: Lupus nephritis (LN) is a severe renal comorbidity associated with systemic lupus erythematosus (SLE), a complex autoimmune disorder with high morbidity and mortality. Diagnosis and monitoring of LN patients still rely on renal biopsy, a procedure that exposes patients to a variety of risks and is not capable of providing longitudinally information about disease prognosis. In this review, we summarized current data of recent promising biomarkers developed in the precision medicine era, particularly under genomic, transcriptomic, proteomic and metabolomic techniques. Genome-wide association-studies have been evaluating the role of endogenous elements beyond the autoimmunity in LN. Transcriptomic methods, including single-cell sequencing, are potential tools in identifying inflammatory signatures, miRNAs and gene expression. Proteomic measures, including anti-C1q antibodies, cytokines, TLRs, VCAM-1, NGAL osteopontin, angiostatin, have been considered helpful to provide a more profound comprehension of the disease pathogenic processes. Metabolomic approaches may identify several abnormal metabolites profiles related with the impairment of cellular functions. Together, these accurate, non-invasive and moderate-cost propedeutic resources may be the novel tools for recognizing, distinguishing and predicting LN progression and prognosis. Furthermore, omics evaluation may also predict responsiveness to treatment and, consequently, change the way we manage LN cases in the near future.
Background C-reactive protein (CRP) is an inflammatory protein used in clinical practice to identify and monitor inflammatory and infectious processes. Recent data suggest CRP might be useful in guiding antibiotic therapy discontinuation among critical care patients. This meta-analysis analyzed the benefits and risks of CRP-guided protocols to guide antibiotic therapy in hospitalized patients in comparison with standard treatment. Methods Studies were searched in four databases: CENTRAL, Medline, Embase and LILACS. The search was performed until Jan 25th, 2023. The reference lists of the articles retrieved and related review studies were hand-screened to find eligible trials that might have been missed. Primary endpoints included the duration of antibiotic therapy for the index episode of infection. The secondary endpoint was the all-cause hospital mortality and infection relapses. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Random effects were used to pool the mean differences and odds ratio of individual studies. The protocol was registered in PROSPERO (CRD42021259977). Results The search strategy retrieved 5209 titles, out of which three studies met the eligibility criteria and were included in this meta-analysis. 727 adult patients were analyzed, of whom 278 were included in the intervention group and 449 were included in the control group. 55,7% of all patients were women. Meta-analysis indicated that experimental groups (CRP-guided) had a lower duration of antibiotic therapy (days) [MMD = -1.82, 95%IC -3.23; -0.40]; with no difference in mortality [OR = 1.19 95%IC 0.67–2.12] or in the occurrence of infection relapse [OR = 3.21 95%IC 0.85–12.05]. Conclusion The use of CRP-guided protocol reduces the total amount of time required for antibiotic therapy when compared to standard protocols of treatment in hospitalized patients with acute bacterial infection. We did not observe statistical differences regarding mortality and infection relapse rates.
Purpose The aim of this narrative review is to sumarize data about the use and role of telemedicine in maternal fetal medicine (MFM). Methods We searched pubmed and scopus to find articles about telemedicine in MFM by using the terms telmedicine or telehealth and maternal fetal medicine. Results Telehealth has been widely used for several medical specialties. During the coronavirus disease 2019 (COVID-19) pandemic, telehealth has gained investment and further research. Even though telemedicine in MFM has not been frequently applied, from 2020 onwards it has increased in both implementation and acceptance worldwide. The need to screen the patients in overloaded centers in a pandemic scenario required telemedicine in MFM, which has exhibited consistently good results concerning health and budget. The aim of this study was to review the telehealth programs and research focused on MFM around the world. Few studies have been applied to MFM and even fewer in developing and undeveloped countries. The majority of studies were concentrated in the USA and in Europe. Conclusion Further research is needed, especially in non-developed countries, to comprehend the potential role of telemedicine in MFM for improving the life quality of the patients, health professionals, and to be cost-efficient.
BACKGROUNDIn systemic lupus erythematosus (SLE) patients, discoid lesions may leave definitive scars such as atrophy, hyperpigmentation, and depigmentation, which are emotionally devastating, as they increase psychological burden of the disease and negatively impacts on health-related quality of life. Cosmetic camouflage has been integrated into medical practice to help patients disguise congenital or acquired disfigurements that are not amenable to medical or surgical treatment. Training is essential in camouflage therapy, once the application and adherence processes are different from regular makeup foundations. We aimed to present a stepby-step video produced to teach how to do cosmetic camouflage, through a QR code access. METHODSA signed authorization for image use was obtained. A video teaching the techniques of cosmetic camouflage was produced, as part of a University Extension Project, by a skillful makeup artist, a dermatology fellow, a lupus patient, medical students and rheumatology professors. After publication in the social media, patients will be able to interact with the staff to solve issues. RESULTSThe best camouflage cosmetics are natural-looking, waterproof, easy to apply, long-lasting, fragrance-free, available in different shades, matte, nonirritating, nonphotosensitizing, noncomedogenic and affordable. It is noteworthy that the cosmetic camouflage should not be done if the skin lesion is injured or inflamed. Steps are as follows: 1) Wash the area with soap and water, or with a micellar solution; 2) Prepare the skin with a moisturizer and a sunscreen; 3) Correct the lesion color not only with skin-colored correctors, but also colored ones, as these are useful in camouflaging certain lesions; 4) Test the foundation in the region you want to cover to identify the most suitable color; 5) Apply the cover cream or foundation; 6) Finish with a colorless powder. The QR code in Fig. 1 give access to the video presenting the technique of cosmetic camouflage. Figure 1. QR code: Video "How to do cosmetic camouflage." CONCLUSION Cosmetic camouflage is an effective intervention and should be recommended in the rheumatologists practice routine as a validated therapy. The video explains the proper way to do the camouflage and facilitates the patient's understanding and adherence.
Background: C-reactive protein (CRP) is an acute-phase marker used in clinical practice to identify and monitor inflammatory and infectious processes. Recent data suggest that CRP might be useful in guiding antibiotic therapy discontinuation among critical care patients. This meta-analysis analyzed the benefits and risks of CRP-guided protocols to define antibiotic therapy discontinuation in hospitalized patients in comparison with standard treatment. Methods: Studies were searched in four databases: Medline, Embase, CENTRAL, and LILACS. The reference lists of the articles retrieved, and related review studies were hand-screened to find eligible trials that might have been missed. Primary endpoints included the duration of antibiotic therapy for the index episode of infection. The secondary endpoint was the all-cause hospital mortality and infection relapses. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Random effects were used to pool the mean differences and odds ratio of individual studies. The protocol was registered in PROSPERO (CRD42021259977).Results: The search strategy retrieved 5209 titles, out of which 03 studies met the eligibility criteria and were included in this meta-analysis. 727 patients were analyzed, of whom 278 were included in the intervention group and 449 were included in the control group. 55,7% of all patients were women. Meta-analysis indicated that experimental groups (CRP-guided) had a shorter duration of antibiotic therapy (days) [MMD= -1.82, 95%IC -3.23; -0.40], with no difference in mortality [OR =1.19 95%IC 0.67-2.12] or occurrence of infection relapse [OR =3.21 95%IC 0.85-12.05] between the two groups. Conclusion: The use of CRP-guided protocol reduced the total amount of time required for antibiotic therapy when compared to standard protocols of treatment in hospitalized patients with an acute bacterial infection. We did not observe statistical differences in mortality and infection relapse rates.
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