Ethics and responsible AI deployment.

As Artificial Intelligence (AI) becomes more prevalent, protecting personal privacy is a critical ethical issue that must be addressed. This article explores the need for ethical AI systems that safeguard individual privacy while complying with ethical standards. By taking a multidisciplinary approach, the research examines innovative algorithmic techniques such as differential privacy, homomorphic encryption, federated learning, international regulatory frameworks, and ethical guidelines. The study concludes that these algorithms effectively enhance privacy protection while balancing the utility of AI with the need to protect personal data. The article emphasises the importance of a comprehensive approach that combines technological innovation with ethical and regulatory strategies to harness the power of AI in a way that respects and protects individual privacy.

Measuring Nurses' Knowledge and Awareness of Climate Change and Climate-Associated Diseases: Protocol for a Systematic Review of Existing Instruments.

BACKGROUND: Climate change is a health emergency. Each year, it is estimated to cost more than 230 million years of life expectancy, with 4-9 million premature deaths associated with air pollution, and 9 million excess deaths due to non-optimal temperatures, representing 7% more temperature-related deaths since 2015 and 66% more since 2000. OBJECTIVE: Identify and evaluate the reliability, fidelity, and validity of instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. METHODS: A systematic literature review will retrieve and assess studies examining instruments measuring nurses' knowledge and awareness of climate change and climate-associated diseases. Using predefined search terms for nurses, climate change, literacy and scales or tools, we will search for published articles recorded in the following electronic databases, with no language or date restrictions, from their inception until 31 October 2023: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb], from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Library Wiley (from 1992), Web of Science Core Collection (from 1900), the Trip Database (from 1997), JBI OVID SP (from 1998), and the GreenFILE EBSCO. We will also hand-search relevant articles' bibliographies and search for unpublished studies using Google Scholar, ProQuest Dissertations and Theses Global, and DART-EUrope.eu. This will be completed by exploring the gray literature in OpenGrey and the Grey Literature Report, from inception until 31 October 2023, in collaboration with a librarian. Twelve bibliographic databases will be searched for publications up to 31 October 2023. The papers selected will be assessed for their quality. RESULTS: The electronic database searches were completed in May 2023. Retrieved articles are being screened, and the study will be completed by October 2023. After removing duplicates, our search strategy has retrieved 3449 references. CONCLUSIONS: This systematic review will provide specific knowledge about instruments to measure nurses' knowledge, awareness, motivation, attitudes, behaviors, beliefs, skills, and competencies regarding climate change and climate-associated diseases.

Climate Change, Environmental Health, and Challenges for Nursing Discipline.

Current data and scientific predictions about the consequences of climate change are accurate in suggesting disaster. Since 2019, climate change has become a threat to human health, and major consequences on health and health systems are already observed. Climate change is a central concern for the nursing discipline, even though nursing theorists' understanding of the environment has led to problematic gaps that impact the current context. Today, nursing discipline is facing new challenges. Nurses are strategically placed to respond to the impacts of climate change through their practice, research, and training in developing, implementing, and sustaining innovation towards climate change mitigation and adaptation. It is urgent for them to adapt their practice to this reality to become agents of change.

Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDITcare Systematic Review.

BACKGROUND: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals' (HCPs) expertise. METHODS: Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. RESULTS: The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. CONCLUSIONS: Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers' characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.

Pah levels in the soil-litter-vegetation-atmosphere system of Atlantic Forest remnants in Southeast Brazil.

Although the Brazilian Atlantic Forest is a hotspot for biodiversity conservation, it is one of the most fragmented biomes in Brazil and also affected by air pollutants such as polycyclic aromatic hydrocarbons (PAHs). The study aimed at measuring the PAH levels in leaf trees, litter, soil, and atmosphere of two Atlantic Forest remnants impacted by air pollutants during summer and winter periods; identifying emission sources; and investigating the relationship among the PAH concentrations in the soil, litter, leaves, and atmosphere. Site 1 is situated in the largest South American city, with rainy summers and dry winters, and characterized by intense urbanization. Site 2 is situated in a large forest continuum and is characterized by wet climate with no defined dry seasons. It is more distant from the anthropogenic urban sources than site 1, but closer to an industrial complex. No differences were detected for PAH amounts (summer + winter) in the particles and wet deposition fluxes between sites. In site 1, the highest concentrations of PAHs in the particles were measured during the winter while in the leaf trees were measured during the summer. PMF model showed that sites 1 and 2 receive PAHs mainly from vehicle emissions and industrial activities, respectively. The accumulation of heavier compounds in soil and leaves via wet deposition was more evident in site 2. PAHs were mainly stored in the soil of site 1, contrasting with site 2, where they were retained in litter, which were attributed to disturbances of decomposer community and reduced decomposition rates.

