Publications by authors named "Evandro Mendes Klumb"

Article Synopsis
  • A new consensus guideline by the Brazilian Society of Rheumatology was created to enhance the diagnosis and treatment of lupus nephritis (LN) through collaboration among 20 rheumatologists and methodologists, using systematic reviews and specific research questions.
  • The guideline emphasizes essential testing for all systemic lupus erythematosus (SLE) patients, with kidney biopsy as the gold standard for LN diagnosis, and outlines 14 key recommendations including a defined target renal response (TRR) for monitoring treatment effectiveness.
  • Hydroxychloroquine is recommended for all SLE patients unless contraindicated, and glucocorticoids are advised for managing LN based on effective grading strategies.
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Objectives: to evaluate the main factors associated with mortality and determine the life expectancy of SLE patients between 2000 and 2019 years in Brazil.

Methods: death data related to SLE available in the Brazilian Unified Health System (SUS) (DATASUS) were evaluated in all Brazilian states. Three groups of death causes potentially associated from SLE were evaluated: cardiovascular and kidney diseases and infections.

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Article Synopsis
  • The study explored the role of complement levels (C3 and C4) as potential biomarkers for monitoring disease activity and risks during pregnancies in women with systemic lupus erythematosus (SLE).
  • Data from 532 lupus patients showed that complement levels generally rise during pregnancy but are notably lower in those with prior lupus nephritis and flares, particularly in the first trimester.
  • Lower or minimal increases in C3 and C4 levels during early pregnancy were linked to higher rates of complications and gestational flares, suggesting these complement levels could help predict risks for SLE patients.
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Background: The p53 and p21 proteins are important regulators of cell cycle and apoptosis and may contribute to autoimmune diseases, such as systemic lupus erythematosus (SLE). As genetic polymorphisms may cause changes in protein levels and functions, we investigated associations of TP53 and p21 (CDKN1A) polymorphisms (p53 72 G > C-rs1042522; p53 PIN3-rs17878362; p21 31 C > A-rs1801270; p21 70 C > T-rs1059234) with the development of systemic lupus erythematosus (SLE) in a Southeastern Brazilian population.

Methods: Genotyping of 353 female volunteers (cases, n = 145; controls, n = 208) was performed by polymerase chain reaction, restriction fragment length polymorphism and/or DNA sequencing.

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Objective: A combination of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) is currently recommended for adults with systemic lupus erythematosus (SLE). However, data on the immunogenicity elicited by sequential pneumococcal vaccination in this patient population are scarce. In this study, we compared short-term antibody responses to both PCV13/PPSV23 (≥8-week interval) and PPSV23/PCV13 (≥12-month interval) vaccination strategies in pneumococcal vaccine-naive adults with SLE.

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During the COVID-19 pandemic, undergraduate medical students (UMS) exposed to isolation, social distancing and complete or partial face-to-face educational activities interruption may present increased stress, depression and anxiety. This study was undertaken to evaluate if, during isolation, UMS involved in online group activities as investigators of a research project (volunteer group) would present better mental health than their colleagues, not involved in that research (control group). A Web-based survey, via the Google Forms platform, including details on demographic data, life habits, previous health conditions, worries with the COVID-19 pandemic, sleep pattern modifications and depression, anxiety and mental stress, using the DASS-21 (Depression, Anxiety and Stress Scale) was implemented from 20 July to 31 August 2020.

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Objective: The aim of this study was to analyze the occurrence and risk factors associated with infections during pregnancy in patients with systemic lupus erythematosus.

Methods: This is a retrospective cohort study using the data of pregnant women who were followed up between 2011 and 2018 at a university hospital.

Results: The data of 221 pregnant women with systemic lupus erythematosus were analyzed.

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Objective: The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE.

Methods: A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched.

