Systemic lupus erythematosus induced by anti-tumor necrosis factor α therapy in inflammatory rheumatic diseases: a case series

This case series aims to characterize the development of systemic lupus erythematosus (SLE) induced by anti-tumor necrosis factor α (anti-TNFα) therapy in patients with inflammatory rheumatic diseases, namely rheumatoid arthritis (RA), spondylarthritis (SpA), and psoriatic arthritis (PsA). Patients with a diagnosis of SLE induced by anti-TNFα therapy and registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) who started their first anti-TNFα between 2001 and 2020 were included. Demographic, clinical, and laboratory data were obtained by consulting Reuma.pt. The diagnosis of SLE induced by anti-TNFα was considered if there was a temporal relationship between the onset of anti-TNFα therapy and manifestations (clinical and immunological) in accordance with the American College of Rheumatology/European League Against Rheumatism criteria (2019). A total of 607 patients with inflammatory rheumatic diseases and six cases of SLE induced by anti-TNF-α therapy were reviewed: two patients were affected by RA, three patients by SpA, and one by PsA. All these patients had articular and constitutional symptoms that improved after discontinuation of the anti-TNFα agent. After switching to a second anti-TNFα agent, there was no recurrence of SLE over time. The development of SLE secondary to anti-TNFα agents in inflammatory rheumatic patients is rare. In this case series, all patients had a mild disease that improved after therapy discontinuation without recurrence of the disease. SLE induced by anti-TNFα should be considered in the follow-up of RA, SpA, and PsA patients.

ALS-associated VRK1 R321C mutation causes proteostatic imbalance and mitochondrial defects in iPSC-derived motor neurons

Vaccinia-related kinase 1 (VRK1) is a gene which has been implicated in the pathological process of a broad range of neurodevelopmental disorders as well as neuropathies, such as Amyotrophic Lateral Sclerosis (ALS). Here we report a family presenting ALS in an autosomal recessive mode of inheritance, segregating with a homozygous missense mutation located in VRK1 gene (p.R321C; Arg321Cys). Proteomic analyses from iPSC-derived motor neurons identified 720 proteins eligible for subsequent investigation, and our exploration of protein profiles revealed significant enrichments in pathways such as mTOR signaling, E2F, MYC targets, DNA repair response, cell proliferation and energetic metabolism. Functional studies further validated such alterations, showing that affected motor neurons presented decreased levels of global protein output, ER stress and downregulation of mTOR signaling. Mitochondrial alterations also pointed to decreased reserve capacity and increased non-mitochondrial oxygen consumption. Taken together, our results present the main pathological alterations associated with VRK1 mutation in ALS.

Wunderlich syndrome as a rare complication of polyarteritis nodosa: a case report

Spontaneous subcapsular and perirenal hemorrhage, known as Wunderlich syndrome (WS), is a rare clinical manifestation of polyarteritis nodosa (PAN). We report a case of a 48-year-old male with a history of recurrent episodes of leg muscle tenderness and dysesthesia, bilateral flank pain, painful nodular skin lesions in the lower limbs, weight loss, and difficult-to-control arterial hypertension. The abdominopelvic computed tomography angiography showed a large left perirenal hematoma, leading to the patient's admission to the intensive care unit. After the exclusion of infectious or neoplastic foci, the patient was diagnosed with PAN and started intravenous methylprednisolone pulses with a good response. Since WS is a rare initial clinical manifestation of PAN, an early diagnosis and aggressive treatment will significantly improve clinical outcomes.

Impact de l’infection par le SARS-CoV-2 sur l’activité de la maladie des patients atteints de rhumatisme psoriasique sous bDMARD : données réelles

Introduction

L’infection par le SARS-CoV-2 peut entraîner une inflammation sévère et il a été suggéré d’induire des poussées de rhumatisme psoriasique (RP). Cependant, l’impact sur l’activité de la maladie et la réponse aux DMARD biologiques modificateurs de la maladie (bDMARD) reste inconnu.

Patients et méthodes

Nous avons réalisé une analyse rétrospective incluant tous les patients atteints de RP, répondant aux critères CASPAR et sous biothérapie, suivis dans le service de rhumatologie d’un CHU universitaire tertiaire. Les données démographiques et cliniques, y compris la survenue d’une infection par le SARS-CoV-2, ont été collectées à partir de notre base de données nationale (reuma.pt). L’activité de la maladie (CDAI, SDAI, DAS28 4v, BASDAI, ASDAS) et les réponses aux bDMARD (réponses EULAR, ASDAS, ASAS, ACR et PsARC) ont été évaluées avant et après l’infection par le SARS-Cov-2.

