Admittance to Wildlife Rehabilitation Centres Points to Adverse Effects of Climate Change on Insectivorous Bats.

Climate change is exerting a broad range of (mostly adverse) effects on biodiversity, and more are expected under future scenarios. Impacts on species that deliver key ecosystem services, such as bats, are especially concerning, so their better understanding is key to preventing or mitigating them. Due to their physiological requirements, bats are especially sensitive to environmental temperatures and water availability, and heatwave-related mortality has been reported for flying foxes and, more anecdotally, other bat species. For temperate regions, to date, no study has highlighted an association between temperature extremes and bat mortality, mostly due to the difficulty of relying on data series covering long timespans. Heatwaves may affect bats, causing thermal shock and acute dehydration so bats can fall from the roost and, in some cases, are rescued by the public and brought to wildlife rehabilitation centres (WRCs). In our work, we considered a dataset spanning over 20 years of bat admittance to Italian WRCs, covering 5842 bats, and hypothesised that in summer, the number of admitted bats will increase in hotter weeks and young bats will be more exposed to heat stress than adults. We confirmed our first hypothesis for both the overall sample and three out of five synurbic species for which data were available, whereas hot weeks affected both young and adults, pointing to an especially concerning effect on bat survival and reproduction. Although our study is correlative, the existence of a causative relationship between high temperatures and grounded bats is still the best explanation for the recorded patterns. We urge such a relationship to be explored via extensive monitoring of urban bat roosts to inform appropriate management of bat communities in such environments and preserve the precious ecosystem services such mammals provide, especially insectivory services.

[Development of a comprehensive public policy for adolescent pregnancy prevention in UruguayDesenvolvimento de uma política pública abrangente de prevenção da gravidez na adolescência no Uruguai]. / Desarrollo de una política pública integral de prevención del embarazo en adolescentes en Uruguay.

This article presents the main characteristics and achievements of Uruguay's National and Intersectoral Strategy for Prevention of Adolescent Pregnancy, implemented from 2016 to 2020. This strategy was implemented in a context in which unintentional adolescent pregnancy continues to be a major social problem for Uruguay and the Region, necessitating comprehensive, sustained, and evidence-based public policies. In Uruguay, adolescent fertility rates have remained high for over a decade. In addition to intersectoral action by government and civil society, the strategy received scientific assistance from the academic community, and technical and financial cooperation from regional and international organizations. Its actions and measures were adopted based on a socio-ecological vision, with cultural sensitivity, a gender-transformative approach, and a human rights perspective. Major barriers include social norms that value maternity as the main life project for women living in poverty, gender stereotypes (pregnancy as the exclusive responsibility of adolescent girls, without involving adolescent boys), the stigma of abortion, a lack of sexual and reproductive health services, and resistance to raising the visibility of pregnancy in girls under 15 years of age who are victims of structural and family violence. It is necessary to ensure the continuity of public policies--adjusted to a gender and human-rights approach--that take into account new scenarios such as the one imposed by the COVID-19 pandemic.

Este artigo apresenta os principais aspectos e os resultados da Estratégia Nacional e Intersetorial para Prevenção da Gravidez na Adolescência, implementada no Uruguai entre 2016 e 2020. A gravidez não intencional na adolescência persiste como uma questão social importante no Uruguai e na Região, exigindo políticas públicas com base em evidências científicas que sejam abrangentes e permanentes. A fecundidade na adolescência no Uruguai tem se mantido elevada há mais de uma década. Além da ação intersetorial do governo e da sociedade civil, a estratégia aprovada recebeu orientação científica de entidades acadêmicas, e cooperação técnica e financeira de organismos regionais e internacionais. As ações e as medidas da estratégia foram elaboradas a partir de uma visão socioecológica, com sensibilidade cultural e enfoque transformador de gênero e uma perspectiva de direitos humanos. Entre as barreiras mais importantes enfrentadas estão as normas sociais que valorizam a maternidade como principal projeto de vida para a mulher que vive em situação de pobreza, os estereótipos de gênero (a gravidez é vista como responsabilidade exclusiva da adolescente, sem envolver o parceiro adolescente), o estigma do aborto, a oferta insuficiente de serviços de saúde sexual e reprodutiva, e a resistência a dar visibilidade à gravidez de menores de 15 anos que são vítimas de violência estrutural e intrafamiliar. É necessário garantir a continuidade das políticas públicas que incorporem uma perspectiva de gênero e direitos humanos, e que sejam adaptadas aos novos cenários da pandemia de COVID-19.

