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Abstract Background: Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods: Cross-sectional study conducted based on the real-life rheumatoid arthritis study database - REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests. Results: We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions: The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.

https://doi.org/10.1186/s42358-021-00186-4 82 downloads

Análise do setor de telecomunicação brasileiro: Uma visão sobre Reclamações
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Sousa, Gustavo Nogueira de

; Guimarães, Isabelle da Silva

; Viana, Julio Augusto Nogueira

; Reinhold, Olaf

; Jacob Junior, Antonio Fernando Lavareda

; Lobato, Fábio Manoel França

RISTI - Revista Ibérica de Sistemas e Tecnologias de Informação

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jun 2020, N. 37 Pages 31 - 48

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Mídias digitais estão cada vez mais presentes no cotidiano do ser humano. Este fato contribui para que o volume de conteúdo gerado por usuário aumente consideravelmente. De um ponto de vista prático, as análises desses dados requerem diferentes perspectivas e métodos para se obter resultados satisfatórios. Essas análises podem subsidiar a tomada de decisão por gestores por meio da identificação de necessidades e problemas, guiando o processo de melhoria continuada de produtos e serviços. Diante disso, este trabalho propõe uma análise de reclamações postadas em uma plataforma online de reclamações, a fim de identificar pontos que orientem a tomada de decisões das empresas e, consequentemente, melhorar o relacionamento com clientes. Os resultados obtidos permitem a identificação de uma cadeia de problemas relacionados. A principal contribuição deste estudo está na provisão de uma abordagem que auxilia no planejamento estratégico de corporações, levando em consideração situações reportadas pelos consumidores.

Digital media are increasingly present in the daily life of human beings. This fact contributes to the increasing volume of user-generated content. From a practical point of view, the analysis of these data requires different perspectives and methods to obtain consistent results. These analyzes can support managers' decision-making by identifying needs and problems, guiding the process of continuous improvement of products and services. Therefore, this work proposes an analysis of complaints posted on an online complaints platform to identify points that guide companies' decision making and, consequently, improve the relationship with customers. The results obtained allow the identification of problems and their relationship. This study's main contribution is the provision of an approach that helps in the corporation's strategic planning, taking into account situations reported by consumers.

https://doi.org/10.17013/risti.37.31-48 937 downloads

Real - rheumatoid arthritis in real life -study cohort: a sociodemographic profile of rheumatoid arthritis in Brazil
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Sacilotto, Nathália de Carvalho

; Giorgi, Rina Dalva Neubarth

; Vargas-Santos, Ana Beatriz

; Albuquerque, Cleandro Pires de

; Radominski, Sebastião Cezar

; Pereira, Ivânio Alves

; Guimarães, Maria Fernanda Brandão Resende

; Bértolo, Manoel Barros

; Louzada Jr, Paulo

; Sauma, Maria de Fátima Lobato da Cunha

; Bonfiglioli, Karina Rossi

; Brenol, Claiton Viegas

; Mota, Licia Maria Henrique da

; Castelar-Pinheiro, Geraldo da Rocha

Advances in Rheumatology

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2020, Volume 60 elocation 20

Abstract: En | Text: En | PDF: En

Abstract Background: In Brazil, socioeconomic differences in the incidence of rheumatoid arthritis (RA) have been demonstrated, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development. This study examines how the socioeconomic condition of the patient with RA in Brazil, assessed according to social class, educational level, employment situation and use of caregivers, affects the times between the beginning of symptoms and diagnosis and the beginning of the use of disease-modifying antirheumatic drugs, as well as the presence of erosive disease and functional status. Methods: This work is part of a multicentric study called REAL - Rheumatoid Arthritis in Real Life in Brazil, which is a prospective observational cohort study. Results: As described in the REAL study, we included a total of 1115 patients. It was noted that patients with an educational classification of up to second grade incomplete presented with erosion percentages above those with a higher grade complete. Patients with caregivers presented a higher percentage of erosion than patients without caregivers. We verified that patients from economic classes above B2 presented fewer occurrences of erosion than those from classes C2, D-E. We also analyzed the average time differences from the beginning of symptoms and diagnosis and the beginning of treatment, according to academic level, erosion and economic classification. Patients with first grade complete showed an HAQ-DI averages higher than those with second grade complete. The patients who had employment showed lower HAQ-DI averages than patients who were not employed. The patients with erosion showed an HAQ-DI value higher than those without erosion. Patients with caregivers showed an HAQ-DI average higher than that of without caregivers. Conclusion: This study showed that the therapeutic window of RA is not being reached, and therefore we should have a policy to expand and ensure access to public health for all patients, especially those with lower levels of education and income. Trial registration: This study was approved by the National Commission of Ethics in Research.

