O objetivo deste artigo foi identificar possível padrão de resposta cognitiva associada a suplementação de estrogênio e/ou progesterona em mulheres após a menopausa. Foi realizada uma revisão sistemática da literatura utilizando o protocolo PRISMA, de corte transversal e análise quanti-qualitativa nas bases de dados PubMed e Scientific Electronic Library Online (SCIELO) utilizando os seguintes Descritores em Ciências da Saúde (DeCS) “Cognição” e “Terapia de reposição hormonal” em inglês e seus sinônimos. Foram identificados 349 artigos que após a aplicação dos filtros resultaram 82 publicações. Não houve duplicidade entre as bases pesquisadas. Após a exclusão de estudos com animais, revisões de literatura e aqueles que a Terapia de Reposição Hormonal foi utilizada com outras finalidades que não o tratamento dos sintomas da menopausa restaram 09 artigos a serem analisados. A terapia hormonal influenciou negativamente a orientação, raciocínio abstrato, volume cerebral e perguntas, além de exacerbar efeitos negativos do Diabetes Mellitus sobre a cognição. Porém, nos domínios atenção, velocidade de processamento, memória operacional e verbal houve uma influência positiva mostrando que as mulheres que utilizaram terapia hormonal obtiveram desempenho melhor que as que nunca utilizaram. Diante dos resultados conflitantes, faz-se necessários mais estudos que avaliem a influência das diferentes formulações, além disso, os fatores de risco para declínio cognitivo devem ser levados em consideração no momento da indicação de terapia hormonal, pois ainda que o tratamento não seja indicado para fins cognitivos, o declínio deste pode causar grande impacto na qualidade de vida das mulheres.

BACKGROUNDChikungunya (CHIK) is a disease that affects thousands of people annually and causes debilitating joint pain. It is transmitted by mosquitoes from the genus Aedes, mainly by Aedes aegypti and Aedes albopictus. In the last 15 years, there have been an increase in the frequency of chikungunya surges that can be related to a greater incidence of more severe forms of the disease than previously described, besides having occurred atypical forms, in which patients expressed, among other autoimmune diseases, the systemic lupus erythematosus (SLE). The SLE is a complex autoimmune disease, with varied clinical presentations and multifactorial etiology, in which genetic and environmental factors interact determining the susceptibility to the disease. As environmental factors, there are viral infections that can intensify undesirable immune responses, stimulating specific immune cells. METHODSThis study identified patients with previous CHIK diagnosis that developed SLE in a university hospital in the state of Paraíba, Brazil, through a cross-sectional retrospective study in medical records of the Alcides Carneiro University Hospital, selecting a case series of patients who manifested SLE after CHIK from 2014 to 2020, which were conducted inpatient or outpatient. The medical records were evaluated based on a questionnaire with specific criteria based on SLICC 2012 e ACR/EULAR 2019 for the diagnosis of SLE, and on clinical, epidemiological and serological criteria for the diagnosis of CHIK.

BACKGROUNDJuvenile systemic lupus erythematosus (JSLE) is a chronic inflammatory, multisystemic, and autoimmune disease with an incidence rate of 0.6/100,000 children under 15 years, with a higher prevalence within women, native Americans, Asian Americans, Latin Americans and African Americans. Some medical findings of this condition are similar to those found in autoimmune lymphoproliferative syndrome (ALPS), which is an inborn error of immunity that results in a defect in the lymphocyte apoptosis, with chronic nonmalignant lymphoproliferation, lymphadenomegaly, and/or splenomegaly. Its incidence and prevalence are unknown but the number of cases worldwide are estimated to exceed several hundred. CASE REPORTFemale patient, 5 years old, first admitted at age of 3 with ecchymosis, disseminated lymph node enlargement, hepatosplenomegaly, recurrent fever and bicytopenia (thrombocytopenia and leukopenia). Tests for negative double T lymphocytes by flow cytometry and specific tests aimed at excluding infections, neoplasms and autoimmune diseases were executed. Positive cytomegalovirus IgG and indirect Coombs were found among the serologies performed. The main diagnostic hypothesis at the time was ALPS. At 5 years old, the patient underwent three more hospitalizations, mainly due to the persistence of thrombocytopenia and severe epistaxis. She used platelet concentrate, pulse therapy with methylprednisolone and immunoglobulin with an unsatisfactory response. Progress was made in the treatment with prednisolone, tranexamic acid and azathioprine and we observed good disease control. The NGS panel for ALPS with CNV did not find pathogenic variants that would define the molecular diagnosis of the syndrome, which made us contest the ALPS's diagnosis. In the latest hospitalization, intense epistaxis and severe thrombocytopenia were found, new laboratory tests were performed, anti-SM and anti-Ro were reactive, and proteinuria was observed in the urine test. Given this clinical and laboratory context, we observed that the patient had the classification criteria for JSLE and started a specific treatment protocol. CONCLUSIONIn the pediatric age group, JSLE has clinical and laboratory classes not only similar to ALPS, but also to other infectious conditions, which can make the diagnosis more complicated to achieve. Given the history, we believe that the careful evaluation of the pediatrician, as well as their attention to the differential diagnosis, are going to establish an early diagnosis in this condition and positively impact these patients' prognosis.

BACKGROUNDSystemic lupus erythematosus (SLE) is a pathology with potentially serious systemic involvement and often difficult to diagnose. Sometimes atypical manifestations occur, such as chorea, which is associated with the presence of antiphospholipid antibodies in the context of SLE. This clinical manifestation is more common in other diagnoses, such as rheumatic fever. In this context, it is necessary to clarify the relationship of chorea in the clinical course of SLE. METHODSIdentify the epidemiological, clinical and laboratory characteristics of patients with SLE and chorea, through a systematic literature review using reports and case series from the Medical Literature and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) databases. RESULTSForty-nine case reports were analyzed, 44 of which were selected for data analysis, after 5 exclusions due to the absence of numerous variables. Most patients were female 30/44 (68.2%). In half of the case reports, chorea manifested itself in the context of pediatric SLE. In 30/44 (68.2%) of cases, chorea appeared before the diagnosis of SLE. The most considered differential diagnosis was rheumatic fever, with a prevalence of 86.6% in the reports that described the possible differential diagnoses. There was the presence of 31/44 (70.5%) positive anti-dsDNA antibody and 24/44 (54.5%) with hypocomplementemia, the two most prevalent findings. In 29/33 (87.8%) of patients in whom antiphospholipid antibodies (aPL) were investigated, at least one of them was positive. Magnetic resonance imaging (MRI) was unchanged in 10/22 (45.4%) of patients who underwent this examination. CONCLUSIONOur study suggested a higher prevalence of SLE associated with chorea in young patients, during disease activity. This was evidenced by both clinical and laboratory tests. The classic relationship with aPL was noted in the reports. In addition, MRI does not show changes in most cases, but it can be used to search for differential diagnoses.