Pioneer of Cardiothoracic Surgery - Joaquim Cavalcanti.

Joaquim de Souza Cavalcanti was a pioneer among us - the Brazilian State of Pernambuco and North-Northeast region - in cardiac surgery in its initial phase (Blalock-Taussig surgery and mitral valvulotomy), in thoracic surgery (pneumectomy, lung lobectomy and segmentectomy, lung decortication, and mediastinal tumor resection), and in numerous techniques and operative tactics in general surgery.

Pioneer of Cardiothoracic Surgery - Joaquim Cavalcanti

ABSTRACT Joaquim de Souza Cavalcanti was a pioneer among us - the Brazilian State of Pernambuco and North-Northeast region - in cardiac surgery in its initial phase (Blalock-Taussig surgery and mitral valvulotomy), in thoracic surgery (pneumectomy, lung lobectomy and segmentectomy, lung decortication, and mediastinal tumor resection), and in numerous techniques and operative tactics in general surgery.

Efficacy of Vafidemstat in Experimental Autoimmune Encephalomyelitis Highlights the KDM1A/RCOR1/HDAC Epigenetic Axis in Multiple Sclerosis.

Lysine specific demethylase 1 (LSD1; also known as KDM1A), is an epigenetic modulator that modifies the histone methylation status. KDM1A forms a part of protein complexes that regulate the expression of genes involved in the onset and progression of diseases such as cancer, central nervous system (CNS) disorders, viral infections, and others. Vafidemstat (ORY-2001) is a clinical stage inhibitor of KDM1A in development for the treatment of neurodegenerative and psychiatric diseases. However, the role of ORY-2001 targeting KDM1A in neuroinflammation remains to be explored. Here, we investigated the effect of ORY-2001 on immune-mediated and virus-induced encephalomyelitis, two experimental models of multiple sclerosis and neuronal damage. Oral administration of ORY-2001 ameliorated clinical signs, reduced lymphocyte egress and infiltration of immune cells into the spinal cord, and prevented demyelination. Interestingly, ORY-2001 was more effective and/or faster acting than a sphingosine 1-phosphate receptor antagonist in the effector phase of the disease and reduced the inflammatory gene expression signature characteristic ofEAE in the CNS of mice more potently. In addition, ORY-2001 induced gene expression changes concordant with a potential neuroprotective function in the brain and spinal cord and reduced neuronal glutamate excitotoxicity-derived damage in explants. These results pointed to ORY-2001 as a promising CNS epigenetic drug able to target neuroinflammatory and neurodegenerative diseases and provided preclinical support for the subsequent design of early-stage clinical trials.

Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus.

INTRODUCTION: Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. PURPOSE: To identify disease and non-disease related factors associated with NP manifestations in early SLE. METHODS: We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. STATISTICAL METHODS: Independent factors associated with NP involvement were identified using a multivariable Cox regression model. RESULTS: Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282-2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335-2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085-5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074-5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130-2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441-0.934, p = 0.0206). CONCLUSIONS: Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.

A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group.

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.

Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL).

AIM: A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria. METHODS: We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed. RESULTS: Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence. CONCLUSIONS: Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

Modulation of KDM1A with vafidemstat rescues memory deficit and behavioral alterations.

Transcription disequilibria are characteristic of many neurodegenerative diseases. The activity-evoked transcription of immediate early genes (IEGs), important for neuronal plasticity, memory and behavior, is altered in CNS diseases and governed by epigenetic modulation. KDM1A, a histone 3 lysine 4 demethylase that forms part of transcription regulation complexes, has been implicated in the control of IEG transcription. Here we report the development of vafidemstat (ORY-2001), a brain penetrant inhibitor of KDM1A and MAOB. ORY-2001 efficiently inhibits brain KDM1A at doses suitable for long term treatment, and corrects memory deficit as assessed in the novel object recognition testing in the Senescence Accelerated Mouse Prone 8 (SAMP8) model for accelerated aging and Alzheimer's disease. Comparison with a selective KDM1A or MAOB inhibitor reveals that KDM1A inhibition is key for efficacy. ORY-2001 further corrects behavior alterations including aggression and social interaction deficits in SAMP8 mice and social avoidance in the rat rearing isolation model. ORY-2001 increases the responsiveness of IEGs, induces genes required for cognitive function and reduces a neuroinflammatory signature in SAMP8 mice. Multiple genes modulated by ORY-2001 are differentially expressed in Late Onset Alzheimer's Disease. Most strikingly, the amplifier of inflammation S100A9 is highly expressed in LOAD and in the hippocampus of SAMP8 mice, and down-regulated by ORY-2001. ORY-2001 is currently in multiple Phase IIa studies.