What Country, University, or Research Institute, Performed the Best on Covid-19 During the First Wave of the Pandemic?: Bibliometric analysis of scientific literature - analysing a 'snapshot in time' of the first wave of COVID-19.

In this article, we conduct data mining and statistical analysis on the most effective countries, universities, and companies, based on their output (e.g., produced or collaborated) on COVID-19 during the first wave of the pandemic. Hence, the focus of this article is on the first wave of the pandemic. While in later stages of the pandemic, US and UK performed best in terms of vaccine production, the focus in this article is on the initial few months of the pandemic. The article presents findings from our analysing of all available records on COVID-19 from the Web of Science Core Collection. The results are compared with all available data records on pandemics and epidemics from 1900 to 2020. This has created interesting findings that are presented in the article with visualisation tools. Supplementary information: The online version contains supplementary material available at 10.1007/s40745-022-00406-8.

Epistemological Equation for Analysing Uncontrollable States in Complex Systems: Quantifying Cyber Risks from the Internet of Things.

The Internet-of-Things (IoT) triggers data protection questions and new types of cyber risks. Cyber risk regulations for the IoT, however, are still in their infancy. This is concerning, because companies integrating IoT devices and services need to perform a self-assessment of its IoT cyber security posture. At present, there are no self-assessment methods for quantifying IoT cyber risk posture. It is considered that IoT represent a complex system with too many uncontrollable risk states for quantitative risk assessment. To enable quantitative risk assessment of uncontrollable risk states in complex and coupled IoT systems, a new epistemological equation is designed and tested though comparative and empirical analysis. The comparative analysis is conducted on national digital strategies, followed by an empirical analysis of cyber risk assessment approaches. The results from the analysis present the current and a target state for IoT systems, followed by a transformation roadmap, describing how IoT systems can achieve the target state with a new epistemological analysis model. The new epistemological analysis approach enables the assessment of uncontrollable risk states in complex IoT systems-which begin to resemble artificial intelligence-and can be used for a quantitative self-assessment of IoT cyber risk posture.

Artificial intelligence in cyber physical systems.

This article conducts a literature review of current and future challenges in the use of artificial intelligence (AI) in cyber physical systems. The literature review is focused on identifying a conceptual framework for increasing resilience with AI through automation supporting both, a technical and human level. The methodology applied resembled a literature review and taxonomic analysis of complex internet of things (IoT) interconnected and coupled cyber physical systems. There is an increased attention on propositions on models, infrastructures and frameworks of IoT in both academic and technical papers. These reports and publications frequently represent a juxtaposition of other related systems and technologies (e.g. Industrial Internet of Things, Cyber Physical Systems, Industry 4.0 etc.). We review academic and industry papers published between 2010 and 2020. The results determine a new hierarchical cascading conceptual framework for analysing the evolution of AI decision-making in cyber physical systems. We argue that such evolution is inevitable and autonomous because of the increased integration of connected devices (IoT) in cyber physical systems. To support this argument, taxonomic methodology is adapted and applied for transparency and justifications of concepts selection decisions through building summary maps that are applied for designing the hierarchical cascading conceptual framework.

Dynamic real-time risk analytics of uncontrollable states in complex internet of things systems: cyber risk at the edge.

The Internet of Things (IoT) triggers new types of cyber risks. Therefore, the integration of new IoT devices and services requires a self-assessment of IoT cyber security posture. By security posture this article refers to the cybersecurity strength of an organisation to predict, prevent and respond to cyberthreats. At present, there is a gap in the state of the art, because there are no self-assessment methods for quantifying IoT cyber risk posture. To address this gap, an empirical analysis is performed of 12 cyber risk assessment approaches. The results and the main findings from the analysis is presented as the current and a target risk state for IoT systems, followed by conclusions and recommendations on a transformation roadmap, describing how IoT systems can achieve the target state with a new goal-oriented dependency model. By target state, we refer to the cyber security target that matches the generic security requirements of an organisation. The research paper studies and adapts four alternatives for IoT risk assessment and identifies the goal-oriented dependency modelling as a dominant approach among the risk assessment models studied. The new goal-oriented dependency model in this article enables the assessment of uncontrollable risk states in complex IoT systems and can be used for a quantitative self-assessment of IoT cyber risk posture.

