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Dourado E, Mazeda C, Freitas R, Martins P, Melo AT, Saraiva L, Guimarães F, Costa E, Almeida DE, Dinis S, Pinto AS, Daniel A, Genrinho I, Couto M, Rodrigues M, Santiago T, Salvador MJ, Duarte AC, Cordeiro A, Santos MJ, Fonseca JE, Cordeiro I, Resende C. Predictors of myositis in systemic sclerosis. Rheumatology (Oxford) 2024:keae089. [PMID: 38321583 DOI: 10.1093/rheumatology/keae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Eduardo Dourado
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- Serviço de Reumatologia, Centro Hospitalar Baixo Vouga, Centro Académico Clínico Egas Moniz, Aveiro, Portugal
- Centro de Investigação em Reumatologia de Aveiro, Centro Académico Clínico Egas Moniz, Aveiro, Portugal
| | - Carolina Mazeda
- Serviço de Reumatologia, Centro Hospitalar Baixo Vouga, Centro Académico Clínico Egas Moniz, Aveiro, Portugal
- Centro de Investigação em Reumatologia de Aveiro, Centro Académico Clínico Egas Moniz, Aveiro, Portugal
- EpiDoc Unit, Nova Medical School, NOVA University Lisbon, Lisboa, Portugal
| | - Raquel Freitas
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Martins
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Ana Teresa Melo
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Liliana Saraiva
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francisca Guimarães
- Serviço de Reumatologia, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Emanuel Costa
- Serviço de Reumatologia, Hospital de Braga, Braga, Portugal
| | | | - Sara Dinis
- Serviço de Reumatologia, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Ana Sofia Pinto
- Serviço de Reumatologia, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Alexandra Daniel
- Serviço de Reumatologia, Hospital Distrital de Leiria, Leiria, Portugal
| | - Inês Genrinho
- Serviço de Reumatologia, Centro Hospitalar Tondela-Viseu
| | - Maura Couto
- Serviço de Reumatologia, Centro Hospitalar Tondela-Viseu
| | - Marília Rodrigues
- Serviço de Reumatologia, Hospital Distrital de Leiria, Leiria, Portugal
| | - Tânia Santiago
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | | | - Ana Cordeiro
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
| | - Maria José Santos
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
| | - João Eurico Fonseca
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
| | - Inês Cordeiro
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Catarina Resende
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, Portugal
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Serain AF, Buitrago-Mejia AJ, de Souza GCA, Corrêa WR, Stefanello MEA, Salvador MJ. Antitumoral photoinduced effects of crude extract, fractions, and naphthoquinones from Sinningia magnifica (Otto & A. Dietr.) Wiehler (Gesneriaceae) in a bioguided study. Photochem Photobiol 2024; 100:190-203. [PMID: 37395166 DOI: 10.1111/php.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Abstract
Photodynamic therapy (PDT) has been used for various purposes, including as an antitumor resource in a noninvasive therapy with minimal side effects. Sinningia magnifica (Otto & A. Dietr.) Wiehler is a rupicolous plant found in rock crevices in Brazilian tropical forests. Initial studies indicate the presence of phenolic glycosides and anthraquinones in species of the genus Sinningia (Generiaceae family). It is known that anthraquinones are natural photosensitizers with potential PDT applications. This led us to investigate the potential compounds of S. magnifica for use as a natural photosensitizer against the melanoma (SK-MEL-103) and the prostate cancer (PC-3) cell lines in a bioguided study. Our results showed that singlet oxygen production by the 1,3-DPBF photodegradation assay greatly increased in the presence of crude extract and fractions. The biological activity evaluation showed photodynamic action against melanoma cell line SK-MEL-103 and prostate cell line PC-3. These results suggest the presence of potential photosensitizing substances, as demonstrated in this in vitro antitumor PDT study by the naphthoquinones Dunniol and 7-hydroxy-6-methoxy-α-dunnione for the first time. Naphthoquinones, anthraquinones and phenolic compounds were identified in the crude extract by UHPLC-MS/MS analysis, motivating us to continue with the bioguided phytochemical study aiming to discover more photochemically bioactive substances in Gesneriaceae plants.
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Affiliation(s)
- A F Serain
- Department of Plant Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - A J Buitrago-Mejia
- Department of Plant Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - G C A de Souza
- Department of Plant Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - W R Corrêa
- Federal Institute of Education, Science and Technology, South of Minas Gerais (IFSULDEMINAS), Inconfidentes, Brazil
| | - M E A Stefanello
- Department of Chemistry, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - M J Salvador
- Department of Plant Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
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Morais A, Duarte AC, Fernandes MO, Borba A, Ruano C, Marques ID, Calha J, Branco JC, Pereira JM, Salvador MJ, Bernardes M, Khmelinskii N, Pinto P, Pinto-Basto R, Freitas S, Campainha S, Alfaro T, Cordeiro A. Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society. Pulmonology 2023:S2531-0437(23)00205-2. [PMID: 38148269 DOI: 10.1016/j.pulmoe.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/23/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking. OBJECTIVE To establish recommendations for CTD-ILD screening based on the current evidence. METHOD Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD. RESULTS The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous. CONCLUSIONS Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.
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Affiliation(s)
- A Morais
- Pulmonology Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; Portuguese Pulmonology Society (SPP).
| | - A C Duarte
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; Portuguese Rheumatology Society (SPR)
| | - M O Fernandes
- Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Rheumatology Society (SPR); Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - A Borba
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; Portuguese Pulmonology Society (SPP)
| | - C Ruano
- Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - I D Marques
- Imaging Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J Calha
- Imaging Department, Hospital Beatriz Ângelo, Loures, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J C Branco
- Imaging Department, Hospital Beatriz Ângelo, Loures, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J M Pereira
- Imaging Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Imaging Department, Unilabs Portugal, Porto, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - M J Salvador
- Rheumatology Department Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Portuguese Rheumatology Society (SPR)
| | - M Bernardes
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - N Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisboa, Portugal; Portuguese Rheumatology Society (SPR)
| | - P Pinto
- Rheumatology Department, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Rheumatology Society (SPR)
| | - R Pinto-Basto
- Pulmonology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Portuguese Pulmonology Society (SPP)
| | - S Freitas
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Portuguese Pulmonology Society (SPP)
| | - S Campainha
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Pulmonology Society (SPP)
| | - T Alfaro
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Portuguese Pulmonology Society (SPP)
| | - A Cordeiro
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; Portuguese Rheumatology Society (SPR)
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Maduro AI, Mendes B, Saraiva AP, Sousa M, Marques M, B Sousa S, Salvador MJ, Malcata A, Serra S. Fibrodysplasia ossificans progressiva: when a double skeleton is present. Clin Rheumatol 2023; 42:3173-3174. [PMID: 37488373 DOI: 10.1007/s10067-023-06712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Ana Isabel Maduro
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Beatriz Mendes
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - André Pinto Saraiva
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Marlene Sousa
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Marta Marques
- Department of Medical Genetic, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Sérgio B Sousa
- Department of Medical Genetic, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Armando Malcata
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sara Serra
- Department of Rheumatology, Centro Hospitalar E Universitário de Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
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Miranda LC, Vaz C, Sousa EV, Salvador MJ, Santos MJ. Acta Reumatológica Portuguesa / ARP Rheumatology: 50 years at a glance - five decades by five Rheumatologists. ARP Rheumatol 2023; 2:182-187. [PMID: 37839031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
| | - Carlos Vaz
- Centro Hospitalar Universitário, São João; Faculdade de Medicina da Universidade do Porto
| | - Elsa Vieira Sousa
- Serviço de Reumatologia Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular da Faculdade de Medicina de Lisboa, Lisboa
| | | | - Maria José Santos
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular da Faculdade de Medicina de Lisboa, Lisboa; Rheumatology, Hospital Garcia de Orta, Almada
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Samões B, Guimarães da Fonseca D, Beirão T, Costa F, Vieira R, Terroso G, Ferreira RM, Nicolau R, Saraiva A, Salvador MJ, Duarte AC, Cordeiro A, Vilas-Boas JP, Genrinho I, Bento da Silva A, Gago L, Resende C, Martins P, Madeira N, Dinis S, Couto M, Santos I, Araújo F, Mourão AF, Gomes Guerra M, Oliveira M, Daniel A, Rodrigues M, Dantas Soares C, Parente H, Furtado C, Fontes T, Abelha-Aleixo J. Assessment of calcinosis in Portuguese patients with systemic sclerosis - a multicenter study. Clin Rheumatol 2023:10.1007/s10067-023-06617-5. [PMID: 37154983 DOI: 10.1007/s10067-023-06617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION/OBJECTIVES The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. METHOD A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. RESULTS We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). CONCLUSIONS Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.
