Risk factors for mortality in 1528 Brazilian childhood-onset systemic lupus erythematosus patients.

OBJECTIVES: To identify associations between mortality in cSLE patients and their characteristics: clinical and laboratory features, disease activity and damage scores, and treatment; to evaluate risk factors associated with mortality in cSLE; and to determine the most frequent causes of death in this group of patients. METHODS: We performed a multicenter retrospective cohort using data from 1,528 cSLE patients followed in 27 pediatric rheumatology tertiary centers in Brazil. Patients' medical records were reviewed according to a standardized protocol, in which information regarding demographic and clinical features, disease activity and damage scores, and treatment were collected and compared between deceased cSLE patients and survivors. Univariate and multivariate analyses by Cox regression model were used to calculate risk factors for mortality, whereas survival rates were analyzed by Kaplan-Meier plots. RESULTS: A total of 63/1,528 (4.1%) patients deceased, 53/63 were female (84.1%), median age at death was 11.9 (9.4-13.1) years and median time interval between cSLE diagnosis and death was 3.2 (0.5-5.3) years. Sepsis was the main cause of death in 27/63 (42.8%) patients, followed by opportunistic infections in 7/63 (11.1%), and alveolar hemorrhage in 6/63 (9.5%) patients. The regression models resulted in neuropsychiatric lupus (NP-SLE) (HR = 2.56, 95% CI = 1.48-4.42) and chronic kidney disease (CKD) (HR = 4.33, 95% CI = 2.33-4.72), as risk factors significantly associated with mortality. Overall patient survival after cSLE diagnosis at 5, 10, and 15 years were 97%, 95.4%, and 93.8%, respectively. CONCLUSIONS: This study confirmed that the recent mortality rate in cSLE in Brazil is low, but still of concern. NP-SLE and CKD were the main risk factors for mortality, indicating that the magnitude of these manifestations was significantly high.

Symptomatic polyautoimmunity at diagnosis of 1463 childhood-onset lupus: A Brazilian multicenter study.

OBJECTIVE: To evaluate symptomatic polyautoimmunity (PA) at childhood-onset systemic lupus erythematosus(cSLE) diagnosis, and its association with demographic data, disease activity, clinical manifestations and laboratorial abnormalities in a large Brazilian cSLE population. METHODS: A multicenter retrospective study was performed in 1463 cSLE(ACR criteria) patients from 27 Pediatric Rheumatology services. Symptomatic PA was defined according to the presence of more than one concomitant autoimmune disease(AD) and symptomatic multiple autoimmune syndrome(MAS) was defined as three or more AD. An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2K were evaluated. RESULTS: At cSLE diagnosis symptomatic PA was observed in 144/1463(9.8%) and symptomatic MAS occurred in solely 10/1463(0.7%). In the former group the more frequently observed associated AD were Hashimoto thyroiditis n = 42/144(29%), antiphospholipid syndrome n = 42/144(29%), autoimmune hepatitis n = 26/144(18%) and type 1 diabetes mellitus n = 23/144(15.9%). Further comparisons between cSLE patients with and without PA showed a higher median age(p = 0.016) and lower mean SLICC criteria (p = 0.039) in those with PA. Additionally, these cSLE patients had less renal involvement(35% vs. 44%, p = 0.038) and red blood cell cast(6% vs. 12%, p = 0.042) and more antiphospholipid antibodies(29% vs. 15%, p < 0.0001). CONCLUSIONS: Approximately 10% of cSLE had symptomatic PA at diagnosis, particularly endocrine autoimmune disorders and antiphospholipid syndrome. Lupus was characterized by a mild disease onset and MAS was infrequently evidenced. Further studies are necessary to determine if this subgroup of cSLE patients have a distinct genetic background with a less severe disease and a better long-term outcome.

