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OBJECTIVE: Psoriatic arthritis (PsA) is a chronic inflammatory disorder affecting the joints, skin and entheses. Despite the importance of the topic, few studies have investigated the association between PsA and sexual function. The purpose of this study was to assess sexuality and the prevalence of sexual dysfunction (SD) in patients with PsA. METHODS: This was an observational, cross-sectional single-center study on 23 PsA patients (male=12; female=11) evaluated with 2 male questionnaires (MSQ= Male Sexual Quotient, and IIEF=International Index of Erectile Function) and 2 female questionnaires (FSQ= Female Sexual Quotient, and FSFI=Female Sexual Function Index) validated for Brazilian Portuguese, in order to determine changes in sexual function. Clinical parameters, musculoskeletal activity and skin activity were also analyzed to identify factors associated with SD. RESULTS: The mean age was 52.1±9.7 years (males) and 49.1±9.6 years (females). Clinically, the patients had low skin and peripheral joint disease activity or were in remission. The mean time of PsA was 10±6.2 years, and 65.2% had a steady sexual partner. The mean MSQ score was 75.8±16.8. The prevalence of SD was 91.7% in men (IIEF), with a predominance of mild SD. The mean FSQ score was 64.9±24.1. The prevalence of SD was 72.7% in women (FSFI), with low domain scores. Also, a significant association was found between female age and total and domain-specific FSFI scores. PASI (Psoriasis Area and Severity Index) and the general satisfaction domain (IIEF) were significantly correlated. CONCLUSION: This study found a high prevalence of SD in PsA patients. Age had a negative impact on female sexual function. Physicians need to be more aware of SD in this population to provide early multidisciplinary treatment and minimize the impact of the disease on the quality of life of patients and their partners.
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Abstract Objective The purpose of this study was to evaluate the clinical-epidemiological profile, associated risk factors and clinical outcomes of patients with acute myeloid leukemia (AML), identifying the main causes of morbidity and mortality and overall survival rate of patients at five years of follow-up. Method This was a retrospective cohort study evaluating the prognosis and clinical outcomes of 222 patients diagnosed with AML at three large hematology centers in Ceará (northeastern Brazil) over a period of five years. Results The mean age at diagnosis was 44.1 ± 16 years, with a female prevalence of 1.3:1. No additional relevant risk factors associated with the development of AML were found, except for the well-established cytogenetic assessment. The overall 5-year survival rate was 39.4% (95%CI: 35.47 - 42.17). The main causes of death were disease progression (37.72%; n = 84) and sepsis (31.58%; n = 70). Conclusion The clinical outcomes in our sample of AML patients were similar to those of other reported groups. Disease progression and infection were the main causes of death. Access to diagnostic flow cytometry and karyotyping was greater in our sample than in the national average. As expected, overall survival differed significantly according to the risk, as determined by cytogenetic testing.
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Leucemia Mieloide Aguda , Prognóstico , LeucemiaRESUMO
ABSTRACT BACKGROUND AND OBJECTIVES: The presence of central sensitization (CS) in people with chronic neck pain requires clarification, as does the possible disparities between genders. Therefore, this study aimed to evaluate the presence of CS in chronic neck pain according to gender. METHODS: Cross-sectional study with the participation of 260 adults (18-59 years old) with chronic neck pain, carried out between September 2022 and September 2023. Instruments were applied to collect sociodemographic profile, pain characteristics, cervical functional disability and presence of SC. The software SPSS 23.0 was used for comparative analyzes. RESULTS: Regarding disparities between genders, there were no differences in the intensity of pain and cervical functional disability (p=0.134 and p=0.277, respectively). However, SC was higher in women (43.5 ± 14.0; p=0.003). In females, CS was related to "pain interference" in the aspects of walking (r=0.311; p=0.001), relationships with people (r=0.309; p=0.001), appreciation of life (r=0.321; p= 0.001) and with cervical functional disability (r=0.570; p=0.001). In males, CS was related to "pain interference" in aspects such as general activity (r=0.311; p=0.008), mood (r=0.376; p=0.001), walking (r=0.313; p= 0.007), relationships with people (r=0.477; p=0.001), sleep (r=0.321; p=0.006), appreciation of life (r=0.427 p=0.001) and functional disability (r=0.667; p<0.001). CONCLUSION: Women with chronic neck pain showed a greater presence of CS, while CS in men was related to a variety of aspects that negatively affect life. Given this, differences between genders could be considered in the management of patients with chronic neck pain.
