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Material and Methods: Retrospectively followed systemic lupus erythematosus female patients (defined by the identification of at least four systemic lupus erythematosus American College of Rheumatology criteria -fulfillment 100%, n = 76) over the past five years. Age of onset, ethnicity, disease duration, number of American College of Rheumatology criteria at the end of follow-up, cumulative: renal, neuropsychiatric and articular phenotypes, hypertension, dyslipidaemia, smoking and Systemic Lupus Erythematosus Disease Activity Index 2K were correlated to the presence and degree of irreversible damage (Systemic Lupus International Collaborating Clinics Damage Index). Accumulation of American College of Rheumatology criteria was measured in a sub-group of patients followed from disease onset (within a year of the first symptom ascribed to systemic lupus erythematosus) (n = 39 -51%); Systemic Lupus Erythematosus Disease Activity Index and Systemic Lupus International Collaborating Clinics Damage Index were performed. Statistical analysis was performed using Chi-square, Wilcoxon Mann-Whitney tests and Spearman correlation rho (Sig. 2-tailed p < 0.05). Results: Systemic Lupus International Collaborating Clinics/Systemic Damage Index > 0 was present in 56.6% and significantly associated to a longer duration, a higher number of American College of Rheumatology criteria and a neuropsychiatric phenotype when compared with those with no damage. The final number of American College of Rheumatology criteria accrued was positively correlated to a higher disease activity over the past five years of follow-up (Spearman´s rho 0.02 and p < 0.05). There was no effect from other features. Discussion and Conclusion: Disease duration and number of American College of Rheumatology criteria predict Systemic Lupus International Collaborating Clinics/ Systemic Damage Index. neuropsychiatric disease has an impact on damage accrual.

Background/Aims: Previous studies demonstrated an alteration of diaphragmatic excursion on the paretic side after stroke; however, it is unclear if this change has clinical repercussions. We aimed to determine if there was an association between the paretic side and the laterality of pneumonia after stroke. Methods: A retrospective analysis of a consecutive cohort of patients admitted to a stroke unit from 2008 to May 2016 was performed. Patients with the diagnosis of acute stroke and pneumonia were included. The laterality of pneumonia was determined through the blinded observation of chest X-rays. Fisher's exact test was applied to study the association between the side of paresis and pneumonia. Results: One hundred and five patients were included. Sixty one percent (n = 64) had an ischemic stroke, 39% (n = 41) had brain hemorrhage, and 49.5% (n = 52) had right side paresis. We did not find in general an association between the side of paresis and the side of pneumonia (p = 1.00); however, we found a statistically significant association in patients with severe lower limb paresis (Medical Research Council, MRC ≤2; p = 0.035). Conclusion: We found an association between severe paresis of the lower limb (MRC ≤2) and ipsilateral pneumonia. We hypothesize that the proximity between the diaphragmatic and inferior limb corticospinal pathways could be the reason for this association.

Introdução: A elevação de troponina é frequente nos doentes internados. O seu significado e classificação (lesão miocárdica crónica versus aguda versus enfarte agudo de miocárdio (EAM), quer tipo 1, quer tipo 2) não se encontram esclarecidos. O objectivo deste estudo foi avaliar o significado e classificar as elevações de troponina em doentes internados numa enfermaria de Medicina Interna. Material e Métodos: Estudo retrospectivo de doentes internados, num período de dois anos, numa enfermaria de Medicina Interna, a quem foram pedidos, pelo menos, 2 doseamentos de troponina I, ao critério do médico assistente, e que tiveram pelo menos um valor acima do limite de referência de 0,1 ng/ mL. A população foi caracterizada quanto à demografia, factores de risco cardiovascular, antecedentes clínicos, achados clínicos e laboratoriais, terapêutica efectuada e prognóstico. Foi interpretada a elevação de troponina de acordo com a quarta definição de EAM. Resultados: Foram incluídos 90 doentes, com idade média de 83 anos (± 8,1), sendo 52% do sexo masculino. Cumpriram critérios de EAM 60 doentes (66%), sendo que os restantes 30 doentes (33%) eram classificáveis como lesão miocárdica aguda, sem EAM. Não encontrámos diferenças clínicas, no tratamento e prognóstico entre estes dois grupos de doentes, à excepção da idade (84 ± 7 vs 81 ± 10 anos, respectivamente, p = 0,039). Os doentes tinham um performance status baixo (43% ECOG 3 ou 4), hipertensão arterial (89%), insuficiência cardíaca (51%), diabetes mellitus tipo 2 (50%), insuficiência renal crónica (35%), fibrilhação auricular ou flutter (35%) e enfarte agudo de miocárdio prévio (33%). A apresentação clínica incluiu dispneia em 44% e dor torácica em 13%. À data da alta, 64% dos doentes foram medicados com estatina e 58% com pelo menos um anti-agregante plaquetário. A morte ocorreu durante o internamento em 17%, sendo que a mortalidade a 30 dias foi de 27% e a um ano de 51%. Conclusão: Neste estudo, verificámos que, dos doentes com elevação de troponina compatível com lesão miocárdica internados numa enfermaria de Medicina Interna, 66% cumpriam os critérios de definição de EAM, enquanto os restantes 33% tinham lesão miocárdica aguda, sem EAM. À excepção da idade (mais elevada nos doentes com EAM) não houve diferença significativa nas características clínicas, abordagem ou prognóstico entre os dois grupos. Os doentes eram idosos e frágeis, com múltiplas comorbilidades, tendo a morte ocorrido duran-te o internamento em 17%, aos 30 dias em 27% e ao 1 ano em 51%, apesar de prescrição de estatina em 64% e de antiagregação em 60%.

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