Efecto de los antimaláricos sobre los diferentes dominios del índice de daño SLICC en pacientes de la cohorte GLADEL / Effect of antimalarials on the different domains of the SLICC damage index in patients of the GLADEL cohort

Objetivos: Estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: Se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL. Variable de estudio: aumento en los dominios del SDI desde el ingreso a la cohorte. Variables independientes: características sociodemográficas, clínicas, laboratorio y tratamientos. El efecto de los AM, como variable dependiente del tiempo, sobre los dominios más frecuentes del SDI (ajustado por factores de confusión) fue examinado con un modelo de regresión de Cox multivariado. Resultados: De 1466 pacientes estudiados, 1049 (72%) recibieron AM con un tiempo medio de exposición de 30 meses (Q1-Q3: 11-57) y 665 pacientes (45%) presentaron daño durante un seguimiento medio de 24 meses (Q1-Q3: 8-55); 301 eventos fueron cutáneos, 208 renales, 149 neuropsiquiátricos, 98 musculoesqueléticos, 88 cardiovasculares y 230 otros. Después de ajustar por factores de confusión, el uso de AM se asoció a un menor riesgo de daño renal (HR 0,652; IC 95%: 0,472-0,901) y en el límite de la significancia estadística (HR 0,701, IC 95%: 0,481-1,024) para el dominio neuropsiquiátrico. Conclusión: En GLADEL, el uso de AM se asoció independientemente a un menor riesgo de daño acumulado renal.

Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.

Oral administration of the LSD1 inhibitor ORY-3001 increases fetal hemoglobin in sickle cell mice and baboons.

Increased levels of fetal hemoglobin (HbF) lessen the severity of symptoms and increase the life span of patients with sickle cell disease (SCD). More effective strategies to increase HbF are needed because the current standard of care, hydroxyurea, is not effective in a significant proportion of patients. Treatment of the millions of patients projected worldwide would best be accomplished with an orally administered drug therapy that increased HbF. LSD1 is a component of corepressor complexes that repress γ-globin gene expression and are a therapeutic target for HbF reactivation. We have shown that subcutaneous administration of RN-1, a pharmacological LSD1 inhibitor, increased γ-globin expression in SCD mice and baboons, which are widely acknowledged as the best animal model in which to test the activity of HbF-inducing drugs. The objective of this investigation was to test the effect of oral administration of a new LSD1 inhibitor, ORY-3001. Oral administration of ORY-3001 to SCD mice (n = 3 groups) increased γ-globin expression, Fetal Hemoglobin (HbF)-containing (F) cells, and F reticulocytes (retics). In normal baboons (n = 7 experiments) treated with ORY-3001, increased F retics, γ-globin chain synthesis, and γ-globin mRNA were observed. Experiments in anemic baboons (n = 2) showed that ORY-3001 increased F retics (PA8695, predose = 24%, postdose = 66.8%; PA8698: predose = 13%, postdose = 93.6%), γ-globin chain synthesis (PA8695: predose = 0.07 γ/γ+ß, postdose = 0.20 γ/γ+ß; PA8698: predose = 0.02 γ/γ+ß, postdose = 0.44 γ/γ+ß), and γ-globin mRNA (PA8695: predose = 0.06 γ/γ+ß, postdose = 0.18 γ/γ+ß; PA8698: predose = 0.03 γ/γ+ß, postdose = 0.33 γ/γ+ß). We conclude that oral administration of ORY-3001 increases F retics, γ-globin chain synthesis, and γ-globin mRNA in baboons and SCD mice, supporting further efforts toward the development of this drug for SCD therapy.

Anti-malarials exert a protective effect while Mestizo patients are at increased risk of developing SLE renal disease: data from a Latin-American cohort.

OBJECTIVE: To examine the role of ethnicity and the use of anti-malarials (protective) on lupus renal disease. METHODS: A nested case-control study (1:2 proportion, n = 265 and 530) within GLADEL's (Grupo Latino Americano De Estudio de Lupus) longitudinal inception cohort was carried out. The end-point was ACR renal criterion development after diagnosis. Cases and controls were matched for follow-up time (end-point or a comparable time, respectively). Renal disease predictors were examined by univariable and multivariable analyses. Additional analyses were done to determine if the protective effect of anti-malarials persisted after adjusting for intake-associated confounders. RESULTS: Of the cases, 233 (87.9%) were women; their mean (s.d.) age at diagnosis was 28.0 (11.9) years and their median (Q3-Q1 interquartile range) follow-up time for cases and controls was 8.3 months (Q3-Q1: 23.5); 56.6% of the cases and 74.3% of the controls were anti-malarial users. Mestizo ethnicity [odds ratio (OR) 1.72, 95% CI 1.19, 2.48] and hypertension (OR 2.26, 95% CI 1.38, 3.70) were independently associated with a higher risk of renal disease, whereas anti-malarial use (OR 0.39, 95% CI 0.26, 0.58), older age at disease onset (OR 0.98, 95% CI 0.96, 0.99) and female gender (OR 0.56, 95% CI 0.32, 0.99) were negatively associated with such occurrence. After adjusting for variables associated with their intake, the protective effect of anti-malarials on renal disease occurrence persisted (OR 0.38, 95% CI 0.25, 0.58). CONCLUSION: Mestizo patients are at increased risk of developing renal disease, whereas anti-malarial use protects patients from such an occurrence.

