Recommendations on cutaneous and hematological manifestations of Sjögren's disease by the Brazilian Society of Rheumatology.

Sjogren's disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations.

Hypocitraturia as a biomarker of renal tubular acidosis in patients with Sjögren's disease.

INTRODUCTION: Sjögren's disease (SD) is an immune-mediated chronic inflammatory disease that affects epithelial tissues, mainly salivary and lacrimal glands. It also presents extraglandular manifestations. The main renal manifestation is tubulointerstitial nephritis (TIN), which can manifest as renal tubular acidosis (RTA). Urinary citrate may be a biomarker of RTA in these patients. The objective of this study was to evaluate whether hypocitraturia is a predictive biomarker of RTA in a sample of patients with SD in a tertiary hospital in southern Brazil. METHODS: All patients with SD who met the inclusion criteria and who participated in the rheumatology outpatient clinic of the Irmandade Santa Casa de Misericórdia de Porto Alegre were included. Demographic, SD, serological and urinary data were obtained. RTA was considered in those patients who persistently presented urinary pH above 5.5 and serum pH below 7.35. Patients who persistently had urinary pH above 5.5 underwent a urinary acidification test with furosemide and fludrocortisone. These patients received 1 mg of fludrocortisone and 40 mg of furosemide and had their urine samples tested 2, 4 and 6 h after taking the medications. The test was stopped at any urine sample with pH 5.5 or less. The variables were expressed as mean and standard deviation or interquartile range. The association between hypocitraturia and RTA was assessed using the chi-square. RESULTS: Forty-two patients were included, 95.2% female with a median age of 61.73 years. The prevalence of complete distal RTA was 4.88%. Twenty-eight patients underwent urine acidification testing. Five patients had hypocitraturia, and two of them had complete distal RTA. The association between hypocitraturia and RTA was statistically significant (p < 0.012), with a sensitivity of 100%, specificity of 91.2% and accuracy of 91.7%. The negative predictive value was 100%. The global renal assessment of the population demonstrated two patients with RTA, one patient with decreased renal function and six patients with proteinuria greater than 0.5 g/24 h. CONCLUSION: The prevalence of RTA in the studied population was 4.88%. Hypocitraturia had high sensitivity and accuracy for the diagnosis of RTA.

Short report: Spatial distribution and growth of sheep farming in Brazilian Amazon.

Sheep farming has grown substantially in the Brazilian Amazon over the previous three decades. This article analyzes the spatial distribution and the dynamics of sheep herd growth using data from the Brazilian Institute of Geography and Statistics-IBGE from 1990 to 2020. The sheep herd growth rates and densities were estimated to assess its dynamics. Maps were then drawn up to show the spatial dynamics of these variables. The highest concentration of herds in the last decade (2010) occurred in Pará, Mato Grosso, and Maranhão states. For each decade there were different growth patterns, but for the entire period (1990 to 2020), there was growth in Mato Grosso, Pará, Maranhão, Tocantins, and Amazonas micro-regions states. The highest density of herd (animals per area) was observed in Maranhão. The potential points for development identified in this study may support strategic planning aimed at strengthening the activity in the region.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic).

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Nivel de complexidade assistencial de idosos internados: Perfil assistencial nas clínicas de um hospital universitário / Nivel de complejidad de atención de ancianos internados: Perfil deatención en los consultorios de un hospital universitario / Level of assistance complexity of the elderly interned: Care profile inclinics a university hospital