RESUMO JUSTIFICATIVA E OBJETIVOS: A presença de sensibilização central (SC) em pessoas com dor cervical crônica carece de esclarecimentos, bem como as possíveis disparidades entre os sexos. Portanto, objetivou-se avaliar a presença de SC na dor cervical crônica de acordo com o sexo. MÉTODOS: Estudo transversal com a participação de 260 adultos (18-59 anos) com dor cervical crônica, realizado entre setembro de 2022 e setembro de 2023. Foram aplicados instrumentos para coletar perfil sociodemográfico, características da dor, incapacidade funcional da cervical e presença de SC. Para análises comparativas foi utilizado o SPSS 23.0. RESULTADOS: Nas disparidades entre os sexos, não houve diferenças na intensidade da dor e incapacidade funcional cervical (p=0,134 e p=0,277, respectivamente). No entanto, a SC foi mais elevada nas mulheres (43,5 ± 14,0; p=0,003). No sexo feminino, a SC apresentou relação com a "interferência da dor" nos aspectos: caminhar (r=0,311; p=0,001), relacionamento interpessoal (r=0,309; p=0,001), apreciação da vida (r=0,321; p=0,001) e com incapacidade funcional da cervical (r=0,570; p=0,001). Já no sexo masculino, a SC teve relação com a "interferência da dor" em aspectos como atividade geral (r=0,311; p=0,008), humor (r=0,376; p=0,001), caminhar (r=0,313; p=0,007), relacionamento interpessoal (r=0,477; p=0,001), sono (r=0,321; p=0,006), apreciação da vida (r=0,427 p=0,001) e incapacidade funcional (r=0,667; p<0,001). CONCLUSÃO: Mulheres com dor cervical crônica mostraram maior presença da SC, enquanto nos homens a SC esteve relacionada a uma variedade de aspectos que afetam negativamente a vida. Diante disso, as diferenças entre os sexos poderiam ser consideradas no gerenciamento de pacientes com dor cervical crônica.
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Metabolic syndrome (MetS) and obesity represent a public health problem worldwide. Bioelectrical impedance analysis (BIA) is a practical and effective way of evaluating body composition, especially abdominal fat. Liraglutide, a GLP-1 analog, reduces body weight and improves cardiometabolic parameters. In this prospective non-randomized intervention study, we evaluated the effect of 6 months of treatment with liraglutide (n = 57) on the clinical, laboratory and BIA findings of adult sex-stratified patients diagnosed with obesity and MetS, compared to a control group receiving sibutramine (n = 46). The groups were statistically similar with regard to the age of females (p = 0.852) and males (p = 0.657). Almost all anthropometric and BIA variables were higher in the treatment group than in the comparative group (p < 0.05). Abdominal circumference (AC) decreased significantly more in the treatment group. In males, body weight and fat mass also decreased (p < 0.05). Liraglutide treatment was associated with a greater reduction in trunk fat mass (FMT) (p < 0.05). AC and FMT were strongly correlated (rho = 0.531, p < 0.001) in the treatment group. In the multiple regression analysis, liraglutide treatment remained independently associated with FMT. Treatment with liraglutide for 6 months promoted weight loss, improved cardiometabolic and inflammatory parameters and led to a significant reduction in FMT correlated with AC in obese MetS patients of both sexes.