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Affiliation(s)
- Beatriz Samões
- Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia E Espinho, Vila Nova de Gaia, Portugal.
| | | | - Tiago Beirão
- Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia E Espinho, Vila Nova de Gaia, Portugal
| | - Flávio Costa
- Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia E Espinho, Vila Nova de Gaia, Portugal
| | - Romana Vieira
- Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia E Espinho, Vila Nova de Gaia, Portugal
| | - Georgina Terroso
- Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Rafaela Nicolau
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - André Saraiva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | | | - Ana Cordeiro
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Inês Genrinho
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Ana Bento da Silva
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | - Laura Gago
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | - Catarina Resende
- Rheumatology Department, Centro Hospitalar e Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Patricia Martins
- Rheumatology Department, Centro Hospitalar e Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Unidade de Investigação Em Reumatologia, Instituto de Medicina Molecular, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Nathalie Madeira
- Rheumatology Department, Unidade Local de Saúde da Guarda - Hospital Sousa Martins, Guarda, Portugal
| | - Sara Dinis
- Rheumatology Department, Unidade Local de Saúde da Guarda - Hospital Sousa Martins, Guarda, Portugal
| | - Maura Couto
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Inês Santos
- Rheumatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Filipe Araújo
- Rheumatology and Osteoporosis Unit, Hospital de Sant'Ana, SCML, Cascais, Portugal
| | - Ana Filipa Mourão
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Lisbon, Portugal
| | - Miguel Gomes Guerra
- Rheumatology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Margarida Oliveira
- Rheumatology Department, Centro Hospitalar Universitário da Cova da Beira, Covilhã, Portugal
| | - Alexandra Daniel
- Rheumatology Department, Hospital Distrital de Leiria, Leiria, Portugal
| | - Marília Rodrigues
- Rheumatology Department, Hospital Distrital de Leiria, Leiria, Portugal
| | | | - Hugo Parente
- Rheumatology Department, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | - Carolina Furtado
- Rheumatology Department, Hospital Do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Tomás Fontes
- Rheumatology Department, Hospital Do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Joana Abelha-Aleixo
- Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia E Espinho, Vila Nova de Gaia, Portugal
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Laranjeira P, Dos Santos F, Salvador MJ, Simões IN, Cardoso CMP, Silva BM, Henriques-Antunes H, Corte-Real L, Couceiro S, Monteiro F, Santos C, Santiago T, da Silva JAP, Paiva A. Umbilical-Cord-Derived Mesenchymal Stromal Cells Modulate 26 Out of 41 T Cell Subsets from Systemic Sclerosis Patients. Biomedicines 2023; 11:biomedicines11051329. [PMID: 37239000 DOI: 10.3390/biomedicines11051329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Systemic sclerosis (SSc) is an immune-mediated disease wherein T cells are particularly implicated, presenting a poor prognosis and limited therapeutic options. Thus, mesenchymal-stem/stromal-cell (MSC)-based therapies can be of great benefit to SSc patients given their immunomodulatory, anti-fibrotic, and pro-angiogenic potential, which is associated with low toxicity. In this study, peripheral blood mononuclear cells from healthy individuals (HC, n = 6) and SSc patients (n = 9) were co-cultured with MSCs in order to assess how MSCs affected the activation and polarization of 58 different T cell subsets, including Th1, Th17, and Treg. It was found that MSCs downregulated the activation of 26 out of the 41 T cell subsets identified within CD4+, CD8+, CD4+CD8+, CD4-CD8-, and γδ T cells in SSc patients (HC: 29/42) and affected the polarization of 13 out of 58 T cell subsets in SSc patients (HC: 22/64). Interestingly, SSc patients displayed some T cell subsets with an increased activation status and MSCs were able to downregulate all of them. This study provides a wide-ranging perspective of how MSCs affect T cells, including minor subsets. The ability to inhibit the activation and modulate the polarization of several T cell subsets, including those implicated in SSc's pathogenesis, further supports the potential of MSC-based therapies to regulate T cells in a disease whose onset/development may be due to immune system's malfunction.
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Affiliation(s)
- Paula Laranjeira
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal
| | | | - Maria João Salvador
- Rheumatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Irina N Simões
- Stemlab S.A., Famicord Group, 3060-197 Cantanhede, Portugal
| | | | - Bárbara M Silva
- Algarve Biomedical Center (ABC), Universidade do Algarve, 8005-139 Faro, Portugal
- Algarve Biomedical Center Research Institute (ABC-RI), Universidade do Algarve, 8005-139 Faro, Portugal
- Doctoral Program in Biomedical Sciences, Faculty of Medicine and Biomedical Sciences, Universidade do Algarve, 8005-139 Faro, Portugal
| | | | | | - Sofia Couceiro
- Stemlab S.A., Famicord Group, 3060-197 Cantanhede, Portugal
| | | | | | - Tânia Santiago
- Rheumatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - José A P da Silva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Rheumatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - Artur Paiva
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Ciências Biomédicas Laboratoriais, 3046-854 Coimbra, Portugal
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Oliveira Pinheiro F, Seabra Rato M, Madureira P, Araújo F, Salvador MJ, Fraga V, Brites L, Cunha Santos F, Silva A, Lopes AR, Cruz M, Vilas Boas JP, Pontes Ferreira M, Samões B, Beirão T, Santos I, Carvalho D, Costa L, Bernardes M. Severe infections in Portuguese patients with rheumatoid arthritis under biologic treatment - a multicenter, nationwide study (SIPPRA-B Study). ARP Rheumatol 2023; 2:111-119. [PMID: 37421190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Despite years of experience with biological disease modifying anti-rheumatic drugs (bDMARD) in rheumatoid arthritis (RA), little is known about differences in infectious risk among bDMARDs. The aim of this study was to assess the incidence and type of infections in RA patients on bDMARDs and to determine possible predictors. METHODS A retrospective multicenter cohort study that included patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with RA, and exposed to at least one bDMARD until April 2021. RA patients under bDMARD and with at least one episode of severe infection (SI), defined as infection that requires hospitalization, use of parenteral antibiotics or that resulted in death, were compared to patients with no report of SI. Demographic and clinical data at baseline and at the time of each SI were collected to establish comparisons between different groups of bDMARDs. Comparisons between different bDMARDs were assessed and logistic regression was performed to identify predictors of SI. RESULTS We included 3394 patients, 2833 (83.5%) female, with a mean age at RA diagnosis of 45.5±13.7 years. SI was diagnosed in 142 of the 3394 patients evaluated (4.2%), totaling 151 episodes of SI. At baseline, patients with SI had a significantly higher proportion of prior orthopedic surgery, asthma, interstitial lung disease, chronic kidney disease and corticosteroid use, higher mean age and longer median disease duration at first bDMARD. Nine patients died (6.0%). Ninety-two SI (60.9%) occurred with the first bDMARD, the majority leading to discontinuation of the bDMARD within 6 months (n=75, 49.7%), while 65 (43.0%) restarted the same bDMARD and 11 (7.3%) switched to another bDMARD (6 of them to a different mechanism of action). In the multivariate analysis, we found that chronic kidney disease, asthma, infliximab, corticosteroid use, interstitial lung disease, previous orthopedic surgery, higher Health Assessment Questionnaire and DAS284V-ESR are independent predictors of SI. CONCLUSION This study described the incidence and types of SI among Portuguese RA patients on biologics, identifying several predictors of SI, both globally and with different bDMARDs. Physicians should be aware of the real-word infectious risk in RA patients on bDMARDs when making treatment decisions.