Objetivo: Conhecer o nível de complexidade assistencial de idosos internados. Métodos: Trata-se de um estudo retrospectivo, descritivo realizado em fichas de 161 idosos internados em um Hospital Universitário, entre janeiro a abril de 2018. Investigou-se dados sociodemográficos, clínicos, estilo de vida e sistema de classificação de pacientes proposto por Fugulin e colaboradores. A pesquisa consta aprovação do Comitê de Ética em Pesquisa do HUUFMA nº 2.306.474. Resultados: O perfil encontrado foi: sexo feminino (64,59%), com média de idade 70,1 (± 6,8), baixa escolaridade (59,01%) e baixa renda (72,67%), sedentário (67,70%), níveis pressóricos alterados (54,03%) e pré-sarcopênicos (39,13). Doenças cardiovasculares (31,0%) como causa de internação. O nível de complexidade assistencial era de cuidados mínimos (63,4%) e as áreas de cuidados mais afetadas foram sinais vitais, alimentação, cuidado corporal e terapêutica. Conclusão: Os idosos requeriam cuidados mínimos da enfermagem, mesmo com diagnóstico de doença cardíaca e condições sociodemográficas e clínicas desfavoráveis(AU)

Objective: To know the level of care complexity of hospitalized elderly. Methods: This is a retrospective, descriptive study carried out on files of 161 elderly people admitted to a University Hospital, between January and April 2018. Sociodemographic, clinical, lifestyle and patient classification system proposed by Fugulin were investigated. and collaborators. The research is approved by the Research Ethics Committee of HUUFMA no 2.306.474. Results: The profile found was: female (64.59%), with a mean age of 70.1 (± 6.8), low education (59.01%) and low income (72.67%), sedentary ( 67.70%), altered blood pressure levels (54.03%) and pre-sarcopenic (39.13%). Cardiovascular diseases (31.0%) as a cause of hospitalization. The level of care complexity was minimal care (63.4%) and the most affected care areas were vital signs, food, body care and therapy. Conclusion: The elderly required minimal nursing care, even with a diagnosis of heart disease and unfavorable sociodemographic and clinical conditions.(AU)

Objetivo: Conocer el nivel de complejidad asistencial del anciano hospitalizado. Métodos: Se trata de un estudio retrospectivo, descriptivo, realizado en expedientes de 161 adultos mayores ingresados en un Hospital Universitario, entre enero y abril de 2018. Se investigó sociodemográfica, clínica, estilo de vida y sistema de clasificación de pacientes propuesto por Fugulin y colaboradores. La investigación está aprobada por el Comité de Ética en Investigación del HUUFMA no 2.306.474. Resultados: El perfil encontrado fue: femenino (64,59%), con edad media de 70,1 (± 6,8), baja escolaridad (59,01%) y bajos ingresos (72,67%), sedentario (67,70%), presión arterial alterada (54,03 %) y presarcopénica (39,13%). Las enfermedades cardiovasculares (31,0%) como causa de hospitalización. El nivel de complejidad asistencial fue atención mínima (63,4%) y las áreas asistenciales más afectadas fueron signos vitales, alimentación, cuidado corporal y terapia. Conclusión: Los ancianos requieren cuidados de enfermería mínimos, incluso con diagnóstico de cardiopatía y condiciones sociodemográficas y clínicas desfavorables.(AU)

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal).

Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

Diabetes mellitus type 2: factors related to adherence to self-care.

OBJECTIVES: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2. METHODS: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão. RESULTS: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities. CONCLUSIONS: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force.

OBJECTIVE: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. METHODS: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. RESULTS: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4-agree-and 5-strongly agree-, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. CONCLUSION: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Caracterização do cuidador informal de idosos hospitalizados: um estudo transversal / Characterization of the informal caregiver of hospitalized elderly: a cross-sectional study / Caracterización del cuidador informal de ancianos hospitalizados: un estudio transversal

