Resiliência e adesão ao tratamento em pacientes com lúpus eritematoso sistêmico

Universidade Federal do Rio Grande do Norte

Ensaio clínico duplo-cego controlado e randômico, comparando a eficácia da Clofazimina com a Cloroquina, no tratamento das lesões cutâneas do Lúpus Eritematoso Sistêmico

PURPOSE: To evaluate the capacity of clofazimine (CFZ) to control cutaneous activity of systemic lupus erythematosus (SLE), compared with chloroquine diphosphate (CDP). METHODS: A prospective, randomized, controlled, double blind clinical trial was carried out in thirty-three patients with SLE and cutaneous lesions (malar rash and/or discoid lupus and/or subacute cutaneous lupus), after approval by the respective Ethics Committee. Sixteen patients received clofazimine - 100mg/day (CFZ group) and 17 received chloroquine diphosphate - 250mg/day (CDP group), during six months. Both groups applied broad-spectrum sunscreens twice a day. The dose of prednisone was kept stable during the study. Cutaneous lesions were evaluated by 2 blinded observers and photographed at baseline and at months 1, 2, 4 and 6. RESULTS: Thirty-three patients began and 27 completed the 6 months of treatment. The groups were homogeneous and comparable in terms of demographic and clinical characteristics. Five CFZ-patients and one CDP-patients dropped out due to severe flare of disease requiring other treatment. At the end of the study, 12 CFZ-patients (75%) and 14 CDP-patients (82,4%) presented complete or near-complete remission of skin lesions; intention-to-treat analysis showed no significant difference in the response rates between groups. Side effects in both groups were frequent, but patients didn t have to discontinue the drugs. CONCLUSIONS: Clofazimine and chloroquine were effective in controlling cutaneous lesions in SLE patients

A doença como ponto de mutação :os processos de significação em mulheres portadores de lúpus eritematoso sistêmico

Systemic lupus erythematous (SLE) is a chronic and auto-immune disease that can affect several systems of one´s body, including the nervous system, causing several clinical evidences, which can put in risk the person´s life. Although the illness could manifest itself at any age or sex, studies indicate higher incidence among women. Its etiology points to the combination of genetic, hormonal and environmental factors. Due to the disease´s complexity, it is evident that it affects all the person´s life as a whole and not only its organic dimension. It is believed that the signification attributed to all the process of sickening influences its treatment, as well as the person´s capacity to cope with the difficulties and implicit profits involved in the process.In this study, eight women who were affected by SLE were interviewed, with the aim of examining carefully the processes of signification as well as the generation of meanings which permeate these women´s sickening processes. The analysis of their speeches evidences distinct forms of giving meaning to the process, regardless of the time of the diagnosis. The fact that the disease is incurable was shocking to all the participants, and it demanded changes in their lives, in order to detain a relative control of their condition. The majority of the participants were able to deal with these modifications, since strategies have been created to face the difficulties and thus to preserve their social life, without damaging their health. However, some of the participants did not obtain strenght to cope with the disease, eventually developing a depressive state. It is observed that not only SLE has innumerable ways of manifestation, but the experience of the illness is very subjective and dynamic. There are also several ways of expressing this experience, according to the implications in the social, cultural and economic context where the participants are inserted. This ratifies the necessity of a interdisciplinary approach to embrace SLE complexity. (310 words, 1.610 characters)

Eosinófilos e proteína catiônica eosinofílica na urina: uma nova abordagem para o diagnóstico da inflamação renal no lúpus eritematoso sistêmico

Universidade Estadual do Rio Grande do Norte

Mulheres com lúpus eritematoso sistêmico: sintomas depressivos e apoio social percebido