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Affiliation(s)
| | - Maria Seabra Rato
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João
| | - Pedro Madureira
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João
| | - Filipe Araújo
- Unidade de Reumatologia e Osteoporose, Hospital Ortopédico de Sant`Ana
| | | | | | - Luisa Brites
- Serviço de Reumatologia, Centro Hospitalar de Leiria
| | | | - Augusto Silva
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, CHULN, Centro Académico de Medicina de Lisboa
| | - Ana Rita Lopes
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, CHULN, Centro Académico de Medicina de Lisboa
| | - Margarida Cruz
- Serviço de Reumatologia, Centro Hospitalar de São Francisco
| | | | | | - Beatriz Samões
- Serviço de Reumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Tiago Beirão
- Serviço de Reumatologia, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Inês Santos
- Serviço de Reumatologia, Centro Hospitalar Tondela-Viseu
| | | | - Lúcia Costa
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João
| | - Miguel Bernardes
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João; Departamento de Medicina, Faculdade de Medicina da Universidade do Porto
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9
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Santiago T, Santiago M, Moreira S, Santos L, Salvador MJ, da Silva JAP. Influence of contextual factors and reliability of ultrasound skin measures in persons with systemic sclerosis and healthy controls. Clin Exp Rheumatol 2022:19425. [PMID: 36995314 DOI: 10.55563/clinexprheumatol/setd1z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To examine the influence of contextual factors upon the evaluation of skin thickness and stiffness by ultrasound and to assess the reliability of these parameters. METHODS Ultrasound dermal thickness (by B-mode, 18MHz) and skin stiffness (by shear-wave elastography, 9MHz) were assessed in persons with systemic sclerosis (SSc) and in healthy controls. The influence of contextual factors upon repeated measures was evaluated: (i) room temperature (16-17ºC vs. 22-24ºC); (ii) time of day (morning vs. afternoon), and (iii) menstrual cycle phase (menstrual vs ovulatory). Differences were analysed using the related-samples Wilcoxon signed-rank test. Inter- and intra-rater reliability of ultrasound skin thickness and stiffness were evaluated in the 17 skin Rodnan sites of 20 persons with SSc and 20 healthy controls, under stable contextual conditions. RESULTS A significant increase in ultrasound dermal thickness was observed at the leg in the afternoon vs morning, in both patients and controls. Similar observations were made for skin stiffness at the leg (in SSc) and at the foot (in SSc and controls) in the afternoon. No significant changes were observed in association with room temperature and menstrual cycle. Intra- and inter-rater-reliability was good to excellent for ultrasound dermal thickness and stiffness, both in SSc and healthy controls. CONCLUSIONS The timing of the ultrasound procedure within each day seems to influence the ultrasound measures at the legs and feet. Our study corroborates that ultrasound dermal thickness and skin stiffness are reliable domains to quantify skin involvement in SSc.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal.
| | - Mariana Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
| | - Sónia Moreira
- Internal Medicine Service, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Lèlita Santos
- Internal Medicine Service, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
| | - José António Pereira da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, and Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Portugal
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10
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Freitas R, Martins P, Dourado E, Santiago T, Guimarães F, Fernandes BM, Garcia S, Samões B, Pinto AS, Gonçalves N, Lourenço MH, Costa E, Rocha M, Couto M, Duarte AC, Araújo F, Cordeiro I, Godinho F, Resende C, Salvador MJ, Cordeiro A, Santos MJ. Clinical features and outcome of 1054 patients with Systemic Sclerosis: analysis of Reuma.pt/SSc registry. ARP Rheumatol 2022; 1:21-29. [PMID: 35633574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a rare connective tissue disorder with heterogeneous manifestations and outcomes. Besides differences in disease characteristics among distinct ethnic groups and geographical regions, several questions regarding the impact of the disease and the effectiveness of treatments remain unanswered. To address these questions, the Rheumatic Diseases Portuguese Register (Reuma.pt) launched a specific protocol for the prospective follow-up of SSc patients. OBJECTIVES To describe the baseline characteristics, disease subsets, treatments used and survival of SSc patients registered in Reuma.pt/SSc. METHODS Data from adult patients with SSc included in Reuma.pt up to November 2020 were analysed. Demographic features, SSc subsets, fulfilment of classification criteria, main clinical and immunological features, comorbidities, treatments used and survival data were described and compared between diffuse cutaneous (dc) and limited cutaneous (lc) disease subsets. Survival was calculated for patients included in Reuma.pt within the first two years of diagnosis. RESULTS In total, 1054 patients were included, 87.5% female, with a mean age at diagnosis of 52.7 +/- 14.8 years. The most common subset was lcSSc (56.3%), followed by dcSSc (17.5%), preclinical SSc (13%), overlap syndrome (9.8%) and SSc sine scleroderma (3.3%). Raynaud's phenomenon (93.4%) and skin thickening (76.9%) were the most frequently observed clinical manifestations. Gastrointestinal (62.8% versus 47.8%), pulmonary (59.5% versus 23%) and cardiac (12.8% versus 6.9%) involvements were significantly more prevalent in dcSSc than lcSSc. Ninety per-cent of patients were Antinuclear antibody positive, 52.5% were Anti-centromere antibody positive and 21% anti-topoisomerase positive, with significant differences between lcSSc and dcSSc. One-third of patients were treated with immunomodulators, 53.6% with vasodilators, 23% with glucocorticoids and 2.3% with biologics. During follow-up, 83 deaths (7.9%) were reported. The overall 1-, 2- and 5-year survivals were 98.0%, 96.8% and 92.6%, respectively, without significant differences between lcSSc and dcSSc. CONCLUSION Reuma.pt/SSc data highlights the importance of registries in improving knowledge about rare and complex diseases, such as SSc. Clinical features of Portuguese SSc patients are similar to those of other populations. In recently diagnosed patients, 5-year survival is over 92%. To the best of our knowledge, this is the first study showing that clinical features of Portuguese SSc are similar to those of other cohorts.
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Affiliation(s)
| | - Patrícia Martins
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa
| | - Eduardo Dourado
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa
| | - Tânia Santiago
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra; Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra
| | | | | | - Salomé Garcia
- Serviço de Reumatologia, Centro Hospitalar Universitário São João
| | - Beatriz Samões
- Serviço de Reumatologia, Centro Hospitalar Vila Nova de Gaia
| | | | - Nuno Gonçalves
- Serviço de Reumatologia, Centro Hospitalar Lisboa Ocidental; Hospital Central do Funchal
| | | | | | - Margarida Rocha
- Serviço de Reumatologia, Centro Hospitalar Universitário do Algarve
| | - Maura Couto
- Serviço de Reumatologia, Centro Hospitalar Tondela - Viseu
| | | | | | - Inês Cordeiro
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte
| | | | - Catarina Resende
- Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte
| | | | - Ana Cordeiro
- Serviço de Reumatologia, Hospital Garcia de Orta
| | - Maria José Santos
- Serviço de Reumatologia, Hospital Garcia de Orta; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa
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11
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Freitas R, Martins P, Dourado E, Santiago T, Guimarães F, Fernandes BM, Garcia S, Samões B, Pinto AS, Gonçalves N, Lourenco MH, Costa E, Rocha M, Couto M, Duarte AC, Araújo F, Cordeiro I, Godinho F, Resende C, Salvador MJ, Cordeiro A, Santos MJ. Gender differences in clinical features and outcomes of a Portuguese systemic sclerosis cohort. Clin Rheumatol 2021; 41:1139-1144. [PMID: 34799767 DOI: 10.1007/s10067-021-05997-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Evidence for the role of sex in the clinical manifestations of systemic sclerosis (SSc) patients is emerging. Some multicenter cohorts have shown that male SSc patients have more severe disease and worse survival. To assess the differences in clinical manifestations and survival in Portuguese SSc patients according to gender. Data from male and female adult SSc patients included in the Rheumatic Diseases Portuguese Register (Reuma.pt) were analysed and compared. Survival was calculated for patients included in Reuma.pt. within the first two years of diagnosis (inception cohort). In total, 1054 adult patients with SSc were included, 12.5% males. No differences in demographic features and comorbidities were found between the sexes, except for a higher rate of cigarette smokers among men. Diffuse cutaneous SSc and anti-topoisomerase antibodies were more prevalent in males than females. Additionally, male patients presented significantly more myositis, interstitial lung disease and gastric involvement. There were no differences in the patterns of drug use between the sexes. During follow-up, more deaths were reported in men than women (12.1% vs 7.3%, p = 0.04). The overall 1-, 3-, and 5-year survivals from diagnosis of the inception cohort (N = 469) for men vs women were 96.4% vs 98.2%, 93% vs 95.9%, and 75.8% vs 93.2%, respectively, with statistically significant differences (p < 0.01). This study confirms the existence of gender differences in clinical and immunological SSc features. Although SSc is less common in men than women, men have a more severe expression of skin and internal organ involvement and worse survival. Key Points • There are differences in SSc disease manifestations between sexes. • Males more commonly have diffuse cutaneous SSc, anti-topoisomerase antibodies, pulmonary and musculoskeletal involvement. • In the inception cohort, men had worse survival rates than women.
