Serum Fatty Acid Profiles Are Associated with Disease Activity in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort.

BACKGROUND: Long-chain omega-3 and omega-6 fatty acids (n-3, n-6 FAs) may modulate inflammation and affect the risk of developing rheumatoid arthritis (RA). However, whether n-3/n-6 FA status affects RA after disease onset is unknown. This study aimed to assess whether FA profiles are independently associated with disease activity in a large prospective cohort of patients with early RA. METHODS: Baseline serum FAs were quantified in 669 patients in the ESPOIR cohort. Principal component analysis identified three serum FA patterns that were rich in n-7-9, n-3 and n-6 FAs (patterns ω7-9, ω3 and ω6), respectively. The association of pattern tertiles with baseline variables and 6-month disease activity was tested using multivariable logistic regression. RESULTS: Pattern ω3 was associated with low baseline and pattern ω6 with high baseline C-reactive protein level and disease activity. Both patterns ω3 and ω6 were associated with reduced odds of active disease after 6 months of follow-up (pattern ω3: odds ratio, tertile three vs. one, 0.49 [95% CI 0.25 to 0.97] and pattern ω6: 0.51 [0.28 to 0.95]; p = 0.04 and 0.03, respectively). CONCLUSIONS: In a cohort of early RA patients, a serum lipid profile rich in n-3 FAs was independently associated with persistently reduced disease activity between baseline and 6-month follow-up. An n-6 FA profile was also associated with lower 6-month disease activity.

Successive new-pathogen prosthetic joint reinfections: Observational cohort study on 61 patients.

OBJECTIVES: Prosthetic joint infection (PJI) treatment failure may be due to relapsing infection (same microorganism) or new-pathogen reinfection (npPJI). The aim was to describe npPJI epidemiological, clinical and microbiological characteristics, their treatments and outcomes, and identify their risk factors. METHODS: This observational, single-center, cohort study was conducted in a French Referral Center for Bone-and-Joint Infections between September 2004 and December 2015. Patients treated for at least two successive hip or knee PJIs in the same joint with a different pathogen were identified in the prospective database. We compared each patient's first PJI and subsequent npPJI(s) to analyze the type and microbiological characteristics of npPJIs. To search for npPJI risk factors, we compared those cases to a random selection of 122 "unique-episode" PJIs treated during the study period. RESULTS: Among 990 PJIs, 79 (8%) npPJIs occurring in 61 patients were included. New-pathogen prosthetic joint infections (npPJIs) developed more frequently in knee (14%) than hip prostheses (5%). Median interval from the first PJI to the npPJI was 26 months. New-pathogen prosthetic joint reinfections (npPJIs) more frequently spread hematogenously (60% vs 33%) and were predominantly caused by Staphylococcus (36%) or Streptococcus (33%) species. Multivariate analysis identified two risk factors: chronic dermatitis (odds ratio: 6.23; P<0.05) and cardiovascular diseases (odds ratio: 2.71; P<0.01). A curative strategy was applied to 70%: DAIR (29%), one-stage (28%), two-stage exchange arthroplasty (7%) or other strategies (7%). The others received prolonged suppressive antibiotic therapy (30%). CONCLUSIONS: New-pathogen prosthetic joint infections (npPJIs) are complex infections requiring management by multidisciplinary teams that should be adapted to each clinical situation.

Weight loss as a prognostic factor for recurrence and survival in oropharyngeal squamous cell carcinoma patients.

Although the mortality rate of oropharyngeal squamous cell carcinoma (OPSCC) has been decreasing over the last 30 years, there has been a significant increase in the frequency of diagnosis of this type of cancer in several countries. Beyond the classic prognostic factors, such as TNM stage, there is a lack of predictive factors for recurrence and treatment response. A retrospective analysis of patients with OPSCC treated at the Oncology Department of the Santa Terezinha University Hospital between 2007 and 2012 was performed, with the aim of identifying new prognostic factors. In addition to the significance of clinical stage as a prognostic factor for recurrence, OPSCC patients with advanced TNM stage and those treated with radiotherapy, chemoradiation or palliative measures, had a worse prognosis. Patients with moderate or severe weight loss (>5%) at diagnosis had a higher tumor recurrence rate compared with those with mild or no weight loss (P=0.007). Furthermore, 76.9% of patients with moderate or severe weight loss, as opposed to 13.3% of patients with mild or no weight loss, eventually succumbed to the disease (P=0.0001). These data suggest that moderate and severe weight loss at diagnosis is a prognostic factor for OPSCC and it is associated with disease recurrence.

Evaluation of the impact of fibromyalgia in disease activity and treatment effect in spondyloarthritis.

BACKGROUND: Fibromyalgia (FM) can coexist with Spondyloarthritis (SpA) leading to diagnostic and treatment dilemmas, especially in the presence of enthesitis. With this study we aimed to estimate the prevalence of FM in SpA and to compare the clinical/disease features and TNF inhibitors (TNFi) in patients with/without FM. METHOD: FM was defined by a score = > 5/6 of the Fibromyalgia Rapid Screening Tool (FiRST). SpA patients (according to the rheumatologist) and consecutively consulting in the day care hospital but also in the outpatient clinic at the rheumatology department of a tertiary care university hospital were included. Demographics, disease characteristics, activity and severity and TNFi treatment were compared in patients with and without FM; retention rate of the first TNFi and associated factors were explored (Kaplan Meier and Cox regression). RESULTS: Of the 196 enrolled SpA patients, 42 (21.4 %) were positively screened for FM. No statistically significant differences in the prevalence of FM were found with regard to the fulfillment of the ASAS criteria for peripheral/axial SpA, nor with regard to the fulfillment of the imaging vs. clinical arm of the ASAS criteria. However, patients with coexisting FM presented significantly with more enthesitis, higher disease activity (BASDAI and VAS) and poorer function scores (BASFI). No differences were found with regard to the initiation of TNFi treatment (79.0 % vs. 70.0 %, respectively), but the retention rate of the first TNFi after 2 years was shorter in the group of patients with FM (28.1 % (95 % CI 12.5-44.0) vs. 41.7 % (95 % CI 32.2-51.3), p = 0.01). CONCLUSION: This study confirms that coexistent FM in SpA might impact the patient-reported outcome indices for disease activity and function, and the retention rate of TNFi treatment.