Do We Need to Use Bats as Bioindicators?

Bats show responses to anthropogenic stressors linked to changes in other ecosystem components such as insects, and as K-selected mammals, exhibit fast population declines. This speciose, widespread mammal group shows an impressive trophic diversity and provides key ecosystem services. For these and other reasons, bats might act as suitable bioindicators in many environmental contexts. However, few studies have explicitly tested this potential, and in some cases, stating that bats are useful bioindicators more closely resembles a slogan to support conservation than a well-grounded piece of scientific evidence. Here, we review the available information and highlight the limitations that arise in using bats as bioindicators. Based on the limited number of studies available, the use of bats as bioindicators is highly promising and warrants further investigation in specific contexts such as river quality, urbanisation, farming practices, forestry, bioaccumulation, and climate change. Whether bats may also serve as surrogate taxa remains a controversial yet highly interesting matter. Some limitations to using bats as bioindicators include taxonomical issues, sampling problems, difficulties in associating responses with specific stressors, and geographically biased or delayed responses. Overall, we urge the scientific community to test bat responses to specific stressors in selected ecosystem types and develop research networks to explore the geographic consistency of such responses. The high cost of sampling equipment (ultrasound detectors) is being greatly reduced by technological advances, and the legal obligation to monitor bat populations already existing in many countries such as those in the EU offers an important opportunity to accomplish two objectives (conservation and bioindication) with one action.

Desarrollo de una política pública integral de prevención del embarazo en adolescentes en Uruguay

[RESUMEN]. Se presentan las principales características y logros de la Estrategia Nacional e Intersectorial para la Prevención del Embarazo en Adolescentes, implementada en Uruguay entre 2016 y 2020. Este proceso se desarrolló en un contexto en el que el embarazo no intencional en adolescentes continúa siendo un problema social relevante para Uruguay y la Región, por lo que se requieren políticas públicas integrales, sostenidas y basadas en evidencias científicas. En Uruguay, la fecundidad adolescente se ha mantenido en niveles elevados por más de una década. Además de la acción intersectorial del Gobierno y la sociedad civil, la estrategia aprobada contó con asesoramiento científico desde el ámbito académico y la cooperación técnica y financiera de organismos regionales e internacionales. Las acciones y medidas adoptadas se basan en una visión socio-ecológica, con sensibilidad cultural, enfoque transformador de género y perspectiva de derechos humanos. Entre las barreras más importantes están las normas sociales que valoran la maternidad como el principal proyecto de vida para las mujeres que viven en contextos de pobreza, los estereotipos de género —el embarazo como una responsabilidad exclusiva de las adolescentes, sin involucrar a los adolescentes varones—, el estigma del aborto, la insuficiente oferta de servicios de salud sexual y reproductiva, y la resistencia a visibilizar el embarazo en niñas menores de 15 años víctimas de la violencia estructural e intrafamiliar. Es necesario asegurar la continuidad de las políticas públicas, ajustadas a un enfoque de género y de derechos humanos, y que se tomen en cuenta los nuevos escenarios, como el que impone la pandemia por COVID-19.