Résultats

Au total, 102 patients atteints de RP ont été inclus. Cinquante-deux étaient des femmes (51 %). L’âge moyen était de 53 ± 11,09 ans et la durée médiane de la maladie était de 15 ans [min 2, max 47]. Au total, 54 (53 %) patients avaient une atteinte axiale prédominante, 26 (26 %) périphérique et 36 (37 %) enthésopathique. Le bDMARD le plus utilisé était l’étanercept (n = 28, 27,5 %) suivi de l’adalimumab (n = 22, 21,6 %) et du sécukinumab (n = 18, 17,6 %). La prévalence de l’infection par le SARS-CoV-2 était de 15,7 % (n = 16). Soixante-trois pour cent ont reçu le vaccin BNT162b2 (Pfizer/BioNtech), 31 % ont reçu l’ARNm-1273 (Moderna), 13 % ont reçu l’AZD1222 (AstraZeneca) et 13 % ont reçu l’AD26.COV2.S (Janssen/Johnson & Johnson). Soixante-trois pour cent étaient infectés avant toute vaccination, 13 % après la première dose et 25 % après la seconde. Les symptômes les plus fréquents étaient l’anosmie (65 %), la dysgueusie (56 %) et la toux (56 %). Tous les patients se sont complètement remis de l’infection, sans nécessiter d’hospitalisation. Quel que soit le score utilisé, la différence entre l’activité moyenne de la maladie après l’infection par le SARS-CoV-2 et celle au départ n’a pas atteint la signification statistique. Au départ et après l’infection, les paramètres moyens de l’activité de la maladie étaient respectivement : CDAI 8,6 ± 5,7 vs 8,6 ± 5,7, p = 0,997 ; SDAI 9,3 ± 6,6 contre 9,2 ± 6,1, p = 0,928 ; DAS 28 4v 2,9 ± 1,2 contre 2,9 ± 1,2, p = 0,818 ; BASDAI 3,6 ± 2,6 contre 3,2 ± 2,7, p = 0,506 ; ASDAS 2,2 ± 1,2 contre 2,2 ± 1, p = 0,721. Le nombre de patients ne répondant pas aux bDMARD (selon EULAR, ASDAS, ASAS, ACR et PsARC) avant l’infection n’était pas différent de celui post-infection.

Conclusion

Notre étude suggère que l’infection par le SARS-CoV-2 n’a aucun impact négatif sur l’activité de la maladie PSA et les réponses bDMARD. Cependant, d’autres études sont encore nécessaires pour mieux comprendre les effets à long terme de l’infection par le SARS-CoV-2.

Examining the imparity of immigrant children enrolled in special education classes in Japan: Roots and recommendations

This study discusses the disparity in numbers between Japanese children and their Brazilian immigrant peers concerning placement in Japanese special education classes. In-depth interviews were conducted with 21 stakeholders including Japanese nationals and Brazilian immigrants to see if there were any ways to explain the larger numbers of immigrant children assigned to such classes. Five main factors affecting the stakeholders emerged: Linguistic and Cultural Related Misunderstandings of Information, Limitations Concerning Counseling and Educational Planning, Requests for Improving the Support System for Non-Japanese Students, Importance of a Second Opinion, and Cultural and Linguistic Effects when Evaluating Non-Japanese Students. The study provides policy recommendations aimed at improving the support system for immigrant communities who face a variety of stresses living in an unfamiliar culture.

The effect of different pulp capping methods on the intrapulpal temperature when using light-cured procedures

Background

To evaluate the intra-pulpal temperature during different direct pulp capping methods and light-cured procedures.

Material and Methods

Class I preparations 5 mm long, 4 mm wide and 4 mm deep were performed in extracted third molars, leaving 0.5 mm of dentin at the pulpal floor with a 1 mm diameter of pulp exposure. Teeth were placed in a customized oral cavity chamber simulator in which the initial temperature was standardized at 36oC. The overall temperature variations (oC) in the pulp chamber during the light-activation processes were recorded live using an infrared camera (FLIR ONE PRO, FLIR Systems). The liners and bases evaluated were: Dycal (Dentisply), TheraCal LC (Bisco), Biodentin (Septodent), Vitrebond Plus (3M/ESPE), and Fuji IX GP (GC), followed by restoration with a bulk fill composite (EvoCeram Bulk Fill, Ivoclar Vivadent). All light-activation procedures were performed with the VALO Grand (Ultradent) light-curing unit. A power analysis was conducted to determine the sample size to provide a power of at least 0.8 with α=0.05. Statistical analyses were performed using ANOVA and Tukey’s test for multiple comparisons.

