Luciana Parente Costa

Exercise training improves arterial baro- and chemoreflex in control and diabetic rats

We investigated the effect of exercise training on blood pressure, heart rate, and arterial baro- and chemoreflex sensitivity in diabetic rats (streptozotocin, 50 mg/kg iv). Male Wistar rats (251+/-10 g) were divided into 4 groups (n=8, each group): sedentary normotensive (SC), sedentary diabetic (SD), trained normotensive (TC), and trained diabetic (TD). Trained groups underwent exercise training on a treadmill (10 weeks). Exercise training induced resting bradycardia (340+/-5 vs. 316+/-8 bpm) and improvement in baroreflex tachycardic response (3.4+/-0.31 vs. 2.7+/-0.06 bpm/mmHg in SC) and chemoreflex bradycardic (145+/-12 vs. 78+/-7 bpm in SC) and pressor (49+/-5 vs. 22+/-3 mmHg in SC) responses in control rats. Diabetic-induced hypotension (SC: 107+/-2 vs. SD: 93+/-2 mmHg) and bradycardia (SC: 340+/-5 vs. SD: 276+/-7 bpm) were reversed by exercise training. Baroreflex tachycardic and bradycardic responses impaired in SD rats (SD: 2.1+/-0.18 and 1.3+/-0.08 vs. SC: 2.7+/-0.06 and 1.3+/-0.08 bpm/mmHg) were enhanced in TD rats (2.5+/-0.1 and 1.7+/-0.06 bpm/mmHg). Chemoreflex bradycardic and pressor responses, attenuated in SD rats (23+/-9 bpm and 7+/-1 mmHg) in relation to SC rats, were improved by exercise (TD: 84+/-15 bpm and 32+/-5 mmHg). The improvement in arterial baro- and chemoreflex-mediated control of circulation in trained control and diabetic rats reinforces the role of exercise in the management of cardiovascular risk in healthy and diabetic individuals.

Incidence, risk factors, and outcome of Herpes zoster in systemic lupus erythematosus.

Background:The incidence and outcome of Herpes zoster (HZ) in systemic lupus erythematosus (SLE) are not completely defined as well as the relevance to HZ of disease and therapy factors. Objective:To determine HZ features in SLE. Patients and Methods:SLE patients (1997 update of the American College of Rheumatology classification criteria) with definitive HZ infection were identified from our Lupus Clinic computerized database of 1145 patients. Results:HZ was diagnosed in 51 SLE patients (4.45%) with an annual incidence rate of 6.4 events/1000 patient-years. At HZ diagnosis, mean disease duration was 9.78 ± 8.37 years, median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was 1, and only 17.6% had SLEDAI ≥8. Frequency of manifestations and immunosuppressor use were similar between patients with and without HZ. Forty-two patients (82.5%) with HZ were under prednisone with concomitant immunosuppressive therapy in 66.7%. Thirty-five patients (68.6%) were using immunosuppressors: azathioprine (39.2%), cyclophosphamide (9.8%), and mycophenolate mofetil (9.8%). The mean lymphocyte count was 1219 ± 803/mm3 (43.1% <1000/mm3 and 17.6% <500/mm3). Only patients using azathioprine and cyclophosphamide had lymphocyte counts <500/mm3 (15% and 40%).All patients received acyclovir, 19.6% had postherpetic neuralgia, and recurrence occurred in only 7.8%. Thoracic nerves were the most involved site (56.8%) followed by lumbar (23.5%). Bacterial suprainfection occurred in 11.7% but was not associated with therapy, lymphocyte count, or SLEDAI scores (P > 0.05). Conclusion:This is the largest cohort to determine that HZ is a late SLE complication with some peculiar features, such as good prognosis and typical dermatomal distribution. In addition, we have identified that the major trigger factor for this viral infection in SLE is therapy, particularly the concomitant use of corticosteroid and immunosuppressors, and not active disease.

Influenza A/H1N1 vaccination of patients with SLE: can antimalarial drugs restore diminished response under immunosuppressive therapy?