[ABSTRACT]. This article presents the main characteristics and achievements of Uruguay’s National and Intersectoral Strategy for Prevention of Adolescent Pregnancy, implemented from 2016 to 2020. This strategy was implemented in a context in which unintentional adolescent pregnancy continues to be a major social problem for Uruguay and the Region, necessitating comprehensive, sustained, and evidence-based public policies. In Uruguay, adolescent fertility rates have remained high for over a decade. In addition to intersectoral action by government and civil society, the strategy received scientific assistance from the academic community, and technical and financial cooperation from regional and international organizations. Its actions and measures were adopted based on a socio-ecological vision, with cultural sensitivity, a gender-transformative approach, and a human rights perspective. Major barriers include social norms that value maternity as the main life project for women living in poverty, gender stereotypes (pregnancy as the exclusive responsibility of adolescent girls, without involving adolescent boys), the stigma of abortion, a lack of sexual and reproductive health services, and resistance to raising the visibility of pregnancy in girls under 15 years of age who are victims of structural and family violence. It is necessary to ensure the continuity of public policies––adjusted to a gender and human-rights approach––that take into account new scenarios such as the one imposed by the COVID-19 pandemic.

[RESUMO]. Este artigo apresenta os principais aspectos e os resultados da Estratégia Nacional e Intersetorial para Prevenção da Gravidez na Adolescência, implementada no Uruguai entre 2016 e 2020. A gravidez não intencional na adolescência persiste como uma questão social importante no Uruguai e na Região, exigindo políticas públicas com base em evidências científicas que sejam abrangentes e permanentes. A fecundidade na adolescência no Uruguai tem se mantido elevada há mais de uma década. Além da ação intersetorial do governo e da sociedade civil, a estratégia aprovada recebeu orientação científica de entidades acadêmicas, e cooperação técnica e financeira de organismos regionais e internacionais. As ações e as medidas da estratégia foram elaboradas a partir de uma visão socioecológica, com sensibilidade cultural e enfoque transformador de gênero e uma perspectiva de direitos humanos. Entre as barreiras mais importantes enfrentadas estão as normas sociais que valorizam a maternidade como principal projeto de vida para a mulher que vive em situação de pobreza, os estereótipos de gênero (a gravidez é vista como responsabilidade exclusiva da adolescente, sem envolver o parceiro adolescente), o estigma do aborto, a oferta insuficiente de serviços de saúde sexual e reprodutiva, e a resistência a dar visibilidade à gravidez de menores de 15 anos que são vítimas de violência estrutural e intrafamiliar. É necessário garantir a continuidade das políticas públicas que incorporem uma perspectiva de gênero e direitos humanos, e que sejam adaptadas aos novos cenários da pandemia de COVID-19.

Zoonotic Risk: One More Good Reason Why Cats Should Be Kept Away from Bats.

Bats are often unfairly depicted as the direct culprit in the current COVID-19 pandemic, yet the real causes of this and other zoonotic spillover events should be sought in the human impact on the environment, including the spread of domestic animals. Here, we discuss bat predation by cats as a phenomenon bringing about zoonotic risks and illustrate cases of observed, suspected or hypothesized pathogen transmission from bats to cats, certainly or likely following predation episodes. In addition to well-known cases of bat rabies, we review other diseases that affect humans and might eventually reach them through cats that prey on bats. We also examine the potential transmission of SARS-CoV-2, the causal agent of COVID-19, from domestic cats to bats, which, although unlikely, might generate a novel wildlife reservoir in these mammals, and identify research and management directions to achieve more effective risk assessment, mitigation or prevention. Overall, not only does bat killing by cats represent a potentially serious threat to biodiversity conservation, but it also bears zoonotic implications that can no longer be neglected.

Artificial illumination influences niche segregation in bats.