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Affiliation(s)
- Raquel Freitas
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal.
| | - Patrícia Martins
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Eduardo Dourado
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisca Guimarães
- Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | - Salomé Garcia
- Rheumatology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Beatriz Samões
- Rheumatology Department, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Ana Sofia Pinto
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - Nuno Gonçalves
- Rheumatology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Rheumatology Department, Hospital Central do Funchal, Funchal, Portugal
| | | | - Emanuel Costa
- Rheumatology Department, Hospital de Braga, Braga, Portugal
| | - Margarida Rocha
- Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Maura Couto
- Rheumatology Department, Centro Hospitalar Tondela - Viseu, Viseu, Portugal
| | | | - Filipe Araújo
- Rheumatology and Osteoporosis Department, Hospital de Sant'Ana, Parede, Portugal
| | - Inês Cordeiro
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Fátima Godinho
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Catarina Resende
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Cordeiro
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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12
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Mesquita M, Santos E, Kassuya CA, Salvador MJ. Chimarrão, terere and mate-tea in legitimate technology modes of preparation and consume: A comparative study of chemical composition, antioxidant, anti-inflammatory and anti-anxiety properties of the mostly consumed beverages of Ilex paraguariensis St. Hil. J Ethnopharmacol 2021; 279:114401. [PMID: 34245836 DOI: 10.1016/j.jep.2021.114401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ilex paraguariensis St. Hil. (Aquifoliaceae) is a medicinal plant widely used by South American populations for centuries and is popularly attributed to stimulating and detoxifying properties. Nowadays, their consume traditionally occurs through three different beverages: chimarrão, terere and mate-tea. AIM OF THE STUDY Although its composition and properties are well studied, literature lacks work comparing the potential of their extracts obtained by a legitimate preparation mode of their popular beverages. Therefore, the purpose of this research is to investigate changes in chemical composition, antioxidant activity, anti-inflammatory efficacy and anxiolytic effect from lyophilized aqueous extracts obtained simulating the legitimate popular preparation mode of chimarrão, terere and mate-tea. MATERIALS AND METHODS In this work, were investigated differences related to preparation technology and dry material used through chemical composition analysis, with the lyophilized aqueous extracts obtained simulating the chimarrão, terere and mate-tea preparation. The chemical composition analysis comprises the total soluble phenolics content, chemical profiles by HPLC-ESI-MS/MS, and quantitative component detection by HPLC-UV/DAD. Moreover, evaluations of comparative antioxidant activity of the extracts (DPPH and ORACFL assays), anti-inflammatory efficacy and anxiolytic effect were performed in vivo. RESULTS Our results showed that chimarrão extracts presented a richer composition in terms of phenolic compounds and purine alkaloids, and better antioxidant activity when compared to the other extracts. In pleurisy test, all products showed anti-inflammatory properties in the dose of 60 mg/kg. In the anxiolytic evaluation, although all extracts presented some effect, chimarrão and terere were better than mate-tea in general. No sign of toxicity was observed. CONCLUSIONS Our findings support that the beverage made as chimarrão has the best composition and the most promising properties overall.
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Affiliation(s)
- M Mesquita
- Institute of Biology, Department of Plant Biology, PPG BCE, University of Campinas (UNICAMP), 13083-970, Campinas, São Paulo, Brazil.
| | - E Santos
- College of Health Science, Federal University of Grande Dourados, Dourados, MS, Brazil.
| | - C A Kassuya
- College of Health Science, Federal University of Grande Dourados, Dourados, MS, Brazil.
| | - M J Salvador
- Institute of Biology, Department of Plant Biology, PPG BCE, University of Campinas (UNICAMP), 13083-970, Campinas, São Paulo, Brazil.
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13
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Santiago T, Santos E, Duarte AC, Martins P, Sousa M, Guimarães F, Azevedo S, Ferreira RM, Guerra M, Cordeiro A, Cordeiro I, Pimenta S, Pinto P, Pinto AM, Salvador MJ, Silva JAPD. Happiness, quality of life and their determinants among people with systemic sclerosis: a structural equation modelling approach. Rheumatology (Oxford) 2021; 60:4717-4727. [PMID: 33521812 DOI: 10.1093/rheumatology/keab083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' objectives and experiences must be core to the study and management of chronic diseases, such as SSc. Although patient-reported outcomes are attracting increasing attention, evaluation of the impact of disease on the overall subjective well-being, equivalent to 'happiness', is remarkably lacking. OBJECTIVES To examine the determinants of happiness and quality of life in patients with SSc, with emphasis on disease features and personality traits. METHODS Observational, cross-sectional multicentre study, including 142 patients, with complete data regarding disease activity, disease impact, personality, health-related quality of life (HR-QoL) and happiness. Structural equation modelling was used to evaluate the association between the variables. RESULTS The results indicated an acceptable fit of the model to the data. Perceived disease impact had a significant negative direct relation with HR-QoL (β = -0.79, P < 0.001) and with happiness (β = -0.52, P < 0.001). Positive personality traits had a positive relation with happiness (β = 0.36, P = 0.002) and an important indirect association upon QoL (β = 0.43) and happiness (β = 0.23). Perceived disease impact is influenced by body image, fatigue and SSc-related disability to a higher degree (β = 0.6-0.7) than by disease activity (β = 0.28) or form (β = 0.17). Impact of disease had a much stronger relation with HR-QoL than with happiness. CONCLUSIONS The results suggest that treatment strategies targeting not only disease control but also the mitigation of relevant domains of disease impact (body image, fatigue, global disability) may be important to improve patients' experience of the disease. The reinforcement of resilience factors, such as positive psychological traits, may also play a contributory role towards better patient outcomes.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - Eduardo Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra
| | | | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | - Marlene Sousa
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | | | | | | | - Miguel Guerra
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | | | - Inês Cordeiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, CHULN.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa
| | | | - Patrícia Pinto
- Centro Hospitalar Vila Nova Gaia/Espinho, Vila Nova de Gaia
| | - Ana Margarida Pinto
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences.,Psychological Medicine Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
| | - José António P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.,Faculty of Medicine, University of Coimbra
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Prata AR, Saraiva L, Salvador MJ, Malcata A. Retro-odontoid pseudotumor: a rare complication of Diffuse Idiopathic Skeletal Hyperostosis. Acta Reumatol Port 2021; 46:279-280. [PMID: 34635629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Ana Rita Prata
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra
| | - Liliana Saraiva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra
| | | | - Armando Malcata
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra
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15
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Santiago T, Santiago M, Coutinho M, Salvador MJ, Da Silva JAP. How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography. Arthritis Res Ther 2020; 22:50. [PMID: 32188488 PMCID: PMC7079468 DOI: 10.1186/s13075-020-02150-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time. Objective To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up. Methods Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann–Whitney U test. Results We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026). Conclusion This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.
