Cell phenotypes as activity biomarkers in patients with Systemic Lupus Erythematosus

Abstract The pathogenesis of systemic lupus erythematosus (SLE) is complex. Few studies in Brazilian population have addressed cell phenotypes associated with immunological responses and their associations with SLE activity. The aim of this study is to investigate cell phenotypes associated to SLE diagnosis, treatment and activity. Twenty-eight SLE female patients (17 inactive, 11 active) and 10 healthy women were included in this study. Markers of natural killer (Nk), T and B cells in peripheral blood were evaluated by flow cytometry. Nkt cells were decreased only in SLE active patients. Activated CD4+, regulatory T FoxP3+ and B cells were decreased in both active and inactive SLE patients, compared to control group. The data corroborate the disruption of immune regulatory response in SLE patients and suggest phenotipic changes as possible biomarkers of SLE activity.

Performance and reference intervals of thrombin generation test: results from the Brazilian longitudinal study of adult health (ELSA-Brasil). A cross-sectional study

ABSTRACT BACKGROUND: The thrombin generation test (TGT) has shown promise for investigation of hemorrhagic and thrombotic diseases. However, despite its potential, it still needs standardization. Moreover, few studies have established reference values for TGT parameters. In Brazil, these values have not yet been established. OBJECTIVE: To determine TGT performance and reference intervals for TGT parameters in healthy individuals. DESIGN AND SETTING: Cross-sectional study conducted among participants in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil). METHODS: The reference sample consisted of 620 healthy individuals. The calibrated automated thrombogram (CAT) method, under low and high tissue factor (TF) conditions, was used to assess thrombin generation. Test performance was analyzed using intra and interassay coefficients of variation (CV) and reference intervals were calculated using the nonparametric method proposed by the International Federation of Clinical Chemistry and the Clinical and Laboratory Standards Institute. RESULTS: The intraassay CV ranged from 1.4% to 2.2% and the interassay CV, 6.8% to 14.7%. The reference intervals for TGT parameters under low and high TF conditions were, respectively: lagtime: 3.0-10.3 and 1.4-3.7 min; endogenous thrombin potential (ETP): 1134.6-2517.9 and 1413.6-2658.0 nM.min; normalized ETP: 0.6-1.3 and 0.7-1.4; peak: 103.2-397.7 and 256.4-479.0 nM; normalized peak: 0.3-1.3 and 0.7-1.2; and time-to-peak: 5.6-16.0 and 3.4-6.7 min. These parameters were categorized relative to sex. Conclusion: TGT performance was adequate and the proposed reference intervals were similar to those of other studies. Our findings may be useful for consolidating the TGT, through contributing to its standardization and validation.

Chronic Lymphocytic Leukemia (CLL): evaluation of AKT protein kinase and microRNA gene expression related to disease pathogenesis

Abstract The present study evaluated 56 patients diagnosed with Chronic Lymphocytic Leukemia (CLL) and a control group of 44 clinically healthy subjects with no previous history of leukemia. Genetic expressions of AKT and microRNAs were evaluated by quantitative PCR (qPCR). A significant increase in AKT gene expression in patients when compared to controls was observed (p = 0.017). When the patients were stratified according to Binet subgroups, a significant difference was observed between the subgroups, with this protein kinase appearing more expressed in the B+C subgroup (p = 0.013). Regarding miRNA expression, miR-let-7b and miR-26a were reduced in CLL patients, when compared to controls. However, no significant differences were observed in these microRNA expressions between the Binet subgroups (A versus B+C). By contrast, miR-21 to miR-27a oncogenes showed no expression difference between CLL patients and controls. AKT protein kinase is involved in the signaling cascade that occurs with BCR receptor activation, leading to increased lymphocyte survival and protection against the induction of cell death in CLL. Thus, increased AKT protein kinase expression and the reduction of miR-let-7b and miR-26a, both tumor suppressors, may explain increased lymphocyte survival in CLL patients and may be promising markers for the prognostic evaluation of this disease.