OBJECTIVE To assess the efficacy and safety of pandemic 2009 influenza A (H1N1) in SLE under different therapeutic regimens. METHODS A total of 555 SLE patients and 170 healthy controls were vaccinated with a single dose of a non-adjuvanted preparation. According to current therapy, patients were initially classified as SLE No Therapy (n = 75) and SLE with Therapy (n = 480). Subsequent evaluations included groups under monotherapy: chloroquine (CQ) (n = 105), prednisone (PRED) ≥20 mg (n = 76), immunosuppressor (IS) (n = 95) and those with a combination of these drugs. Anti-H1N1 titres and seroconversion (SC) rate were evaluated at entry and 21 days post-vaccination. RESULTS The SLE with Therapy group had lower SC compared with healthy controls (59.0 vs 80.0%; P < 0.0001), whereas the SLE No Therapy group had equivalent SC (72 vs 80.0%; P = 0.18) compared with healthy controls. Further comparison revealed that the SC of SLE No Therapy (72%) was similar to the CQ group (69.5%; P = 0.75), but it was significantly reduced in PRED ≥20 mg (53.9%; P = 0.028), IS (55.7%; P = 0.035) and PRED ≥20 mg + IS (45.4%; P = 0.038). The concomitant use of CQ in each of these later regimens was associated with SC responses comparable with SLE No Therapy group (72%): PRED ≥20 mg + CQ (71.4%; P = 1.00), IS + CQ (65.2%; P = 0.54) and PRED ≥20 mg + IS + CQ (57.4%; P = 0.09). CONCLUSION Pandemic influenza A H1N1/2009 vaccine response is diminished in SLE under immunosuppressive therapy and antimalarials seems to restore this immunogenicity. Trial registration. www.clinicaltrials.gov, NCT01151644.

Juvenile onset Systemic Lupus Erythematosus thyroid dysfunction: a subgroup with mild disease?

The aim of this study was to evaluate the frequency of thyroid dysfunction and thyroid antibodies in patients with juvenile onset Systemic Lupus Erythematosus (JOSLE) and its association with clinical and immunological features. Seventy-seven patients with JOSLE, 64 females, median age 19 years, were consecutively enrolled from March to December 2007. Clinical data related to thyroid dysfunction and lupus were obtained by chart review and patient interview. Serum levels of TSH, free T4, anti-thyroglobulin (TgAb), anti-thyroperoxidase (TPOAb), TRAb and lupus related autoantibodies were analyzed by standard techniques. Nine patients were diagnosed as hypothyroidism and 4 hyperthyroidism. 28% JOSLE patients had moderate/high titer of thyroid antibodies: 23% TgAb, 2.6% TPOAb and 3.9% TRAb. JOSLE patients with positive thyroid autoantibodies had higher frequency of anti-U1RNP antibodies than patients without these antibodies (40.9 vs. 14.5%, OR:0.25, CI:0.08-0.76, p = 0.017). Furthermore, renal/neurological/hematological involvement was less frequently observed in patients with hypothyroidism (55.6 vs. 87.5%, OR:0.18, CI:0.04-0.81, p = 0.035) and with thyroid antibodies (68.4 vs. 90.9%, OR:0.22, CI:0.06-0.82, p = 0.027) than in patients without these alterations. No association with PTPN22 polymorphism was found. In conclusion, JOSLE patients have high prevalence of subclinical hypothyroidism. The novel association of anti-thyroid antibodies with anti-U1RNP antibodies in JOSLE seems to identify a subgroup of patients with less life-threatening organ involvement.

Demographic, clinical, laboratorial, and radiological characteristics of rheumatic fever in Brazil: systematic review

Rheumatic fever (RF) is characterized by a non-suppurative inflammatory process that begins after a group A betahemolytic streptococci infection. Its prevalence is higher in developing countries, such as Brazil. However, in our country, systematic epidemiologic data on the disease are scarce and incomplete. Rheumatic fever has an estimated incidence of 3% among Brazilian children and adolescents. We undertook a systematic review of the main Brazilian studies using the LILACS, Scielo, and Medline databases searching for expressions like Febre Reumatica and Rheumatic Fever. Ten epidemiological studies were selected and comparative analysis did not show a predominance of gender, clinical presentation, and laboratorial and radiological parameters in the different regions of the country.Rheumatic fever (RF) is characterized by a non-suppurative inflammatory process that begins after a group A betahemolytic streptococci infection. Its prevalence is higher in developing countries, such as Brazil. However, in our country, systematic epidemiologic data on the disease are scarce and incomplete. Rheumatic fever has an estimated incidence of 3% among Brazilian children and adolescents. We undertook a systematic review of the main Brazilian studies using the LILACS, Scielo, and Medline databases searching for expressions like Febre Reumática and Rheumatic Fever. Ten epidemiological studies were selected and comparative analysis did not show a predominance of gender, clinical presentation, and laboratorial and radiological parameters in the different regions of the country.

Digital vasculitis in systemic lupus erythematosus: a minor manifestation of disease activity?