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Affiliation(s)
- T Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - M Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Coutinho
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M J Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J A P Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Azevedo S, Guimarães F, Leite Silva J, Barros R, Capela S, Abreu P, Cunha Miranda L, Dourado E, Faustino A, Ferreira J, Las V, Martins F, Martins Rocha T, Meirinhos T, Salvador MJ, Santos-Faria D, Soares Rodrigues M, Teixeira F, Cunha I. The role of opioid analgesics in rheumatic disorders: a position paper from the Portuguese Rheumatology Society. Acta Reumatol Port 2020; 45:7-19. [PMID: 32572015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pain is a common feature of most rheumatic diseases and it is often the main reason for the patient to seek for a clinical appointment. Chronic pain has a major impact on patient's quality of life, being frequently associated with functional incapacity, sleep and mood disorders. This leads to absenteeism and heavy consumption of health resources, both representing huge burdens on national economy. Managing musculoskeletal pain is pivotal but can be challenging. The use of the available pharmaceutical armamentarium should be parsimonious. Opioids are strong analgesic drugs that mostly act through their agonist action on µ-receptors in the central nervous system. Opioid-related side effects are not negligible and are mediated through both central and peripheral opioid receptors. The use of opioids is well established in the treatment of oncologic pain but their role in the management of musculoskeletal pain is still controversial. Inflammatory rheumatic diseases, osteoarthritis, osteoporotic fractures, chronic low back pain and fibromyalgia represent diverse major rheumatic conditions that frequently lead to chronic pain. In order to standardize and optimize management of musculoskeletal chronic pain in these prevalent diseases, the Portuguese Rheumatology Society elaborated this position paper. The objectives were: a) to define the importance of pain assessment and classification; b) to guide patient selection, appropriate choice of opioids, their management, and raise awareness of their adverse effects; c) to review the existent data on possible indications of opioid therapy on rheumatic diseases.
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17
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Affiliation(s)
- Tânia Santiago
- Centro Hospitalar e Universitário de Coimbra,and University of Coimbra, Coimbra, Portugal
| | - Barbara Ruaro
- University of Genova, San Martino Polyclinic Hospital Genoa, Italy
| | - Maurizio Cutolo
- University of Genova, San Martino Polyclinic Hospital Genoa, Italy
| | - Mariana Santiago
- Centro Hospitalar e Universitário de Coimbra,and University of Coimbra, Coimbra, Portugal
| | - Maria João Salvador
- Centro Hospitalar e Universitário de Coimbra,and University of Coimbra, Coimbra, Portugal
| | - J A P da Silva
- Centro Hospitalar e Universitário de Coimbra,and University of Coimbra, Coimbra, Portugal
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18
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Santiago T, Santiago M, Ruaro B, Salvador MJ, Cutolo M, Silva JAP. Ultrasonography for the Assessment of Skin in Systemic Sclerosis: A Systematic Review. Arthritis Care Res (Hoboken) 2019; 71:563-574. [DOI: 10.1002/acr.23597] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Tânia Santiago
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Mariana Santiago
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Barbara Ruaro
- University of GenoaIRCCS San Martino Polyclinic Hospital Genoa Italy
| | - Maria João Salvador
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Maurizio Cutolo
- University of GenoaIRCCS San Martino Polyclinic Hospital Genoa Italy
| | - J. A. P. Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
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19
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Sepriano A, Ramiro S, van der Heijde D, Ávila-Ribeiro P, Fonseca R, Borges J, Teixeira L, Carvalho PD, Cerqueira M, Neves J, Meirinhos T, Barcelos A, Sequeira G, Salvador MJ, Canas da Silva J, Santos H, Bernardes M, Vieira-Sousa E, Canhão H, Branco JC, Pimentel-Santos F, Landewé R. Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study. Arthritis Rheumatol 2017; 68:2671-2679. [PMID: 27273894 DOI: 10.1002/art.39772] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/26/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA). METHODS Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score. RESULTS In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08-13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59-1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68-1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment. CONCLUSION Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.
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Affiliation(s)
- A Sepriano
- Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands.
| | - S Ramiro
- Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - R Fonseca
- Centro Hospitalar São João, Porto, Portugal
| | - J Borges
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - L Teixeira
- Hospital Garcia de Orta, Almada, Portugal
| | - P D Carvalho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Cerqueira
- Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - J Neves
- Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | - A Barcelos
- Hospital Infante D. Pedro, Aveiro, Portugal
| | | | - M J Salvador
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - H Santos
- Instituto Português de Reumatologia, Lisbon, Portugal
| | | | - E Vieira-Sousa
- Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal
| | - H Canhão
- Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal
| | - J C Branco
- Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal
| | - F Pimentel-Santos
- Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal
| | - R Landewé
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical Center, Heerlen, The Netherlands
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Daniel A, Eugénio G, Serra S, Malcata A, Salvador MJ. Diagnostic utility of Magnetic Ressonance Imaging in Eosinophilic Fasciitis. Acta Reumatol Port 2017; 42:271-272. [PMID: 28379209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Sara Serra
- Centro Hospitalar e Universitário de Coimbra
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Santiago T, Alcacer-Pitarch B, Salvador MJ, Del Galdo F, Redmond AC, da Silva JAP. A preliminary study using virtual touch imaging and quantification for the assessment of skin stiffness in systemic sclerosis. Clin Exp Rheumatol 2016; 34 Suppl 100:137-141. [PMID: 26939859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/18/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To evaluate ultrasound Virtual Touch Imaging and Quantification (VTIQ) as a method for determining absolute skin stiffness in patients with systemic sclerosis (SSc). METHODS Skin thickness, assessed by the modified Rodnan Skin Score (mRSS) and absolute skin stiffness, using VTIQ, were measured at all mRSS anatomical sites to quantify the shear wave velocity (in m/s) in 26 SSc patients and in 17 age- and gender-matched controls. Correlations between mRSS and absolute skin stiffness, and comparisons between patients and controls were analysed statistically using Mann-Whitney U tests and correlations between variables using Pearson's. P values <0.05 were considered significant. RESULTS Shear wave velocity as a measure of skin stiffness was significantly higher in SSc than in controls in 11 out of 16 mRSS sites investigated. Shear-wave velocity was strongly correlated with the local mRSS in the following anatomical sites: forearm, hand, phalanx, and thigh. In the patient group, clinically unaffected skin could also be differentiated from healthy skin using shear-wave velocity. CONCLUSIONS VTIQ represents an innovative and promising technique that provides, for the first time, a non-invasive, absolute quantification of skin stiffness. Further studies of VTIQ are required, but this early study supports the clinical and scientific potential of this new measure of skin involvement in SSc.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Begonya Alcacer-Pitarch
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Maria João Salvador
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Francesco Del Galdo
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
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22
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Baptista R, Serra S, Martins R, Teixeira R, Castro G, Salvador MJ, Pereira da Silva JA, Santos L, Monteiro P, Pêgo M. Exercise echocardiography for the assessment of pulmonary hypertension in systemic sclerosis: a systematic review. Arthritis Res Ther 2016; 18:153. [PMID: 27368695 PMCID: PMC4930605 DOI: 10.1186/s13075-016-1051-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) complicates the course of systemic sclerosis (SSc) and is associated with poor prognosis. The elevation of systolic pulmonary arterial pressure (sPAP) during exercise in patients with SSc with normal resting haemodynamics may anticipate the development of PAH. Exercise echocardiography (ExEcho) has been proposed as a useful technique to identify exercise-induced increases in sPAP, but it is unclear how to clinically interpret these findings. In this systematic review, we summarize the available evidence on the role of exercise echocardiography to estimate exercise-induced elevations in pulmonary and left heart filling pressures in patients with systemic sclerosis. METHODS We conducted a systematic review of the literature using MEDLINE, Cochrane Library and Web of Knowledge, using the vocabulary terms: ('systemic sclerosis' OR 'scleroderma') AND ('exercise echocardiography') AND ('pulmonary hypertension'). Studies including patients with SSc without a prior diagnosis of PAH, and subjected to exercise echocardiography were included. All searches were limited to English and were augmented by review of bibliographic references from the included studies. The quality of evidence was assessed by the Effective Public Health Practice Project system. RESULTS We identified 15 studies enrolling 1242 patients, who were mostly middle-aged and female. Several exercise methods were used (cycloergometer, treadmill and Master's two step), with different protocols and positions (supine, semi-supine, upright); definition of a positive test also varied widely. Resting estimated sPAP levels varied from 18 to 35 mm Hg, all in the normal range. The weighted means for estimated sPAP were 22.2 ± 2.9 mmHg at rest and 43.0 ± 4.3 mmHg on exercise; more than half of the studies reported mean exercise sPAP ≥40 mmHg. The assessment of left ventricular diastolic function on peak exercise was reported in a minority of studies; however, when assessed, surrogate variables of left ventricular (LV) diastolic dysfunction were associated with higher sPAP on exercise. CONCLUSIONS We found very high heterogeneity in the methods, the protocols and the estimated sPAP response to exercise. LV diastolic dysfunction was common and was associated with greater elevation of sPAP on exercise.