Uso del girasol (Helianthus annuus ) en la alimentación animal: aspectos productivos y nutricional / Use of the sunflower (Helianthus annuus) in the animal feed: aspects productive and nutritional / Uso do girassol (Helianthus annuus) na alimentação animal: aspectos produtivos e nutricionais

El maíz y la soja son para alimentar la base, y representan una gran parte de los costos de producción. Los estudios demuestran que es posible la sustitución parcial de alimentos tradicionales utilizados en la alimentación animal para alimentos alternativos, como el de girasol, lo que reduce los costos de producción y la dependencia de los productores en relación con la soja y el maíz en la alimentación animal. Girasol puede ser ofrecido como alimento para animales en forma de harina de pastel y ensilaje, por ejemplo, siendo la variable de cantidad y en función de la especie utilizada y cómo es que se ofrecen. En general, el girasol tiene un gran potencial para sustituir en parte y en algunos casos los alimentos totalmente tradicionales en la alimentación animal . El objetivo era discutir, demostrar y ejemplificar el potencial y los desafíos de la utilización de girasol en la alimentación animal , así como su valor nutritivo y sus factores limitantes.(AU)

Corn and soybeans is the base to feed and represent a large share of the production costs. Studies show that is possible the partial replacement of traditional foods used in animal feed for alternative foods, such as sunflower, which reduces production costs and the dependence of the producer in relation to soybeans and corn in animal feed. Sunflower can be offered as food for animals in the form of pie, meal and silage, for example, being your quantity variable and depending on the specie used and how it is offer. In general, sunflower has great potential to partially replace and, in some cases, totally, traditional foods in animal feed. The object was to discuss, demonstrate and exemplify the potential and challenges of using sunflower in animal feed, as well as its nutritional value and its limiting factors.(AU)

O milho e a soja são as bases da alimentação animal e representam uma grande fatia dos custos de produção. Estudos demonstram ser possível a substituição parcial de alimentos tradicionais usados na alimentação animal por alimentos alternativos, como o girassol, diminuindo os custos de produção e a dependência do produtor em relação à soja e ao milho na alimentação dos animais. O girassol pode ser oferecido como alimento para o animal na forma de torta, farelo e silagem, por exemplo, sendo sua quantidade de uso variável em função da espécie e da forma como é oferecido. De forma geral, o girassol apresenta grande potencial para substituir parcialmente e, em alguns casos, totalmente, os alimentos tradicionais na alimentação animal. Objetivou-se discutir, demonstrar e exemplificar as potencialidades e desafios da utilização do girassol na alimentação animal, bem como seu valor nutricional e seus fatores limitantes.(AU)

Uso del girasol (Helianthus annuus ) en la alimentación animal: aspectos productivos y nutricional / Use of the sunflower (Helianthus annuus) in the animal feed: aspects productive and nutritional / Uso do girassol (Helianthus annuus) na alimentação animal: aspectos produtivos e nutricionais

El maíz y la soja son para alimentar la base, y representan una gran parte de los costos de producción. Los estudios demuestran que es posible la sustitución parcial de alimentos tradicionales utilizados en la alimentación animal para alimentos alternativos, como el de girasol, lo que reduce los costos de producción y la dependencia de los productores en relación con la soja y el maíz en la alimentación animal. Girasol puede ser ofrecido como alimento para animales en forma de harina de pastel y ensilaje, por ejemplo, siendo la variable de cantidad y en función de la especie utilizada y cómo es que se ofrecen. En general, el girasol tiene un gran potencial para sustituir en parte y en algunos casos los alimentos totalmente tradicionales en la alimentación animal . El objetivo era discutir, demostrar y ejemplificar el potencial y los desafíos de la utilización de girasol en la alimentación animal , así como su valor nutritivo y sus factores limitantes.