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Article Synopsis
  • - The study aimed to investigate the impact of chronic hydroxychloroquine use on COVID-19 incidence among rheumatic disease patients compared to non-users in the same households during the early months of the pandemic in Brazil.
  • - Researchers analyzed data from 10,443 participants, finding no significant difference in COVID-19 symptoms between patients on hydroxychloroquine and those not taking it; however, factors like lung disease and systemic sclerosis diagnosis increased risk for COVID-19 in patients.
  • - The study highlighted that recent influenza vaccination provided a protective effect against COVID-19, reinforcing the importance of immunization for at-risk populations like those with rheumatic diseases.
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Objective: The objective of this study was to evaluate the potential impact of irreversible damage accrual in women with systemic lupus erythematosus (SLE) and adverse maternal and/or fetal/neonatal outcomes.

Methods: Retrospective cohort study with SLE pregnant patients was carried out from January 2011 to January 2020 at the Hospital University Pedro Ernesto (HUPE) of the State University of Rio de Janeiro, Brazil. Irreversible damage was defined according to SLICC/ACR damage index (SDI).

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Article Synopsis
  • Systemic lupus erythematosus (SLE) is an autoimmune disease that causes periods of illness and can damage vital organs, affecting patients' quality of life.
  • This study examined the impact of a 12-week whole-body vibration exercise program on fatigue, functional ability, and quality of life in women with SLE who are on chronic glucocorticoid treatment.
  • Results showed that women in the whole-body vibration exercise group experienced a significant reduction in fatigue and improved functional ability compared to those in the isometry group, suggesting that this exercise method could be beneficial for managing SLE symptoms.
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Purpose: The objective of this review is to address the barriers limiting access to diagnosis and treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in Brazil, specifically for patients in the public healthcare system, arguably those with the least access to innovation.

Design: A selected panel of Brazilian experts in SLE/LN were provided with a series of relevant questions to address in a multi-day conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved.

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Objectives: To analyse maternal variables associated with occurrence of small for gestational age (SGA) newborns in pregnancies of women with systemic lupus erythematosus (SLE), considering clinical and laboratory characteristics prior to conception, during gestation and comorbidities.

Methods: Retrospective cohort study with SLE pregnant patients and singleton deliveries after 22 weeks. SGA newborn was defined as birth weight below 10th percentile and SLE activity at conception and during gestation was measured using the SLE Pregnancy Disease Activity Index (SLEPDAI).

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Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level.

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To obtain the opinion of patients with rheumatoid arthritis or lupus erythematosus about the use of antimalarials through questionnaires and to evaluate their adherence to medication. A cross-sectional study of patients treated with antimalarial medication for a period equal to or longer than 1 year attended between November 2012 and October 2014. A structured questionnaire with 12 questions was filled out.

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Purpose: To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity - Snellen's table, color vision test - Ishihara's table, fundoscopy, and retinography - red-free).

Methods: A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity.

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Introduction: In contrast to organ transplantation, few studies correlate the monitoring of pp65 antigenemia with a diagnosis of cytomegalovirus (CMV) in patients with systemic lupus erythematosus (SLE).

Objective: To highlight the importance of CMV outside transplantation, we monitored pp65 antigenemia in a series of SLE patients.

Methods: From March 2015 to March 2016, SLE patients presenting kidney involvement, fever, and an unclear infection at hospital admission were monitored through pp65 antigenemia.

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Objective: To investigate potential associations of four substitutions in NAT2 gene and of acetylator phenotype of NAT2 with systemic lupus erythematosus (SLE) and clinical phenotypes.

Methods: Molecular analysis of 481C>T, 590G>A, 857G>A, and 191G>A substitutions in the NAT2 gene was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, from DNA extracted from peripheral blood samples obtained from patients with SLE (n=91) and controls (n=97).

Results And Conclusions: The 857GA genotype was more prevalent among nonwhite SLE patients (OR=4.

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The term autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) or Shoenfeld's syndrome refers to a wide group of immune-mediated diseases triggered by external agents. Several substances, such as vaccine adjuvants, squalene and silicone implants, are implied in the pathogenesis of ASIA syndrome. Treatment and prognosis of this complex condition are not completely known due to lack of good quality evidence.

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