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Affiliation(s)
- Rui Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Sara Serra
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Martins
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Rogério Teixeira
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Graça Castro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
| | - Maria João Salvador
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José António Pereira da Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lèlita Santos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mariano Pêgo
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-001, Coimbra, Portugal
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23
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Carvalho PD, Costa C, Rodrigues M, Salvador MJ, Pereira da Silva JA, Malcata A. [Dermatomyositis-like syndrome in x-linked agammaglobulinemia]. Acta Reumatol Port 2016; 41:78-81. [PMID: 27115112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary immunodeficiencies (PIDs) encompass more than 250 different pathological conditions. X-linked agammaglobulinemia (XLA) has been occasionally associated with cutaneous and muscular manifestations resembling dermatomyositis, often termed dermatomyositis-like syndrome (DLS). This syndrome has been associated with cutaneous, muscular and central nervous system manifestations, accompanying a persistent infection by an Echovirus. According to sixteen previously reported cases, this syndrome has a poor prognosis. We report the case of a 27-years old male, with XLA and DLS, successfully treated with 6 cycles of human immunoglobulin and methotrexate. Clinical symptoms improved dramatically with a complete resolution of the musculoskeletal manifestations. Despite this clinical response, prognosis should remain reserved. The evolution of this syndrome remains unpredictable and therapeutic options are limited. To the best of our knowledge, there are only a few reports of similar cases which have survived so many months after the diagnosis.
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24
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Herculano EA, Da Costa C, Rodriques AKBF, Araújo-Júnior JX, Santana EG, França PHB, Gomes EA, Salvador MJ, Moura FBP, Ribeiro EAN. Evaluation of cardiovascular effects of edible fruits of Syzygium cumini Myrtaceae (L) skeels in rats. TROP J PHARM RES 2014. [DOI: 10.4314/tjpr.v13i11.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Brighenti FL, Salvador MJ, Delbem ACB, Delbem ÁCB, Oliveira MAC, Soares CP, Freitas LSF, Koga-Ito CY. Systematic screening of plant extracts from the Brazilian Pantanal with antimicrobial activity against bacteria with cariogenic relevance. Caries Res 2014; 48:353-60. [PMID: 24603299 DOI: 10.1159/000357225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
This study proposes a bioprospection methodology regarding the antimicrobial potential of plant extracts against bacteria with cariogenic relevance. Sixty extracts were obtained from ten plants--(1) Jatropha weddelliana, (2) Attalea phalerata, (3) Buchenavia tomentosa, (4) Croton doctoris, (5) Mouriri elliptica, (6) Mascagnia benthamiana, (7) Senna aculeata, (8) Unonopsis guatterioides, (9) Allagoptera leucocalyx and (10) Bactris glaucescens--using different extraction methods - (A) 70° ethanol 72 h/25°C, (B) water 5 min/100°C, (C) water 1 h/55°C, (D) water 72 h/25°C, (E) hexane 72 h/25°C and (F) 90° ethanol 72 h/25°C. The plants were screened for antibacterial activity at 50 mg/ml using the agar well diffusion test against Actinomyces naeslundii ATCC 19039, Lactobacillus acidophilus ATCC 4356, Streptococcus gordonii ATCC 10558, Streptococcus mutans ATCC 35688, Streptococcus sanguinis ATCC 10556, Streptococcus sobrinus ATCC 33478 and Streptococcus mitis ATCC 9811. The active extracts were tested to determine their minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), cytotoxicity and chemical characterization. Forty-seven extracts (78%) were active against at least one microorganism. Extract 4A demonstrated the lowest MIC and MBC for all microorganisms except S. gordonii and the extract at MIC concentration was non-cytotoxic. The concentrated extracts were slightly cytotoxic. Electrospray ionization with tandem mass spectrometry analyses demonstrated that the extract constituents coincided with the mass of the terpenoids and phenolics. Overall, the best results were obtained for extraction methods A, B and C. The present work proved the antimicrobial activity of several plants. Particularly, extracts from C. doctoris were the most active against bacteria involved in dental caries disease.
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Affiliation(s)
- F L Brighenti
- Department of Biosciences and Oral Diagnosis, Universidade Estadual Paulista (UNESP), São José dos Campos, Brazil
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26
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Galante Santiago M, Raposo M, Carvalheiro T, Andrade Â, João Salvador M, Pereira da Silva JA, Paiva A. A3.24 Distinct profile of cytokine production by th17 cells in systemic sclerosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Carvalheiro T, Andrade Â, Lemos M, Galante Santiago M, Silva C, João Salvador M, Pereira da Silva JA, Paiva A. A3.25 systemic sclerosis patients exhibit an increased frequency of T cells and NK cells with effector/cytotoxic phenotype. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sánchez-Fidalgo S, da Silva MS, Cárdeno A, Aparicio-Soto M, Salvador MJ, Frankland Sawaya ACH, Souza-Brito ARM, de la Lastra CA. Abarema cochliacarpos reduces LPS-induced inflammatory response in murine peritoneal macrophages regulating ROS-MAPK signal pathway. J Ethnopharmacol 2013; 149:140-147. [PMID: 23792124 DOI: 10.1016/j.jep.2013.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/07/2013] [Accepted: 06/01/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Abarema cochliacarpos (Gomes) Barneby and Grimes (Fabaceae), known by the vulgar name of Babatenã, has been traditionally used in Northeast Brazil, as an anti-inflammatory remedy. Previous studies have demonstrated its anti-inflammatory and antiulcer effects in skin lesion, alcohol gastric ulcer and acute and chronic colitis. AIMS The present study was designed to evaluate the antioxidant and anti-inflammatory effects of the butanolic fraction from A. cochliacarpos (BFAC) and its major flavonoid, (+)-catechin, in LPS-stimulated murine peritoneal macrophages. Moreover, we studied the role of mitogen-activated protein kinase (MAPK)s and NF-kB signaling pathways possibly involved in the beneficial effects. MATERIALS AND METHODS The quantification of the extract was carried out by ultra-performance liquid chromatography analysis. Cell viability was determined using SRB assay. Nitric oxide (NO) production was analyzed by Griess method and intracellular reactive oxygen species (ROS) by fluorescence analysis. In addition, cyclooxygenase (COX-2) and inducible nitric oxide synthase (iNOS) expression, MAPK activation and IkappaBalpha (IKBα) degradation, were determined by Western blot. RESULTS After BFAC characterization, (+)-catechin was revealed as its major constituent. Both BFAC and (+)-catechin, exerted significant anti-oxidant and anti-inflammatory effects inhibiting LPS-induced intracellular ROS and NO production in peritoneal macrophages. Additionally, the extract but also its major component reduced pro-inflammatory proteins expression probably through c-Jun N-terminal kinase and p38 MAPK signaling pathways. CONCLUSION These data suggest that the beneficial effects of BFAC might be mediated, at least in part, by the presence of (+)-catechin. Conclusively our findings confirm the potential of A. cochliacarpos as a new therapeutic strategy for the management of inflammatory and oxidative stress-related diseases.