https://doi.org/10.1186/s42358-020-0121-5 482 downloads

The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil
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Castelar-Pinheiro, Geraldo da Rocha

; Vargas-Santos, Ana Beatriz

; Albuquerque, Cleandro Pires de

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda B. Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima Lobato da Cunha

; Pereira, Ivânio Alves

; Brenol, Claiton Viegas

; Coutinho, Evandro Silva Freire

; Mota, Licia Maria Henrique da

Advances in Rheumatology

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2018, Volume 58 elocation 9

Abstract: En | Text: En | PDF: En

Abstract Background: There are few data on the epidemiology, clinical manifestations and management of RA in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease. Herein, we report the formation of the REAL - Rheumatoid Arthritis in Real Life, the first nationally representative multicenter prospective observational study in Brazil. Methods: The REAL study was designed to include a total of 1300 evaluable patients from 13 tertiary care public health centers specialized in RA management and representative of 5 regions of Brazil. Each center was expected to enroll ~ 100 consecutively seen patients and follow them prospectively in a systematic protocol-driven fashion with scheduled visits at baseline, 6 and 12 months. Core clinical, laboratory and patient-reported outcomes measures were required to be collected at each visit. Results: A total of 1115 patients (89.4% female, mean age of 56.7 years and median disease duration of 12.7 years) were enrolled from 11 participating centers. Almost 80% of patients were of middle-low or low socioeconomic classes. The median educational time was 8 years, with 3.23% being below literacy level. The interval between symptoms and diagnosis varied from 1 to 457 months (median 12 months). Almost half of the patients were on glucocorticoids, 96.5% on DMARDs, with 35.7% on biologics. Median HAQ-DI was 0.875, ranging from 0 to 3. Median DAS28-ESR was 3.5, with 58.7% of patients presenting moderate or high disease activity. Conclusions: The first large cohort of Brazilian patients with RA in a real-life setting shows several striking differences from previously published cohorts from other countries. The long delay for diagnosis and start of DMARDs may partly explain the high frequency of erosive disease. An elevated percentage of patients on moderate or high disease activity was seen, despite of the high frequency of corticosteroid and biologics utilization. Data from this cohort may enable public health managers of developing countries better allocate the limited resources available for the care of RA patients.

https://doi.org/10.1186/s42358-018-0017-9 526 downloads

Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil)
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Yonekura, Claudia Leiko

; Oliveira, Rene Donizeti Ribeiro

; Titton, David C.

; Ranza, Roberto

; Ranzolin, Aline

; Hayata, André L.

; Duarte, Ângela

; Silveira, Inês G.

; Carvalho, Hellen M. da S. de

; Moraes, Júlio C. Bertacini de

; Abreu, Mirhelen Mendes de

; Valim, Valéria

; Bianchi, Washington

; Brenol, Claiton Viegas

; Pereira, Ivanio A.

; Costa, Izaias

; Macieira, José C.

; Miranda, José R.S.

; Guedes-Barbosa, Luiz S.

; Bertolo, Manoel B.

; Sauma, Maria Fátima Lobato da C.

; Silva, Marília B.G.

; Freire, Marlene

; Scheinberg, Morton A.

; Toledo, Roberto A.

; Oliveira, Sheila K.F.

; Fernandes, Vander

; Pinheiro, Marcelo M.