OBJETIVO: descrever o perfil sociodemográfico e clínico, os hábitos de vida e a sobrecarga do trabalho de cuidador familiar de idosos internados em um hospital universitário. MÉTODO: trata-se de um estudo transversal, quantitativo, realizado com 161 cuidadores/familiares de idosos durante a hospitalização em um hospital universitário. Foi aplicado aos participantes o Questionário de Avaliação de Sobrecarga do Cuidador Informal, sendo os dados analisados no programa STATA 12.0®. RESULTADOS: caracterizou-se a predominância do sexo feminino, com média de idade de 63 anos, sedentários, com sobrepeso, com hipertensão arterial sistêmica como principal comorbidade e detectou-se sobrecarga grave (41,6%) e extremamente grave (29,9%) nos participantes da pesquisa. Observou-se que o instrumento utilizado apresentou boa consistência interna, onde os domínios Sobrecarga Emocional, Implicações na Vida Pessoal, Sobrecarga Financeira e Suporte Familiar apresentaram maior pontuação. CONCLUSÃO: a sobrecarga dos cuidadores informais dos idosos foi detectada como grave e extremamente grave, repercutindo diretamente na saúde mental, vida social e financeira.

OBJECTIVE: to describe the sociodemographic and clinical profile, life habits and workload of a family caregiver of elderly people admitted to a university hospital. METHOD: this is a cross-sectional, quantitative study carried out with 161 caregivers/relatives of the elderly during hospitalization at a university hospital. The Informal Caregiver Burden Assessment Questionnaire was applied to the participants, and the data were analyzed using the STATA 12.0® program. RESULTADOS: we characterized the predominance of females, with a mean age of 63 years, sedentary, overweight, with systemic arterial hypertension as the main comorbidity, and severe (41.6%) and extremely severe (29.9%) overload was detected in the research participants. It was observed that the instrument used had good internal consistency, where the domains Emotional Burden, Implications for Personal Life, Financial Burden and Family Support had higher scores. CONCLUSION: the burden of informal caregivers of the elderly was detected as serious and extremely serious, directly impacting mental health, social and financial life.

OBJETIVO: describir el perfil sociodemográfico y clínico, los hábitos de vida y la sobrecarga de trabajo de cuidador familiar de ancianos internados en un hospital universitario. MÉTODO: trátase de un estudio transversal, cuantitativo, realizado con 161 cuidadores/familiares de ancianos durante la hospitalización en un hospital universitario. El Cuestionario de Evaluación de Sobrecarga del Cuidador Informal fue dado a los participantes y los datos fueron analizados en el programa STATA 12.0®. RESULTADOS: quedó caracterizada la predominancia del sexo femenino, con promedio de edad de 63 años, sedentarios, con sobrepeso, con hipertensión arterial sistémica como principal comorbilidad y se detectó sobrecarga grave (41,6%) y extremamente grave (29,9%) en los participantes de la investigación. Se observó que el instrumen-to utilizado presentó buena consistencia interna, donde los dominios Sobrecarga Emocional, Implicancias en la Vida Personal, Sobrecarga Financiera y Apoyo Familiar presentaron puntuación más elevada. CONCLUSIÓN: la sobrecarga de los cuidadores informales de los ancianos fue detectada como grave y sumamente grave, repercutiendo directamente en la salud mental, vida social y financiera.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Diabetes mellitus type 2: factors related to adherence to self-care / Diabetes mellitus tipo 2: factores relacionados a la adhesión al autocuidado / Diabetes mellitus tipo 2: fatores relacionados com a adesão ao autocuidado

ABSTRACT Objectives: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2. Methods: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão. Results: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities. Conclusions: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

RESUMEN Objetivos: analizar variables sociodemográficas y clínicas relacionadas a la adhesión a actividades de autocuidado en personas con diabetes mellitus tipo 2. Métodos: estudio cuantitativo, transversal, realizado con 270 personas con diabetes, entre diciembre de 2019 y octubre de 2020, en São Luís, Maranhão. Resultados: hubo adhesión más favorable al autocuidado cuanto al uso del medicamento (Md=7,0) y cuidados con los pies (Md= 6,0) y adhesión menos deseable cuanto al monitoreo de la glucemia (Md=1,0), práctica de actividad física (Md=2,0) y alimentación general (Md=4,0). Las variables franja etaria (p=0,007), escolaridad (p=0,015), índice de masa corporal (p=0,035), complicación del diabetes (p=0,009) y acompañamiento nutricional (p=0,000) presentaron relación con las actividades de autocuidado. Conclusiones: la identificación de factores relacionados a la adhesión al autocuidado se mostró esencial para el fortalecimiento de la línea de cuidados en enfermedades crónicas y direccionamiento de acciones educativas, visando mejorar la calidad de vida de personas con diabetes.

