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Introduction Preeclampsia (PE) is an important cause to maternal and perinatal morbimortality. The usage of acetylsalicylic acid (ASA) and Calcium (Ca) has been recommended to risk patients’ groups as preventive measures. Amongst the preeclampsia developing risk groups there are primiparous patients. However, we verified that this kind of intervention has been barely done in São Paulo and it seems not to be changed despite the consistent evidence to recommend its usage. Objectives Evaluate the ASA and Ca prescription frequency to primiparous patients. Methodology A comparative and retrospective study between two groups of primiparous patients was conducted. Firstly, all primiparous patients who have developed preeclampsia between January and May of 2016 and whose child-birth happened in Hospital Maternidade Vila Nova Cachoeirinha (HMEC) in São Paulo were identified through records evaluation and prenatal care portfolio. After that, a control group of primiparous patients who did not present any pathology during the gestation period was chosen and they were paired accordingly to their maternal age and gestational age at the child-birth. Results From that 23 primiparous pregnant woman with preeclampsia, 17.4% took ASA; 8.7% took Ca. Amongst the primiparous who did not develop preeclampsia, 2% took ASA; 12.2% took Ca and 2% took both medications (Table 1). There were no significant differences among the groups ( p = 0.094). Conclusion Despite the consistent evidences for the usage of ASA and Ca, apparently the primary care in São Paulo city did not widely incorporate the recommendation of preventive measures to PE among high-risk patients. It is possible to assume that this behavior standard is similar among patients with other risk factors. Considering the strategic matter of prenatal care, that observation can be taken as a first step in order to enlarge this analysis and guide public policies to increase the usage of ASA and Ca in PE-risk patients. The authors thank the support FAPESP 2014.00213/7. [ABSTRACT FROM AUTHOR]

Introduction Pre-eclampsia (PE) is one of the biggest causes for maternal mortality in the world. Identifying risk groups and using acetylsalicylic acid (AAS) and calcium (Ca) are pointed as important measures in the attempt to reduce maternal and fetal morbidity. Aim To assess, among patients with PE, the percentage of risk factors (RF) identifiable and to verify, among them, how many have used some prevention method. Methodology it were evaluated medical records and prenatal cards of all patients that have developed PE ( n = 50) between January and May 2016. Also, a targeted questionnaire was applied to identify the RF and the use of some preventive medication for PE. It were considered RF: primiparity, previous PE history, chronic arterial hypertension, pre-existent kidney disease, thrombophilias, autoimmune diseases, multiple pregnancy, PE family history, diabetes mellitus, obesity and advanced maternal age. All patients have signed a free informed consent. Results The results are presented in the attached table. The vast majority of patients with PE (90%) had some RF identifiable during prenatal and a great part (86%) presented more than one. However, it was observed a small prescription rate of AAS and/or Ca in this population. Conclusion We have observed that among patients with PE, the RF presence is considerable. We also have observed a low prescription of AAS and Ca in this population. PE is a potentially fatal pathology and the interventions in an attempt to prevent its arising are few. We have verified that despite they exist, they are not used in the routine practice. Actions for making the assisting team more conscious shall be employed, as well as disseminating the scientific knowledge in a more comprehensive form. [ABSTRACT FROM AUTHOR]

Introduction Since the publication of the MAGPIE study, the use of magnesium sulphate (MgSO 4 ) was widespread throughout the world for patients with pre-eclampsia (PE). Except for imminent eclampsia or eclampsia itself, the decision to use is based on subjective clinical aspects. To reduce this pattern of care, the adoption of PIERS as a predictive model has been recommended as a tool which allows evaluating objectively the risk of maternal and/or adverse perinatal outcomes. We found that, in recent years, in our clinical practice the use of MgSO 4 is based on from subjective judgment. The introduction of PIERS tool at our current care routine could support decisions more objectively and reduce patient exposure to a drug that can have side effects? Objective To evaluate from PIERS the relative risks of adverse events within 48 hours in patients with PE who used the MgSO 4 based on subjective clinical decision. Methodology This study is a retrospective cohort study whose data were obtained through chart analysis and calculation of PIERS from patients diagnosed with PE and had received MgSO 4 between January and May 2016. Patients with outcome already installed, as eclampsia, were excluded. PIERS calculator was accessed on the website: https://pre-empt.cfri.ca/monitoring/fullpiers . Results