Artificial light at night (ALAN) is a pervasive form of pollution largely affecting wildlife, from individual behaviour to community structure and dynamics. As nocturnal mammals, bats are often adversely affected by ALAN, yet some "light-opportunistic" species exploit it by hunting insects swarming near lights. Here we used two potentially competing pipistrelle species as models, Kuhl's (Pipistrellus kuhlii) and common (Pipistrellus pipistrellus) pipistrelles, both known to forage in artificially illuminated areas. We set our study in a mountainous area of central Italy, where only recently did the two species become syntopic. We applied spatial modelling and radiotracking to contrast potential vs. actual environmental preferences by the two pipistrelles. Species distribution models and niche analysis showed a large interspecific niche overlap, including a preference for illuminated areas, presenting a potential competition scenario. Pipistrellus pipistrellus association with ALAN, however, was weakened by adding P. kuhlii as a biotic variable to the model. Radiotracking showed that the two species segregated habitats at a small spatial scale and that P. kuhlii used artificially illuminated sites much more frequently than P. pipistrellus, despite both species potentially being streetlamp foragers. We demonstrate that ALAN influences niche segregation between two potentially competing species, confirming its pervasive effects on species and community dynamics, and provide an example of how light pollution and species' habitat preferences may weave a tapestry of complex ecological interactions.

Sick bats stay home alone: fruit bats practice social distancing when faced with an immunological challenge.

Along with its many advantages, social roosting imposes a major risk of pathogen transmission. How social animals reduce this risk is poorly documented. We used lipopolysaccharide challenge to imitate bacterial infection in both a captive and a free-living colony of an extremely social, long-lived mammal-the Egyptian fruit bat. We monitored behavioral and physiological responses using an arsenal of methods, including onboard GPS to track foraging, acceleration sensors to monitor movement, infrared video to record social behavior, and blood samples to measure immune markers. Sick-like (immune-challenged) bats exhibited an increased immune response, as well as classic illness symptoms, including fever, weight loss, anorexia, and lethargy. Notably, the bats also exhibited behaviors that would reduce pathogen transfer. They perched alone and appeared to voluntarily isolate themselves from the group by leaving the social cluster, which is extremely atypical for this species. The sick-like individuals in the open colony ceased foraging outdoors for at least two nights, thus reducing transmission to neighboring colonies. Together, these sickness behaviors demonstrate a strong, integrative immune response that promotes recovery of infected individuals while reducing pathogen transmission inside and outside the roost, including spillover events to other species, such as humans.

Desarrollo de una política pública integral de prevención del embarazo en adolescentes en Uruguay / Development of a comprehensive public policy for adolescent pregnancy prevention in Uruguay / Desenvolvimento de uma política pública abrangente de prevenção da gravidez na adolescência no Uruguai

RESUMEN Se presentan las principales características y logros de la Estrategia Nacional e Intersectorial para la Prevención del Embarazo en Adolescentes, implementada en Uruguay entre 2016 y 2020. Este proceso se desarrolló en un contexto en el que el embarazo no intencional en adolescentes continúa siendo un problema social relevante para Uruguay y la Región, por lo que se requieren políticas públicas integrales, sostenidas y basadas en evidencias científicas. En Uruguay, la fecundidad adolescente se ha mantenido en niveles elevados por más de una década. Además de la acción intersectorial del Gobierno y la sociedad civil, la estrategia aprobada contó con asesoramiento científico desde el ámbito académico y la cooperación técnica y financiera de organismos regionales e internacionales. Las acciones y medidas adoptadas se basan en una visión socio-ecológica, con sensibilidad cultural, enfoque transformador de género y perspectiva de derechos humanos. Entre las barreras más importantes están las normas sociales que valoran la maternidad como el principal proyecto de vida para las mujeres que viven en contextos de pobreza, los estereotipos de género —el embarazo como una responsabilidad exclusiva de las adolescentes, sin involucrar a los adolescentes varones—, el estigma del aborto, la insuficiente oferta de servicios de salud sexual y reproductiva, y la resistencia a visibilizar el embarazo en niñas menores de 15 años víctimas de la violencia estructural e intrafamiliar. Es necesario asegurar la continuidad de las políticas públicas, ajustadas a un enfoque de género y de derechos humanos, y que se tomen en cuenta los nuevos escenarios, como el que impone la pandemia por COVID-19.