RESUMO Objetivos: analisar as variáveis sociodemográficas e clínicas relacionadas com a adesão às atividades de autocuidado em pessoas com diabetes mellitus tipo 2. Métodos: estudo quantitativo, transversal, realizado com 270 pessoas com diabetes, entre dezembro de 2019 e outubro de 2020, em São Luís, Maranhão. Resultados: houve adesão mais favorável ao autocuidado quanto ao uso do medicamento (Md=7,0) e cuidados com os pés (Md= 6,0) e adesão menos desejável quanto à monitorização da glicemia (Md=1,0), prática da atividade física (Md=2,0) e alimentação geral (Md=4,0). As variáveis faixa etária (p=0,007), escolaridade (p=0,015), índice de massa corporal (p=0,035), complicação do diabetes (p=0,009) e acompanhamento nutricional (p=0,000) apresentaram associação com as atividades de autocuidado. Conclusões: a identificação dos fatores relacionados com a adesão ao autocuidado mostrou-se essencial para o fortalecimento da linha de cuidados em doenças crônicas e direcionamento das ações educativas, visando melhorar a qualidade de vida das pessoas com diabetes.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)

Abstract Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome.

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

Influência da idade materna nas condições perinatais em nascidos vivos de São Luís, Maranhão / Influence of maternal age in perinatal conditions in live births of São Luís, Maranhão / Influencia de la edad materna en las condiciones perinatales en nacidos vivos de San Luís, Maranhão

Objetivo: investigar os fatores maternos e perinatais associados aos extremos da idade reprodutiva da mulher em São Luís, Maranhão. Método: trata-se de um estudo transversal, realizado em São Luís/MA, com população de 16.474 mães. Os dados foram coletados no Sinasc disponibilizado pela Secretaria Municipal. Utilizou-se o Teste Qui-quadrado de Pearson e calculou-se a Odds Ratio com nível de significância de α = 0.05. Resultados: verificou-se que as adolescentes apresentaram maior chance de nascimentos prematuros (OR=1,37; p< 0,001 mulheres com idade avançada apresentaram maior risco para baixo peso ao nascer (OR=1,22; p=0,022). Tanto as adolescentes (OR=2,09; p< 0,001) quanto as mães com idade avançada (OR=1,85; p<0,0011) possuem chances aumentadas para realizarem menos que seis consultas de pré-natal. Conclusão: os resultados perinatais, nascimento prematuro, baixo peso ao nascer e a realização de menos de seis consultas pré-natais são elevados nas gestações de adolescentes e mulheres em idade avançada

Objective: to investigate maternal and perinatal factors associated with extremes of women's reproductive age in São Luís, Maranhão. Method: this is a cross-sectional study conducted in São Luís/MA, with a population of 16,474 mothers. The data were collected in the Sinasc provided by the Municipal Health Secretariat. We used the Pearson Chi-square test and calculated the odds ratio with a significance level of α=0.05. Results: it was verified that the adolescents had a higher chance of preterm birth (OR=1.37; p<0,001); Women aged 35 years or older were at increased risk for low birth weight (OR=1.22; p=0.022). Both adolescents (OR=2.09; p<0,001) and older mothers (OR=1.85; p<0,001) have an increased chance to perform less than six prenatal visits. Conclusion: perinatal outcomes, preterm birth, low birth weight and fewer than six prenatal visits are frequent in the pregnancies of adolescents and women of advanced age

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review).