Sedentarismo em população específica de funcionários de uma empresa pública / Sedentarism in the population of employees of a public company

JUSTIFICATIVA E OBJETIVOS: Nas sociedades contemporâneas surge uma doença que representa elevado risco para doenças cardiovasculares e morte, um novo problema de saúde pública que afeta todas as idades, denominado sedentarismo. O objetivo deste estudo foi discutir as nuances da definição de indivíduo ativo e sedentário, através de diferentes métodos descritos na literatura médica, analisando-se a incidência de sedentarismo e o perfil da população de empregados de uma empresa pública. MÉTODO: Os funcionários do sistema do Banco Nacional de Desenvolvimento Social (BNDES) foram solicitados a responder ao Questionário Internacional de Atividade Física (IPAQ), durante a realização do exame periódico de 2008 para quantificação da atividade física por eles realizada. RESULTADOS: Encontrou-se incidência de 25% de sedentarismo, sem correlação definitiva com idade, sexo ou índice de massa corporal (IMC). CONCLUSÃO: Os resultados afirmam a necessidade de estimular-se a prática de atividade física nas empresas como forma de redução dos fatores de risco cardiovasculares.

BACKGROUND AND OBJECTIVES: In the contemporary society, arises a new disease that carries high risk to cardiovascular diseases and death, a new public health problem that affects all ages, sedentarism. The object of this paper was to define what it means to be an active and sedentary individual, through the methods available in the literature and to investigate the incidence of sedentarism in a public company. METHOD: The application of the international physic activity questionnaire (IPAQ) to the employees of the Brazilian Development Bank, intending to quantify the intensity of the physical activity realized in their daily activities.RESULTS: It was found an incidence of 25% of sedentarism in the studied population, without definitive correlation with age, sex or body mass index (BMI). CONCLUSION: The results show the necessity to fight sedentarism and to stimulate the practice of physical activities as a way to reduce the incidence on cardiovascular risk factors.

Caquexia reumatoide - como diagnosticar / Rheumatoid cachexia - how to diagnose

A caquexia reumatoide é caracterizada pela perda involuntária de massa magra, predominantemente de músculo-esquelético, que ocorre também em vísceras e sistema imune, com massa gorda estável ou pouco elevada, e com pequena ou nenhuma perda de peso. Constitui uma condição pouco reconhecida na prática clínica e, nos casos severos, com importante perda de peso, há aumento da morbidade, com mortalidade prematura, embora a perda de massa muscular com um índice de massa corpórea normal também esteja associada com uma resposta clínica insatisfatória. A causa é multifatorial, incluindo a produção acentuada de citocinas, entre elas o TNF-alfa, e diminuição da atividade física. A composição corporal pode ser analisada utilizando as medidas antropométricas, densitometria de corpo total e outras técnicas, mas os resultados devem ser interpretados com cautela. Atualmente, a ressonância magnética tem sido estudada como importante exame para definir, com mais confiança, a massa muscular e a distribuição de gordura corporal. A caquexia apresenta pouca resposta à dieta de forma isolada, mas treinamento de resistência progressivo e terapia com antifator de necrose tumoral a são medidas que prometem melhorar esta manifestação extra-articular incapacitante da artrite reumatoide.

Rituximabe na síndrome de Felty refratária / Rituximab in the refractory Felty's syndrome

Os autores relatam o caso de uma paciente de 29 anos com diagnóstico de artrite reumatoide soropositiva que com seis meses de evolução desenvolveu granulocitopenia severa e esplenomegalia, embora mantivesse em remissão o quadro articular. Não apresentou resposta à corticoterapia oral e em forma de pulsos, além do metotrexato e leflunomida, tendo apresentado reação adversa ao uso do infliximabe e falta de resposta ao adalimumabe. Diante das infecções de repetição, apesar dos vários esquemas de antibióticos e uso crônico do G-CSF, dos altos títulos de fator reumatoide, dos níveis elevados da VHS e da PCR, utilizou-se o rituximabe no esquema clássico de tratamento da artrite reumatoide. Houve resposta clínica completa com aumento crescente do número de neutrófilos e normalização dos mesmos além da queda dos títulos de fator reumatoide, da VHS e da PCR. Atualmente, a paciente encontra-se em remissão clínica e laboratorial, em uso de prednisona 5 mg/dia e metotrexato 10 mg/semana.