Emergy unsustainability index for agricultural systems assessment: A proposal based on the laws of thermodynamics.

The anthropic effects of agriculture call for more sustainable systems. Agricultural sustainability conventionally communicates an idea of perennity. However, the sustainability of living open systems, like agricultural systems, can be regarded as a mere utopian idea when the effects of the laws of thermodynamics are taken into account. Under such physical laws, what really exists is the fact that any system alone has the property of unsustainability. The rate of entropy production can denote the potential level of the unsustainability of a system. The higher the rate of entropy production in an agricultural system, the higher its potential for unsustainability. Directly measuring entropy in living open systems is unfeasible. Even so, such systems are subject to the laws of thermodynamics. Indirect measurements of entropy in living open systems can be assessed by approximation through an analysis of the energy flows of the system. We used emergy analysis to account for the energy flows and compare the unsustainability among agricultural systems. However, the indicators proposed by emergy analysts have been more aligned with the perspective of sustainability. To change this perspective, we propose an emergy unsustainability index applied in this paper specifically to agricultural systems (EUIAS). EUIAS is not a simple inversion of the ESI obtained by the ratio between the Emergy Yield Ratio (EYR) and the Environmental Loading Ratio (ELR). The use of renewable exergy stored from one production cycle to another is one of the peculiarities of long-term agricultural systems. Therefore, quantifying the renewable and non-renewable fractions of resources used is fundamental to the EUIAS. A higher EUIAS means that an agricultural system is more dependent on non-renewable economic resources than renewable resources, and, in general, environmental impacts are higher due to the use of non-renewable resources.

COVID-19 what have we learned? The rise of social machines and connected devices in pandemic management following the concepts of predictive, preventive and personalized medicine.

OBJECTIVES: Review, compare and critically assess digital technology responses to the COVID-19 pandemic around the world. The specific point of interest in this research is on predictive, preventive and personalized interoperable digital healthcare solutions. This point is supported by failures from the past, where the separate design of digital health solutions has led to lack of interoperability. Hence, this review paper investigates the integration of predictive, preventive and personalized interoperable digital healthcare systems. The second point of interest is the use of new mass surveillance technologies to feed personal data from health professionals to governments, without any comprehensive studies that determine if such new technologies and data policies would address the pandemic crisis. METHOD: This is a review paper. Two approaches were used: A comprehensive bibliographic review with R statistical methods of the COVID-19 pandemic in PubMed literature and Web of Science Core Collection, supported with Google Scholar search. In addition, a case study review of emerging new approaches in different regions, using medical literature, academic literature, news articles and other reliable data sources. RESULTS: Most countries' digital responses involve big data analytics, integration of national health insurance databases, tracing travel history from individual's location databases, code scanning and individual's online reporting. Public responses of mistrust about privacy data misuse differ across countries, depending on the chosen public communication strategy. We propose predictive, preventive and personalized solutions for pandemic management, based on social machines and connected devices. SOLUTIONS: The proposed predictive, preventive and personalized solutions are based on the integration of IoT data, wearable device data, mobile apps data and individual data inputs from registered users, operating as a social machine with strong security and privacy protocols. We present solutions that would enable much greater speed in future responses. These solutions are enabled by the social aspect of human-computer interactions (social machines) and the increased connectivity of humans and devices (Internet of Things). CONCLUSION: Inadequate data for risk assessment on speed and urgency of COVID-19, combined with increased globalization of human society, led to the rapid spread of COVID-19. Despite an abundance of digital methods that could be used in slowing or stopping COVID-19 and future pandemics, the world remains unprepared, and lessons have not been learned from previous cases of pandemics. We present a summary of predictive, preventive and personalized digital methods that could be deployed fast to help with the COVID-19 and future pandemics.

