Distinct antibody profile: a clue to primary antiphospholipid syndrome evolving into systemic lupus erythematosus?

We have performed a retrospective study to determine if patients with antiphospholipid syndrome that developed systemic lupus erythematosus (APS/SLE) had distinct clinical and/or serological features. All 80 primary APS (PAPS) patients followed up at our APS unit were included in the study and divided into two groups: 14 APS/SLE and 66 PAPS. Prior or at onset of lupus manifestations, six patients were uniformly negative for lupus and Sjögren autoantibodies, and the other eight patients had persistent positive. In the first year after diagnosis of SLE, three patients remained with negative antibodies, the other seven patients maintained the same antibodies, and four patients developed other antibodies. APS/SLE group had a significant lower mean age at PAPS diagnosis (26.0 ± 8.0 vs. 34.2 ± 11.9 years, p = 0.03) and a longer disease duration (14.0 ± 7.0 vs. 6.0 ± 5.0 years, p < 0.0001). The mean time for PAPS to develop SLE was 5.2 ± 4.3 years. The typical clinical and laboratorial findings of APS did not discriminate both groups of patients. At lupus onset, antinuclear antibodies were more frequently observed in those who evolved to SLE (100 vs. 51.5%, p = 0.0005). Anti-double-stranded DNA (dsDNA), anti-ribosomal P, anti-Ro/SS-A, anti-La/SS-B, and anti-U1RNP antibodies were exclusively found in the APS/SLE patients, whereas anti-Smith (Sm) antibodies were not detected in both groups. The detection of a distinct subgroup of lupus-associated autoantibody in PAPS patients seems to be a hint to overt SLE disease, particularly in those patients with young age at diagnosis.

Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil.

OBJECTIVE: To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. METHODS: A retrospective study performed by analysis of medical charts (n = 7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the chi2 test (p < 0.05). RESULTS: In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the > or = 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. CONCLUSIONS: The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.

Apgar score and neonatal mortality in a hospital located in the southern area of São Paulo City, Brazil / Escore de Apgar e mortalidade neonatal em um hospital localizado na zona sul do município de São Paulo

Objective: To correlate the Apgar score, and neonatal mortality and its causes at a hospital located in the southern area of São Paulo City. Methods: A retrospective study performed by analysis of medical charts (n=7,094) of all live newborns during the period of 2005 to 2009, with data up to 28 days of life in reference to weight, Apgar score, survival and cause of mortality. Cases were analyzed by the X² test (p < 0.05). Results: In 7,094 births, there were 139 deaths, 58.3% during the first week, and 3.6% of them with Apgar < 4 in the 1st minute. A positive association was found between mortality and this variable, with significantly declining values up to 2,000 g in weight. In the group with weight < 1,000 g, the association with Apgar < 4 in the 1st minute with mortality was three-fold greater than in the 1,000-1,500 g weight group, and 35-fold greater than in the ? 3,000 g group. Among newborns with Apgar 8-10, the rate of mortality and low weight was two times greater than in those with weight > 2,499 g. Fetal distress and prematurity were associated with early neonatal death; malformations and fetal distress to late mortality. The predictive value of death with Apgar < 4 varied, according to weight, from 62.74% in the < 1,000 g group to 5.5%, in the > 3,000 g group. Conclusions: The Apgar score proved linked to factors both epidemiological and related to attention given to the birth and neonatal mortality, and was associated with extremely low birth weight.

Objetivo: Correlacionar o escore de Apgar e a mortalidade neonatal e suas causas em um hospital localizado na zona Sul do município de São Paulo. Métodos: Estudo retrospectivo por análise de prontuário (n=7.094), de todos os recém-nascidos vivos, no período de 2005 a 2009, com dados referentes até os 28 dias de vida, quanto a peso, escore de Apgar, sobrevida e causa de mortalidade. Os casos foram analisados pelo teste do X² (p < 0,05). Resultados: Nos 7.094 nascimentos, houve 139 óbitos, 58,3% na primeira semana, 3,6% com Apgar < 4 no 1º minuto. Foi encontrada associação positiva entre mortalidade e essa variável, com valores decrescentes significantemente até o peso de 2.000 g. No grupo de peso < 1.000 g, a associação do Apgar < 4 no 1º minuto com mortalidade foi três vezes maior do que no grupo 1.000 a 1.500 g e 35 vezes maior do que no grupo ? 3.000 g. Entre os recém-nascidos com Apgar de 8 a 10, a mortalidade entre baixo peso foi duas vezes maior do que nos de peso > 2.499 g. O sofrimento fetal e a prematuridade se associaram a óbito neonatal precoce; malformações e o sofrimento fetal à mortalidade tardia. O valor preditivo de morrer quando o Apgar < 4 variou, conforme o peso, entre 62,74% no grupo < 1.000 g a 5,5% no grupo > 3.000 g. Conclusões: O escore de Apgar se mostrou ligado a fatores epidemiológicos e de atenção ao parto, à mortalidade neonatal e se associou a extremo baixo peso.

