Abstract Background The reproducibility and reliability of the modified Rodnan's Skin Score (mRSS) are debated due to investigator-related subjectivity. Here, we evaluate if durometry correlates with mRSS in patients with diffuse systemic sclerosis (SSc). Methods This cross-sectional study was conducted from December 2018 to June 2019, including 58 diffuse SSc patients. Two certified researchers, blind to each other's scores, performed the mRSS, followed by durometry at 17 predefined skin sites. For durometry and mRSS, individual scores per skin site were registered. Durometry and mRSS results measured by each researcher, as well as scores from different researchers, were compared. Skin thickness measurements from forearm skin biopsies were available in a subset of the patients, for comparisons. Statistical analyses included Cohen's Kappa Coefficient, Intraclass Correlation Coefficient, Kendall's Coefficient and Spearman's test. Results Mean (standard deviation, SD) patient age was 44.8 (12.9) years, and 88% were female. Inter-rater agreement varied from 0.88 to 0.99 (Intraclass correlation coefficient) for durometry, and 0.54 to 0.79 (Cohen's Kappa coefficient) for mRSS, according to the specific evaluated sites. When data were compared with skin thickness assessed in forearm biopsies, durometry correlated better with skin thickness than mRSS. Conclusion Durometry may be considered as an alternative method to quantify skin involvement in patients with diffuse SSc. The strong inter-rater agreement suggests that the method may be useful for the assessment of patients by multiple researchers, as in clinical trials.

Introdução: A hemoglobina S (HbS) é uma hemoglobina instável que facilmente se oxida, causando aumento da produção de metemoglobina (MetHb) em pacientes com anemia falciforme (AF). Objetivos: Determinar os níveis de MetHb e verificar a influência do tratamento com a hidroxiureia (HU) sobre as dosagens desse marcador em pacientes com AF. Materiais e métodos: Amostras de sangue de 53 pacientes adultos com AF em estado basal, em uso ou não de HU, e 30 indivíduos saudáveis foram coletadas para avaliar os níveis de MetHb. A dosagem de MetHb foi realizada pelo método espectrofotométrico. Os parâmetros hematológicos, a dosagem de HU e a concentração de hemoglobina F (HbF) e HbS foram retirados dos prontuários médicos. Resultados: Níveis de MetHb apresentaram-se mais elevados estatisticamente em pacientes com AF em relação ao grupo-controle (p < 0,0001). Não foi verificada diferença estatística nos níveis de MetHb entre pacientes em uso ou não de HU. Observou-se correlação positiva entre as dosagens de MetHb e a concentração de HbS (r = 0,2557; p = 0,0323). Conclusão: A presença da HbS favoreceu a degradação da hemoglobina, causando elevação da produção de MetHb. Tratamento com HU, entretanto, não influenciou nos níveis desse marcador.

Introduction: Hemoglobin S (HbS) is unstable hemoglobin that easily oxidizes, causing methemoglobin (MetHb) increased production in patients with sickle-cell anemia (SCA). Objectives: To determine MetHb levels and the influence of hydroxyurea (HU) therapy on this marker in patients with SCA. Materials and methods: Blood samples from 53 patients with SCA at the steady-state, with and without HU therapy, and 30 healthy individuals were collected to evaluate MetHb levels. The MetHb measurement was performed by spectrophotometry. Complete blood count, HU measurements, and fetal hemoglobin (HbF) and HbS concentrations were taken from medical records. Results: MetHb levels were statically higher in patients with SCA when compared to control group (p < 0.001). There was no statistical difference in MetHb level between SCA patients, either using or not HU. We obtained a positive correlation between MetHb measurements and HbS concentration (r = 0.2557; p = 0.0323). Conclusion: HbS presence favored hemoglobin breaking down, and consequently increased MetHb production. Treatment with HU, however, did not influence the levels of this marker.

O presente artigo busca entender como o modo de governar a América portuguesa, pouco a pouco, foi tendo suas bases assentadas na escrita. Para tal, faz uso dos regimentos dados aos governadores-gerais, desde 1548, ano da instalação do governo-geral na Bahia, para, posteriormente, compará-los à correspondência do governador-geral Antônio Luís Gonçalves da Câmara Coutinho. Desse modo, pretende-se demonstrar como carta e regimento eram conjugados tendo em vista o bom governo do Estado do Brasil.

The present article seeks to understand how the way of ruling the Portuguese America gradually started to be put to writing. For that purpose, the author takes the titles of privilege granted to the general governors since 1548, the year of installation of the general government in Bahia, and compares them with the correspondence of the general governor Antônio Luís Gonçalves da Câmara Coutinho. The article intends to demonstrate how the letters and the titles were combined in order to ensure a good government to the State of Brazil.

Le présent article cherche à comprendre comment la façon de gouverner l'Amérique portugaise a commencé peu a peu à se fonder sur l'écriture. Pour ce faire, l'auteur se base sur les regimentos (Titres de privilèges) octroyés aux gouverneurs généraux depuis 1548, année de l'installation du gouvernement général à Bahia, pour ensuite les comparer à la correspondance du gouverneur général Antônio Luís Gonçalves da Câmara Coutinho. L'article tente, de cette façon démontrer comment les chartes et les titres de privilèges étaient conjugués en vue d'assurer un bon gouvernement à l'Etat du Brésil.

Nos últimos anos, a historiografia tem chamado a atenção para a complexidade dos mecanismos que possibilitaram a consolidação do império português. O estudo aqui apresentado pretende contribuir em favor dessa tendência, destacando, para isso, o papel fundamental dos oficiais régios na governação portuguesa no ultramar. Destaca-se o fato de estes oficiais estarem engajados em redes de poder, que lhes possibilitaram defender seus interesses pessoais, mas não só. Ao destacar-se a amplitude dessas redes, que chegavam mesmo a atingir membros da Igreja, pode-se perceber como foi se formando uma memória administrativa. Isso possibilita a identificação destes homens enquanto instrumentos de poder e de produção de conhecimento, bem como possibilita vê-los enquanto um dos pilares que garantiam sustentação do império português.

In the last few years, the historiography has called attention upon the complex mechanisms that made possible the consolidation of the Portuguese empire. The study presented here intends to contribute in this way by looking into the crucial role played by royal officials within the overseas Portuguese government. Attention is given to the fact that these officials were engaged in power networks, which enabled them to defend their own interests, but not only this. By stressing the amplitude of these networks, which could even involve Church members, one can perceive how an administrative memory was being formed. This made possible to perceive these men as instruments of power and as producers of knowledge, as well as to see them as pillars that gave sustentation to the Portuguese empire.