Aspectos etiológicos e epidemiológicos do pênfigo foliáceo endêmico (fogo selvagem) / Etiological and epidemiological aspects of pemphigus foliaceus (wild fire)

Introdução: Durante a primeira metade do século XX, o pênfigo foliáceo endêmico (fogo selvagem) teve importante impacto social, econômico e político no Brasil. Após mais de um século desde seus primeiros relatos essa doença ainda guarda interrogações sobre o envolvimento de fatores ambientais desencadeantes e sua característica autoimune e endêmica. O objetivo do trabalho é revisar trabalhos publicados por mais de um século, destacando os aspectos epidemiológicos da doença (das diferentes formas endêmicas pelo mundo) e avanços no estudo da sua etiologia. Material e Métodos: Utilizaram-se de trabalhos no PubMed, LILACS, CAPES, Google Acadêmico, Anais Brasileiros de Dermatologia. Resultados: O fogo selvagem sofreu grande redução do número de casos, principalmente a partir da década de 80 do século XX. O número de estudos sobre a doença vem diminuindo a cada década, várias informações sobre seus aspectos etiológicos e epidemiológicos permanecem há mais de um século sem comprovação precisa. Conclusões: Concluímos que o reduzido número de trabalhos atuais sobre o fogo selvagem se deve a redução considerável da sua incidência após mudanças ecológicas, avanços tecnológicos e melhoria das condições de vida da população das áreas endêmicas. As autoridades deveriam torná-la de notificação compulsória, facilitando a identificação de novos casos e de possíveis áreas endêmicas nos dias atuais. Mais estudos na área contribuiriam também ao estudo das doenças autoimunes em geral e dos fatores relacionados com o aumento da incidência de pênfigo vulgar em áreas endêmicas para fogo selvagem.

[Nephrocalcinosis associated with the use of anabolic steroid]. / Nefrocalcinose associada ao uso de esteroide anabolizante.

UNLABELLED: The anabolic steroid have been used as a therapeutic tool in various clinical conditions. However, indiscriminate use associated with other nutritional supplements has generated serious adverse effects. CASE REPORT: Male, 21 years old, admitted with nausea, fatigue, appetite loss, headache and hypertension. Blood tests showed Cr: 3.9 mg% U: 100 mg% and Total Calcium 14 mg/dl. Ultrasonography and renal biopsy were consistent with nephrocalcinosis. There has been gradual improvement in renal function and calcium levels after vigorous hydration and furosemide. However, after 1 year, renal calcium deposits persist, corticomedullary ratio reduced in ultrasound and stable creatinine of 1.4 mg/dl. Previous cases showed acute tubular necrosis and interstitial nephritis with little calcium deposits in the renal interstitium. In this case we found severe nephrocalcinosis associated with nephrosclerosis. Our objective is to report the occurrence of acute kidney Injury with nephrocalcinosis associated with use of anabolic steroid and provide a review of the matter.

Nefrocalcinose associada ao uso de esteroide anabolizante / Nephrocalcinosis associated with the use of anabolic steroid

Os esteroides anabolizantes têm sido usados como arma terapêutica em diversas condições clínicas. Entretanto, o uso abusivo e indiscriminado, associado a outros suplementos nutricionais, tem gerado efeitos adversos graves. Relato do caso: Sexo masculino, 21 anos, admitido com náuseas, astenia, hiporexia, cefaleia e hipertensão arterial. Exames no sangue evidenciaram Cr: 3,9 mg/dl U:100 mg/dl e Cálcio total 14 mg/dl. Ultrassonografia e biópsia renal compatíveis com nefrocalcinose. Houve melhora gradativa da função renal e da calcemia após hidratação vigorosa e furosemida. Entretanto, após 1 ano, persistiram depósitos renais de cálcio e relação córticomedular reduzida ao ultrassom e creatinina estável em 1,4 mg/dl. Casos anteriores evidenciaram necrose tubular aguda e nefrite intersticial com poucos depósitos de cálcio no interstício renal. Nesse caso, encontramos nefrocalcinose acentuada associada à nefroesclerose. O objetivo deste estudo é relatar a ocorrência de injúria renal aguda com nefrocalcinose associada ao uso de esteroide anabolizante e oferecer uma revisão do assunto. .

The anabolic steroid have been used as a therapeutic tool in various clinical conditions. However, indiscriminate use associated with other nutritional supplements has generated serious adverse effects. Case report: Male, 21 years old, admitted with nausea, fatigue, appetite loss, headache and hypertension. Blood tests showed Cr: 3.9 mg% U: 100 mg% and Total Calcium 14 mg/dl. Ultrasonography and renal biopsy were consistent with nephrocalcinosis. There has been gradual improvement in renal function and calcium levels after vigorous hydration and furosemide. However, after 1 year, renal calcium deposits persist, corticomedullary ratio reduced in ultrasound and stable creatinine of 1.4 mg/dl. Previous cases showed acute tubular necrosis and interstitial nephritis with little calcium deposits in the renal interstitium. In this case we found severe nephrocalcinosis associated with nephrosclerosis. Our objective is to report the occurrence of acute kidney Injury with nephrocalcinosis associated with use of anabolic steroid and provide a review of the matter. .