From 50 patients with PE in the period, 21 used the MgSO 4 by severe PE. Table 1 shows frequencies of relative risk calculated. Among the total of 21 patients, 33.3% had risk less than 1.0% and 47.6% less than 47.6%. Just in two patients PIERS was above 10.0%. No patient had side effects related to the use of MgSO4 or adverse outcome installed within 48 h after delivery. Discussion We found that a high percentage of patients with low risk estimated by PIERS were submitted to MgSO4. Probably the incorporation of PIERS calculator in decisions in patients with PE could reduce uncertainties and improve the standard of care. Despite the small number of patients included, apparently we are using magnesium sulfate too much. Thanks to FAPESP. Processo n o 2014-00213/7. [ABSTRACT FROM AUTHOR]

Introduction Hypertension in pregnancy, especially preeclampsia (PE), may result in maternal and perinatal complications and the best form of treatment is the interruption of gestation through the safest method for the mother and baby. In Brazil, there are high rates of Cesarean (CS) among patients with PE. Would it be possible to change these routines to reduce risks and costs associated with the actual patterns of care? Objective To assess the type of delivery in patients with PE in a public maternity in Sao Paulo (Brazil) and propose changes in this pattern. Methodology Retrospective Cohort of 117 patients with PE treated in a reference center (MEVNC) in 2016 and 2017. Maternal variables were assessed and related to childbirth and perinatal period. Baseline characteristics and labor and delivery characteristics according to PE early and late were analyzed. Results The average maternal age was 29.0 years, 51.3 being nulliparous and the BMI average was 29.1. Mild PE was present in 85.0%. The overall cesarean rate was 32.0%. Among patients with early PE the rate was 72.0% while in patients with late PE the rate was 77.0%. The reasons for CS were maternal risk in 30.7% and fetal risk in 22.7%. Discussion The overall rate of CS of the institution being on average, 34%. However in patients with PE CS rates are very high. Our results contrast with the literature, when compared with different places. Two aspects could be considered: insecurity related to maternal prognosis and the difficulties of assessing fetal well-being. Two interventions could be tested to modify this pattern: the adoption of the model PIERS for maternal care and fetal monitoring for fetal scalp samples for pH and lactate evaluation. In this way, the introduction of these alternatives could innovate the current standard of clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: There is now evidence that magnesium sulfate can prevent and control eclamptic seizures. For women with pre-eclampsia, magnesium sulfate reduces by more than one half the risk of eclampsia. After Magpie Trial our clinical practice has been modified in terms of more liberal use of MgSO4, but the evidence regarding the benefit-to-risk ratio of MgSO4 prophylaxis in mild preeclampsia remains uncertain . Thus we consider important to evaluate whether there are specific characteristics between patients who received the medicine that might signal risk and justify our decisions. Objectives: To identify in a group of hypertensive patients who used magnesium sulfate, clinical and/or laboratory characteristics that can be defined as specific risk factors and be useful to base clinical decisions. Methods: The study was conducted at the Maternity School of Vila Nova Cachoeirinha, a public institution located in the north of the city of São Paulo (Baazil) between 01/07 and 31/12/2011. This is a retrospective study of a series of 103 pregnant women with hypertensive disorders, defined according to NHBPEP. We excluded patients admitted in labor. Patients were assigned into two groups according to the use of MgSO4. We compared clinical and laboratory characteristics between the two groups. Results: Of 103 patients included, 31 (30.1%) received MgSO4. Among the outcomes analyzed, there were significant differences in the group that received MgSO4 in terms of blood pressure equal to or greater than 110mmHg, clinical symptoms (eg headache and visual disturbance) and at least some evidence of organ dysfunction (hepatic, renal, haematologic, or central nervous system) (Table 1). Table 1. Variables associated with theuse of magnesium sulfate. Conclusion: We can say that in our institution over the years was an increase in the use of magnesium sulfate. Our results support the hypothesis that about one in three patients treated at this institution receive the medication. Although our protocol admits that the decision may be based on subjective criteria, we identified some objective characteristics that supported their application, and that these criteria do not differ from the classic recommendations. We can also conclude that in our clinical experience we do not have identified a clear justification for support the routinely use of magnesium sulphate for all women with preeclampsia. [Copyright &y& Elsevier]