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Doenças Cardiovasculares , Síndrome Metabólica , Masculino , Adulto , Feminino , Humanos , Síndrome Metabólica/tratamento farmacológico , Síndrome Metabólica/metabolismo , Liraglutida/farmacologia , Liraglutida/uso terapêutico , Impedância Elétrica , Estudos Prospectivos , Obesidade/complicações , Obesidade/tratamento farmacológico , Obesidade/diagnóstico , Peso CorporalRESUMO
Introduction: Acne is a chronic inflammatory disease that affects the pilosebaceous unit, and there are conflicting evidences regarding its association with metabolic syndrome (MS) and insulin resistance (IR). Methods: A cross-sectional study was performed with 162 acne patients, over 20 years of age, matched for age and sex with 78 healthy controls without acne. The measured parameters included waist circumference (WC), body mass index (BMI), systolic blood pressure, diastolic blood pressure, fasting blood glucose, fasting insulin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and total cholesterol. Acne severity was determined according to the Global Acne Grading System. The criteria used for the diagnosis of MS were those of the Harmonizing the Metabolic Syndrome Statement, adjusted for South Americans, and the IR was calculated using the HOMA-IR. Results: The prevalence of MS was significantly higher in cases, compared to controls (12.3% vs. 2.6%, P = 0.014), as was the prevalence of IR (11.7% vs. 3.8%, P = 0.047). In addition, MS and IR showed a positive correlation with the degree of acne severity (P = 0.011 and P = 0.021, respectively). HDL levels were significantly lower in cases (P = 0.012) and showed an association with acne severity (P = 0.038). In the logistic regression model, the risk factor that independently influenced both MS and IR in patients with acne was the WC (P = 0.001). Conclusions: Adults with acne, especially the most severe cases, are significantly more likely to have MS, IR, and lower HDL levels, compared to controls without acne.
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Acne Vulgar , Doenças Cardiovasculares , Resistência à Insulina , Síndrome Metabólica , Humanos , Adulto , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Resistência à Insulina/fisiologia , Fatores de Risco , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Prevalência , Estudos Transversais , Obesidade/epidemiologia , Glicemia/metabolismo , Triglicerídeos , Índice de Massa Corporal , Fatores de Risco de Doenças Cardíacas , Acne Vulgar/complicações , Acne Vulgar/diagnóstico , Acne Vulgar/epidemiologiaRESUMO
OBJECTIVE: The purpose of this study was to evaluate the clinical-epidemiological profile, associated risk factors and clinical outcomes of patients with acute myeloid leukemia (AML), identifying the main causes of morbidity and mortality and overall survival rate of patients at five years of follow-up. METHOD: This was a retrospective cohort study evaluating the prognosis and clinical outcomes of 222 patients diagnosed with AML at three large hematology centers in Ceará (northeastern Brazil) over a period of five years. RESULTS: The mean age at diagnosis was 44.1 ± 16 years, with a female prevalence of 1.3:1. No additional relevant risk factors associated with the development of AML were found, except for the well-established cytogenetic assessment. The overall 5-year survival rate was 39.4% (95%CI: 35.47 - 42.17). The main causes of death were disease progression (37.72%; n = 84) and sepsis (31.58%; n = 70). CONCLUSION: The clinical outcomes in our sample of AML patients were similar to those of other reported groups. Disease progression and infection were the main causes of death. Access to diagnostic flow cytometry and karyotyping was greater in our sample than in the national average. As expected, overall survival differed significantly according to the risk, as determined by cytogenetic testing.