The authors report a case of a 29 year old woman who has seropositive rheumatoid arthritis for six months, and developed severe granulocytopenia and important splenomegaly, however she didnït show any joint inflammation. She did not respond either to pulse or oral steroids, or to oral methotrexate and leflunomide. She also developed an adverse reaction to the use of infliximab and did not respond well to adalimumab. Although she has had repeated infections, despite the various forms of antibiotics and long-term use of G-CSF, with high titers of rheumatoid factor, and high levels of ESR and CRP, the classic Rituximab method for treating rheumatoid arthritis was used. There was a good clinical response with an increase in the number of neutrophils following normalization of them, together with the reduction of rheumatoid factor titers, ESR and CRP. At the moment, the patient is in remission, according to both clinical and laboratory criteria and taking 5mg of prednisone per day and 10mg of methotrexate per week.

Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children.

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were <18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p<0.05). On the other hand, myalgias, Sjögren's syndrome and cranial nerve involvement were more frequently seen in adults (p<0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.

Abordagem diagnóstica da tuberculose latente na artrite reumatóide: [revisão] / Latent tuberculosis diagnosis in rheumatoid arthritis: [review]

Apesar de terem revolucionado a prática reumatológica, o uso dos inibidores do fator de necrose tumoral (anti-TNFs) no tratamento da artrite reumatóide (AR) fez surgir um problema considerado solucionado em muitos países desenvolvidos: o risco elevado de reativação de infecção tuberculosa latente (ITBL). Desse modo, a identificação de casos de ITBL passou a ser obrigatória antes do início da terapêutica com anti-TNF. O teste cutâneo da tuberculina (PPD) não é um teste de screening ideal nesse grupo de pacientes em virtude de sua baixa especificidade, sua reação cruzada com antígenos vacinais e de outras micobactérias ambientais e, principalmente, por conta da incapacidade de o paciente com AR produzir uma resposta adequada ocasionada por uma anormalidade na responsividade das células T, característica da doença. Ensaios com base na detecção da produção de IFNgama in vitro por células mononucleares periféricas estimuladas por antígenos específicos (ESAT-6 e CFP-10), que não são encontrados na vacina BCG nem em outras micobactérias ambientais, parecem ser mais acurados que o PPD na detecção de ITBL em virtude de maior especificidade, melhor correlação com medidas indiretas de exposição ao Mycobacterium tuberculosis e menor reação cruzada com a vacinação por BCG e infecções por outras micobactérias.

Despite representing a major advance in rheumatology practice, the use of tumor necrosis factor blockade (anti-TNFs) in the treatment of rheumatoid arthritis (RA) has given rise to a problem that was considered solved in many developed countries, i.e. the heightened risk of reactivation of latent tuberculosis infection (LTBI). The identification of cases of LTBI has thus been made obligatory prior to starting any anti-TNF treatment. The cutaneous tuberculin test (PPD) is not the ideal screening test for this group of patients. Low specificity, cross-reactivity with vaccine antigens and other exogenous microorganisms coupled to a defect in the cell-mediated component of the immunological response account for the inadequacy of PPD as a screening tool in this subset of patients. Assays using the detection of in vitro IFNgamma production by peripheral blood mononuclear cells stimulated by specific antigens (ESAT-6 and CFP-10), which are found neither in the BCG vaccine nor in other micro-organisms in the environment should perform better than the PPD, owing to a presumed higher specificity as well as to correlation with indirect measures of exposure to Mycobacterium tuberculosis besides decreased cross-reactivity determined by prior BCG vaccination and/or other infections.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: estudo multicêntrico brasileiro / Sertraline for the treatment of mild to moderate major depression: brazilian multicenter study