Introduction: Around the world each year 10% to 15% of direct maternal deaths are associated with hypertensive disorders in pregnancy. Not only it can be devastating and life threatening for the mothers but also for the babies. Risks for the baby include poor growth and prematurity . In low and middle income countries many public hospitals have limited access to neonatal intensive care, and so the mortality and morbidity is likely to be considerably higher than in settings where such facilities are available. Thus, the approach to the problem preeclampsia should include issues related to prematurity and its impact, since many of these babies develop definitive complications, constituting a major public health problem with social and economic repercussions. Objectives: To evaluate the prevalence of preterm births in a public hospital health of the city of São Paulo, checking its main causal conditions, focusing in particular on the importance of hypertensive disorders in its determinism. Methods: This was a retrospective study of a consecutive series of preterm infants, defined as gestational age less than 37 weeks born at Maternity School Vila Nova Cachoeirinha, situated at the north of Sao Paulo City, in the period from 01/04 to 31/12/2011. The study population was classified according to three main groups of causal factors: spontaneous labor, premature rupture of membranes and elective preterm delivery. In this group was evaluated the specific participation of hypertensive disorders. Results: The number of live births during the study period was 5302 babies. Among these 433 had gestational age less than 37 weeks, corresponding to a prematurity rate of 8.16%. Of all infants, 385 cases were included in the analysis. Regarding the causes of the onset of preterm labor found that 140 cases (36.4%) presented with spontaneous labor, 128 cases (33.2%) had premature rupture of membranes and 117 (30.4%) cases were born as a result of elective preterm delivery. In the latter group 88 cases (75.2%) had complications related to hypertensive disorders. Regarding the general population of premature infants, hypertension accounted for 22.8% of cases. Conclusion: We conclude that among the various obstetric problems, hypertensive disorders represent an important impact on preterm birth in our setting, considering that our institution is a reference to this type of care across the city of São Paulo. This knowledge is a fundamental tool to support the adoption of interventions that can detect groups at risk for hypertension in pregnancy, the promotion of follow-up to intercept severe cases and provide an efficient network of maternity care that may have neonatal intensive care units. This set of measures is essential to minimize the impact of this serious problem. [Copyright &y& Elsevier]

Introduction Pre-eclampsia (PE) is a public health problem with possible fatal consequences for mother and fetus. Recent studies point that the regular consumption of chocolate and its metabolites could exert a beneficial cardiovascular effect, acting in the endothelial dysfunction and oxidative stress, important changes also observed in PE. Literature has been controversial regarding this issue but there are still many questions about the possible impact of these substances in the physiopathological process involved in PE. Aim To assess, in a convenience sample, the chocolate consumption profile in patients diagnosed with PE. Methodology A comparative and retrospective study was performed between two groups of primiparous patients. Initially were identified all patients that have developed pre-eclampsia between January and May 2016 ( n = 49) whose birthing happened on Maternity Hospital Vila Nova Cachoeirinha (HMEC) at the city of São Paulo by means of medical records and prenatal cards. A control group ( n = 48) of primiparous patients was formed that did not present pathologies during pregnancy, paired according to maternal age and birth gestational age. Through the questionnaire, it was evaluated the weekly chocolate consumption frequency in these patients. The following possibilities were considered: (a) less than once a week, (b) once a week, (c) twice a week and (d) more than 3 times a week. Results For all consumption ranges informed, meaningful differences among the groups were not detected (Table 1). Conclusion Despite some studies suggest the use of chocolate in pregnancy as a possible protective factor for PE development, the results obtained in the sample studied do not identify any correlation. However, it shall be considered the limitations of this study having in sight the sample size included and the difficulties to define accurately the quality of the food consumed. Additional studies are needed to understand the possible impact of chocolate consumption in the physiopathological process and consequential PE prevention. The authors thank the support of FAPESP 2014.00213/7. [ABSTRACT FROM AUTHOR]