Evaluation of miR-15a, miR-16-1, ZAP-70, Ang-2, and Bcl-2 as potential prognostic biomarkers in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a blood cancer characterized by the accumulation of clonal B-lymphocytes. This study evaluated the mRNA gene expression of miR-15a, miR-16- 1, ZAP-70, and Ang-2 by qPCR, as well as the plasma levels of Bcl-2 by Elisa immunoassay, in CLL patients and healthy controls. Significant differences were observed when comparing patients and controls regarding miR-15a (p < 0.001), miR-16-1 (p < 0.001) mRNA, Ang-2 gene expression, and Bcl-2 plasma levels (p < 0.001). When stratified by risk, differences were maintained with a significantly reduced expression in high-risk patients. A positive correlation was observed between miR-15a and platelets (R2 = 0.340; p = 0.009) as well as between Bcl-2 and leukocytes (R2 = 0.310; p = 0.019). Conversely, negative correlations were observed between ZAP-70 and platelets (R2 = - 0.334; p = 0.011), between miR-15a and lymphocytes (R2 = - 0.376; p = 0.004), as well as between miR-16-and lymphocytes (R2 = - 0.515; p = 0.00004). The data suggest that a reduction in miR-15a and miR-16-1 expressions, in addition to an overexpression of Bcl-2, are associated with the reduction in apoptosis and, consequently, to a longer survival of lymphocytes, thus contributing to lymphocyte accumulation and aggravation of the disease. By contrast, Ang-2 expression was significantly higher in A than in B + C Binet groups. This context leads to the speculation that this biomarker should be investigated in more robust studies within populations with a still relevantly indolent form of the disease in an attempt to identify those patients with a greater potential for an aggravation of the disease

Value of immature reticulocyte fraction in anemias and other hematologic conditions: a brief narrative review

Novos parâmetros hematológicos, como a fração de reticulócitos imaturos (IRF), tendem a se tornar ferramentas importantes na prática clínica. O IRF identifica os reticulócitos mais imaturos, que contêm grande quantidade de ácido ribonucleico, sendo um importante parâmetro para avaliar a atividade da medula óssea, em tempo real, para o diagnóstico diferencial das anemias, acompanhamento do seu tratamento, e para o acompanhamento ou recuperação da medula óssea em diversas condições clínicas. No entanto, ainda há um longo caminho a percorrer antes que a IRF possa ser usada na prática clínica. Assim sendo, é urgente estabelecer os valores de referência e padronizar as metodologias utilizadas pelos diferentes analisadores hematológicos e como expressar seus resultados. Esta revisão narrativa fornece uma perspectiva crítica sobre o IRF e seu potencial para o uso clínico, bem como suas limitações.

New hematological parameters, such as immature reticulocyte fraction (IRF), tend to become important tools in clinical practice. IRF identifies the most immature reticulocytes that contain a large amount of ribonucleic acid, being an important parameter to evaluate bone marrow activity in real time for differential diagnosis of anemias, monitoring of its treatment, and for follow-up or bone marrow recovery in various clinical conditions. However, there is still a long way to go before IRF can be used in clinical practice. Thus, it is urgent to establish reference values and to standardize of the methodologies used by different hematological analyzers and how to express the results. This narrative review provides a critical perspective on IRF, its potential of clinical use and limitations.

Atrial Fibrillation and Use of Rivaroxaban: Performance of the Prothrombin Time / INR as a Function of Time After Blood Collection

Abstract Background Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by "direct oral anticoagulants", as factor X inhibitor. Objectives This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture. Methods We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant. Results An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose. Conclusion We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Activated platelets in central venous catheters: a flow cytometry and numerical simulation approach