; Castro, Glaucio

; Vieira, Walber Pinto

; Baaklini, Cesar Emile

; Ruffino-Netto, Antonio

; Pinheiro, Geraldo da Rocha Castelar

; Laurindo, Ieda Maria Magalhães

; Louzada-Junior, Paulo

Revista Brasileira de Reumatologia

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2017, Volume 57 Suppl. 2 Pages s477 - s483

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivos Avaliar incidência de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biológicos na prática clinica. Pacientes e métodos Estudo de coorte com dados do Registro Brasileiro de Monitoração de Terapias Biológicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doença (MMCDs) sintéticas, 942 MMCDs sintéticas em associação com anti-TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sintéticas em associação com outros biológicos (abatacepte, rituximabe e tocilizumabe). Avaliaram-se ocorrência de tuberculose, tempo de exposição às drogas e triagem para TB. Análise estatística: teste t não pareado e teste de Fisher bicaudal; p < 0,05. Resultados O tempo de exposição dos controles foi de 981 pacientes-ano, do grupo de anti-TNF foi de 1.744 pacientes-ano (adalimumabe = 676, infliximabe = 547 e etanercepte = 521 pacientes-ano) e o de outros biológicos de 336 pacientes-ano. A incidência de TB foi de 1,01/1.000 pacientes-ano nos controles e de 2,87 pacientes-ano nos usuários de anti-TNF (adalimumabe = 4,43/1.000 pacientes-ano; etanercepte = 1,92/1.000 pacientes-ano e infliximabe = 1,82/1.000 pacientes-ano). Não houve casos de tuberculose no grupo de outros biológicos. O tempo médio de exposição até a ocorrência de tuberculose foi de 27(11) meses para o grupo anti-TNF. Conclusões A incidência de tuberculose foi maior nos usuários de MMCDs sintéticas e anti-TNF do que nos usuários de MMCDs sintéticas e de MMCDs sintéticas e biológicos não anti-TNF, e também mais tardia, sugerindo infecção durante o tratamento, e não falha na triagem.

Abstract Objectives To assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice. Patients and methods This cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1552 treatments, including 415 with only synthetic disease-modifying anti-rheumatic drugs, 942 synthetic DMARDs combined with anti-tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t-test and Fisher's two-tailed test; p < 0.05. Results The exposure times were 981 patient-years in the controls, 1744 patient-years in the anti-TNF group (adalimumab = 676, infliximab = 547 and etanercept = 521 patient-years) and 336 patient-years in the other biologics group. The incidence rates of tuberculosis were 1.01/1000 patient-years in the controls and 2.87 patient-years among anti-TNF users (adalimumab = 4.43/1000 patient-years; etanercept = 1.92/1000 patient-years and infliximab = 1.82/1000 patient-years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of tuberculosis was 27(11) months for the anti-TNF group. Conclusions The incidence of tuberculosis was higher among users of synthetic DMARDs and anti-TNF than among users of synthetic DMARDs and synthetic DMARDs and non-anti-TNF biologics and also occurred later, suggesting infection during treatment and no screening failure.

https://doi.org/10.1016/j.rbre.2017.05.005 3602 downloads

Endovascular management of massive pulmonary embolism with clot fragmentation and suction
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Belczak, Sergio Quilici

; Sincos, Igor Rafael

; Aun, Ricardo

; Lederman, Alex

; Mioto Neto, Boulanger

; Saliture, Fernando

; Lobato, Manoel

Jornal Vascular Brasileiro

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mar 2013, Volume 12 N. 1 Pages 49 - 52

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A embolia pulmonar maciça com disfunção do ventrículo direito pode ser tratada com trombólise, embolectomia ou trombectomia mecânica percutânea. Este estudo descreve nossa experiência com dois pacientes com embolia pulmonar maciça tratados com trombectomia mecânica percutânea e relata os resultados a médio prazo desse procedimento. Um homem de 28 anos e uma mulher de 70 anos foram diagnosticados com trombose venosa profunda e embolia pulmonar maciça. Inicialmente, eles tiveram edema de membros inferiores seguido por início súbito de dispneia. O exame físico revelou edema, taquipneia, desconforto torácico, turgência jugular. Em ambos havia sinais de hipóxia e precisaram receber oxigênio usando uma cânula nasal. A ultrassonografia Doppler ecocardiograma e angiotomografia foram utilizadas para estabelecer os diagnósticos. Os pacientes foram submetidos à trombectomia mecânica percutânea utilizando o sistema Aspirex® (Straub Medical). Sua condição clínica e os achados dos estudos de imagem melhoraram substancialmente. No acompanhamento a médio prazo, os pacientes apresentaram melhora significativa do quadro.

Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical), and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.

2406 downloads

Application of roasted rice bran in cereal bars
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Garcia, Marina Costa

; Lobato, Luciana Pereira

; Benassi, Marta de Toledo

; Soares Júnior, Manoel Soares

Food Science and Technology

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dec 2012, Volume 32 N. 4 Pages 718 - 724

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O objetivo do trabalho foi avaliar a viabilidade da utilização do farelo de arroz torrado, em microondas, como ingrediente de barras de cereais ricas em fibras, para obtenção de um produto com boa aceitabilidade. A influência dos teores de flocos de arroz, flocos de milho e farelo de arroz torrado nas características físicas, químicas de barras de cereais foram estudados. A aceitabilidade global de três formulações selecionadas também foi avaliada. O aumento no teor de farelo de arroz torrado nas formulações reduziu a força de ruptura e atividade de água, a densidade foi intermediária e houve escurecimento das barras. O conteúdo de lipídeos e fibra alimentar total foram maiores nas formulações com maior teor de farelo de arroz, portanto, classificada como alimento funcional. A formulação com a proporção de 0,34/0,32/0,34 de farelo de arroz torrado/flocos de arroz/flocos de milho, se apresentou mais próxima do desejável. Barras de cereais formuladas com teores de farelo de arroz torrado entre 10 e 20% foram aceitas pelos consumidores.

The objective of this study was to evaluate the viability of using microwave-roasted rice bran as an ingredient in high-fiber cereal bars to obtain a product with good acceptability. The influence of the rice flakes, corn flakes, and roasted rice bran levels on the physical and chemical characteristics of the cereal bars was studied. The overall acceptability of three selected formulations was also evaluated. An increase in the roasted rice bran level in the formulation reduced the force of rupture and water activity, resulted in intermediate density, and caused darkening of the bars. The contents of lipid and total dietary fiber were higher in the formulation with the highest rice bran content, which was therefore classified as functional food. The formulation containing 0.34; 0.32; and 0.34 roasted rice bran, rice flakes, and corn flakes, respectively, seemed to be the best outcome. Cereal bars with roasted rice bran levels between 10 and 20% were accepted by consumers.

5841 downloads

Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave
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Belczak, Sergio Quilici

; Sincos, Igor Rafael

; Aun, Ricardo

; Mioto Neto, Boulanger

; Lobato, Manoel

; Saliture, Fernando

; Ledermain, Alex

Jornal Vascular Brasileiro

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mar 2012, Volume 11 N. 1 Pages 73 - 76

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%). O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.

Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%). The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

3208 downloads

Inner tubing endograft: a new technique for bifurcation preservation
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Lederman, Alex

; Saliture Neto, Fernando Tavares

; Mioto Netto, Boulanger

; Bub, Guilherme Linhares

; Lobato, Manoel Augusto

; Aun, Ricardo

Jornal Vascular Brasileiro

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sep 2009, Volume 8 N. 3 Pages 255 - 258

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O tratamento de artérias de pequeno calibre e suas bifurcações é um grande desafio para o cirurgião endovascular. Descrevemos uma nova técnica endovascular que foi usada no tratamento de uma aorta de pequeno calibre e que também pode ser usada para preservar outras bifurcações. O uso de três stents retos pode permitir ao cirurgião endovascular o tratamento de bifurcação mantendo o fluxo em ambas as artérias distais.

Treating narrow arteries and their bifurcations is a major challenge to the endovascular surgeon. We describe a new endovascular technique that was used to treat a narrow aorta and that may also be used to preserve other bifurcations. Using three straight stents may enable the endovascular surgeon to treat bifurcation while maintaining flow to both distal arteries.

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