Objectives Epidemiological data points that 50.0% of the Brazilian population has abnormal body mass index (BMI), of all ages and social classes. Whereas excess fatty tissue may favor the occurrence of PE and that both conditions are correlated with future risk of cardiovascular disease, we consider important to observe the possible impact of these conditions among Brazilian women. Methods An observational study was conducted among women with PE. The proportion of BMI in early prenatal care and two years after childbirth without subsequent pregnancy were calculated. A total of 23 inpatients from Maternidade Escola de Vila Nova Cachoeirinha in 2011 and 2012 with PE (NHBPEP criteria) were analyzed. The BMI was calculated weight/height2. A BMI greater than or equal to 25 is overweight. BMI greater than or equal to 30 is obesity. Results At early prenatal care, over 90.0% of patients had abnormal BMI, mainly obesity class. Two years after the BMI showed no consistent reduction, but with a higher number of overweight (Table 1). Conclusions This initial observation suggests that high rates of abnormal BMI in our population might have some impact on the incidence of PE. Although the limits of our findings due to limited number of patients and for not having a control group, it is remarkable the rate of abnormal BMI in both moments of life of these women. It would be reasonable to assume that beyond the risks related to PE, the remaining risk can be amplified by the nutritional status. We believe that these aspects have not been adequately explored in Brazil and deserve special attention from researchers and health authorities. Disclosures N. Sass: None. D.C. Ferreira: None. M.M. Almeida: None. T.A. Facca: None. M.R. Silveira: None. E. Chalem: None. H.A. Korkes: None. L.G. Oliveira: None. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the adipokine levels in early rheumatoid arthritis (eRA) and first-degree relatives (FDR) of patients with RA and establish their association with rheumatic disease activity and periodontal variables., Method: A cross-sectional study with eRA patients, FDR and a healthy population. Adipokine levels, clinical, joint radiological indexes and periodontal variables were evaluated. A descriptive, bivariate analysis was performed based on the adipokine levels by χ 2 , Fisher's test and Mann-Whitney U test. A logistic regression was made for associations., Results: High leptin levels were associated with the diagnosis of eRA (odds ratio [OR] = 2.79; 95% CI 1.54-5.07). Early rheumatoid arthritis with high adiponectin levels was less likely to have Multidimensional Health Assessment Questionnaire score >3, body mass index (BMI) >25 and Routine Assessment of Patient Index Data 3 score >12 (OR = 0.16; 95% CI 0.03-0.72). Early rheumatoid arthritis was more likely to present high leptin and interleukin (IL)6 levels with low adiponectin simultaneously (OR = 5.03; 95% CI 1.05-24.0). High leptin levels were associated with the FDR adjusted for IgG2 Porphyromonas gingivalis, swollen joints, P gingivalis and low IL6 (OR = 2.57; 95% CI 1.14-5.95)., Conclusion: High adipokine levels in eRA may modulate the disease activity. Having more than 1 adipokine at high serum levels is associated with increased disability, disease activity and BMI, indicating that RA is controlled by adiponectin levels in the early stages of the disease. High leptin levels, presence of P gingivalis and swollen joints may be the factors associated with the development of RA in FDR., (© 2019 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Background and Objective: Experimental models suggest the use of different therapy protocols in rheumatoid arthritis (RA) as modulators on periodontal condition. This study evaluated the effects of conventional drug treatment and anti-TNF therapy in patients with RA on microbiological and periodontal condition, establishing the association of markers of periodontal infection with indexes of rheumatic activity., Materials and Methods: One hundred seventy nine individuals with RA were evaluated (62 with anti-TNF-. and 115 with only DMARDs). The periodontal evaluation included plaque and gingival indexes, bleeding on probing (BOP), clinical attachment loss (CAL), pocket depth (PD) and subgingival plaque samples for microbiological analysis. Rheumatologic evaluations included a clinical examination, rheumatoid factor (RF), antibodies against cyclic-citrullinated peptides (ACPAs), and activity markers (DAS28-ERS), high sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR)., Results: Anti-TNF-alpha therapy influenced periodontal microbiota with a higher frequency of T. denticola (p=0.01). Methotrexate combined with leflunomide exhibited a higher extension of CAL (p=0.005), and anti-TNF-alpha therapy with methotrexate was associated with a lower extension of CAL (p=0.05). The use of corticosteroids exerted a protective effect on the number of teeth (p=0.027). The type of DMARD affected P. gingivalis, T. forsythia and E. nodatum presence. Elevated ACPAs titers were associated with the presence of red complex periodontal pathogens (p=0.025). Bleeding on probing was associated with elevated CPR levels (p=0.05), and ESR was associated with a greater PD (p=0.044) and presence of red complex (p=0.030)., Conclusion: Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Objective: The aim of this study was to design and validate LupusCol, an instrument for the evaluation of health-related quality of life (HRQoL) in Colombian adult