The central venous catheter that is inserted in patients undergoing hemodialysis can cause hemodynamic instability and trigger complications such as thrombus formation. The objective of this study was to investigate hemostatic and numerical influences on thrombus formation in patients undergoing hemodialysis with a central venous catheter. Participants were assigned to three groups: I: clinical and laboratorial healthy individuals matched by sex and age (controls); II: participants after one month of insertion of the catheter and III: participants after 4 months of insertion of the catheter. Platelet activation was investigated by GPIIb/IIIa and p-selectin expressions using flow cytometry. A three-dimensional model of the catheter was constructed in the numerical simulation for the calculation of partial differential equation of a platelet activation model. A significant difference was detected by the expression of p-selectin comparing the group I (33.42 ± 4.74), group II (40.79 ± 5.54) and group III(51.00 ± 7.21) (p < 0.0001). The median values for GPIIb/IIIa were 10426 (10029-10721), 13921 (13412-15652) and 19946 (18714-21815) after catheter insertion (p < 0.0001), for groups I, II and III, respectively. Excluding the first arterial orifice, venous orifices tend to have greater platelet activation when compared to the other arterial orifices. The results of this study showed the influence of arterial and venous lateral orifices in stimulating the development of thrombi associated with the activation of platelet markers the longer the catheter was used.

Thrombin generation and thromboelastometry tests in dogs with chronic kidney disease / Testes de geração de trombina e tromboelastometria em cães com doença renal crônica

Patients with chronic kidney disease (CKD) have paradoxical hemostatic potential because they have bleeding episodes but are also prone to thrombosis. Few studies have evaluated blood viscoelastic properties in dogs with kidney disease; on the other hand, hypercoagulability has been observed in these patients. It is also emphasized that the platelet function and its participation in this process have not yet been fully understood. The objective of this study was to evaluate and compare the Thrombin Generation Test (TGT) and also viscoelastic properties of the blood measured by thromboelastometry (TEM) in dogs with proteinuria in CKD. Twenty healthy dogs (Control Group) and 19 dogs with CKD in stage III or IV, classified according to International Renal Interest Society - IRIS, were selected, and the reference test of urine protein:creatinine ratio (UPCR) should be greater than one (CKD group). Blood samples for TEM, thrombin generation, Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), and fibrinogen concentration was collected at a single time for both groups after inclusion criteria being confirmed. Statistical analysis was performed according to the distribution of variables at 5% significance level. Differences were observed between healthy dogs and those with proteinuria in CKD noted in TEM. The TGT was unable to differentiate between sick and healthy groups. However, when the nephropathy was stratified, increases in TTP and peak thrombin concentration by TGT were observed in females and dogs over 30 days of diagnosis of CKD. Both tests signaled a discrete state of hypercoagulability. In fact, TEM is more sensitive to detect hypercoagulability in dogs with CKD. However, the TGT has potential clinical application by allowing long-term sample storage.(AU)

Os pacientes com doença renal crônica (DRC) apresentam um potencial hemostático paradoxal, pois apresentam episódios de sangramento, mas também são propensos à trombose. Poucos estudos avaliaram as propriedades viscoelásticas sanguíneas em cães com doenças renais, entretanto, a hipercoagulabilidade já foi observada nestes pacientes. Ressalta-se ainda que a função plaquetária e sua participação neste processo ainda não foram totalmente esclarecidas. O objetivo foi avaliar e comparar o teste de geração de trombina (TGT) e as propriedades viscoelásticas sanguíneas medidas pela tromboelastometria (TEM) em cães com DRC proteinúrica. Foram selecionados 20 cães saudáveis (grupo controle) e 19 cães com DRC em estágios III ou IV classificados segundo o IRIS e a relação proteína/creatinina urinária maior que um (grupo DRC). As amostras de sangue para a realização da tromboelastometria (TEM), geração de trombina, tempo de protrombina (TP), tempo de tromboplastina parcial ativada (TTPA) e concentração de fibrinogênio foram colhidas em momento único para ambos os grupos após os critérios de inclusão confirmados. A análise estatística foi realizada de acordo com a distribuição das variáveis, ao nível de 5% de significância. Foi observada diferença entre os cães saudáveis e os com DRC proteinúrica observados na TEM. O teste de geração de trombina não foi capaz de diferenciar os grupos doente e saudável. Entretanto, quando os nefropatas foram analisados de forma estratificada, foram observados aumentos do ETP e da concentração máxima de trombina (peak) pelo TGT em fêmeas e em cães com mais de 30 dias de diagnóstico da DRC. Ambos os testes sinalizando para um discreto estado de hipercoagulabiliade. A tromboelastometria é mais sensível para detectar a hipercoagulabilidade em cães com DRC. Entretanto, o teste de geração de trombina tem melhor aplicabilidade por permitir o armazenamento da amostra em longo prazo.(AU)