Caracterização clínica de pacientes com artrite psoriásica / Clinical characterization of patients with psoriatic arthritis

JUSTIFICATIVA E OBJETIVO: A artrite psoriásica é doença de apresentação clínica variável e heterogênea, seja do ponto de vista dermatológico ou reumatológico, podendo haver múltiplas combinações entre seus subtipos. Esse estudo teve por objetivo caracterizar clinicamente uma população portadora de artrite psoriásica para traçar um perfil dos pacientes e contribuir para o entendimento da doença. MÉTODOS: Estudo com delineamento transversal com 45 pacientes com diagnóstico de artrite psoriásica em tratamento no serviço de Reumatologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Os dados demográfico e clínicos-sociais, cutâneos e articulares obtidos foram analisados de modo descritivo. RESULTADOS: Pertencem ao sexo masculino 57,8% dos pacientes. A média de idade foi de 52,9 anos. A maior parte tem sobrepeso e dislipidemia. Utilizam metotrexato 64,4% dos pacientes e inibidores do TNF-α 31,1%. A psoríase em placas foi observada em 88,9% dos casos. As articulações mais comumente afetadas foram as mãos e os punhos acompanhadas de manifestações extra-articulares em 86,7% dos pacientes. CONCLUSÃO: A população estudada foi composta majoritariamente por pacientes do sexo masculino, portadores de fatores de risco cardiovascular, psoríase em placas, poliartrite periférica e com presença marcante de manifestações extra-articulares...

BACKGROUND AND OBJECTIVE: Psoriatic arthritis is a disease with variable and heterogeneous clinical presentation at the dermatological or rheumatological point of view. Multiple combinations within their subtypes are possible. This survey had the aim to characterize a group of patients with psoriatic arthritis and describe a pattern of them to contribute to better understanding the disease. METHODS: This study had cross- sectional design and had evaluated 45 patients with psoriatic arthritis under treatment at the Rheumatology Department of University Hospital Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Demographic and clinical data obtained were treated descriptively. RESULTS: Male patients are 57.8% of the sample. They are 52.9 years-old at average. Most of them are overweight and dyslipidemic. Utilize methotrexate 64.4% of patients and TNF-α inhibitors 31.1%. Plaque type psoriasis was found in 88.9%. Joints most affected are hands and wrists accompanied by 86.7% of extra-articular manifestations. CONCLUSION: Sample studied is composed mostly by male gender, with cardiovascular risk factors, plaque type psoriasis, peripherical polyarthritis and with extra-articular manifestations...

Psoriatic arthritis: a clinical entity distinct from psoriasis?

Psoriasis and psoriatic arthritis are complex and heterogeneous clinical entities, whose presentations comprise multiple combinations of subtypes. There are doubts even if they are distinct entities or merely variants of the same disease. Epidemiologically, psoriasis can be considered a common disease because it affects about 2% of the world population. Regarding psoriatic arthritis, there is no consensus in the literature about its true incidence and prevalence in the general population. Genetic, immune, and environmental factors interact culminating in skin and joint manifestations of psoriatic disease. The central role of activated T lymphocytes in the pathogenesis of both psoriasis and psoriatic joints is now recognized. Furthermore, proinflammatory cytokines can be found in increased concentrations in both skin and synovium of patients with psoriatic arthritis. Since 1964, when the relationship between psoriasis and psoriatic arthritis was recognized, many studies have been conducted to better understand the common mechanism of both diseases. The HLA has already been considered the center of the psoriatic arthritis immunopathogenesis; today, TNF-α plays such a role. This paper is a review of various factors associating psoriasis and psoriatic arthritis leading to the hypothesis of a single disease with multiple presentations.

Artrite psoriásica: entidade clínica distinta da psoríase? / Psoriatic arthritis: a clinical entity distinct from psoriasis?

