62 research outputs found
20 years of experience with tumour necrosis factor inhibitors : what have we learned?
No full textTNF inhibitors are biologic DMARDs approved for the treatment of active RA in mid-1990s. They still represent a valuable therapeutic option to control the activity, disability and radiographic progression of the disease. In the context of TNF inhibitors, there are currently several molecules and different administration routes that provide optimal treatment personalization, allowing us to respond to a patient's needs in the best possible way. The increasing use of TNF inhibitors has not only improved the management of RA, but it has also helped in our understanding of the pathogenetic mechanisms of the disease. This review focuses on the basis of this targeted therapy and on the knowledge gained from their use about therapeutic effects and adverse events. Effectiveness analysed from drug registries and safety issues are presented together with recent data on infections (in particular, Mycobacterium tuberculosis and hepatitis B), cancer (lymphoma, skin cancers) and cardiovascular risk
The multifaceted aspects of interstitial lung disease in rheumatoid arthritis
No full textInterstitial lung disease (ILD) is a relevant extra-articular manifestation of rheumatoid arthritis (RA) that may occur either in early stages or as a complication of long-standing disease. RA related ILD (RA-ILD) significantly influences the quoad vitam prognosis of these patients. Several histopathological patterns of RA-ILD have been described: usual interstitial pneumonia (UIP) is the most frequent one, followed by nonspecific interstitial pneumonia (NSIP); other patterns are less commonly observed. Several factors have been associated with an increased risk of developing RA-ILD. The genetic background plays a fundamental but not sufficient role; smoking is an independent predictor of ILD, and a correlation with the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies has also been reported. Moreover, both exnovo occurrence and progression of ILD have been related to drug therapies that are commonly prescribed in RA, such as methotrexate, leflunomide, anti-TNF alpha agents, and rituximab. A greater understanding of the disease process is necessary in order to improve the therapeutic approach to ILD and RA itself and to reduce the burden of this severe extra-articular manifestation
Cardiovascular Comorbidities Relate More than Others with Disease Activity in Rheumatoid Arthritis.
No full textOBJECTIVES:To explore the influence of comorbidities on clinical outcomes and disease activity in rheumatoid arthritis (RA). METHODS:In patients included in the cross-sectional observational multicenter international study COMORA, demographics, disease characteristics and comorbidities (hypertension, diabetes, hyperlipidemia, renal failure, ischemic heart disease, stroke, cancer, gastro-intestinal ulcers, hepatitis, depression, chronic pulmonary disease, obesity) were collected. Multivariable linear regression models explored the relationship between each comorbidity and disease activity measures: 28-swollen joint count (SJC), 28-tender joint count (TJC), erythrocyte sedimentation rate (ESR), patient's and physician's global assessment (PtGA, PhGA), patient reported fatigue and 28-Disease Activity Score (DAS28). Results are expressed as mean difference (MD) adjusted for the main confounders (age, gender, disease characteristics and treatment). RESULTS:A total of 3,920 patients were included: age (mean ±SD) 56.27 ±13.03 yrs, female 81.65%, disease duration median 7.08 yrs (IQR 2.97-13.27), DAS28 (mean ±SD) 3.74 ± 1.55. Patients with diabetes had more swollen and tender joints and worse PtGA and PhGA (MD +1.06, +0.93, +0.53 and +0.54, respectively). Patients with hyperlipidemia had a lower number of swollen and tender joints, lower ESR and better PtGA and PhGA (MD -0.77, -0.56, -3.56, -0.31 and -0.35, respectively). Patients with history of ischemic heart disease and obese patients had more tender joints (MD +1.27 and +1.07) and higher ESR levels (MD +5.64 and +5.20). DAS28 is influenced exclusively by cardiovascular comorbidities, in particular diabetes, hyperlipidemia, ischemic heart disease and obesity. CONCLUSIONS:Cardiovascular comorbidities relate more than others with disease activity in RA. Diabetes and hyperlipidemia in particular seem associated with higher and lower disease activity respectively influencing almost all considered outcomes, suggesting a special importance of this pattern of comorbidities in disease activity assessment and clinical management