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, rare, multisystem, with a very heterogeneous clinical and serological manifestations standard. The patient, in addition to suffering injuries on his physical and physiological functioning, may also face a number of psychosocial problems. Research indicates that SLE can cause significant damage to the psychological realm, especially with the presence of anxiety and depression. In 1999, the American College of Rheumatology (ACR), proposed the establishment of 19 neuropsychiatric clinical syndromes attributed to SLE. Depression lies between mood disorders and is one of the most common psychiatric manifestations in this group, being found more frequently in these patients than in the general population. Studies also suggest that social support plays an important role in the development of coping strategies, in SLE management and depression. This study has as main objective verify the association between depressive symptoms and perceived social support in patients with SLE. The specific objectives turned to: investigte the prevalence of depressive symptoms; investigate the perceived social support and verify if there is an association between depression, social support and sociodemographic variables. We used a sociodemographic questionnaire, the Beck Depression Scale, and the Perceived Social Support Scale. The analysis was performed through descriptive and inferential statistics. The final sample could count with 79 SLE women, with an average age of 35.7 years. 44 (55.7%) of the participants were married. Only 6 (7.59%) had completed higher education and 32 (40.51%) have not finished high school. Seventy-one (89.87%) had an income below three minimum salaries and 71 (89.87) practiced a religion, and the Catholic (67.71%) was the most mentioned by them. Of the total sample, 37 (46.74%) had been diagnosed SLE more than 7 years before, and 25 (31.65%) had the disease for more than 10 years. Only 19 (24.05%) had some work activity. Forty-two of them (53.17%) had depressive symptoms levels from mild to severe, and 51 (64.46%) reported pain levels of 5, or above. The study found a significant association between depressive symptoms and pain (p = 0.013) and depressive symptoms and work activity (p = 0.02). When we examined the perception of social support, the results showed high levels among participants. Using the Spearman correlation test we found a strong correlation between depressive symptoms and social support (p= 0,000037). It means that the higher the frequency of support, the lower the score of depression. These findings are relevant because depressive symptoms in patients with SLE have a multicausal and multifactorial character and may remain unnoticed, since many of them are confused with the manifestations of the disease. This fact requires a careful assessment from professionals, not only in the clinical setting, but also considering other psychosocial reasons, that may be influencing the emergence or worsening of symptoms. These results also corroborate other studies, which not only confirm the predictive role of social support in the physical wellbeing, but also in the psychological.

Mulheres com lúpus eritematoso sistêmico: sintomas depressivos e apoio social percebido

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, rare, multisystem, with a very heterogeneous clinical and serological manifestations standard. The patient, in addition to suffering injuries on his physical and physiological functioning, may also face a number of psychosocial problems. Research indicates that SLE can cause significant damage to the psychological realm, especially with the presence of anxiety and depression. In 1999, the American College of Rheumatology (ACR), proposed the establishment of 19 neuropsychiatric clinical syndromes attributed to SLE. Depression lies between mood disorders and is one of the most common psychiatric manifestations in this group, being found more frequently in these patients than in the general population. Studies also suggest that social support plays an important role in the development of coping strategies, in SLE management and depression. This study has as main objective verify the association between depressive symptoms and perceived social support in patients with SLE. The specific objectives turned to: investigte the prevalence of depressive symptoms; investigate the perceived social support and verify if there is an association between depression, social support and sociodemographic variables. We used a sociodemographic questionnaire, the Beck Depression Scale, and the Perceived Social Support Scale. The analysis was performed through descriptive and inferential statistics. The final sample could count with 79 SLE women, with an average age of 35.7 years. 44 (55.7%) of the participants were married. Only 6 (7.59%) had completed higher education and 32 (40.51%) have not finished high school. Seventy-one (89.87%) had an income below three minimum salaries and 71 (89.87) practiced a religion, and the Catholic (67.71%) was the most mentioned by them. Of the total sample, 37 (46.74%) had been diagnosed SLE more than 7 years before, and 25 (31.65%) had the disease for more than 10 years. Only 19 (24.05%) had some work activity. Forty-two of them (53.17%) had depressive symptoms levels from mild to severe, and 51 (64.46%) reported pain levels of 5, or above. The study found a significant association between depressive symptoms and pain (p = 0.013) and depressive symptoms and work activity (p = 0.02). When we examined the perception of social support, the results showed high levels among participants. Using the Spearman correlation test we found a strong correlation between depressive symptoms and social support (p= 0,000037). It means that the higher the frequency of support, the lower the score of depression. These findings are relevant because depressive symptoms in patients with SLE have a multicausal and multifactorial character and may remain unnoticed, since many of them are confused with the manifestations of the disease. This fact requires a careful assessment from professionals, not only in the clinical setting, but also considering other psychosocial reasons, that may be influencing the emergence or worsening of symptoms. These results also corroborate other studies, which not only confirm the predictive role of social support in the physical wellbeing, but also in the psychological.

Avaliação dos parâmetros de estresse oxidativo no lúpus eritematoso

OBJECTIVE: The aim of this work was to analyse some oxidative stress parameters in patients of Systemic Lúpus Erythematosus. PATIENTS AND METHODS: Determinations of reduced glutathione content in whole blood were carried out. The activity of superoxide dismutase, gluthatione peroxidase and catalase in erythrocytes and the concentration of reactive substances of acid thiobarbituric in plasma of patients female (n =19) with SLE no activity of disease (Mex-SLEDAI < 2), with average ages of 32 ± 11 years, through the spectrophotometrical methods and from healthy individuals (n =30). Statistical data were analyzed by student t-test, p<0,05. RESULTS: Our data indicated a significant decrease on the activity of catalase and significant increase on the concentration of reactive substances of acid thiobarbituric in patients with SLE comparing with healthy individuals. There was no significant difference in other parameters. CONCLUSION: The results showed that oxidative stress has a role in the pathogenesis of the disease in SLE, even in patients without active disease.