Impact of oral hygiene in patients undergoing mechanical ventilation in the COVID-19 pandemic

SUMMARY COVID-19, caused by SARS-CoV-2, can present respiratory complications that often lead patients to depend on mechanical ventilation (MV) for several days. It is known that Pneumonia Associated with Mechanical Ventilation (PAMV) is frequent in patients who use this equipment for a long time. As a consequence of COVID-19, its prolonged use can lead to a worse prognosis for the patients. For this reason, in addition to the insufficiency of devices for mechanical ventilation to meet the current demand, it is necessary to adopt measures aimed at preventing complications that may aggravate the patient's clinical condition and, consequently, increase the average hospital stay and the respective hospital care costs. Therefore, the objective of this study was to discuss, in a concise and practical way, and based on the available literature, the importance of adopting adequate oral hygiene protocols for patients on mechanical ventilation. Based on the data obtained, it was identified that the adoption of effective oral hygiene measures, especially under the supervision of dental professionals, can contribute to the reduction of morbidity and mortality associated with MV, resulting in greater availability of mechanical ventilation equipment. Since such equipment is in great demand during the COVID-19 pandemic, the knowledge and implementation of effective oral hygiene measures will undoubtedly have an impact on improving the quality of care offered to patients, therefore benefiting all those in critical health conditions and assisted in ICUs.

RESUMO A COVID-19, causada pelo Sars-CoV-2, pode apresentar complicações respiratórias que, muitas vezes, levam o paciente a depender da ventilação mecânica por vários dias. Sabe-se que a Pneumonia Associada à Ventilação Mecânica (PAVM) é frequente nos pacientes que utilizam esse equipamento por um longo período de tempo e que sua ocorrência, consequente à COVID-19, pode cursar com um pior prognóstico para o paciente. Por esse motivo, e somado à insuficiência de aparelhos para atendimento da demanda atual, faz-se necessária a adoção de medidas que visem à prevenção de complicações que possam agravar o quadro clínico do paciente e, consequentemente, aumentar o tempo médio de internação e os respectivos custos da assistência. Sendo assim, o objetivo deste estudo foi discorrer de forma concisa e prática, com base na literatura disponível, sobre a importância da adoção de protocolos adequados de higiene oral nos pacientes em ventilação mecânica. Com base nos dados obtidos, identificou-se que a adoção de medidas efetivas de higiene oral, principalmente sob a supervisão do profissional dentista, pode contribuir para a redução da morbimortalidade associada à PAVM, resultando em maior disponibilidade de equipamentos de ventilação mecânica. Desde que tais equipamentos estão sendo muito demandados durante a pandemia da COVID-19, o conhecimento e a implantação de medidas efetivas de higiene oral, indubitavelmente, repercutirão na melhoria da qualidade da assistência oferecida aos pacientes, portanto, beneficiando todos aqueles em situação crítica de saúde e assistidos em UTIs.

Acesso ao tratamento da mulher com câncer de mama / Access to treatment of women with breast cancer

