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  • Brito-Zeron, Pilar, et al. (författare)
  • Epidemiological profile and north–south gradient driving baseline systemic involvement of primary Sjögren’s syndrome
  • 2019
  • Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 59:9, s. 2350-2359
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To characterize the systemic phenotype of primary Sjögren’s syndrome at diagnosis by analysing the EULAR-SS disease activity index (ESSDAI) scores.Methods: The Sjögren Big Data Consortium is an international, multicentre registry based on worldwide data-sharing cooperative merging of pre-existing databases from leading centres in clinical research in Sjögren’s syndrome from the five continents.Results: The cohort included 10 007 patients (9352 female, mean 53 years) with recorded ESSDAI scores available. At diagnosis, the mean total ESSDAI score was 6.1; 81.8% of patients had systemic activity (ESSDAI score ≥1). Males had a higher mean ESSDAI (8.1 vs 6.0, P < 0.001) compared with females, as did patients diagnosed at <35 years (6.7 vs 5.6 in patients diagnosed at >65 years, P < 0.001). The highest global ESSDAI score was reported in Black/African Americans, followed by White, Asian and Hispanic patients (6.7, 6.5, 5.4 and 4.8, respectively; P < 0.001). The frequency of involvement of each systemic organ also differed between ethnic groups, with Black/African American patients showing the highest frequencies in the lymphadenopathy, articular, peripheral nervous system, CNS and biological domains, White patients in the glandular, cutaneous and muscular domains, Asian patients in the pulmonary, renal and haematological domains and Hispanic patients in the constitutional domain. Systemic activity measured by the ESSDAI, clinical ESSDAI (clinESSDAI) and disease activity states was higher in patients from southern countries (P < 0.001).Conclusion: The systemic phenotype of primary Sjögren’s syndrome is strongly influenced by personal determinants such as age, gender, ethnicity and place of residence, which are key geoepidemiological players in driving the expression of systemic disease at diagnosis. 
  • Brito-Zerón, Pilar, et al. (författare)
  • Influence of geolocation and ethnicity on the phenotypic expression of primary Sjögren's syndrome at diagnosis in 8310 patients : a cross-sectional study from the Big Data Sjögren Project Consortium
  • 2017
  • Ingår i: Annals of the Rheumatic Diseases. - : BMJ Publishing Group. - 0003-4967 .- 1468-2060. ; 76:6, s. 1042-1050
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To analyse the influence of geolocation and ethnicity on the clinical presentation of primary Sjögren's syndrome (SjS) at diagnosis.METHODS: The Big Data Sjögren Project Consortium is an international, multicentre registry designed in 2014. By January 2016, 20 centres from five continents were participating. Multivariable logistic regression analyses were performed.RESULTS: We included 7748 women (93%) and 562 men (7%), with a mean age at diagnosis of primary SjS of 53 years. Ethnicity data were available for 7884 patients (95%): 6174 patients (78%) were white, 1066 patients (14%) were Asian, 393 patients (5%) were Hispanic, 104 patients (1%) were black/African-American and 147 patients (2%) were of other ethnicities. SjS was diagnosed a mean of 7 years earlier in black/African-American compared with white patients; the female-to-male ratio was highest in Asian patients (27:1) and lowest in black/African-American patients (7:1); the prevalence of sicca symptoms was lowest in Asian patients; a higher frequency of positive salivary biopsy was found in Hispanic and white patients. A north-south gradient was found with respect to a lower frequency of ocular involvement in northern countries for dry eyes and abnormal ocular tests in Europe (OR 0.46 and 0.44, respectively) and Asia (OR 0.18 and 0.49, respectively) compared with southern countries. Higher frequencies of antinuclear antibodies (ANAs) were reported in northern countries in America (OR=1.48) and Asia (OR=3.80) while, in Europe, northern countries had lowest frequencies of ANAs (OR=0.67) and Ro/La (OR=0.69).CONCLUSIONS: This study provides the first evidence of a strong influence of geolocation and ethnicity on the phenotype of primary SjS at diagnosis.
  • Brito-Zerón, Pilar, et al. (författare)
  • SARS-CoV-2 infection in patients with primary Sjögren syndrome : characterization and outcomes of 51 patients.