Psoríase e artrite psoriásica são entidades clínicas complexas e heterogêneas que podem apresentar-se por meio de múltiplas combinações entre seus subtipos; há dúvidas, inclusive, se são entidades distintas ou apenas variantes de uma mesma doença. Epidemiologicamente, a psoríase pode ser considerada doença comum, por afetar cerca de 2% da população mundial. Em relação à artrite psoriásica, não há consenso na literatura atual sobre suas reais incidência e prevalência na população geral. Fatores genéticos, imunológicos e ambientais interagem entre si até culminarem nas manifestações clínicas cutâneas e articulares da doença psoriásica. Atualmente, é reconhecido o papel central do linfócito T ativado na patogenia tanto da psoríase quanto da artrite psoriásica. Além disso, citocinas pró-inflamatórias podem ser encontradas em concentrações aumentadas tanto na sinóvia quanto na pele de portadores de artrite psoriásica. Desde 1964, quando a relação entre psoríase e artrite psoriásica foi reconhecida oficialmente, muitos estudos foram conduzidos na tentativa de melhor compreender o mecanismo em comum das duas doenças. O antígeno leucocitário humano já foi considerado o centro da imunopatogenicidade psoriásica - hoje, o fator de necrose tumoral alfa exerce tal papel. Trata-se, portanto, da revisão de variados fatores que associam psoríase e artrite psoriásica e que convergem para a hipótese de se tratar de doença única com múltiplas apresentações, dentre elas a artropatia característica.

Psoriasis and psoriatic arthritis are complex and heterogeneous clinical entities, whose presentations comprise multiple combinations of subtypes. There are doubts even if they are distinct entities or merely variants of the same disease. Epidemiologically, psoriasis can be considered a common disease because it affects about 2% of the world population. Regarding psoriatic arthritis, there is no consensus in the literature about its true incidence and prevalence in the general population. Genetic, immune, and environmental factors interact culminating in skin and joint manifestations of psoriatic disease. The central role of activated T lymphocytes in the pathogenesis of both psoriasis and psoriatic joints is now recognized. Furthermore, proinflammatory cytokines can be found in increased concentrations in both skin and synovium of patients with psoriatic arthritis. Since 1964, when the relationship between psoriasis and psoriatic arthritis was recognized, many studies have been conducted to better understand the common mechanism of both diseases. The HLA has already been considered the center of the psoriatic arthritis immunopathogenesis; today, TNF-α plays such a role. This paper is a review of various factors associating psoriasis and psoriatic arthritis leading to the hypothesis of a single disease with multiple presentations.

Cutaneous manifestations in end-stage renal disease.

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

Manifestações cutâneas na doença renal terminal / Cutaneous manifestations in end-stage renal disease

A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.

The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.

Subclinical encephalopathy in chronic obstructive pulmonary disease

BACKGROUND: Clinical and experimental evidence suggests that chronic obstructive pulmonary disease (COPD) is associated with a variety of mental symptoms that range from cognitive slowing to mental confusion and dementia. PURPOSE: To test the hypothesis that COPD leads to cognitive impairment in the absence of acute confusion or dementia. METHOD: The global cognitive status of 30 patients with COPD without dementia or acute confusion and 34 controls was assessed with a Brazilian version of the Mini-Mental State Exam (MMSE). RESULTS: The MMSE scores were significantly lower in the patient group and inversely related to the severity of COPD. This finding could not be attributed to age, education, gender, daytime sleepiness, hypoxemia, chronic tobacco use, or associated diseases such as diabetes, depression, high blood pressure or alcoholism. CONCLUSION: These results suggest the existence of a subclinical encephalopathy of COPD characterized by a subtle impairment of global cognitive ability.

CONTEXTO: Evidências clínicas e experimentais sugerem que a doença pulmonar obstrutiva crônica (DPOC) se associa a sintomas neurocomportamentais que variam da lentidão cognitiva à confusão mental e à demência. PROPÓSITO: Testar a hipótese de que a DPOC pode comprometer a cognição na ausência de estado confusional agudo ou de demência. MÉTODO: O estado cognitivo global de 30 pacientes com DPOC sem demência e sem confusão mental aguda e o de 34 controles foi examinado com a versão brasileira do Mini-Exame do Estado Mental (MEEM). RESULTADOS: As pontuações no meem mostraram-se significativamente mais baixas nos pacientes, e inversamente relacionadas à gravidade da DPOC. Este achado não pôde ser atribuído a diferenças de idade, escolaridade, sonolência diurna, hypoxemia, tabagismo crônico, ou a doenças associadas como diabetes, depressão, hipertensão arterial ou alcoolismo. CONCLUSÃO: Estes resultados sugerem a existência de uma encefalopatia subclínica da DPOC caracterizada por comprometimento sutil da capacidade cognitiva global.