Disease-related malnutrition in systemic sclerosis: Evidences and implications
No full textThe present review summarises evidences and provides recommendations for the screening and management of malnutrition in systemic sclerosis (SSc). This complication is frequently underestimated when assessing patients and this may lead to an impaired estimation of prognosis. The presence of malnutrition is indicated by anthropometric and biohumoral changes reflecting protein stores (low serum prealbumin) and influenced by organ involvement in SSc (skin and the gastrointestinal tract). Patients at high risk of malnutrition or with low prealbumin levels have shown increased mortality risk and, therefore, a nutritional assessment is mandatory in every SSc patient. This screening is especially important as malnutrition represents a potentially modifiable risk factor with nutritional interventions. The pillars of nutritional treatment are also discussed
The Issue of Gender Bias Represented in Authorship in the Fields of Exercise and Rehabilitation: A 5-Year Research in Indexed Journals
No full textDespite progress made in recent decades, gender bias is still present in scientific publication authorship. The underrepresentation of women and overrepresentation of men has already been reported in the medical fields but little is known in the fields of exercise sciences and rehabilitation. This study examines trends in authorship by gender in this field in the last 5 years. All randomized controlled trials published in indexed journals from April 2017 to March 2022 through the widely inclusive Medline dataset using the MeSH term “exercise therapy” were collected, and the gender of the first and last authors was identified through names, pronouns and photographs. Year of publication, country of affiliation of the first author, and ranking of the journal were also collected. A chi-squared test for trends and logistic regression models were performed to analyze the odds of a woman being a first or last author. The analysis was performed on a total of 5259 articles. Overall, 47% had a woman as the first author and 33% had a woman as the last author, with a similar trend over five years. The trend in women’s authorship varied by geographical area, with the higher representation of women authors in Oceania (first: 53.1%; last: 38.8%), North-Central America (first: 45.3%; last: 37.2%), and Europe (first: 47.2%; last: 33.3%). The logistic regression models (p < 0.001) indicated that women have lower odds of being authors in prominent authorship positions in higher-ranked journals. In conclusion, over the last five years, in the field of exercise and rehabilitation research, women and men are almost equally represented as first authors, in contrast with other medical areas. However, gender bias, unfavoring women, still exists, especially in the last authorship position, regardless of geographical area and journal ranking
The perfume in the univers of Proust
No full textopenNella tesi, Le parfum dans l’univers proustien, analizziamo la tematica della percezione olfattiva nella produzione letteraria di Proust. Uno dei punti fondamentali per capire al meglio le scelte tematiche e stilistiche dell’autore è comprendere le fondamentali fonti di ispirazione, proprio per questo viene dedicato un intero capitolo all’ispirazione di Proust. Il profumo è protagonista di diverse figure di stile, in particolare della metafora, che l’autore utilizza per dare colore alla sua scrittura. Impossibile parlare di Proust senza approfondire in questo caso la tematica della memoria involontaria, sono diverse le occasioni in cui lo scrittore si è servito delle sensazioni per affrontare le sue memorie. Per la creazione dell’opera Alla ricerca del tempo perduto, Proust s’ispira alle teorie filosofiche di Schopenhauer.In the thesis, the perfume in the universe of Proust, we analyze the theme of olfactory perception in Proust's literary production. One of the key points to better understand the author's thematic and stylistic choices is to understand the fundamental sources of inspiration, it is for this reason that an entire chapter is devoted to Proust's inspiration. Perfume is the protagonist of several figures of style, in particular metaphor is used by the author to give color to his writing. It is impossible not to mention Proust without deepening the subject of involuntary memory , there are several occasions in which the writer used sensations to address his memoirs. In the creation of the work In Search of Lost Time, Proust was inspired by the philosophical theories of Schopenhauer