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Affiliation(s)
- S Sánchez-Fidalgo
- Department Pharmacology, School of Pharmacy, University of Seville, Spain
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Carvalheiro T, Santiago M, Silva C, Salvador MJ, Silva JAP, Paiva A. A3.24 Alterations in χδ T Cells Homeostasis in Systemic Sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203216.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baptista R, Serra S, Martins R, Salvador MJ, Castro G, Gomes M, Santos L, Monteiro P, da Silva JAP, Pêgo M. Exercise-Induced Pulmonary Hypertension in Scleroderma Patients: A Common Finding but with Elusive Pathophysiology. Echocardiography 2012; 30:378-84. [DOI: 10.1111/echo.12063] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Sara Serra
- Department of Rheumatology; Coimbra University Hospital; Coimbra; Portugal
| | - Rui Martins
- Department of Cardiology; Coimbra University Hospital; Coimbra; Portugal
| | | | - Graça Castro
- Department of Cardiology; Coimbra University Hospital; Coimbra; Portugal
| | - Manuel Gomes
- Department of Internal Medicine; Coimbra University Hospital; Coimbra; Portugal
| | | | | | | | - Mariano Pêgo
- Department of Cardiology; Coimbra University Hospital; Coimbra; Portugal
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Serra S, Monteiro P, Vaz A, Pires E, Monteiro R, Inês L, Salvador MJ, Bernardo J, Malcata A. [Septic arthritis and gout--a case report]. Acta Reumatol Port 2012; 37:70-74. [PMID: 22781515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors describe a 54 year-old male patient, admitted after presenting in the emergency room with acute oligoarthritis affecting the shoulders and right tibiotarsal and sternoclavicular joints, with a week's duration. He was non-febrile and related a purulent discharge from the stump of a traumatic amputation of the left thumb, starting a few days prior to the presenting complaints. There was a previous history of gouty arthritis and moderate alcoholism. Lab work revealed an elevation of the acute phase markers, with marked neutrophilia. Upon admittance, the patient underwent arthrocentesis, revealing a purulent discharge with sodium monourate crystals, which cultured positively for meticillin-sensitive Staphylococcus aureus. Besides antibiotherapy, on Day 5 the patient presented with a cervical abscess with extension to mediastinum; the abscess was drained by a cardiothoracic surgeon, and the right sternoclavicular and first costochondral articulations were found to be destroyed. The authors note that, although it is a rare occurrence septic arthritis can coexist with gout, while discussing the possible mecanisms of this association, as well as particular details of the clinical case presented.
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Affiliation(s)
- S Serra
- Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Portugal.
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Machado P, Bogas M, Ribeiro A, Costa J, Neto A, Sepriano A, Raposo A, Cravo AR, Vilar A, Furtado C, Ambrósio C, Miguel C, Vaz C, Catita C, Nour D, Araújo D, Vieira-Sousa E, Teixeira F, Brandão F, Canhão H, Cordeiro I, Gonçalves I, Ferreira J, Fonseca JE, da Silva JAP, Romeu J, Ferreira J, Costa L, Maurício L, Cunha-Miranda L, Parente M, Coutinho M, Cruz M, Oliveira M, Salvador MJ, Santos MJ, Pinto P, Valente P, Abreu P, Roque R, Ramiro S, Capela S, Las V, Barcelos A. 2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis. Acta Reumatol Port 2012; 37:26-39. [PMID: 22781512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.
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Affiliation(s)
- Pedro Machado
- Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.
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Fonseca JE, Bernardes M, Canhão H, Santos MJ, Quintal A, Malcata A, Neto A, Cordeiro A, Rodrigues A, Mourão AF, Ribeiro AS, Cravo AR, Barcelos A, Cardoso A, Vilar A, Braña A, Faustino A, Silva C, Duarte C, Araújo D, Nour D, Sousa E, Simões E, Godinho F, Brandão F, Ventura F, Sequeira G, Figueiredo G, Cunha I, Matos JA, Branco J, Ramos J, Costa JA, Gomes JA, Pinto J, Silva JC, Silva JA, Patto JV, Costa L, Miranda LC, Inês L, Santos LM, Cruz M, Salvador MJ, Ferreira MJ, Rial M, Queiroz MV, Bogas M, Araújo P, Reis P, Abreu P, Machado P, Pinto P, André R, Melo R, Garcês S, Cortes S, Alcino S, Ramiro S, Capela S. Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update. Acta Reumatol Port 2011; 36:385-388. [PMID: 22472929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist’s clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).
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Affiliation(s)
- João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal.
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34
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Serra S, Monteiro P, Pires E, Vieira R, Telechea O, Inês L, Salvador MJ, Malcata A. [Relapsing polychondritis, interstitial granulomatous dermatitis and antiphospholipid syndrome: an unusual clinical association]. Acta Reumatol Port 2011; 36:292-297. [PMID: 22113604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors describe the case of a 49 year-old male patient with a 3-year history of antiphospholipid syndrome, admitted after presenting in the emergency room with erythematous nodular skin lesions, affecting the face and neck, with a week's duration. Local biopsies were suggestive of interstitial granulomatous dermatitis. The patient described lesions compatible with bilateral auricular chondritis, two weeks prior to the appearance of the nodules, which resolved spontaneously after 3 days. There was a previous episode of nasal chondritis, two years previously, and another episode starting at the 7th day of hospitalization. These findings, taken together with a diagnosis of seronegative polyarthritis established 5 years before the current events, lead to a diagnosis of relapsing polychondritis.
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Affiliation(s)
- S Serra
- Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Portugal.
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35
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Fonseca JE, Canhão H, Reis P, Santos MJ, Branco J, Quintal A, Malcata A, Araújo D, Ventura F, Figueiredo G, da Silva JC, Patto JV, de Queiroz MV, Santos RA, Neto AJ, de Matos AD, Rodrigues A, Mourão AF, Ribeiro AS, Cravo AR, Barcelos A, Cardoso A, Vilar A, Braña A, Faustino A, Silva C, Godinho F, Cunha I, Costa JA, Gomes JAM, Pinto JAA, da Silva JAP, Miranda LC, Inês L, Santos LM, Cruz M, Salvador MJ, Ferreira MJ, Rial M, Bernardes M, Bogas M, Araújo P, Machado P, Pinto P, de Melo RG, Cortes S, Alcino S, Capela S. Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update. Acta Reumatol Port 2010; 35:95-98. [PMID: 20505635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).
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36
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Serra S, Salvador MJ, Malcata A. [Gorham syndrome, a rare disease...]. Acta Reumatol Port 2009; 34:666-667. [PMID: 20087270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sara Serra
- Interna do Internato Complementar de Reumatologia, Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Praceta Mota Pinto, Coimbra
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37
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Oliveira P, Monteiro P, Coutinho M, Salvador MJ, Costa ME, Malcata A. [Health-related quality of life and chronic pain experience in rheumatic diseases]. Acta Reumatol Port 2009; 34:511-519. [PMID: 19830929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess differences among health-related quality of life, pain threshold and perception,and passive coping strategies with chronic pain(specifically retreating, worrying, and resting), as well as associations among variables in three groups of rheumatic patients - fibromyalgia (FM),rheumatoid arthritis (RA), and osteoarthritis (OA). MATERIAL AND METHODS 86 participants diagnosed with FM (n = 25), RA (n = 31) and OA (n = 30) completed the following measures: Clinical and Sociodemographic Questionnaire (QSDC), Medical Outcomes Study 36-item Short Form Health Survey(SF-36v2), Pain Coping Inventory (PCI), visual analogic scale (VAS) for pain, and dolorimeter for threshold pain. SPSS software was used to perform statistical analyses. RESULTS FM patients reported the lowest levels of quality of life and threshold pain, as well as the highest levels of pain perception and passive coping with chronic pain. Associations between variables support that experience with chronic pain is managed more successfully in OA patients, followed by RA patients and, finally, by FM patients. CONCLUSIONS Our findings support the adoption ofa biopsychosocial model for assessment and intervention with rheumatic patients, considering specificities associated to each illness.
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Affiliation(s)
- Paula Oliveira
- Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto.
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38
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Vaz C, Couto M, Duarte C, Salvador MJ, Inês L, Malcata A. [An unusual case of generalized pain: paramyloidosis simulating fibromyalgia]. Acta Reumatol Port 2009; 34:431-435. [PMID: 19727056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The authors report a case of a 52-year old female previously followed at the Outpatient Rheumatology Clinic with the diagnosis of Fibromyalgia (FM). Approximately 2 years after this diagnosis, she presents with a 2nd degree burn in a hand, as a result of thermal hypoesthesia. The patient described hipostesia of the distal upper and lower limbs, incontinence of the anal sphincter and chronic diarrhoea with progressive worsening. The electromiography showed sensory-motor axonal polyneuropathy, chronic, moderate to severe. The muscle and nerve biopsy showed deposition of amyloid substance. The search for TTR Met 30 was positive, confirming the diagnosis of familial amyloidotic polyneuropathy. This is the first reported case of familial amyloidotic polyneuropathy as part of the differential diagnosis of fibromyalgia.