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INTRODUCTION: Acute myocardial infarct/angina (AMI-A) is a possible complication in primary antiphospholipid syndrome (pAPS) patients. This study compares data obtained from pAPS patients with and without AMI-A. METHODS: This cross-sectional study of 66 (85.2% female) pAPS patients (Sidney criteria). Demographics, clinical data, medication use, and antiphospholipid antibodies were evaluated. Patients were divided into two groups: pAPS with AMI-A and pAPS without AMI-A. RESULTS: Sixty-six patients with primary APS (six with AMI-A and 60 without AMI-A) were selected. They were similar for demographics, disease duration, and anthropometrics (p > 0.05). Patients with AMI-A compared to those patients without AMI-A had more frequently dyslipidemia (66 vs. 28%, p = 0.05), systemic hypertension (83 vs. 37%, p = 0.02), and increased levels of lipoprotein (a) (116 ± 67 vs. 36 ± 35 mg/dl, p = 0.0002). Interesting, current physical activity (66.7 vs. 23%, p = 0.04) was more seen in the first group when compared to the second one. Patients with AMI-A used more statins (66 vs. 22%, p = 0.017) and acetylsalicylic (100 vs. 28%, p = 0.05). Higher median levels of IgM anticardiolipin antibodies [70 (0-120) vs. 9 (0-120), p = 0.03] were observed in the first group. CONCLUSIONS: pAPS patients and AMI-A have distinct clinical and laboratory spectra from those without AMI-A. It is characterized by dyslipidemia and hypertension, hyper lipoprotein(a), and a lower IgM anticardiolipin frequency.
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Personality traits have been shown to contribute to the development and persistence of fibromyalgia (FM)-related symptoms. The aim of this study was to identify the most prevalent personality factor in Brazilian female FM patients, using the Factorial Personality Battery (FPB) and comparing patients to age-matched healthy controls. This was a cross-sectional study based on 40 FM patients and 40 age-matched controls. The FPB is a Brazilian self-reporting questionnaire based on the Big Five Inventory, containing 126 items and scored on a Likert scale. The study included 80 participants aged on the average 46.6 ± 6.7 years (FM) and 45.6 ± 13.8 years (controls) (p = 0.121). The groups differed significantly with regard to schooling (p = 0.013). Time of disease and time to diagnosis was 11.3 ± 7.3 and 6.6 ± 4.5 years, respectively. Fourteen patients (35%) had hypertension and 52% reported sedentary lifestyle. Many had generalized anxiety disorder (82.5%) and/or major depressive disorder (35%). Three facets of Neuroticism were highly significant: vulnerability (p = 0.008), emotional instability (p < 0.001), and depression (p < 0.001). A significant association was found between Openness and time to diagnosis (p < 0.033). Using multiple linear regression, we identified the independent associations Extraversion x systemic arterial hypertension (OR = - 0.65, p = - 0.013) and Openness x sedentary lifestyle (OR = - 0.48, p = 031). Neuroticism was the predominant factor, while Openness was found to be negatively correlated with time to diagnosis, suggesting personality assessments can help identify FM patterns used to tailor treatment and enhance compliance.
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Fibromialgia/psicologia , Personalidade , Adulto , Brasil , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Neuroticismo , Determinação da PersonalidadeRESUMO
OBJECTIVE: The aims of this cross-sectional study were to evaluate the prevalence of MetS in PsA patients compared with sex- and age-matched healthy controls and to test possible associations with clinical and laboratory variables. METHODS: The prevalence of MetS was determined for 76 PsA patients and 76 sex- and age-matched healthy controls, using the criteria of NCEP/ATPIII and Harmonizing, adjusted for South Americans. Multivariate logistic regression analysis was used to identify independent risk factors for MetS. RESULTS: Metabolic syndrome was significantly more prevalent in the PsA group than in the control group (53.9% vs 18.4%, p < 0.001). Psoriatic arthritis was associated with hypertension, diabetes mellitus, increased waist circumference (WC), elevated body mass index, and raised levels of blood glucose and triglycerides. When comparing MetS and non-Mets PsA patients, MetS was not significantly associated with disease activity, skin involvement, or quality of life. In the logistic regression model, the variables independently associated with MetS were use of biologic disease-modifying antirheumatic drugs (p = 0.001), elevated arterial pressure (p = 0.006), age (p = 0.0015), WC (p = 0.004), and low HDL (p = 0.042). CONCLUSIONS: In this study on PsA patients from Northeastern Brazil, MetS was highly prevalent and associated with biologic disease-modifying antirheumatic drugs use, increased WC, and low HDL.
