A major cause of morbidity and mortality in the context of the antiphospholipid syndrome (APS) is the occurrence of thrombotic events. Besides the pathogenic roles of antiphospholipid antibodies (aPL), other risk factors and medical conditions, which are conditions for traditional risk of an individual without the APS, can coexist in this patient, raising their risk of developing thrombosis. Therefore, the clinical and laboratory investigation of comorbidities known to increase cardiovascular risk in patients with antiphospholipid antibody syndrome is crucial for the adoption of a more complete and effective treatment. Experimental models and clinical studies show evidence of association between APS and premature formation of atherosclerotic plaques. Atherosclerosis has major traditional risk factors: hypertension, diabetes mellitus, obesity, dyslipidemia, smoking, and sedentary lifestyle that may be implicated in vascular involvement in patients with APS. The influence of nontraditional risk factors as hyperhomocysteinemia, increased lipoprotein a, and anti-oxLDL in the development of thromboembolic events in APS patients has been studied in scientific literature. Metabolic syndrome with all its components also has been recently studied in antiphospholipid syndrome and is associated with arterial events.

Recentemente, na cidade de Curitiba/PR, ocorreu um fato que gerou grande repercussão nacional e suscitou questões acerca da "eutanásia", tema controverso e pouco debatido na população em geral, o que motivou a realização deste artigo. O objetivo do trabalho consiste em analisar aspectos envolvidos no processo de morrer: eutanásia e ortotanásia e sua relação com o princípio bioético da autonomia. Trata-se de revisão reflexiva de literatura tendo como base matéria publicada na imprensa, abordando a visão de um grupo de acadêmicos de medicina a respeito do tema. A eutanásia é considerada uma prática ilegal segundo o Código Penal brasileiro e vai de encontro aos princípios éticos da medicina. A ortotanásia não deve se confundir com aquela prática, encaixando-se como opção legítima a ser adotada por pacientes com doença terminal em intenso sofrimento físico e psíquico.

BackgroundThere is a physiologic elevation of total cholesterol (TC) and triglycerides (TG) during pregnancy. Some authors define dyslipidemia (DLP) in pregnant women when TC, LDL and TG concentrations are above the 95th percentile (p95%) and HDL concentration is below the 5th percentile (P5%) for gestational age (GA).ObjectiveTo compare the prevalence of DLP in pregnant women using percentiles criteria with the V Brazilian Guidelines on Dyslipidemia and the association with maternal and fetal outcomes.ResultsPregnant women with high-risk conditions, aged 18-50 years, and at least one lipid profile during pregnancy was classified as the presence of DLP by two diagnostic criteria. Clinical and laboratorial data of mothers and newborns were evaluated.Conclusion433 pregnant women aged 32.9 ± 6.5 years were studied. Most (54.6%) had lipid profile collected during third trimester. The prevalence of any lipid abnormalities according to the criteria of the National Guidelines was 83.8%: TC ≥ 200 mg/dL was found in 49.9%; LDL ≥ 160 mg/dL, in 14.3%, HDL ≤ 50 mg/dL in 44.4% and TG ≥ 150 mg/dL in 65.3%. Any changes of lipid according to percentiles criteria was found in 19.6%: elevation above the P95% for TC was found in 0.7%; for LDL, 1.7%; for TG 6.4% and HDL lower than the P5% in 13%. The frequency of comorbidity: hypertension, diabetes, smoking, obesity and preeclampsia was similar among pregnant women when DLP was compared by both criteria.ConclusionThe prevalence of DLP during pregnancy varies significantly depending on the criteria used, however none demonstrated superiority in association with comorbidities.

Chikungunya virus (CHIKV) infection is caused by an arbovirus prevalent in various parts of the world. The virus can induce autoantibodies and rheumatic diseases, such as rheumatoid arthritis and spondylarthritis. However, until now, no case of Sjögren syndrome (SS) was described associated with CHIKV. In this article, we describe a 49-year-old female with polyarthralgia and a temporary rash on her trunk and arms. Her physical examination showed polyarthritis of her ankles and wrists. Serologies for CHIKV were interpreted as positive with IgM 6.5 (normal range < 0.8) and negative for IgG. Antinuclear antibodies were positive at a titer of 1:640 as well as anti-Ro/SS-A. The diagnosis of subacute CHIKV infection was determined. The Schirmer test, Rose Bengal, and salivary scintigraphy were positive and the diagnosis of SS was confirmed. She was treated with hydroxychloroquine, methotrexate, and a single dose of betamethasone depot. This is the first report on CHIKV associated with SS. Sequence analysis of the CHIKV proteome versus SS autoantigens showed an extensive peptide sharing between the virus and numerous SS autoantigens, thus supporting the hypothesis that autoimmune cross-reactivity might causally link CHIKV to SS.

RBRE-155; No. of Pages 8 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx REVISTA BRASILEIRA DE REUMATOLOGIA w w w . r e u m a t o l o g i a . c o m . b r Thrombosis Hemorrhage Warfarin a b s t r a c t Introduction: Discussion about the intensity of warfarin in patients with antiphospholipid syndrome (APS) remains present in our days. Objectives: To evaluate which intensity of anticoagulation with warfarin is associated with a greater reduction of thromboembolic events in the treatment of patients with APS, as well as assess the risk of bleeding in the different treatment modalities. Methodology: A systematic review of the literature was carried out with search from electronic databases: PubMed, LILACS and SciELO, with the use of the key-words: treatment, warfarin, antiphospholipid syndrome, antiphospholipid antibody syndrome and their respective translations into Portuguese, in different combinations. In addition, a meta-analysis with the aid of Review Manager 5.2 software by Cochrane was performed. Results: Only two articles met the inclusion criteria for this study. Regarding the main outcome assessed in this study, the two studies showed similar values, indicating higher frequency of thrombotic events in high-intensity groups. The comparative analysis of the randomized clinical trial evaluated showed an increased thrombotic risk for those patients who received intervention with high-intensity warfarin. Another finding of the metaanalysis was the higher incidence of minor bleeding, also in the experimental group, that received warfarin keeping International Normalized Ratio (INR) > 3. Conclusion: In individuals with APS and prevalence of venous events, the use of moderate intensity (MI) anticoagulation (INR: 2-3) is the most suitable. However, this evidence cannot yet be extended to patients with arterial events, due to the limited representation of this sample of subjects in the two clinical trials included in this meta-analysis. RBRE-155; No. of Pages 8 2 r e v b r a s r e u m a t o l . 2 0 1 5;x x x(x x):xxx-xxx Intensidade da anticoagulação no tratamento da trombose na síndrome antifosfolípide: meta-análisePalavras-chave: Síndrome antifosfolípide Trombose Hemorragia Varfarina r e s u m o Introdução: a discussão sobre a intensidade de varfarina em pacientes com síndrome antifosfolípide (SAF) permanece presente nos dias atuais. Objetivos: avaliar qual intensidade de anticoagulação com varfarina está associada com maior redução de eventos tromboembólicos no tratamento de pacientes com SAF, assim como avaliar o risco de hemorragia nas diferentes modalidades de tratamento. Metodologia: foi realizada uma revisão sistemática da literatura a partir de busca nas bases de dados eletrônicos: PubMed, LILACS e SciELO, sendo utilizadas as palavras-chave: treatment, warfarin, antiphospholipid syndrome, antiphospholipid antibody syndrome e suas respectivas traduç ões para o português, em diferentes combinaç ões. Também foi realizada uma metaanálise com auxílio do programa Review Manager 5.2 da Cochrane. Resultad...