Clinical and Ultrasonographic Remission in Bio-naïve and Bio-failure Patients with Rheumatoid Arthritis at 24 Weeks of Upadacitinib Treatment: The UPARAREMUS Real-Life Study
No full textIntroduction: Clinical remission is the main target in the management of patients with rheumatoid arthritis (RA). However, several authors found synovitis in patients with RA in clinical remission at ultrasonography (US). Upadacitinib is a selective Janus kinase 1 inhibitor that achieved significantly higher remission rates than adalimumab and abatacept in patientswith RA. Here we present the 24-week data of the UPAdacitinib Rheumatoid Arthritis REmissionUltraSonography (UPARAREMUS) study.Methods: This is a longitudinal multicenter observational study, enrolling bio-naïve andbio-inadequate responder patients affected by RA. The primary endpoint was the proportionof patients achieving both clinical and US remission at week 24. The proportion of patientsachieving clinical remission with different composite indexes at week 12 and 24 was also evaluated. US of four target joints (wrists and second metacarpophalangeal bilaterally) was performed at baseline and weeks 12/24, and US remission was defined as the absence of power Doppler (PD) signal ≥ 2 in one target joint, or PD ≥ 1 in two target joints.Results: After 12 weeks and 24 weeks, 40% and 63.6% of patients achieved US plus clinicalremission. The following parameters were associated with US plus clinical remission: beingbio-naïve and having a shorter disease duration, although at multivariate analysis significantodds ratio (OR) was found only for being bio-naïve.Conclusions: UPARAREMUS is the first study evaluating the efficacy of upadacitinib in reaching both clinical and US remission in patients with RA. At 24 weeks, 63.6% of patients reached the primary endpoint, the only baseline associated parameter was being bio-naïve
Corpos desenhados: olhares de crianças de Brasília através da escola e da mídia
No full textTese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Educação. Programa de Pós-Graduação em Educação.A cultura corporal infantil é o tema geral desta tese. Considera-se como pressuposto a corporeidade enquanto elemento fundamental da formação humana, que se integra às demais dimensões do sujeito. Partiu-se da crítica à concepção naturalizada da corporeidade, que dominou o pensamento moderno, sugerindo a plasticidade e a educabilidade do corpo. Um dos efeitos dessa concepção tem sido a prática da educação fragmentada do sujeito. Por outro lado, o culto ao corpo, amplamente propalado pelos meios de comunicação de massa nos tempos atuais, reforça tal concepção. Escola e mídia atuam como filtros semelhantes ante o olhar das crianças sobre a cultura corporal. Com objetivo de conhecer as representações e expressões corporais de crianças, construídas pelo processo de interação social, procedeu-se à observação do comportamento de alunos de 1a a 3a séries da Escola-Parque 210/211 Norte, em Brasília. Integramos a pesquisa às atividades de ensino da escola, que é voltada exclusivamente para o ensino de Artes e de Educação Física. Desse modo, acompanhamos as crianças por meio de desenhos, jogos dramáticos, brincadeiras e atividades de música e dança. Observamos que, embora, a escola e a mídia filtrem o olhar das crianças, a arte oportuniza a produção de outras imagens corporais
Power Consumption Trade-offs in Short-distance Wireless Transceivers for Sensor Nodes
No full textThis paper reviews system level considerations for the design of Ultra Low-Power Radio (ULP radio) transceivers with the capability to operate at short distances (similar to 1m) with a data rate of 1 Mbit/s and with a very low power consumption (similar to 1mW); the target application is a Sensor Node (SN). It is shown that under practical constraints an Ultra-Wide-Band impulse radio architecture (UWB-IR) is more power efficient than narrow-band modulated carrier approaches for the same bit-error rate (BER) performance.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000287267300037&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=8e1609b174ce4e31116a60747a720701Computer Science, Hardware & ArchitectureEngineering, Electrical & ElectronicTelecommunicationsEICPCI-S(ISTP)
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