Nayara Felicidade Tomaz Braz

Body composition and adipokines plasma levels in patients with myasthenia gravis treated with high cumulative glucocorticoid dose

This study aimed to evaluate changes in body composition, i.e. overweight, obesity, fat accumulation and low lean body mass and plasma levels of adipokines in patients with MG. The study enrolled 80 patients with MG, and 62 controls. Body fat mass and body lean mass was analyzed by dual-energy X-ray absorptiometry technique (DXA). Plasma levels of leptin were analyzed by Luminex® and adiponectin and resistin were analyzed by ELISA. The mean age of patients with MG was 41.9years, with 13.5years of length of illness, and mean cumulative dose of glucocorticoids 38,123mg. Our results showed that the frequency of obesity is higher in MG patients than in controls, and patients with MG presented higher body fat mass, android body adiposity and total body fat than controls. MG patients presented lower levels of resistin and higher levels of leptin in comparison with controls. There were no differences in the plasma levels of adiponectin. Higher total body fat and lower body lean mass were associated with increased severity of MG symptoms. This result points to the relevance of estimation of body composition in planning long-term care of MG patients.

Longitudinal assessment of clinical and inflammatory markers in patients with amyotrophic lateral sclerosis

OBJECTIVE To evaluate potential associations between clinical features and inflammatory markers in patients with amyotrophic lateral sclerosis (ALS). METHODS A consecutive series of 68 patients (39 males and 29 females) with sporadic ALS were subjected to a comprehensive clinical assessment and blood draw. A subset of these patients underwent a new assessment within 6-12 months after the baseline visit. In addition, a group of 62 subjects composed by age and sex-matched healthy subjects (38 males and 24 females) was enrolled in this study. Peripheral blood was drawn and plasma levels of chemokines and cytokines were measured by cytometric bead array and enzyme-linked immunosorbent assay. RESULTS Our sample was composed by patients with ALS with an average age of 58 (±12.3) years old and 3 (±2.7) years of disease length at the baseline visit. Patients with ALS presented increased plasma levels of interleukin (IL)-6 and IL-8 in comparison with controls. After multivariate analysis, higher levels of IL-6 and lower levels of IL-2 were significantly associated with increased likelihood of ALS diagnosis. When evaluating the subset of patients assessed longitudinally, we did not find any significant difference in the levels of inflammatory markers between the two time points. Older age at ALS onset was the only factor associated with a faster rate of disease progression. CONCLUSIONS IL-6 levels could discriminate between ALS and controls and may be regarded as a potential biomarker of ALS diagnosis. An increase in IL-2 levels was associated with a protective effect on the odds of ALS diagnosis. Older age at ALS onset predicted a fast rate of disease progression.

Muscle strength and psychiatric symptoms influence health-related quality of life in patients with myasthenia gravis

Myasthenia gravis (MG) is a neuromuscular autoimmune disease characterized by skeletal muscle weakness which can impact motor function and, furthermore, produce negative impact on the health-related quality of life (HRQOL). OBJECTIVE To evaluate the predictors for HRQOL in patients with MG. METHODS Eighty patients were evaluated with the MG Foundation of America classification and the MG Composite scale. HRQOL was estimated by the MGQOL15, while anxious and depressive symptoms were evaluated with the Hospital Anxiety and Depression Scale (HAD). RESULTS The mean age of patients was 41.9 years with mean illness duration of 13.5 years. Almost half of the patients (43.75%) had significant anxiety and more than a quarter (27.50%) had depressive symptoms. Factors that influenced the HRQOL in MG were skeletal muscle weakness and anxiety and depressive symptoms (p < .001 in logistic regression model). CONCLUSION Anxiety and depressive symptoms, besides motor symptoms, influence HRQOL in MG. Mental health must be a clinical focus in addition to the treatment of somatic symptoms during the course of MG.

Eficácia do Nintendo Wii em desfechos funcionais e de saúde de indivíduos com doença de Parkinson: uma revisão sistemática

The objective of this study was to conduct a systematic review of the literature on the effectiveness of Nintendo Wii in the improvement of functional and health outcomes of individuals with Parkinson’s disease. A systematic review of the literature was developed following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), with research in MEDLINE, SciELO, LILACS, PEDro through a search strategy that combined the terms Wii, Parkinson’s Disease, rehabilitation, and physical therapy, followed by manual search. Inclusion criteria were: experimental studies or quasi-experiments related to interventions involving the use of Nintendo Wii to improve functional outcomes in individuals with Parkinson’s disease, published until February 2016, without language restriction. The methodological quality of the studies was assessed with the PEDro scale. Of the 701 studies found, we included seven that met the inclusion criteria - most of the articles (57.14%) had bad methodological quality and were quasi-experiments. The results suggest that the use of Wii seems effective to improve functional outcomes (balance, mobility, motor performance and independence) and health (reducing the risk of falls), being more consistent the results for the improvement of balance. Studies with better methodological quality are needed for the establishment of evidence. Standardization on the types of games, intensity and frequency suitable for each type of patient with PD are still required.