  • 2021
  • Ingår i: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 60:6, s. 2946-2957
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To analyse the prognosis and outcomes of SARS-CoV-2 infection in patients with primary SS.METHODS: We searched for patients with primary SS presenting with SARS-CoV-2 infection (defined following and according to the European Centre for Disease Prevention and Control guidelines) among those included in the Big Data Sjögren Registry, an international, multicentre registry of patients diagnosed according to the 2002/2016 classification criteria.RESULTS: A total of 51 patients were included in the study (46 women, mean age at diagnosis of infection of 60 years). According to the number of patients with primary SS evaluated in the Registry (n = 8211), the estimated frequency of SARS-CoV-2 infection was 0.62% (95% CI 0.44, 0.80). All but two presented with symptoms suggestive of COVID-19, including fever (82%), cough (57%), dyspnoea (39%), fatigue/myalgias (27%) and diarrhoea (24%), and the most frequent abnormalities included raised lactate dehydrogenase (LDH) (88%), CRP (81%) and D-dimer (82%) values, and lymphopenia (70%). Infection was managed at home in 26 (51%) cases and 25 (49%) required hospitalization (five required admission to ICU, four died). Compared with patients managed at home, those requiring hospitalization had higher odds of having lymphopenia as laboratory abnormality (adjusted OR 21.22, 95% CI 2.39, 524.09). Patients with comorbidities had an older age (adjusted OR 1.05, 95% CI 1.00, 1.11) and showed a risk for hospital admission six times higher than those without (adjusted OR 6.01, 95% CI 1.72, 23.51) in the multivariate analysis.CONCLUSION: Baseline comorbidities were a key risk factor for a more complicated COVID-19 in patients with primary SS, with higher rates of hospitalization and poor outcomes in comparison with patients without comorbidities.
  • di Bernardo, M., et al. (författare)
  • Bifurcations in Nonsmooth Dynamical Systems
  • 2008
  • Ingår i: SIAM Review. - 0036-1445 .- 1095-7200. ; 50:4, s. 629-701
  • Forskningsöversikt (refereegranskat)abstract
    • A review is presented of the one-parameter, nonsmooth bifurcations that occur in a variety of continuous-time piecewise-smooth dynamical systems. Motivated by applications, a pragmatic approach is taken to defining a discontinuity-induced bifurcation (DIB) as a nontrivial interaction of a limit set with respect to a codimension-one discontinuity boundary in phase space. Only DIBs that are local are considered, that is, bifurcations involving equilibria or a single point of boundary interaction along a limit cycle for flows. Three classes of systems are considered, involving either state jumps, jumps in the vector field, or jumps in some derivative of the vector field. A rich array of dynamics are revealed, involving the sudden creation or disappearance of attractors, jumps to chaos, bifurcation diagrams with sharp corners, and cascades of period adding. For each kind of bifurcation identified, where possible, a kind of "normal form" or discontinuity mapping (DM) is given, together with a canonical example and an application. The goal is always to explain dynamics that may be observed in simulations of systems which include friction oscillators, impact oscillators, DC-DC converters, and problems in control theory.
  • di Bernardo, M., et al. (författare)
  • Discontinuity-induced bifurcations of equilibria in piecewise-smooth and impacting dynamical systems
  • 2008
  • Ingår i: Physica D. - 0167-2789 .- 1872-8022. ; 237:1, s. 119-136
  • Tidskriftsartikel (refereegranskat)abstract
    • A rich variety of dynamical scenarios has been shown to occur when a fixed point of a non-smooth map undergoes a border-collision. This paper concerns a closely related class of discontinuity-induced bifurcations, those involving equilibria of n-dimensional piecewise-smooth flows. Specifically, transitions are studied which occur when a boundary equilibrium, that is one lying within a discontinuity manifold, is perturbed. It is shown that such equilibria can either persist under parameter variations or can disappear giving rise to different bifurcation scenarios. Conditions to classify among the possible simplest scenarios are given for piecewise-smooth continuous, Filippov and impacting systems. Also, we investigate the possible birth of other attractors (e.g. limit cycles) at a boundary-equilibrium bifurcation.
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