Introdução: O presente estudo teve por objetivo avaliar a eficácia, segurança e tolerabilidade da sertralina no tratamento de pacientes com depressão maior leve e moderada. Pacientes e métodos: Os pacientes selecionados tinham idade > 18 anos e estavam em tratamento ambulatorial. Medicamentos anteriores foram suspensos durante um período de wash-out de duas semanas. A seguir, os pacientes receberam a sertralina, na dose inicial de 50 mg/dia, até a quarta semana. A partir de então a dose diária de manutenção poderia ser aumentada até 200 mg, de acordo com a eficácia e tolerabilidade. A eficácia terapêutica foi avaliada pelos escores nas escalas Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton para Depressão (HAM-D) e de Impressão Clínica Global (ICG). Resultados: Foram avaliados quanto à segurança e à eficácia 51 pacientes (42 mulheres). O tratamento com sertralina mostrou reduções significativas dos escores nas escalas MADRS, HAM-D e ICG de 15,7±6,1; 12,2±3,9 e 3,5±0,6 para 6,2±6,5; 5,4±4,7 e 2,3±1,0 (P<0,0001). A sertralina foi bem tolerada, sendo os eventos adversos mais freqüentes desconforto gastrointestinal (N=14; 24,6), cefaléia (N=7; 12,3), alterações do sono (N=7; 12,3), tontura (N=4; 7,0) e anorexia (N=4; 7,0). Seis pacientes descontinuaram o estudo por eventos adversos. Conclusão: A sertralina se mostrou eficaz e com bom perfil de segurança e tolerabilidade no tratamento de pacientes com depressão maior leve e moderada.

Estudo comparativo de quatro critérios de classificação para artrite psoriásica / Comparative study of four classification criteria for psoriatic arthritis

OBJETIVO: comparar o desempenho de quatro grupos de critérios propostos para definir artrite psoriásica (AP) em pacientes portadores de artropatia inflamatória: Moll e Wright, Bennet, Vasey e Espinoza e Fournié. MÉTODOS: foram analisados dados clínicos e laboratoriais de 195 pacientes divididos em dois grupos: 65 portadores de artrite psoriásica (grupo AP) e 130 portadores de artrite reumatóide (grupo AR). Os casos foram representados pelo grupo AP. Após definição dos falsos positivos, verdadeiros negativos, verdadeiros positivos e falsos negativos foram calculadas a sensibilidade e a especificidade de cada critério. RESULTADOS: os critérios de Fournié foram os que apresentaram melhor desempenho, com sensibilidade de 93,84 por cento e especificidade de 96,22 por cento. Os de Bennet foram os que demonstraram sensibilidade mais baixa (26,15 por cento), por outro lado, obtiveram especificidade de 100 por cento. CONCLUSÃO: os critérios de Fournié parecem ser os mais efetivos em identificar as diversas formas da AP, inclusive nos casos da AP sem lesão cutânea ou nas formas entesopáticas difusas, permitindo que se faça diagnóstico mais precocemente e evitando as possíveis complicações que podem levar à incapacidade e deformidades permanentes.

OBJECTIVE: to compare the sensitivity and specificity of the four classification criteria of psoriatic arthritis (PA) in patients with inflammatory arthropathy: the Moll's and Wright's criteria, Bennet criteria, Vasey and Espinoza's criteria and Fournié's criteria. METHODS: we analysed 195 patients distributed in two groups: 65 patients with psoriatic arthritis (PA group) and 130 patients with rheumatoid arthritis (RA group). After defining the true positives, true negatives, false positives and false negatives, we calculated the sensitivity and specificity of each criteria. RESULTS: the Fournié's criteria were those with better performance, showing a sensitivity of 93.84 percent and specificity of 96.22 percent. The Bennet's criteria had a lower sensitivity (26.15 percent), but on the other hand, the high specificity (100 percent). CONCLUSION: the Fournié's criteria appears to be the most efficient to identify the various PA's forms, including the cases of PA without cutaneous psoriasis or in the group with diffuse enthesopathies, allowing an early diagnostic and avoiding the possible complications that can lead to permanent incapacity and deformity.

Doenca de Castleman mimetizando doenca de Still do adulto / Castleman's disease mimicking adult-onset Still's disease

A doenca de Castleman (DC) é uma doenca linfoproliferativa não neoplásica rara, de etiologia desconhecida, que se caracteriza clinicamente por adenomegalias isoladas ou múltiplas, podendo ou não estar associada a sintomas sistêmicos, como febre e perda de peso. Estes sintomas podem levar a um diagnóstico equivocado de doenca auto-imune e o diagnóstico diferencial deve ser feito através de exame anatomopatológico do linfonodo acometido, que caracteristicamente, na DC, mostra um padrão de células plasmáticas com infiltrado hialino. Os autores relatam o caso de uma paciente de 24 anos de idade, com apresentacão inicial de febre, poliartrite e "rash", sugerindo doenca de Still do adulto cujo achado anatomopatológico confirmou o diagnóstico de DC.