The objective of this study is to determine if digital vasculitis (DV), a clinical manifestation with a high systemic lupus erythematosus disease activity index (SLEDAI) score, is associated with lupus severity. DV and other clinical manifestations defined according to the SLEDAI were evaluated in 168 consecutive patients with systemic lupus erythematosus (SLE). Two groups were defined according to presence (DV+, n = 27) or absence of DV (DV−, n = 141) at the time of evaluation. The exclusion criterion was the presence of antiphospholipid syndrome (Sapporo’s criteria). The two groups were comparable with regard to age (P = 0.09), gender (P = 1.00), white race (P = 0.81), and disease duration (P = 0.78). Compared to the DV− group, the DV+ group had a significantly higher frequency of mucocutaneous manifestations (66.7 vs. 39.0%, P = 0.01), haematological abnormalities (22.2 vs. 6.4%, P = 0.02) and constitutional symptoms (11.1 vs. 0.7%, P = 0.01). Renal and neurological involvements were similar in both groups (P = 0.57 and P = 1.00, respectively). The evaluation of each SLEDAI parameter confirmed that the DV+ group had higher frequencies of mild manifestations, such as new rash (P = 0.02), alopecia (P = 0.02), oral ulcers (P = 0.045), fever (P = 0.01) and leucopenia (P = 0.005). In contrast, both groups had similarly increased anti-dsDNA (P = 0.78) and decreased complement levels (P = 0.29). In conclusion, DV in patients with SLE identifies a subgroup of a mild disease. The high ‘weighted’ index attributed to this alteration in the SLEDAI score should therefore be revised.

Microbiological and clinical assessment of the abutment and non-abutment teeth of partial removable denture wearers

OBJECTIVE The aim of this study was assessing the changes in both clinical and microbiological parameters of healthy individuals after rehabilitation with removable partial denture (RPD). DESIGN 11 women received unilateral or bilateral free-end saddle RPD in the mandibular arch. Clinical and microbiological parameters of abutment, non-abutment, and antagonist teeth were assessed at baseline (RPD installation) and after 7, 30, 90, and 180days of function. The Checkerboard DNA-DNA hybridization technique was used to identify and quantify up to 43 different microbial species from subgingival biofilm samples. Probing depth, gingival recession, and bleeding on probing were also investigated over time. RESULTS The total and individual microbial genome counts were shown significantly increased after 180days with no significant differences between abutment, non-abutment, or antagonist teeth. Streptococcus spp., Aggregatibacter actinomycetemcomitans, and other species associated to periodontitis (Peptostreptococcus anaerobius, Prevotella nigrescens, and Tannerella forsythia), as well as opportunistic Candida spp., were recovered in moderate counts. Abutment teeth presented higher values of gingival recession when compared with non-abutment or antagonist teeth, irrespectively time of sampling (p<0.05). No significant differences were found between groups regarding bleeding on probing or probing depth over time. CONCLUSIONS Overall, the microbial counts significantly increased after 6 months of denture loading for both abutment and non-abutment teeth with no significant differences regarding the microbial profile over time. Bleeding on probing and probing depth showed no significant difference between groups over time whereas gingival recession increased in the abutment teeth.

Treinamento físico melhora a disfunção quimiorreflexa em ratos diabéticos por estreptozotocina

O objetivo do presente estudo foi avaliar os efeitos do treinamento fisico na pressao arterial, na freq uencia cardiaca e na sensibilidade quimiorreflexa em ratos diabeticos por estreptozotocina. Os animais foram divididos em grupos controle (CS, n = 6), diabetico sedentario (DS, n = 6) e diabetico treinado (DT, n = 6). Uma semana apos a inducao do diabetes (Estreptozotocina, 50 mg/kg), ratos machos Wistar foram submetidos a um protocolo de treinamento fisico em esteira ergometrica por 10 semanas. Os sinais de pressao arterial foram gravados e processados em um sistema de aquisicao de dados (CODAS,1KHz). Cianeto de potassio (KCN,100 ug/kg) foi utilizado para avaliar a resposta bradicardica desencadeada pela estimulacao dos quimiorreceptores. A bradicardia e a hipotensao do diabetes (DS:274 ± 6 bpm e 94 ± 2 mmHg vs CS:332 ± 5 bpm e 108 ± 2 mmHg) foram atenuadas pelo treinamento fisico (DT:299 ± 5 bpm e 107 ± 2 mmHg). A resposta bradicardica foi menor nos ratos DS (33 ± 5 bpm) quando comparado aos ratos CS (182 ± 3 bpm) e DT (89 ± 10 bpm). Concluindo, o treinamento fisico reverteu a hipotensao e a bradicardia e melhorou a sensibilidade quimioreflexa em ratos STZ. Considerando que diabeticos com reflexos cardiovasculares anormais apresentam maior mortalidade que diabeticos com funcao reflexa autonomica normal, os resultados obtidos sugerem que o treinamento fisico pode contribuir para a reducao do risco cardiovascular nesta populacao devendo ser considerado no manejo do paciente diabetico