Corn and soybeans is the base to feed and represent a large share of the production costs. Studies show that is possible the partial replacement of traditional foods used in animal feed for alternative foods, such as sunflower, which reduces production costs and the dependence of the producer in relation to soybeans and corn in animal feed. Sunflower can be offered as food for animals in the form of pie, meal and silage, for example, being your quantity variable and depending on the specie used and how it is offer. In general, sunflower has great potential to partially replace and, in some cases, totally, traditional foods in animal feed. The object was to discuss, demonstrate and exemplify the potential and challenges of using sunflower in animal feed, as well as its nutritional value and its limiting factors.

O milho e a soja são as bases da alimentação animal e representam uma grande fatia dos custos de produção. Estudos demonstram ser possível a substituição parcial de alimentos tradicionais usados na alimentação animal por alimentos alternativos, como o girassol, diminuindo os custos de produção e a dependência do produtor em relação à soja e ao milho na alimentação dos animais. O girassol pode ser oferecido como alimento para o animal na forma de torta, farelo e silagem, por exemplo, sendo sua quantidade de uso variável em função da espécie e da forma como é oferecido. De forma geral, o girassol apresenta grande potencial para substituir parcialmente e, em alguns casos, totalmente, os alimentos tradicionais na alimentação animal. Objetivou-se discutir, demonstrar e exemplificar as potencialidades e desafios da utilização do girassol na alimentação animal, bem como seu valor nutricional e seus fatores limitantes.

Uso del girasol (Helianthus annuus ) en la alimentación animal: aspectos productivos y nutricional / Use of the sunflower (Helianthus annuus) in the animal feed: aspects productive and nutritional / Uso do girassol (Helianthus annuus) na alimentação animal: aspectos produtivos e nutricionais

El maíz y la soja son para alimentar la base, y representan una gran parte de los costos deproducción. Los estudios demuestran que es posible la sustitución parcial de alimentos tradicionales utilizados en la alimentación animal para alimentos alternativos, como el degirasol, lo que reduce los costos de producción y la dependencia de los productores enrelación con la soja y el maíz en la alimentación animal. Girasol puede ser ofrecido comoalimento para animales en forma de harina de pastel y ensilaje, por ejemplo, siendo la variablede cantidad y en función de la especie utilizada y cómo es que se ofrecen. En general, elgirasol tiene un gran potencial para sustituir en parte y en algunos casos los alimentostotalmente tradicionales en la alimentación animal . El objetivo era discutir, demostrar yejemplificar el potencial y los desafíos de la utilización de girasol en la alimentación animal ,así como su valor nutritivo y sus factores limitantes. 

Corn and soybeans is the base to feed and represent a large share of the production costs.Studies show that is possible the partial replacement of traditional foods used in animal feedfor alternative foods, such as sunflower, which reduces production costs and the dependenceof the producer in relation to soybeans and corn in animal feed. Sunflower can be offered asfood for animals in the form of pie, meal and silage, for example, being your quantity variableand depending on the specie used and how it is offer. In general, sunflower has great potentialto partially replace and, in some cases, totally, traditional foods in animal feed. The objectwas to discuss, demonstrate and exemplify the potential and challenges of using sunflower inanimal feed, as well as its nutritional value and its limiting factors

O milho e a soja são as bases da alimentação animal e representam uma grande fatia doscustos de produção. Estudos demonstram ser possível a substituição parcial de alimentostradicionais usados na alimentação animal por alimentos alternativos, como o girassol,diminuindo os custos de produção e a dependência do produtor em relação à soja e ao milhona alimentação dos animais. O girassol pode ser oferecido como alimento para o animal naforma de torta, farelo e silagem, por exemplo, sendo sua quantidade de uso variável emfunção da espécie e da forma como é oferecido. De forma geral, o girassol apresenta grandepotencial para substituir parcialmente e, em alguns casos, totalmente, os alimentostradicionais na alimentação animal. Objetivou-se discutir, demonstrar e exemplificar aspotencialidades e desafios da utilização do girassol na alimentação animal, bem como seuvalor nutricional e seus fatores limitantes.