Results

The intrapulpal temperature increased above a 10oC to 20oC threshold difference for all liners and bases that were light cured. When added as second layers, neither of those could provide thermal insulation following additional light-activated procedures (p=0.25). The higher the number of procedures requiring light-activation, the longer the pulp temperature remained in those increased temperature thresholds.

Conclusions

For direct pulp capping procedures, a reduced number light activation procedures should be indicated to reduce the time intra-pulpal temperature rises above a 10oC threshold.

Key words:Liner, base, calcium hydroxide, glass ionomer, dental adhesive, bulkfill composite.

Color difference between the vita classical shade guide and composite veneers using the dual-layer technique

Background

The purpose of this in vitro study was to evaluate the color difference between the Vita Classical Shade Guide and composite veneers using the dual-layer technique.

Material and Methods

Thirty samples were fabricated using a custom-made mold (Easy Layering Shade Guide Kit, 3M) using two resin composites: Filtek Supreme Ultra (3M); and Estelite Omega (Tokuyama) (n=3). The composite veneers were made by layering the different enamel and body or dentin shades from each composite. The color measurements were taken using a spectrophotometer (Vita Easyshade V®, Vita Zahnfabrik). The ΔE00 between the Vita Classical Shade Guide (Vita Zahnfabrik) and the composite veneers were calculated using the CIEDE2000 formula.

Results

For the composite veneers using Filtek Supreme Ultra, the best match for A1 Vita shade was achieved layering either EA1 with DA2 or DA3; EA2 with DA1 or DA2 (ΔE00= 1.53 ~ 1.96 ± 0.4). For A2 Vita shade the best match would be EA3 with DA3 or EA3 with DA2 (ΔE00= 1.40 ~ 1.85 ± 0.1); or for A3 Vita shade the best match would be EA3 with DA2 2.50±(0.6). For the composite veneers using Estelite Omega, the were no best match for neither A1, A2 or A3 Vita shade (ΔE00> 2.5).

Conclusions

The combination of enamel and dentin shades from Filtek Supreme Ultra provided acceptable color match for A1, A2 and A3 shades from the Vita Shade Guide, while Estelite Omega did not provide acceptable color match for any of the Vita Shade Guide standard shades tested.

Key words:Color, color matching, optical properties, resin composite, layering.

Effect of dental headlights spectrum on the polymerization and working time of light-cured resin composites

Background

The use of dental headlights is a common practice to better illuminate the operatory field and achieve excellence in restorative dentistry. However, visible light-cured dental materials can have reduced working time under headlight illumination. The aim of this study was to evaluate the influence of the spectral irradiance power of two dental headlights on the degree of polymerization and working time of light-curable dental composites.

Material and Methods

Two headlights, StarLight Nano 3 (StarMed) (SN) and Zeon Endevour XL (Orascoptic) (ZE) were characterized using a spectrophotometer coupled to an integrating sphere (MARC® Light Collector, BlueLight Analytics). The degree of conversion of the two composites, Filtek Supreme (3M) and Tetric Prime (Ivoclar Vivadent), was evaluated using an FTIR spectroscope (NicoletTM iS20, Thermo Fisher).

Results

Both headlights emitted a significant amount of blue light. The Zeon headlamp without filter emitted a broader spectrum with lower blue intensity and higher CRI than the White LED of the Nano 3. The Zeon headlamp with the blue blocking filter emitted a broader spectrum than the Orange LED of the Nano 3. There were no differences in the degree of conversion and working time of the Filtek Supreme and Tetric Prime composites when illuminated by the different headlamps. Both Zeon and the White LED of the Nano 3 were capable to cure the composites within only 5-10 minutes of irradiation. There were no changes in the degree of conversion of the composites when the Orange LED of the Nano 3 or the blue blocking filter of the Zeon were used.

Conclusions

Both headlights reduced the working time of light-cured materials. The use of orange filters prevented the composite polymerization and maintained the working time.

Key words:Surgical Headlight, degree of conversion, working time, light-curing.