Antiphospholipid syndrome plus rheumatic fever: a higher risk factor for stroke?

To compare clinical and laboratory findings between patients with primary antiphospholipid syndrome (PAPS) versus secondary APS due to rheumatic fever (APS-RF) (according to Jones criteria). Seventy-three APS patients (Sapporo criteria) were enrolled, and demographic, clinical, and laboratory data were collected. Exclusion criteria were heart congenital abnormalities and previous infectious endocarditis. Patients were divided into two groups: PAPS (n = 68) and APS-RF (n = 5). The mean current age, disease duration, frequencies of female gender, and Caucasian race were similar in APS-RF and PAPS patients (P > 0.05). Remarkably, the frequency of stroke was significantly higher in APS-RF compared to PAPS patients (80% vs. 25%, P = 0.02). Of note, echocardiogram of these patients did not show intracardiac thrombus. No significant differences were found in peripheral thromboembolic events (P = 1.0), pulmonary thromboembolism (P = 1.0), miscarriage (P = 0.16), thrombocytopenia (P = 0.36), arterial events (P = 0.58), and thrombosis of small vessels (P = 1.0). There were no differences in the frequencies of comorbidities such as diabetes mellitus, hypertension, smoking, and hyperlipidemia in both groups (P > 0.05). The frequencies of lupus anticoagulant, IgG, and IgM anticardiolipin were similar in two groups. APS patients associated with rheumatic fever without infective endocarditis may imply a high stroke risk as compared with PAPS, and future studies are needed to confirm this finding.

Segunda etapa da Campanha Nacional de Multivacinação do município de São Paulo, 2005: perfil de cobertura de diferentes Unidades Básicas de Saúde / Second stage of the national multivaccination campaign in the city of São Paulo, 2005: profile of coverage at different health centers

OBJETIVO: Analisar a cobertura vacinal das crianças durante a segunda etapa da Campanha Nacional de Multivacinação em Unidades Básicas de Saúde (UBS), comparando as diferentes regiões do município de São Paulo. MÉTODOS: Levantamento quantitativo e qualitativo de variáveis referentes às crianças imunizadas durante a vacinação realizada no dia 20/08/2005. Utilizou-se questionário padronizado para a coleta dos seguintes dados: idade, gênero, motivo do atraso vacinal, modo como foi informado da campanha e conhecimento dos responsáveis sobre o intuito da vacinação contra poliomielite. A amostra compreendeu 401 crianças de zero a cinco anos das regiões Norte, Sul, Leste e Oeste da cidade de São Paulo. Foi aplicado o teste de Mann-Whitney, para comparar as idades das crianças de acordo com o gênero, e o qui-quadrado, para verificar a associação entre as regiões municipais, gênero, idade e atraso vacinal. RESULTADOS: A cobertura da segunda etapa da Campanha, de acordo com dados fornecidos pelo Ministério da Saúde, foi de 84,7 por cento - aquém do preconizado. Nossos resultados mostraram que a região Leste apresentou mais crianças com atraso vacinal, justificado pelo difícil acesso à UBS. A televisão foi o meio de divulgação mais eficiente e o médico, o menos. CONCLUSÕES: Existem bolsões de baixa cobertura vacinal. Nenhuma das regiões estudadas atingiu a meta preconizada pelo Programa Nacional de Imunizações (100 por cento). Os gestores locais e os profissionais de saúde devem ser sensibilizados quanto à importância da Campanha.

OBJECTIVE: To compare children vaccine coverage during the second stage of the National Campaign of Multivaccination among Health Centers of different regions of São Paulo city, São Paulo, Brazil. METHODS: This quantitative and qualitative survey enrolled 401 children from 0-5 years old, immunized during the National Campaign of Multivaccination on August 20th, 2005, at North, South, East and West regions of São Paulo city. Standardized questionnaire for data collection was applied to get the following data: ages, gender, reason for vaccination delay, how the adults were informed about the Campaign and how knowledgeable were the adults in charge of the children about the objectives of polio immunization. Mann-Whitney test was applied to compare the children's age by gender and chi-square test was applied to verify the association among the city regions, gender, age and vaccination delay. RESULTS: The coverage of the second stage of the Campaign, according to the National Health Department, was of 84.7 percent, which was below expectation. Our results showed that the East region of São Paulo city presented more children with immunization delays. This finding was justified by difficulties regarding transportation to Health Centers in this area. Television was the most efficient way to inform parents about the Campaign and the physicians, the less efficient one. CONCLUSIONS: None of the studied region reached the goal set by the National Program of Immunization (100 percent). Local managers and the health professionals should be sensitized regarding the importance of immunization campaigns.