ABSTRACT This article presents the main characteristics and achievements of Uruguay's National and Intersectoral Strategy for Prevention of Adolescent Pregnancy, implemented from 2016 to 2020. This strategy was implemented in a context in which unintentional adolescent pregnancy continues to be a major social problem for Uruguay and the Region, necessitating comprehensive, sustained, and evidence-based public policies. In Uruguay, adolescent fertility rates have remained high for over a decade. In addition to intersectoral action by government and civil society, the strategy received scientific assistance from the academic community, and technical and financial cooperation from regional and international organizations. Its actions and measures were adopted based on a socio-ecological vision, with cultural sensitivity, a gender-transformative approach, and a human rights perspective. Major barriers include social norms that value maternity as the main life project for women living in poverty, gender stereotypes (pregnancy as the exclusive responsibility of adolescent girls, without involving adolescent boys), the stigma of abortion, a lack of sexual and reproductive health services, and resistance to raising the visibility of pregnancy in girls under 15 years of age who are victims of structural and family violence. It is necessary to ensure the continuity of public policies--adjusted to a gender and human-rights approach--that take into account new scenarios such as the one imposed by the COVID-19 pandemic.

RESUMO Este artigo apresenta os principais aspectos e os resultados da Estratégia Nacional e Intersetorial para Prevenção da Gravidez na Adolescência, implementada no Uruguai entre 2016 e 2020. A gravidez não intencional na adolescência persiste como uma questão social importante no Uruguai e na Região, exigindo políticas públicas com base em evidências científicas que sejam abrangentes e permanentes. A fecundidade na adolescência no Uruguai tem se mantido elevada há mais de uma década. Além da ação intersetorial do governo e da sociedade civil, a estratégia aprovada recebeu orientação científica de entidades acadêmicas, e cooperação técnica e financeira de organismos regionais e internacionais. As ações e as medidas da estratégia foram elaboradas a partir de uma visão socioecológica, com sensibilidade cultural e enfoque transformador de gênero e uma perspectiva de direitos humanos. Entre as barreiras mais importantes enfrentadas estão as normas sociais que valorizam a maternidade como principal projeto de vida para a mulher que vive em situação de pobreza, os estereótipos de gênero (a gravidez é vista como responsabilidade exclusiva da adolescente, sem envolver o parceiro adolescente), o estigma do aborto, a oferta insuficiente de serviços de saúde sexual e reprodutiva, e a resistência a dar visibilidade à gravidez de menores de 15 anos que são vítimas de violência estrutural e intrafamiliar. É necessário garantir a continuidade das políticas públicas que incorporem uma perspectiva de gênero e direitos humanos, e que sejam adaptadas aos novos cenários da pandemia de COVID-19.

Body Size Variation in Italian Lesser Horseshoe Bats Rhinolophus hipposideros over 147 Years: Exploring the Effects of Climate Change, Urbanization and Geography.

Body size in animals commonly shows geographic and temporal variations that may depend upon several environmental drivers, including climatic conditions, productivity, geography and species interactions. The topic of body size trends across time has gained momentum in recent years since this has been proposed as a third universal response to climate change along with changes in distribution and phenology. However, disentangling the genuine effects of climate change from those of other environmental factors is often far from trivial. In this study, we tested a set of hypotheses concerning body size variation across time and space in Italian populations of a rhinolophid bat, the lesser horseshoe bat Rhinolophus hipposideros. We examined forearm length (FAL) and cranial linear traits in a unique historical collection of this species covering years from 1869 to 2016, representing, to the best of our knowledge, the longest time series ever considered in a morphological assessment of a bat species. No temporal changes occurred, rejecting the hypotheses that body size varied in response to climate change or urbanization (light pollution). We found that FAL increased with latitude following a Bergmann's rule trend, whereas the width of upper incisors, likely a diet-related trait, showed an opposite pattern which awaits explanation. We also confirmed that FAL is sexually dimorphic in this species and ruled out that insularity has any detectable effect on the linear traits we considered. This suggests that positive responses of body size to latitude do not mean per se that concurring temporal responses to climate change are also expected. Further investigations should explore the occurrence of these patterns over larger spatial scales and more species in order to detect the existence of general patterns across time and space.