Avaliação da acuidade visual em escolares no município de Herval d'Oeste, Santa Catarina, Brasil / Visual acuity assessment in schoolchildren in the municipality of Herval d'Oeste, Santa Catarina state, Brazil / Evaluación de la agudeza visual en estudiantes en el municipio de Herval d'Oeste, Santa Catarina, Brasil

Objetivos: Avaliar a acuidade visual por meio da aplicação de um teste de triagem, identificar a prevalência de baixa visão e providenciar o seu manejo adequado. Métodos: Estudo quantitativo e transversal, no qual foram avaliados escolares de 1ª a 5ª série do ensino fundamental de duas escolas municipais de Herval d'Oeste-SC, no segundo semestre de 2011, por meio da aplicação de um questionário com as variáveis: sexo, idade, uso prévio de óculos, percepção da própria visão e pela aplicação do Teste de Snellen para levantar medidas de acuidade visual (AV). Os alunos que apresentaram AV <0,7 e sinais e sintomas de alteração ocular foram encaminhados para exame oftalmológico. Resultados: A amostragem foi de 318 alunos: 158 (49,6%) do sexo masculino e 160 (50,3%) do sexo feminino, com idade entre 5 e 15 anos. Desses, 30 alunos apresentaram baixa acuidade visual e foram encaminhados ao atendimento oftalmológico, sendo que 24 crianças compareceram às consultas oftalmológicas e, destas, 19 (79,16%) necessitaram de correção óptica. Os diagnósticos mais prevalentes foram: astigmatismo, hipermetropia e miopia. Conclusão: A detecção da baixa visão na população escolar por meio de testes de triagem é importante tarefa de promoção da saúde e estratégia eficaz à prevenção de distúrbios visuais, os quais podem interferir no desenvolvimento intelectual, psicológico e social. Deve-se considerar a efetiva implantação dos programas e ações de promoção da saúde por meio da integração entre saúde, educação e comunidade.

Objectives: To evaluate visual acuity through the application of a screening test; identify the prevalence of low vision; and provide proper management to it. Methods: A cross-sectional and quantitative study in which first-to-fifth grade students of two elementary schools in the municipality of Herval d'Oeste were evaluated in the second half of 2011, by means of a questionnaire with the following variables: gender, age, previous use of glasses, perception of their own vision, and application of the Snellen Test to assess visual acuity (VA). Students presenting VA<0.7 and signs and symptoms of ocular disorders were referred to an ophthalmologist. Results: The sample comprised 318 students: 158 (49.6%) males and 160 (50.3%) females, between 5 and 15 years old. Thirty of these students showed low visual acuity and were referred to eye care, and 24 children attended ophthalmic examinations - 19 (79.16%) needed optical correction. The most prevalent diagnoses were astigmatism, hyperopia, and myopia. Conclusion: The detection of low vision among schoolchildren through screening tests is an important task of health promotion and an effective strategy to prevent visual disorders, which can interfere with intellectual, psychological and social development. The effective implementation of programs and actions to promote health through the integration of health, education and community should be considered.

Objetivos: Evaluar la agudeza visual mediante la aplicación de una prueba de selección, identificar la prevalencia de la baja visión y proporcionar bases para su adecuado tratamiento. Métodos: Estudio cuantitativo y transversal en el que fueron evaluados estudiantes de primero a quinto año de educación primaria en dos escuelas de Herval d'Oeste-SC, en el segundo semestre de 2011, mediante la aplicación de un cuestionario con las siguientes variables: sexo, edad, uso previo de anteojos, percepción de su propia visión y aplicación de la prueba de Snellen de agudeza visual (AV). Los estudiantes que presentaron AV <0,7 y signos y síntomas de problemas visuales fueron remitidos a un oftalmólogo. Resultados: La muestra fue de 318 alumnos: 158 (49,6%) varones y 160 (50,3%) mujeres, con edades comprendidas entre 5 y 15 años. De éstos, 30 estudiantes presentaron agudeza visual baja y fueron remitidos a la atención oftalmológica, siendo que 24 niños asistieron a los exámenes oftalmológicos y, de éstos, 19 (79,16%) requirieron corrección óptica. Los diagnósticos más frecuentes fueron astigmatismo, hipermetropía y miopía. Conclusión: La detección de baja visión a través de pruebas de selección es una tarea importante de promoción de la salud y una estrategia efectiva para prevenir alteraciones visuales que pueden interferir con el desarrollo intelectual, psicológico y social de los estudiantes. Se debe tener en cuenta la aplicación efectiva de los programas y acciones de promoción de la salud a través de la integración entre salud, educación y comunidad.

Grupo de gestantes para qualificação do pré natal e melhora da adesão ao aleitamento materno

Este trabalho trata-se de um projeto de intervenção, com o objetivo de desenvolver uma estratégia (grupo de gestantes) que aumente a adesão de gestantes ao pré-natal, assim como incentivar a prática do aleitamento materno.