RESUMO O objetivo do estudo foi caracterizar o acesso ao tratamento da mulher com diagnóstico de câncer de mama no estado do Piauí, Brasil. Estudo transversal analítico, desenvolvido em duas instituições hospitalares de referência, no período de janeiro a junho de 2018. A população compreendeu mulheres diagnosticadas com câncer de mama que realizaram tratamento no período de 2016 a 2017. A amostra foi de 155 participantes. A amostragem foi estratificada proporcional. Os dados foram processados no IBM® SPSS®, e calculadas estatísticas uni e bivariadas. Constatou-se que o tempo para o tratamento foi de, em média, 112,7 (±93,6) dias, variando de 12 a 550 dias (≡18,3 meses ou 1,5 anos), sendo que 71,6% das mulheres iniciaram o tratamento em um período superior a 60 dias do diagnóstico do câncer de mama. Foram verificadas associações estatisticamente significativas entre o atraso para início do tratamento e o território estadual de residência (p=0,041) e o estágio da doença (p=0,037). Dessa forma, o acesso ao tratamento do câncer de mama não está acontecendo como preconizado. Ressalta-se, portanto, a necessidade de uma maior organização dos serviços de saúde em rede, levando em conta as necessidades da população, por meio do atendimento em tempo oportuno.

ABSTRACT This study was aimed at characterizing the access to treatment of women diagnosed with breast cancer in the state of Piauí, Brazil. A cross-sectional analytical study was developed in two referral hospital institutions from January/2018 to June/2018. The population comprised women diagnosed with breast cancer who underwent treatment in the period from 2016 to 2017. The sample amounted to 155 participants. Sampling was proportionally stratified. The data was processed in IBM® SPSS®, and uni and bivariate statistics were calculated. It was noted that the average time for treatment was of 112.7 (± 93.6) days, varying from 12 to 550 days (≡18.3 months or 1.5 years), with 71.6 % of the women starting treatment within a period higher than 60 days following breast cancer diagnosis. Statistically significant associations were verified between the delay to start treatment and the state territory of residence (p = 0.041) and the disease stage (p = 0.037). The conclusion is that women are not having access to breast cancer treatment as recommended. Therefore, it is worth noting the need for greater organization in the network of health services, taking into account the needs of the population through timely health care.

Standardization and evaluation of the performance of the thrombin generation test under hypo- and hypercoagulability conditions

ABSTRACT Background: In order to standardize a thrombin generation() protocol, we analyzed the analytical variables and sensitivity of this test to hypo/hypercoagulability states. Methods: The effect of the tissue factor concentration and the intra- and interassay precision were analyzed. To evaluate the hypercoagulability status, the plasma of women under an oral contraceptive was tested, while plasma from hemophilia A patients at 1, 3 and 7 days after recombinant FVIII infusion, and lyophilized plasma deficient in FVII or FVIII were used for the evaluation of hypocoagulability. Results: The intra-assay coefficient of variation was <10% with 1 and 5 pM of low and high TF. The oral contraceptive users showed increased thrombin generation in comparison to non-users, which was more pronounced with low TF (endogenous thrombin potential ETP) p = 0.0009; peak p = 0.0009; lagtime p = 0.0008). In relation to the FVIII-deficient plasma, a higher TG was observed as FVIII levels were increased and a better discrimination was obtained for different concentrations of FVIII with low TF (ETP p < 0.0001; peak p < 0.0001; lagtime p = 0.0004). Using low TF, plasma from hemophilia A patients showed higher TG values after 1 day of recombinant FVIII infusion vs after 3 days (ETP p < 0.0001; peak p < 0.0001; lagtime p = 0.0407), while the lowest values were observed after 7 days. With FVII-deficient plasma, thrombin generation was lower than normal plasma and a more pronounced difference was observed with high TF compared to low TF (ETP p < 0.0001; peak p < 0.0001; lagtime p < 0.0001). Conclusion: Under our conditions the thrombin generation test seems to be sensitive to evaluation of hyper/hypocoagulability states. Standardization of the thrombin generation test may have an application in the evaluation of bleeding and thrombotic disorders.