Toxicity and larvicidal activity on Aedes aegypti of citronella essential oil submitted to enzymatic esterification

The essential oil of citronella (Cymbopogon winterianus) has several biological activities, among them the insect repellent action. Some studies showed that cinnamic acid esters can be applied as natural pesticides, insecticides and fungicides. In this context, the objective of the present work was to evaluate the production of esters from citronella essential oil with cinnamic acid via enzymatic esterification. Besides, the essential oil toxicity before and after esterification against Artemia salina and larvicidal action on Aedes aegypti was investigated. Esters were produced using cinnamic acid as the acylating agent and citronella essential oil (3:1) in heptane and 15 wt% NS 88011 enzyme as biocatalysts, at 70 °C and 150 rpm. Conversion rates of citronellyl and geranyl cinnamates were 58.7 and 69.0% for NS 88011, respectively. For the toxicity to Artemia salina LC50 results of 5.29 μg mL-1 were obtained for the essential oil and 4.36 μg mL-1 for the esterified oils obtained with NS 88011. In the insecticidal activity against Aedes aegypti larvae, was obtained LC50 of 111.84 μg mL-1 for the essential oil of citronella and 86.30 μg mL-1 for the esterified oils obtained with the enzyme NS 88011, indicating high toxicity of the esters. The results demonstrated that the evaluated samples present potential of application as bioinsecticide.

A NANOTECNOLOGIA NO BRASIL E O DESENVOLVIMENTO DE PRODUTOS COM ATIVIDADE ANTIMICROBIANA

NANOTECHNOLOGY IN BRAZIL AND THE DEVELOPMENT OF PRODUCTS WITH ANTIMICROBIAL ACTIVITY. Due to the tremendous technological potential and applicability in various industry branches, nanotechnology investments have been increasing over the years. In particular, the control of microorganisms using nanomaterials with antimicrobial action has aroused great interest in the industry. This control makes it necessary in the most diverse situations, such as food conservation, pharmaceutical industry, hospital environments, and even domestic and commercial environments. This extraordinary interest is due, in particular, to the physical-chemical characteristics of materials on a nanoscale that attributes greater efficiency in combating microorganisms. Therefore, researchers and entrepreneurs have directed investments and efforts towards developing new products and/or new applications for antimicrobial products already existing on the market. In this work, we made a brief presentation of the history of nanotechnology in Brazil with a focus on Brazilian companies that developed products or services with nanomaterials with antimicrobial action, and on the description of some of the existing applications in the Brazilian market, highlighting the productive potential of the parents.

Corporate Psychopaths: implications for organizational health and well-being

Studies on Psychopathy in corporate settings and its toxic effects at the workplace are of the utmost importance. Corporate psychopaths reach upper echelon positions, and demonstrate egocentrism, lack of guilt or remorse; they influence those who are around them to achieve their own goals. In this regard, this study aims to discuss the implications of leaders named corporate psychopaths for the organizational health and well-being.

For this purpose, the study adopted an empirical-theoretical approach, a quantitative evaluation and a survey as the method of data collection, by applying a questionnaire made up by the Self Report Psychopathy (SRP) scale (Paulhus, Neumann, & Hare, 2014), in order to illuminate the non-pathological traits of Psychopathy; the Well-being at work Scale (Paschoal & Tamayo, 2008); and the Perception of Organizational Health Scale by Gomide Jr., Moura, Cunha, & Sousa (1999). The questionnaire was applied to 100 employees from the administrative area of an open capital Brazilian company in the educational area.

The results showed that employees who identified psychopathy traits in their immediate leaders externalized preoccupation, irritation, depression, anxiety, frustration, nervousness, tension and rage, demonstrating uneasiness at the workplace. They also reported that there is a dishonest competition to achieve higher hierarchical positions, no respect between colleagues, and people do not trust each other, demonstrating therefore aspects that reveal a compromised organizational health.

The study will make a contribution by providing insights into how companies can recognize and avoid the selection and recruitment of employees who exhibit psychopathy traits, especially due to the potential of these employess becoming leaders and compromising organizational health and well-being. The issue deserves especial attention and more studies should be carried out regarding the consequences of psychopathic leaders' actions for corporate and public health.

Key messages

Provide insights into how companies can recognize and avoid the selection and recruitment of employees who exhibit psychopathy traits and compromising organizational health and welbeing. The issue deserves especial attention and more studies should be carried out regarding the consequences of psychopathatic leaders’ actions for corporate and public health.