Disease presentation of 1312 childhood-onset systemic lupus erythematosus: influence of ethnicity.

OBJECTIVE: To evaluate the influence of ethnicity in presentation of childhood-onset systemic lupus erythematosus (cSLE) patients. METHODS: This multicenter study included cSLE patients (American College of Rheumatology criteria) followed in 27 Pediatric Rheumatology services of Brazil. Ethnicities were classified in four groups according to the parents' and all four grandparents' self-reported ethnicity. The statistical analysis was performed using the Bonferroni's correction (p < 0.0027). RESULTS: According to ethnic groups, 1537 cSLE patients were classified in Caucasian (n = 786), African-Latin American (n = 526), Asian (n = 8), and others/unknown (n = 217). Comparisons between 1312 African-Latin American and Caucasian revealed similar median age at cSLE diagnosis [12.2(2.6-18) vs. 12.1(0.3-18) years, p = 0.234], time interval to diagnosis [0.25(0-12) vs. 0.3(0-10) years, p = 0.034], and SLEDAI-2K score [14(0-55) vs. 14(0-63), p = 0.781] in both groups. The mean number of diagnostic criteria according to SLICC (6.47 ± 1.911 vs. 5.81 ± 1.631, p < 0.0001) and frequencies of maculopapular lupus rash (8% vs. 3%, p < 0.0001), palate oral ulcers (17% vs. 11%, p = 0.001), tongue oral ulcers (4% vs. 1%, p = 0.001), and nonscarring alopecia (29% vs. 16%, p < 0.0001) were significantly higher in African-Latin American, whereas malar rash (45% vs. 58%, p < 0.0001) was more frequent in Caucasian. The presence of anti-phospholipid antibody (23% vs. 12%, p < 0.0001), low complement levels (58% vs. 41%, p < 0.0001), and isolated direct Coombs test (10% vs. 5%, p = 0.001) was also significantly higher in the former group. CONCLUSIONS: Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of the former group. The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients. Key Points • Our study demonstrated that disease presentation severity of African-Latin American cSLE patients is comparable with Caucasian. • Mucocutaneous manifestations and autoantibodies profile were the only distinctive features of African-Latin American cSLE patients. • African-Latin American cSLE patients had more often anti-phospholipid antibodies and hypocomplementemia. • The unique mixed background of Brazilian patients probably minimized race diversity spectrum of these patients.

Diffuse alveolar hemorrhage in childhood-onset systemic lupus erythematosus: a severe disease flare with serious outcome.

OBJECTIVE: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. METHODS: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). RESULTS: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1-151) vs. 4 (1-151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5-40) vs. 6 (0-44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. CONCLUSIONS: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.

Anti-RO/SSA and anti-La/SSB antibodies: Association with mild lupus manifestations in 645 childhood-onset systemic lupus erythematosus.

BACKGROUND: To our knowledge there are no studies assessing anti-Ro/SSA and anti-La/SSB autoantibodies in a large population of childhood-systemic lupus erythematosus (cSLE) patients. METHODS: This was a retrospective multicenter cohort study performed in 10 Pediatric Rheumatology services, São Paulo state, Brazil. Anti-Ro/SSA and anti-La/SSB antibodies were measured by enzyme linked immunosorbent assay (ELISA) in 645 cSLE patients. RESULTS: Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p=0.032), photosensitivity (73% vs. 65%, p=0.035), cutaneous vasculitis (43% vs. 35%, p=0.046) and musculoskeletal involvement (82% vs. 75%, p=0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58years, p=0.973). Secondary Sjögren syndrome was observed in only five patients with this antibody (2.5% vs. 0%, p=0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p<0.0001), anti-RNP (39% vs. 21%, p<0.0001) and anti-ribossomal P protein (46% vs. 21%, p=0.002) was also significantly higher in patients with anti-Ro/SAA antibodies. Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p=0.0005), anti-Sm (59% vs. 31%, p<0.0001) and anti-RNP (42% vs. 23%, p<0.0001) were significantly higher in the former group. CONCLUSIONS: Our large multicenter cohort study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Secondary Sjögren syndrome was rarely observed in these patients, in spite of comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE.