Influência da fase de lactação e do intervalo entre as ordenhas sobre a composição e produção de leite de cabras no semiárido / Influence of lactation and the interval between milkings on the composition and production of milk goats in the semiarid

Objetivou-se com esse trabalho avaliar a influência da fase de lactação e do intervalo de tempo entre as ordenhas sobre os constituintes e a produção de leite de cabras no semiárido da Paraíba. Foram utilizados 28 animais da raça Anglo Nubiana distribuídos em um delineamento inteiramente casualizado em arranjo fatorial do tipo 3 x 2, três fases de lactação e dois turnos de ordenha. A análise de variância não revelou efeito (P>0,05) de fase de lactação para proteína, gordura e sólidos totais. Contudo, houve diferença significativa (P<0,05) para lactose e produção de leite dentro das fases de lactação e intervalo entre ordenhas. Para acidez e densidade houve efeito (P<0,05) de fase de lactação e do turno da ordenha. Houve correlação negativa entre o turno da ordenha para produção de leite, acidez, lactose, densidade, proteína e gordura. Com relação à fase de lactação observou-se correlação negativa para produção de leite e lactose e correlação positiva para acidez e proteína. A composição do leite de cabra sofre influência da fase de lactação e do intervalo entre ordenhas. Intervalo de tempo igual entre as ordenhas favorece a produção de um leite com uma composição mais uniforme.

The objective of this study was to evaluate the influence of lactation stage and the time interval between milking on ingredients and the production of milk goats in the semiarid region of Paraíba. We used 28 animals of Anglo Nubian breed distributed in a completely randomized design in a factorial arrangement of type 3 x 2, three stages of lactation and two milking shifts. Analysis of variance revealed no effect (P>0.05) were lactating for fat, protein and total solids. However, there was significant difference (P<0.05) for lactose and milk production within the phases of lactation and the interval between milking. For acidity and density was no effect (P<0.05), lactation stage and the milking turn. There was a negative correlation between the shift milking for milk, acidity, lactose, density, protein and fat. With respect to stage of lactation negative correlation was observed for milk and lactose positive correlation for acidity and protein. The goat milk composition is influenced by the stage of lactation and the interval between milking. Equal time interval between milking favors the production of milk with a more uniform composition.

Influência da fase de lactação e do intervalo entre as ordenhas sobre a composição e produção de leite de cabras no semiárido / Influence of lactation and the interval between milkings on the compositionand production of milk goats in the semiarid

Objetivou-se com esse trabalho avaliar a influência da fase de lactação e do intervalo de tempo entre as ordenhas sobre os constituintes e a produção de leite de cabras no semiárido da Paraíba. Foram utilizados 28 animais da raça Anglo Nubiana distribuídos em um delineamento inteiramente casualizado em arranjo fatorial do tipo 3 x 2, três fases de lactação e dois turnos de ordenha. A análise de variância não revelou efeito (P>0,05) de fase de lactação para proteína, gordura e sólidos totais. Contudo, houve diferença significativa (P<0,05) para lactose e produção de leite dentro das fases de lactação e intervalo entre ordenhas. Para acidez e densidade houve efeito (P<0,05) de fase de lactação e do turno da ordenha. Houve correlação negativa entre o turno da ordenha para produção de leite, acidez, lactose, densidade, proteína e gordura. Com relação à fase de lactação observou-se correlação negativa para produção de leite e lactose e correlação positiva para acidez e proteína. A composição do leite de cabra sofre influência da fase de lactação e do intervalo entre ordenhas. Intervalo de tempo igual entre as ordenhas favorece a produção de um leite com uma composição mais uniforme.

The objective of this study was to evaluate the influence of lactation stage and the time interval between milking on ingredients and the production of milk goats in the semiarid region of Paraíba. We used 28 animals of Anglo Nubian breed distributed in a completely randomized design in a factorial arrangement of type 3 x 2, three stages of lactation and two milking shifts. Analysis of variance revealed no effect (P>0.05) were lactating for fat, protein and total solids. However, there was significant difference (P<0.05) for lactose and milk production within the phases of lactation and the interval between milking. For acidity and density was no effect (P<0.05), lactation stage and the milking turn. There was a negative correlation between the shift milking for milk, acidity, lactose, density, protein and fat. With respect to stage of lactation negative correlation was observed for milk and lactose positive correlation for acidity and protein. The goat milk composition is influenced by the stage of lactation and the interval between milking. Equal time interval between milking favors the production of milk with a more uniform composition.