Avaliação demográfica, clinico-laboratorial e genética de indivíduos com lupus eritematoso sistêmico e artrite reumatóide residentes em região tropical

The aetiology of autoimmunes disease is multifactorial and involves interactions among environmental, hormonal and genetic factors. Many different genes may contribute to autoimmunes disease susceptibility. The major histocompatibility complex (MHC) genes have been extensively studied, however many non-polymorphic MHC genes have also been reported to contribute to autoimmune diseases susceptibility. The aim of the present study was to evaluate the influence of SLC11A1 gene in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Ninety-six patients with SLE, 37 with RA and 202 controls enrolled in this case-control study, were evaluated with regard to demographic, genetic, laboratorial and clinical data. SLE mainly affects females in the ratio of 18 women for each man, 88,3% of the patients aged from 15 to 45 years old and it occurs with similar frequency in whites and mulattos. The rate of RA between women and men was 11:1, with 77,1% of the cases occurring from 31 to 60 years. The genetic analysis of the point mutation -236 of the SLC11A1 gene by SSCP did not show significant differences between alleles/genotypes in patients with SLE or RA when compared to controls. The most frequent clinical manifestations in patients with SLE were cutaneous (87%) and joint (84.9%). In patients with RA, the most frequent out-joint clinical manifestation were rheumatoid nodules (13,5%). Antinuclear antibodies were present in 100% of the patients with SLE. There was no significant relation between activity of disease and presence of rheumatoid factor in patients with RA, however 55,6% of patients with active disease presented positive rheumatoid factor. Significant association between alleles/genotypes of point mutation -236 and clinical manifestations was not found

Avaliação demográfica, clinico-laboratorial e genética de indivíduos com lupus eritematoso sistêmico e artrite reumatóide residentes em região tropical

The aetiology of autoimmunes disease is multifactorial and involves interactions among environmental, hormonal and genetic factors. Many different genes may contribute to autoimmunes disease susceptibility. The major histocompatibility complex (MHC) genes have been extensively studied, however many non-polymorphic MHC genes have also been reported to contribute to autoimmune diseases susceptibility. The aim of the present study was to evaluate the influence of SLC11A1 gene in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Ninety-six patients with SLE, 37 with RA and 202 controls enrolled in this case-control study, were evaluated with regard to demographic, genetic, laboratorial and clinical data. SLE mainly affects females in the ratio of 18 women for each man, 88,3% of the patients aged from 15 to 45 years old and it occurs with similar frequency in whites and mulattos. The rate of RA between women and men was 11:1, with 77,1% of the cases occurring from 31 to 60 years. The genetic analysis of the point mutation -236 of the SLC11A1 gene by SSCP did not show significant differences between alleles/genotypes in patients with SLE or RA when compared to controls. The most frequent clinical manifestations in patients with SLE were cutaneous (87%) and joint (84.9%). In patients with RA, the most frequent out-joint clinical manifestation were rheumatoid nodules (13,5%). Antinuclear antibodies were present in 100% of the patients with SLE. There was no significant relation between activity of disease and presence of rheumatoid factor in patients with RA, however 55,6% of patients with active disease presented positive rheumatoid factor. Significant association between alleles/genotypes of point mutation -236 and clinical manifestations was not found

Atuação das equipes da atenção primária na identificação precoce do câncer infanto-juvenil

Identificar o conhecimento de profissionais da atenção primária sobre a identificação precoce do câncer infanto-juvenil e descrever o desempenho das equipes de saúde antes da realização de treinamentos para identificação precoce do câncer infanto-juvenil. Método: Os dados foram obtidos por um questionário e grupo focal com 30 profissionais de uma Unidade de Saúde da Família, e analisados por temas geradores. Resultados: Os profissionais possuem conhecimentos sobre a identificação do câncer infanto-juvenil, e, demandam conhecer mais sobre os sinais e sintomas para identificação precoce, e a prestação de uma assistência sistematizada. Conclusão: Torna-se fundamental estimular a qualificação dos profissionais da atenção primária para a identificação precoce e o fortalecimento de uma rede de assistência que proporcione atendimento integral e a redução no retardo do diagnóstico de câncer infanto-juvenil

Justiça juvenil: teoria e prática no sistema socioeducativo

Em um momento histórico de violações e ameaças aos direitos fundamentais de crianças e adolescentes, é preciso somar esforços na luta pela transformação das políticas voltadas para esses sujeitos. A ideologia que fundamenta a criminalização de adolescentes pobres e da periferia é a mesma que impõe a redução da idade penal e que autoriza e legitima as violências institucionais cometidas no sistema socioeducativo. “Justiça juvenil: teoria e prática no sistema socioeducativo” vem apresentar fundamentos teóricos e experiências práticas com vistas à desconstrução desses processos ideológicos e à defesa intransigente da proteção integral