Produção dos sentidos de saúde construídos no Grupo Sol, por pessoas vivendo com HIV/AIDS / Production of constructed health directions in the Sol Group, for people living with HIV / AIDS / Producción de las direcciones de salud construido en el Grupo Sol, para personas que viven con VIH/SIDA

Objetivo: dar visibilidade à produção dos sentidos de saúde construídos, em grupo, por pessoas que vivem com HIV/AIDS (PVHA). Método: estudo exploratório e descritivo, de abordagem qualitativa, realizado com 23 PVHA participantes de, pelo menos, 15 reuniões em grupo, no Hospital Universitário Antônio Pedro, da Universidade Federal Fluminense, em especial, no ambulatório de HIV/AIDS, onde se tem desenvolvido uma estratégia de acolhimento, uma "tecnologia", designada por "Grupo SOL". Realizaram-se entrevistas semiestruturadas, capturadas de modo individual, analisadas de acordo com a Técnica de Análise de Conteúdo. Resultados: as categorias emergiram das falas dos depoentes: A tecnologia de potência de vida e Construção do pertencimento na produção de saúde no Grupo SOL. Conclusão: a partir da emergência das falas dos participantes, houve uma forte contribuição daqueles na potencialização dos processos de individuação dos envolvidos, assim como a possibilidade do modus operandi do trabalho constituir-se numa tecnologia social, no campo da saúde.(AU)

Objective: to give visibility to the production of health directions constructed as a group for people living with HIV/AIDS (PLWHA). Method: an exploratory and descriptive study of qualitative approach, accomplished with 23 PLWHA participants from at least 15 group meetings at the Antônio Pedro University Hospital, Fluminense Federal University, especially in the outpatient HIV/AIDS, where it has developed a strategy to host a "technology" called "SOL Group". There were semi-structured interviews, taken individually, analyzed according to the Content Analysis Technique. Results: categories emerged from the speeches of the deponents: Life Power Technology and Construction of belonging in health production in the SOL Group. Conclusion: from the emergence of participants' speech, there was a strong contribution that the potentiating of the involved processes of individuation, as well as the possibility of working modus operandi being in a social technology in the health field.(AU)

Objetivo: dar visibilidad a la producción de los sentidos de salud construido en grupo, para personas que viven con VIH/SIDA (PVVS). Método: estudio descriptivo y exploratorio, con enfoque cualitativo, realizado con 23 participantes de PVVS al menos 15 encuentros en grupo, en el University Hospital Antônio Pedro, de la Universidade Federal Fluminense, en clínica particular ambulatoria VIH/SIDA, donde se ha desarrollado una estrategia, una "tecnología" llamada "Sol". Se realizaron entrevistas semiestructuradas, capturadas individualmente, que fueron analizadas según la técnica de análisis de contenido. Resultados: las categorías surgieron de los discursos de los deponentes: la tecnología de potencia de vida y construcción de la pertenencia en la producción de salud en el grupo de sol. Conclusión: a partir de la emergencia de los discursos de los participantes, hubo una fuerte contribución en la potenciación de los procesos de individuación de los envueltos, así como la posibilidad del modus operandi de la obra constituye una tecnología social en el campo de la salud.(AU)

Pancreatitis Subtypes Survey in 852 Childhood-Onset Systemic Lupus Erythematosus Patients.