SAT0118 Association of renin-angiotensin system imbalance with subclinical atherosclerosis and disease activity in rheumatoid arthritis

Background Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD). The renin-angiotensin system (RAS) is a hormonal cascade with important role in hydroelectrolytic homeostasis, blood pressure and regulation of cardiovascular remodeling. Angiotensin II (Ang II) acts as a proinflammatory mediator (1). Objectives To investigate the association of serum levels of RAS components with the presence of subclinical atherosclerosis using carotid ultrasonography in women with RA. Methods Women with RA according to ACR/EULAR 2010 or ACR 1987 criteria and without clinical ischemic CVD were included. Disease activity was assessed using the DAS28. The presence of atherosclerotic plaques and the thickness of the medium-intimal complex (EMI) of the arterial wall in the common carotid artery were evaluated by ultrasonography, Serum levels of angiotensin (Ang) II, Ang-(1-7), angiotensin converting enzyme (ECA) and ECA II were determined by enzyme immunoassay. Results 50 women with RA, mean age 48.2 years (±7.32), mean duration of disease of 15.35 years (±8.56), DAS28 of 4.02 (±1.41) and CDAI of 14.23 (±11.53) were included. Seven patients presented altered EMI, eight had atherosclerotic plaque. The prevalence of risk factors for CVD was: 12% of smoking, 12% of family history of premature CVD, 46% of arterial hypertension, 10% of diabetes, 62% of dyslipidemia, 94% of abdominal obesity and 46% of metabolic syndrome. The control group consisted of 30 healthy women, mean age of 46.3 years (±7.72). RA patients had a higher serum concentration of Ang II (p<0.01), Ang-(1-7) (p<0.01), and ACE (p<0.01) than the control group (table 1). There was a negative correlation between ECA II and EMI (p=0.041, rho -0.290). EMI correlated positively with age (p=0.022, rho 0.324), disease duration (p=0.012, rho 0.315) and overall Framingham risk (p=0.008, rho 0.368) and Ang II correlated positively with DAS28 (p=0.034, rho 0.301) and CDAI (p=0.040, rho 0.291).Table 1 Comparison between plasma concentrations of SRA biomarkers in patients with rheumatoid arthritis (RA) and the control group (CG). RAS Biomarkers (pg/mL) RA (n = 50) Mean±SD CG (n = 30) Mean±SD p value Ang II 407.60±278.68 198.77±105.48 <0.01a Ang-(1-7)  162.06±234.58 36.94±61.36 <0.01a ACE  266.21±103.64 222.69±147.61 <0.01a ACE II 71.86±27.32 153.57±225.04 0.17a RA = rheumatoid arthritis; CG= control group; SD= standard deviation; Ang = angiotensin, ACE =angiotensin converting enzyme. aMann-Whitney Test. Conclusions Imbalance of RAS components, especially Ang II and ECA II, may be associated to CVD in RA patients. Ultrasonography of the carotid arteries can identify patients that could benefit from ECA blockade. Reference: [1] Chang Y, Wei W. Angiotensin II in inflammation, immunity and rheumatoid arthritis. Clin Exp Immunol 2015;179:137-145. doi: 10.1111/cei.12467 Acknowledgements: National Council for Scientific and Technological Development (CNPq), Foundation for Research Support of Minas Gerais (FAPEMIG) Disclosure of Interest: None declared

Silica exposure and disease in semi-precious stone craftsmen, Minas Gerais, Brazil

BACKGROUND Brazil is an exporter of precious stones and craftsmen often work in poor conditions. We assessed silica-related diseases among crystal craftsmen and the complexity of its control. METHODS Case-series including 118 subjects evaluated from 2006 to 2015, based on medical interviews, chest X-rays, spirometry, and respirable silica samples. RESULTS Median age and length of exposure were 32 and 13 years, respectively. Silicosis, with 1/0 as a threshold, was diagnosed radiologically in 57 individuals (48.3%). Respirable silica concentrations were 0.9-29.3 times greater than the Brazilian occupational exposure limit. A Receiver Operating Characteristic (ROC) curve with the same diagnosis threshold showed best discrimination at a cut point of 12.5 years of exposure, corresponding to 4.85 mg-y/m3 of cumulative silica exposure. There was a significant decline in FEV1 across radiological and cumulative silica exposure categories. Eleven individuals (9.3%) had mycobacterial diseases at baseline or follow-up. CONCLUSION Crystal craftsmen continue to suffer from silicosis, lung function impairment, comorbidity, and death due to silicosis. To date collective protection in some work sheds has not diminished silica levels. Long-term follow-up is needed to evaluate further improvements in preventive measures. Am. J. Ind. Med. 60:239-247, 2017.

Influence of Cytokines and Soluble Receptors in the Quality of Life and Functional Capacity of Workers Exposed to Silica.

Objectives: The aim of the study was to evaluate the plasma levels of inflammatory mediators in subjects exposed to silica, with and without silicosis compared with unexposed control group; and to check the association between inflammatory mediators with pulmonary function, quality of life, functional capacity, and dyspnea grade. Methods: Inflammatory mediators were measured by enzyme-linked immunosorbent assay. There were 30 subjects exposed to silica and 24 control group. Results: Interleukin-6 plasma levels were higher in subjects exposed to silica with and without silicosis than in the control group. There was a positive correlation between radiological severity and the quality of life, whereas there was a negative correlation between radiological severity and pulmonary function. A negative correlation between sTNFR1 plasma level and functional capacity was found. Interleukin-10 was negatively correlated with the quality of life total score and was positively correlated with the functional capacity and pulmonary function.