BACKGROUND: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. CONCLUSION: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

Caracterização sociodemográfica e clínica de homens com câncer de próstata / Sociodemographic and clinical characterization of men with prostate cancer / Caracterización sociodemográfica y clinica de hombres con cáncer de próstata

RESUMO Objetivo Caracterizar aspectos socioeconómicos, demográficos, de saúde e clínicos de homens com câncer de próstata no Maranhão. Metodologia Estudo prospectivo, descritivo de base primária. Resultados: Do total de 226 homens com câncer de próstata,44,2% tinham entre 71-80 anos, 82,3% autoreferiram a raça parda, 62,8% não eram aposentados, 90,3% tinham renda mensal de até dois salários mínimos, 63,7% tinham menos de oito anos de estudo, 80,5% eram casados, 61,9% eram do interior do estado, 76,1% não praticavam atividade física, 53,1% procuravam assistência em saúde apenas quando apresentavam algum problema, 51,3% realizaram a cirurgia de retirada de próstata. Conclusão Ferramentas e estratégias devem ser desenvolvidas voltadas para o público masculino, focadas na promoção e prevenção do câncer de próstata, observando características inerentes dos homens por região possibilitando um diagnóstico precoce e consequente possibilidade de cura.(AU)

ABSTRACT Objective To characterize socioeconomic, demographic, health and clinical aspects of men with prostate cancer in the state of Maranhão, Brazil. Methodology Prospective, descriptive primary study. Results Of 226 men with prostate cancer, 44.2% were aged 71-80 years, 82.3% self-reported as mestizo, and 62.8% were not retired. Moreover, 90.3% had a monthly income of up to two minimum wages, 63.7% had less than eight years of schooling, 80.5% were married, 61.9% were from the interior of the state, and 76.1% did not practice physical activity. Regarding their health, 53.1% sought health care only when they presented a problem and 51.3% underwent prostatectomy. Conclusion Tools and strategies developed for the male public should focus on the promotion and prevention of prostate cancer, taking into account the inherent characteristics of men by region, thus enabling early diagnosis and consequent possibility of cure.(AU)

RESUMEN Objetivo Caracterizar aspectos socioeconómicos, demográficos, de salud y clínicos de hombres con cáncer de próstata en el estado de Maranhão, Brasil. Metodología Estudio prospectivo, descriptivo de fuente primaria. Resultados Del total de 226 hombres con cáncer de próstata, 44,2% tenían entre 71-80 años, 82,3% se auto-describían como mestizos, 62,8% no eran jubilados, el 90,3% tenían ingresos mensuales de hasta dos salarios mínimos, el 63,7% tenían menos de ocho años de estudio, el 80,5% estaban casados, el 61,9% eran del interior del estado, el 76,1% no practicaba actividad física, el 53,1% buscaban asistencia en salud solo cuando se presentaba algún problema, y el 51,3% se realizó prostatectomía. Conclusión Las herramientas y estrategias desarrolladas y dirigidas al público masculino deben enfocarse en la promoción y prevención del cáncer de próstata, teniendo en cuenta las características inherentes de los hombres por región, posibilitando así el tratamiento oportuno de la enfermedad y aumentando la posibilidad de curación.(AU)

[Sociodemographic and clinical characterization of men with prostate cancer]. / Caracterização sociodemográfica e clínica de homens com câncer de próstata.

OBJECTIVE: To characterize socioeconomic, demographic, health and clinical aspects of men with prostate cancer in the state of Maranhão, Brazil. METHODOLOGY: Prospective, descriptive primary study. RESULTS: Of 226 men with prostate cancer, 44.2% were aged 71-80 years, 82.3% self-reported as mestizo, and 62.8% were not retired. Moreover, 90.3% had a monthly income of up to two minimum wages, 63.7% had less than eight years of schooling, 80.5% were married, 61.9% were from the interior of the state, and 76.1% did not practice physical activity. Regarding their health, 53.1% sought health care only when they presented a problem and 51.3% underwent prostatectomy. CONCLUSION: Tools and strategies developed for the male public should focus on the promotion and prevention of prostate cancer, taking into account the inherent characteristics of men by region, thus enabling early diagnosis and consequent possibility of cure.