OBJECTIVE: Pancreatitis is a rare and a life-threatening systemic lupus erythematosus (SLE) manifestation in childhood-onset SLE (cSLE). The objective of this study was to systematically classify pancreatitis in cSLE according to the International Study Group of Pediatric Pancreatitis and determine the overall prevalence, clinical features, laboratory, and first episode outcomes. METHODS: A multicenter cohort study in 10 pediatric rheumatology centers, including 852 patients with cSLE. RESULTS: Pancreatitis was diagnosed in 22 of 852 (2.6%) patients with cSLE. It was classified as acute pancreatitis in 20 (91%), acute recurrent pancreatitis in 2 (9%), and none of them had chronic pancreatitis. None of them had gallstones, traumatic pancreatitis, or reported alcohol/tobacco use. The comparison of patients with pancreatitis (first episode) and without this complication revealed a shorter disease duration (1 [0-10] vs 4 [0-23] years, P < 0.0001) and higher median of Systemic Lupus Erythematosus Disease Activity Index 2000 (21 [0-41] vs 2 [0-45], P < 0.0001). The frequencies of fever (P < 0.0001), weight loss (P < 0.0001), serositis (P < 0.0001), nephritis (P < 0.0001), arterial hypertension (P < 0.0001), acute renal failure (P < 0.0001), macrophage activation syndrome (P < 0.0001), and death (P = 0.001) were also higher in patients with pancreatitis. The frequencies of intravenous methylprednisolone use (P < 0.0001) and the median of prednisone dose (55 [15-60] vs 11 [1-90] mg/day, P < 0.0001) were significantly higher in patients with pancreatitis. Of note, the 2 patients with acute recurrent pancreatitis had 2 episodes, with pain-free interval of 1 and 4 years. CONCLUSIONS: This was the first study characterizing pancreatitis using the International Study Group of Pediatric Pancreatitis standardized definitions in patients with cSLE showing that the predominant form is acute pancreatitis seen in association with glucocorticoid treatment and active severe disease.

A Multicenter Study of Invasive Fungal Infections in Patients with Childhood-onset Systemic Lupus Erythematosus.

OBJECTIVE: To study the prevalence, risk factors, and mortality of invasive fungal infections (IFI) in patients with childhood-onset systemic lupus erythematosus (cSLE). METHODS: A retrospective multicenter cohort study was performed in 852 patients with cSLE from 10 pediatric rheumatology services. An investigator meeting was held and all participants received database training. IFI were diagnosed according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria (proven, probable, and possible). Also evaluated were demographic, clinical, and laboratory data, and disease activity [SLE Disease Activity Index 2000 (SLEDAI-2K)], cumulative damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), treatment, and outcomes. RESULTS: IFI were observed in 33/852 patients (3.9%) with cSLE. Proven IFI was diagnosed in 22 patients with cSLE, probable IFI in 5, and possible IFI in 6. Types of IFI were candidiasis (20), aspergillosis (9), cryptococcosis (2), and 1 each disseminated histoplasmosis and paracoccidioidomycosis. The median of disease duration was lower (1.0 vs 4.7 yrs, p < 0.0001) with a higher current SLEDAI-2K [19.5 (0-44) vs 2 (0-45), p < 0.0001] and current prednisone (PRED) dose [50 (10-60) vs 10 (2-90) mg/day, p < 0.0001] in patients with IFI compared with those without IFI. The frequency of death was higher in the former group (51% vs 6%, p < 0.0001). Logistic regression analysis revealed that SLEDAI-2K (OR 1.108, 95% CI 1.057-1.163, p < 0.0001), current PRED dose (OR 1.046, 95% CI 1.021-1.071, p < 0.0001), and disease duration (OR 0.984, 95% CI 0.969-0.998, p = 0.030) were independent risk factors for IFI (R(2) Nagelkerke 0.425). CONCLUSION: To our knowledge, this is the first study to characterize IFI in patients with cSLE. We identified that disease activity and current glucocorticoid use were the main risk factors for these life-threatening infections, mainly in the first years of disease course, with a high rate of fatal outcome.