Abstract Background: Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. Methods: We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). Results: We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. Conclusions: Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.

Non-criteria Antiphospholipid Antibodies: a narrative review

SUMMARY The 2006 Revised Sapporo Classification Criteria for Definite Antiphospholipid Syndrome included as laboratory criteria the tests for antiphospholipid antibodies whose accuracy was regarded as satisfactory according to the evidence available at that time. In practice, however, the sensitivity and specificity of these "criteria" of antiphospholipid antibodies are sometimes insufficient for identifying or ruling out antiphospholipid syndrome. It has been studied whether the accuracy of the laboratory diagnosis of the syndrome could be improved by testing for non-criteria antiphospholipid antibodies. In this work, we review evidence on the clinical associations and diagnostic value of the most commonly studied non-criteria antibodies, namely: antiphosphatidylethanolamine, anti-annexin A5, anti-prothrombin, anti-phosphatidylserine/prothrombin complex, IgA anticardiolipin, and IgG anti-domain I of the β2 glycoprotein antibodies.

RESUMO A classificação de Sapporo revisada para a síndrome antifosfolipídica definida de 2006 incluiu como critérios laboratoriais aqueles testes para anticorpos antifosfolípides cuja acurácia era considerada satisfatória de acordo com a evidência então disponível. Porém, na prática, a sensibilidade e especificidade desses anticorpos antifosfolípides "critério" são por vezes insuficientes para identificar ou descartar a síndrome antifosfolípide. Tem-se estudado se a acurácia do diagnóstico laboratorial da síndrome poderia ser melhorada por meio da testagem de anticorpos antifosfolípides não critério. Neste trabalho revisamos a evidência a respeito das associações clínicas e valor diagnóstico dos anticorpos não critério mais estudados, nomeadamente: anticorpos antifosfatidiletanolamina, antianexina A5, antiprotrombina, anticomplexo fosfatidilserina/protrombina, IgA anticardiolipina e IgG antidomínio I da anti-β2 glicoproteína I.

Conhecimento dos estudantes de Medicina sobre a avaliação curricular padronizada no processo seletivo da residência médica / Medicine students? awareness of the standardized curriculum evaluation in the scope of the admission process for medical residency

Introdução: a residência médica (RM) é um curso de especialização destinado aos médicos visando à formação de profissionais não docentes. O ingresso deve constar, obrigatoriamente, de uma prova escrita, sendo, facultativas uma prova prática e entrevista. De modo geral, a entrevista consta da análise e arguição do currículo. Objetivos: apurar ograu de informação, o status atual na formação do currículo dos acadêmicos da Faculdade de Medicina (FM) da Universidade Federal de Juiz de Fora (UFJF) e destacar formas de como conseguir a máxima pontuação na avaliação do currículo. Método: pesquisa transversal, aplicada, original, exploratória e descritiva, de campo, quantitativa. Aplicou--se questionário a 381 acadêmicos. Resultados: grau de informação dos estudantes sobre a RM: médio e baixo (89,76%); meios de informação sobre o processo seletivo: por colegas do curso (49,20%); quanto à procura ativa de informações sobre a seleção: 56,17% não procuraram; possuem inglês com certificado: 8,92%; realizaram monitorias: 45,41%; publicações em revistas indexadas: 9,42%. Conclusões: a qualidade das informações sobre aprova de avaliação curricular para RM não é satisfatória e, na maioria das vezes, oriundas de fontes não oficiais; o conhecimento dos alunos sobre o processo de avaliação é baixo; o modelo atual de avaliação curricular é complexo e detalhista, abrindo brechas para diferentes pontuações para um mesmo item do currículo; como contribuição, nota-se que a quase totalidade da amostra pretende cursar uma especialização médica, dissociando--se da política estatal quanto à formação de futuros médicos generalistas...

Introduction: Medical residency (MR) is a specialization course aimed at qualifying nondocent professionals. Admission in Brazil must compulsorily comprise a written test and optionally a practical exam and interview. Usually, interviews are part of curriculum analysis and oral examination. Objectives: To assess the information level and the current status of the curriculum of students of the School of Medicine (FM) at the Federal University of Juiz de Fora (UFJP) and to identify ways of obtaining maximum score in the curriculum evaluation. Method: This is an original, exploratory, descriptive, quantitative cross-study of 381 questionnaires filled out by students. Results: Students level of information about MR: low-average (89.76 %); sources of information on the admission process: through course colleagues (49.20 %); active search for information about the process: 56.17 % have not searched further information; certificate of English competence: 8.92 %; tutoring: 45.41% ; publication in peer-reviewed journals: 9.42%. Conclusions: The students? information about the curriculum evaluation for the MR admission process are qualitatively unsatisfactory and usually rely on non-official sources; the students have low knowledge of the evaluation process; the current process of curriculum evaluation is complex and detailed, including the possibility of different scores for the very same item of the curriculum. As a contribution, this study shows that virtually the whole sample intend to attend a specialization curse, which diverges from the state policy of educating future generalist doctors...