Voleibol infanto-juvenil brasileiro: Somatotipia, qualidades físicas e marcadores genéticos dos atletas em diferentes níveis de qualificação esportiva

The elaboration of profiles with characteristics that can be parameters in the different categories of sports modalities and the investment in scientific studies have revealed a significant importance in the development of new generations of athletes. Based in the exposed, the purpose of this study was to identify and compare the somatotype characteristics, physical qualities and genetic markers of Brazilian male volleyball players in the 14-17 category playing at different levels (international, national and regional). We used a scale, stadiometer, pachymeter, and adipometer to evaluate somatotype, attack and block reach test, medicine ball toss, 30-meter agility test , the AAHPER -30 test to evaluate basic physical qualities and the dermatoglyphic method to identify genetic markers. The results show the superiority of the national team over the other squads in the somatotype component (ectomorphy), and in the level of basic physical qualities. We found no significant difference in genetic markers among the teams studied. We conclude that Brazilian volleyball players at different performance levels have characteristics peculiar to the sport, with height and physical qualities being significantly different among these teams. The results confirm de necessity of knowing the athletes specific characteristics when dealing with high performance teams using nutrition, medicine, physiology and genetics specific knowledges to achieve a better sportive development

Estudo da correlação das características dermatoglífica e somatotípica com as qualidades físicas das atletas de voleibol da Seleção Infanto-juvenil do Estado do Rio Grande do Norte

The purpose of the present study is to identify the dermatoglyphic and somatotypic characteristics and the physical qualities of athletes from the under-17 State volleyball team, in Rio Grande do Norte, Brazil. The sample was composed of athletes, n = 14, aged 15.0 ± 0.88 years, weight (Kg) 58.3 ± 5.90 and height (cm) 169.4 ± 7.97, members of the referred team. For data collection Cummins & Midlo s (1942), o dermatoglyphic method and Heath & Carter s (1967) somatotypic method were used and to evaluate physical qualities, 2400m, 50m, Shuttle Run, abdominal , Sargent test and medicine-ball toss were performed. Fingerprints show that the group presents genetic predisposition for the following physical qualities: explosive force and velocity. As to somatotype, the group was endo-ectomorphic. At physical evaluation the group presented low Vo2 max values and reasonable levels of explosive force, local muscular endurance, agility and velocity. We conclude that: according to the dermatoglyphic model observed, the group needs training strategies to improve coordination and agility; somatotype reveals the necessity for reducing fat levels and increasing muscular mass; the evaluation of physical qualities demonstrates the need for better physical preparation. This study traces the profile of the under-17 volleyball player from Rio Grande do Norte, with respect to genetic and somatotypic aspects and physical qualities, which will serve as a parameter for future state teams

Entre desvios e normas: infração juvenil feminina na cidade de Natal - RN

This paper presents some reflections on the social world of young female transgression. The context corresponds to those ones that obey social and educational measures in The Padre João Maria Education Centre (CEDUC), in Natal- RN. This behavior, according to the Statute of Children and Young (ECA, 1990), is defined as "conduct described as crime or misdemeanor." Our goal is to discuss aspects of the contexts in which young women are interacting with the universe of total institutional control mechanisms. Through the socio-anthropological analysis of the ethnographic practice in field research, it was necessary to question the concept of misuse engaged in the practice of penalties awarded to young women in the context of private freedom. So was built a frame relating the representations of the relations of gender, generation, the practice of violence and crime from the look on CEDUC/ Padre João Maria Education Centre

Protagonismo juvenil: uma avaliação do programa agente jovem de desenvolvimento humano na cidade de Natal RN (2006/2007).

This paper presents a critical rescue of the term youth, while simultaneously is presented as the lifetime of between 15 and 24 years. Rescue two features in the literature. The first considers youth as a transition period and the second phase work that from a predisposition to rebellion. Discusses the design plural of that term, youth recital to this social and historical aspects of different societies to which it relates and highlights the importance of realizing the diversity of it. Where the object of investigation, the Young Agent Program, the overall objective of the study is to evaluate the effectiveness of the actions of the Young Agent Program for Human Development in Natal-RN. Specifically aims to evaluate the effectiveness of the Young Agent Program: a) as an enhancer of the integration of young people in social spaces of family, school and community, b) as to (re) insertion and the incorporation of issues related to health in adolescence, and c ) regarding the work of young people as multipliers of the actions of the program. With regard to the methodological procedures presents a review of the literature on youth, and the categories of human development, leadership and evaluation of youth policies for the construction of theoretical and analytical approach, using documentary data collection in the Municipal Labor and Social Services - SEMT on the Young Agent Program, and interviews with actors involved in the program. Finally, evaluates the effectiveness of the Young Agent Program from the perspective of participants