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Antirreumáticos , Artrite Psoriásica , Produtos Biológicos , Doenças Cardiovasculares , Síndrome Metabólica , Antirreumáticos/efeitos adversos , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Produtos Biológicos/uso terapêutico , Índice de Massa Corporal , Brasil/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Fatores de Risco de Doenças Cardíacas , Humanos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Prevalência , Qualidade de Vida , Fatores de RiscoRESUMO
Introdução: a Síndrome Antifosfolípide é caracterizada por eventos trombóticos e perdas gestacionais de repetição e é considerada a trombofilia adquirida mais comum. Quando não está associada a alguma doença do tecido conectivo é dita primária e seu tratamento é baseado em anticoagulação por longo período com warfarin. Isso requer controle rigoroso do tempo de protrombina realizada pela monitoração dos valores de INR para que se evite em um extremo o risco de sangramento e em outro o risco de trombose. Objetivo: realizar uma revisão daa literatura sobre polimorfismos genéticos da citocromo P450 na síndrome antifosfolipide. Metodologia: revisão narrativa da literatura. Resultados: embora investigações tenham identificado a influência de vários genes na resposta ao warfarin, a maioria das evidências sugere um papel mais importante para o polimorfismo de dois genes: o gene do citocromo P450(CYP)2C9 (CYP2C9) e o gene do complexo redutase epóxido vitamina K 1 (VKORC1). De fato, o warfarin é administrado como uma mistura racêmica de S e R-warfarin e estes enantiômeros são extensivamente metabolizados no fígado por diferentes enzimas do citocromo P450(CYP), com a CYP2C9 servindo como a principal enzima no metabolismo da S-warfarin. Nesse sentido, a farmacogenética da terapia com warfarin é relevante para melhorar a segurança e a efetividade dessa terapia. Polimorfismos estruturais no gene CYP2C9 criam variantes alélicos que codificam enzimas com diferentes atividades catalíticas. As freqüências alélicas destes variantes diferem entre diferentes grupos étnicos, sem estudos no Brasil em pacientes com SAF. Conclusão: o conhecimento da presença de polimorfismos genéticos da citocromo P450 em usuários de warfarin é de fundamental importância. Desde que sangramentos ou alvos subterapeuticos podem advir da presença dessas alterações genéticas.
Introduction: antiphospholipid Syndrome is characterized by thrombotic events and repeated pregnancy losses and is considered the most common acquired thrombophilia. When it is not associated with any connective tissue disease, it is said to be primary and its treatment is based on long-term anticoagulation with warfarin. This requires strict control of the prothrombin time performed by monitoring the INR values to avoid the risk of bleeding at one extreme and the risk of thrombosis at the other. Objective: To perform a review of the literature on genetic polymorphisms of cytochrome P450 in antiphospholipid syndrome. Methods: narrative literature review Results: although investigations have identified the influence of several genes on the response to warfarin, most evidence suggests a more important role for the polymorphism of two genes: the cytochrome P450 (CYP) 2C9 (CYP2C9) gene and the reductase complex gene vitamin K 1 epoxide (VKORC1). In fact, warfarin is administered as a racemic mixture of S and R-warfarin and these enantiomers are extensively metabolized in the liver by different enzymes of cytochrome P450 (CYP), with CYP2C9 serving as the main enzyme in the metabolism of S-warfarin . In this sense, the pharmacogenetics of warfarin therapy is relevant to improve the safety and effectiveness of this therapy. Structural polymorphisms in the CYP2C9 gene create allelic variants that encode enzymes with different catalytic activities. The allele frequencies of these variants differ between different ethnic groups, with no studies in Brazil in patients with APS. Conclusion: knowledge of the presence of genetic polymorphisms of cytochrome P450 in users of warfarin is of fundamental importance. Since bleeding or subtherapeutic targets may result from the presence of these genetic changes.