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Affiliation(s)
- Cláudia Vaz
- Serviço de Reumatologia dos Hospitais Universidade de Coimbra, Praceta Mota Pinto, 3000-075 Coimbra.
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39
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Monteiro P, Coutinho M, Salvador MJ, Malcata A. [Primary Sjögren syndrome and inclusion body myositis]. Acta Reumatol Port 2009; 34:261-265. [PMID: 19474780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors report the case of a 69-years-old woman with Sjögren's syndrome. After 8 years of disease she developed muscle weakness and the diagnosis of inclusion body myositis was established. This is a rare association. The patient had a good response to the immunosupressive treatment. Similar cases can be found in the literature and there seems to be a subset of inclusion body myositis associated with autoimmune diseases that shows a better response to treatment and a more favourable prognosis.
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Affiliation(s)
- Paulo Monteiro
- Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra - Portugal.
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40
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Vaz C, Salvador MJ, Malcata A. [Congenital diastasis of pubic symphysis]. Acta Reumatol Port 2009; 34:441. [PMID: 19727059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Cláudia Vaz
- Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Praceta Mota Pinto 3000-075, Coimbra.
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41
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Monteiro P, Coutinho M, Machado P, Garcia J, Salvador MJ, Inês L, Silva J, Malcata A. [Intersticial lung disease as the sole manifestation of antisynthetase syndrome]. Acta Reumatol Port 2009; 34:256-260. [PMID: 19474779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors report a clinical case of a woman who had a 3 years diagnosis of hipersensitivity pneumonitis based on intersticial lung disease without other manifestations. The diagnosis of antisynthetase syndrome was made three years after the initial symptoms upon the onset of systemic manifestations with articular involvement, myositis and determination of anti-PL 7 antibodies. In this syndrome, the isolated pulmonary involvement is rare.
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Affiliation(s)
- Paulo Monteiro
- Serviço de Reumatologia, Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra - Portugal.
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42
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Monteiro P, Duarte C, Salvador MJ, Malcata A. [Report of an amyopathic dermatomyositis clinical case]. Acta Reumatol Port 2009; 34:266-270. [PMID: 19474781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The authors report a clinical case of a 41-years-old man with astenia and myalgias maintained for many years without an accurate diagnosis. Amyopathic dermatomyositis was diagnosed based on the presence of typical cutaneous lesions and the absence of myositis. Subsequent evidence of subclinical myositis allowed the diagnosis of hypomyophatic dermatomyositis. Finally, the diagnosis of classical dermatomyositis could be made when the patient presented elevated levels of muscle enzimes. There was a good clinical response to imunossupressor therapy and the patient remains asymptomatic. Differences in the clinical management of amyopathic, hypomyopathic and classic dermatomyositis are discussed.
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Affiliation(s)
- Paulo Monteiro
- Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra - Portugal.
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43
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Monteiro P, Garcia J, Salvador MJ, Malcata A. [Sacral schwannoma in a lumbar spinal stenosis: a rare condition]. Acta Reumatol Port 2009; 34:438-440. [PMID: 19727058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Paulo Monteiro
- Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra.
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44
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Monteiro P, Abreu P, Salvador MJ, Malcata A. [Secondary amyloidosis and systemic lupus erythematosus]. Acta Reumatol Port 2009; 34:400-404. [PMID: 19727051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The authors report a clinical case of a 57 years old woman with systemic lupus erythematosus diagnosed 25 years before and secondary amyloidosis. Secondary amyloidosis can be associated with inflammatory or infectious chronic diseases, however the association with systemic lupus erythematosus is rare. We discuss the association between the two entities.
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Affiliation(s)
- Paulo Monteiro
- Serviço de Reumatologia dos Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra, Portugal.
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45
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Pereira IC, Barbosa AM, Salvador MJ, Soares AM, Ribeiro W, Cogo JC, Zamuner SR. Anti-inflammatory activity of Blutaparon portulacoides ethanolic extract against the inflammatory reaction induced by Bothrops jararacussu venom and isolated myotoxins BthTX-I and II. J Venom Anim Toxins Incl Trop Dis 2009. [DOI: 10.1590/s1678-91992009000300013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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46
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Silva JAP, Salvador MJ, Duarte C. [Rheumatology training in Europe new paradigms recommended by the European Board of Rheumatology]. Acta Reumatol Port 2008; 33:123-124. [PMID: 18604179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Cunha I, Saavedra MJ, Oliveira MA, Salvador MJ, Malcata A. [Hajdu-Cheney Syndrome: a case of acroosteolysis]. Acta Reumatol Port 2007; 32:169-74. [PMID: 17576397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Acroosteolysis is a rare clinical manifestation characterized by bone resorption of the terminal phalanges. It can occur in association with the variety of systemic diseases or be idiopathic. The authors describe a case of 47-year-old woman with acroosteolysis of distal phalanges since childhood, congenital amaurosis, premature loss of teeth and mal perforans. Because of the rate and exuberant manifestations found, with no etiological cause identified, the authors diagnosed Hajdu-Cheney Syndrome. Hajdu-Cheney is a rare, autosomal dominant disorder, with sporadic cases, apparently representing new mutations. Based on this case the authors review the differential diagnoses of acroosteolysis and the clinical manifestation of the Hajdu-Cheney syndrome
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Affiliation(s)
- I Cunha
- Interna do Internato Complementar de Reumatologia do Servico de Reumatologia do Hosipitais da Universidade de Coimbra, Portugal.
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48
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Couto M, Ambrósio C, Velez J, Salvador MJ, Malcata A. [Low back pain with 'red flags': a case of spondylodiscitis]. Acta Reumatol Port 2007; 32:67-72. [PMID: 17450767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Spondylodiscitis is a serious clinical entity. Despite the decrease in mortality from about 25% in the pre-antibiotic era to near 5%, it remains significant and the associated morbidity is still relevant. The rate of residual neurological deficits among survivors is around 7%. In 30% of patients some related symptoms persist, the most important being pain. The authors report the case of a 74-year-old male patient with recent onset low back pain, which caused considerable disability. With this work the authors intend to alert to the fact that in a patient with a common symptom such as low back pain, the presence of "red flags" requires a quick investigation and diagnosis in order to prevent serious damage.
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49
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Taleb-Contini SH, Salvador MJ, Balanco JMF, Albuquerque S, de Oliveira DCR. Antiprotozoal effect of crude extracts and flavonoids isolated from Chromolaena hirsuta
(asteraceae). Phytother Res 2004; 18:250-4. [PMID: 15103676 DOI: 10.1002/ptr.1431] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Phytochemical study of Chromolaena hirsuta (Hook. & Arn.) R. King & H. Robinson crude extract (collected in Furnas, MG-Brasil) produced fifteen flavonoids, two triterpenes and five steroids. IR, UV,(1)H and (13)C NMR spectroscopy and GC analysis were used for the identification of these compounds. The dichloromethanic and ethanolic crude extracts (flowers and leaves) and six flavonoids isolated from this specie have been assayed for antiprotozoal activity against tripomastigote forms of Trypanosoma cruzi and promastigote forms of Leishmania amazonensis. The crude extracts significantly reduced the viability of T. cruzi and Leishmania amazonensis, and the six flavonoids showed considerable antiproliferative effect of development of two parasites evaluated. This is the fi rst report of antiprotozoal activity of extracts of C. hirsuta.
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Affiliation(s)
- S H Taleb-Contini
- Departamento de Química, Faculdade de Filoso fi a Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, (SP), Brasil
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50
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Abstract
A chloroform crude extract (aerial part) and two compounds, apigenin (1) and cynaropicrin (2), isolated from Moquinia kingii were evaluated against Trypanosoma cruzi trypomastigotes in vitro. Antimicrobial activity was also screened using twenty-two strains including gram-positive and gram-negative bacteria and the yeasts Candida albicans and C. tropicalis. The chloroform crude extract, fractions and isolated compounds from M. kingii were active for both activities. The IC50 values for trypanocidal activity obtained for cynaropicrin and apigenin were 93.5 microg/ml and 181 microg/ml, respectively, while the minimum inhibitory concentrations (MICs) varied from 100 microg/ml to 2500 microg/ml, against the strains of bacteria and yeasts evaluated.
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Affiliation(s)
- E C Schinor
- Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto-SP, Brasil
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