patients with SLE., Methods: Items and domains of the initial instrument were defined. Preliminary tests were made with the participation of patients. Validity and reliability tests of the administration method were conducted. Usability tests were applied to the version obtained in the previous phases to complete the validation process., Results: Following preliminary tests, six items and one domain were excluded and two new items were added to the instrument, producing a form with 44 questions and 7 domains, which was submitted for validity and reliability tests. Factor analysis excluded three items, obtaining a Pearson's correlation (PC) for the criteria validity of -0, 48; a Cronbach's α coefficient for internal consistency of 0, 96; an intraclass correlation coefficient (ICC) for personal test-retest-telephone of 0.96 and an ICC personal test-retest-personal of 0.96. For interrater concordance a PC of 0.8, an ICC of 0.77 and a Lin's coefficient of 0.86 were found. Sensitivity to change was demonstrated through analysis of variance, obtaining significant indicators about the scale, demonstrating the instrument's ability to detect changes in HRQoL., Conclusion: The design and validation process was completed successfully. The scale has significant values for validity, reliability and sensitivity to change in the studied population., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: In clinical practice, it is sometimes difficult to diagnose a relapse in patients suffering from systemic lupus erythematosus (SLE) and lupus nephritis (LN) having potential complications, including renal failure and death. Some immunological markers can help to determine their association with LN and, therefore, diagnose the early onset of complications., Objectives: Evaluating the association between systemic and/or kidney activity and anti-P ribosomal and anti-dsDNA antibodies in patients suffering from active SLE., Methods: 389 patients were evaluated, 140 of whom were subsequently included in the study. The patients were divided into two groups by means of case-control studies, including Colombian patients having American College of Rheumatology (ACR) classification criteria for SLE (1997). The SLE disease activity index (SLEDAI) was applied and all patients presenting an increase of 5 or more compared to their last evaluation, as well as presenting renal manifestations, were considered to be cases; all patients had an activity score. An ELISA kit and the indirect immunofluorescence method with Crithidia luciliae were used for determining the presence of anti-P ribosomal and anti-dsDNA antibodies, respectively., Results: No association was found between anti-P ribosomal antibodies and LN (p=0.2971) but anti-P ribosomal antibodies showed association with a >5 SLEDAI score (OR=4.87; 1.32-17.98 95% CI; p=0.008). The coexistence of anti-P ribosomal and anti-dsDNA antibodies was associated with LN (OR=3.52; 1.07-13.42 95% CI; p=0.019) and anti-dsDNA was associated with LN (p=0.001)., Conclusion: There was no association between anti-P ribosomal antibodies and LN but anti-P ribosomal antibodies coexisting with anti-dsDNA antibodies was associated with LN, thereby suggesting that the coexistence of two antibodies is nephritogenic to a greater extent. Additional studies are needed to evaluate the coexistence of kidney-specific antibodies in SLE to determine the biological nature of LN., (Copyright 2010 Elsevier B.V. All rights reserved.)

Characterization of the extent to which particular combinations of autoimmune diseases occur in excess of that expected by chance may offer new insights into possible common pathophysiological mechanisms. The goal of this study was to investigate the spectrum of polyautoimmunity (i.e. autoimmune diseases co-occurring within patients) and familial autoimmunity (i.e. diverse autoimmune diseases co-occurring within families) in patients with systemic sclerosis (SSc). A cross-sectional study of two convenience samples of patients with SSc, one in Canada and the other in Colombia, was performed. History of other autoimmune diseases in the SSc patients as well as a family history of autoimmunity was obtained. Of 719 patients, 273 (38%) had at least one other autoimmune disease. A total of 366 autoimmune diseases were reported, of which the most frequent were autoimmune thyroid disease (AITD, 38%), rheumatoid arthritis (RA, 21%), Sjögren's syndrome (18%), and primary biliary cirrhosis (4%). There were 260 (36%) patients with first-degree relatives with at least one autoimmune disease, of which the most frequent were RA (18%) and AITD (9%). Having at least one first-degree relative with autoimmune disease was a significant predictor of polyautoimmunity in SSc patients. No significant differences in polyautoimmunity or familial autoimmunity were noted between diffuse and limited subsets of disease. Our results indicate that polyautoimmunity is frequent in patients with SSc and autoimmune diseases cluster within families of these patients. Clinically different autoimmune phenotypes might share common susceptibility variants, which acting in epistatic pleiotropy may represent risk factors for autoimmunity.