Diagnostic test accuracy of novel biomarkers for lupus nephritis-An overview of systematic reviews.

INTRODUCTION: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiorgan inflammatory involvement and a mortality rate that is 2.6-fold higher than individuals of the same age and sex in the general population. Approximately 50% of patients with SLE develop renal impairment (lupus nephritis). Delayed diagnosis of lupus nephritis is associated with a higher risk of progression to end-stage renal disease, the need for replacement therapy, and mortality. The initial clinical manifestations of lupus nephritis are often discrete or absent and are usually detected through complementary tests. Although widely used in clinical practice, their accuracy is limited. A great scientific effort has been exerted towards searching for new, more sensitive, and specific biomarkers in recent years. Some systematic reviews have individually evaluated new serum and urinary biomarkers tested in patients with lupus nephritis. This overview aimed to summarize systematic reviews on the accuracy of novel serum and urinary biomarkers for diagnosing lupus nephritis in patients with SLE, discussing how our results can guide the clinical management of the disease and the direction of research in this area. METHODS: The research question is "What is the accuracy of the new serum and urinary biomarkers studied for the diagnosis of LN in patients with SLE?". We searched for systematic reviews of observational studies evaluating the diagnostic accuracy of new serum or urinary biomarkers of lupus nephritis. The following databases were included: PubMed, EMBASE, BIREME/LILACS, Scopus, Web of Science, and Cochrane, including gray literature found via Google Scholar and PROQUEST. Two authors assessed the reviews for inclusion, data extraction, and assessment of the risk of bias (ROBIS tool). RESULTS: Ten SRs on the diagnostic accuracy of new serum and urinary BMs in LN were selected. The SRs evaluated 7 distinct BMs: (a) antibodies (anti-Sm, anti-RNP, and anti-C1q), (b) cytokines (TWEAK and MCP-1), (c) a chemokine (IP-10), and (d) an acute phase glycoprotein (NGAL), in a total of 20 review arms (9 that analyzed serum BMs, and 12 that analyzed BMs in urine). The population evaluated in the primary studies was predominantly adults. Two SRs included strictly adults, 5 reviews also included studies in the paediatric population, and 4 did not report the age groups. The results of the evaluation with the ROBIS tool showed that most of the reviews had a low overall risk of bias. CONCLUSIONS: There are 10 SRs of evidence relating to the diagnostic accuracy of serum and urinary biomarkers for lupus nephritis. Among the BMs evaluated, anti-C1q, urinary MCP-1, TWEAK, and NGAL stood out, highlighting the need for additional research, especially on LN diagnostic panels, and attempting to address methodological issues within diagnostic accuracy research. This would allow for a better understanding of their usefulness and possibly validate their clinical use in the future. REGISTRATION: This project is registered on the International Prospective Registry of Systematic Reviews (PROSPERO) database (CRD42020196693).

Organização do cuidado às condições crônicas por equipes de Saúde da Família na Amazônia / Organization of health care for chronic conditions by Family Health teams in the Amazon

Este estudo tem por objetivo descrever a organização do cuidado especialmente direcionado a condições crônicas por equipes da Estratégia Saúde Família no estado do Amazonas e região Amazônica, Brasil. Trata-se de pesquisa avaliativa baseada em observação em unidades básicas de saúde e entrevistas com profissionais. Os resultados indicam alta rotatividade de profissionais, baixa disponibilidade de insumos indispensáveis ao atendimento; organização fragmentária do cuidado; limitado uso de protocolos, planejamento e programação baseados em critérios de risco e vulnerabilidade. A situação reflete-se em falta de longitunidalidade e integralidade do cuidado, pautado em demanda espontânea e voltado às queixas clínicas.

We describe health care organization, mainly as for chronic diseases, by Family Health Strategy teams in Amazonas State and Amazon region, Brazil. The assessing research grounds on basic health units' observation and on interviews with professionals. The results indicate high professionals' turnover, low availability of essential inputs to care; fragmented care organization; limited use of protocols, planning and scheduling based on risk and vulnerability criteria. The current condition is reflected in the lack of care longitudinal follow up and comprehensiveness, which relies on spontaneous demand and is addressed to clinical complaints.

[Use of psychoactive drugs by health sciences undergraduate students at the Federal University in Amazonas, Brazil]. / Uso de psicotrópicos entre universitários da área da saúde da Universidade Federal do Amazonas, Brasil.

A survey was conducted with 521 undergraduate health sciences students from the Federal University in Amazonas, Manaus, Brazil. Lifetime alcohol consumption was reported by 87.7% students, as compared to 30.7% for tobacco, with the latter reported more frequently by males (39.7%). The most common illicit drugs were solvents (11.9%), marijuana (9.4%), amphetamines and anxiolytics (9.2% each), cocaine (2.1%), and hallucinogens (1.2%). The main reason for illicit drug use was curiosity. Lifetime use of anabolic steroids was reported by 2.1% of the students. Alcohol abuse in the previous 30 days was reported by 12.4% of the students. Events following drinking included: fights (4.7%), accidents (2.4%), classroom absenteeism (33.7%), and job absenteeism (11.8%). Another important finding was that 47.3% of students drove after drinking. Opinions on drug abuse and patterns agree with those from similar studies in other regions of Brazil.

Uso de psicotrópicos entre universitários da área da saúde da Universidade Federal do Amazonas, Brasil / Use of psychoactive drugs by health sciences undergraduate students at the Federal University in Amazonas, Brazil

Foi realizado um levantamento sobre uso de psicotrópicos entre estudantes da Faculdade de Ciências da Saúde da Universidade Federal do Amazonas, Manaus, Brasil, em uma amostra de 521 alunos. O "uso na vida" de álcool foi relatado por 87,7 por cento dos estudantes (IC95 por cento: 85,34-90,06) e o de tabaco por 30,7 por cento (IC 95 por cento: 27,39-34,01), sendo o último maior entre estudantes do sexo masculino (39,7 por cento; IC95 por cento: 33,33-46,01). As substâncias ilegais mais usadas foram: solventes (11,9 por cento; IC95 por cento: 9,57-14,23), maconha (9,4 por cento; IC95 por cento: 7,30-11,50), anfetamínicos e ansiolíticos (ambos com 9,2 por cento; IC95 por cento: 7,12-11,28), cocaína (2,1 por cento; IC95 por cento: 1,07- 3,13) e alucinógenos (1,2 por cento; IC95 por cento: 0,42-1,98). O principal motivo relatado para o uso de drogas ilegais foi a curiosidade. O "uso na vida" de esteróides anabolizantes foi citado por 2,1 por cento dos estudantes. O uso abusivo de álcool nos últimos 30 dias foi relatado por 12,4 por cento dos universitários. Entre os eventos ocorridos após a ingestão de bebidas alcoólicas, os estudantes citaram envolvimento em briga (4,7 por cento), acidentes (2,4 por cento), faltaà escola (33,7 por cento), falta ao trabalho (11,8 por cento) e conducão de veículos (47,3 por cento). A opinião sobre as drogas e o padrão de uso dos estudantes não diferem muito dos estudos semelhantes em outras regiões do Brasil.