Avaliação da composição e da contagem de células somáticas do leite de cabra cru do Cariri paraibano / Evaluation of composition and counting of somatic cells of cair raw of Cariri paraibano

A CCS é um método aceito internacionalmente para avaliar a sanidade da glândula mamária. Objetivou-se neste trabalho determinar a composição e a contagem de células somáticas no leite de cabra cru do Cariri paraibano proveniente quatro mini usinas denominadas A, B, C e D. Os resultados médios obtidos para os parâmetros físico-químicos foram 3,5% de gordura; 3,0% de proteína; 4,2% de lactose; 11,70% de sólidos totais; 8,2% de sólidos não gordurosos e 1,4 x 106 para CCS. Os resultados obtidos demonstram que dos componentes do leite apenas a lactose estava fora dos padrões e que a alta CCS reforça a necessidade de implementação dos programas de controle de qualidade para melhoria da sanidade da glândula mamária.

Avaliação da qualidade do leite de cabra em uma mini usina do Cariri paraibano através da contagem de células somáticas e contagem bacteriana total / Evaluation of quality of goat milk in a mini parairan Cariri usina through somatic cell count and total bacterial count

A qualidade do leite é definida por diversos fatores entre eles a sanidade da glândula mamária e a higienização dos equipamentos processadores de leite. O objetivo desse estudo foi avaliar a qualidade do leite através da determinação dos componentes do leite e da contagem de células somáticas e contagem bacteriana total. Foram avaliadas 27 amostras de leite de cabra cru em uma mini usina do Cariri paraibano. De acordo com os resultados encontrados verifica-se que os valores médios de lactose e a CBT encontram se fora dos padrões estabelecidos, já a CCS apresentam índices altos de acordo com os limites fisiológicos considerados normais para a espécie. Esses resultados demonstram falhas no manejo e a necessidade de implementação de melhorias contínuas.

Diagnóstico das condições higienicossanitárias do processo de fabricação de queijo de coalho no Sertão Paraibano / Diagnosis of hygienic and sanitary conditions of the process of cheese production in the Sertão Paraibano

As condições gerais e adequações quanto às Boas Práticas de Fabricação (BPF) foram averiguadas em oito queijarias artesanais de queijo de coalho no sertão Paraibano, com o principal objetivo de investigar as conformidades e não conformidades relativas a sua implementação. Para tanto, usou-se como critério avaliativo um checklist baseado na Resolução RDC nº 275 da ANVISA/MS. Os resultados mostraram que das oito queijarias, apenas uma classificou-se como de baixo risco, ou seja, com mais de 76% de adequações. Nos itens edificações e instalações, controle de pragas e da água, higiene dos manipuladores, ausência de tratamento térmico da matéria-prima e documentação, as queijarias D e E apresentaram os maiores níveis de não conformidade. Conclui-se que as queijarias artesanais apresentam um alto risco para veiculação de Doenças Transmissíveis por Alimentos e, se faz necessária a adoção das BPF pelas queijarias e uma maior fiscalização pelos órgãos oficiais, pois as inadequações observadas podem comprometer a qualidade dos produtos e a segurança dos consumidores.

The general conditions and adequacies regarding the Good Manufacturing Practices (GMP) were verified in eight artisanal curdled cheese factories with the objective to investigate the conformities and non-conformities related to its implementation. Therefore, it was used, as evaluation criteria, a checklist based on the Resolution ­ RDC number 275 of ANVISA/MS. The results showed that from the eight evaluated cheese factories, only one was classified as low risk, that is, with more than 76% of adequacies. On the edification and facilities aspects, plague and water control, handlers' hygiene, lack of thermal treatment of raw material and documents, cheese factories D and E showed the highest levels of non-conformity. It can be concluded that artisanal cheese factories present a high risk for the propagation of Foodborne Diseases, so it is necessary the adoption of GMP by the cheese factories and a stricter supervision made by the official bodies since the verified inadequacies could compromise the quality of the products as well as the safety of consumers.

Apolipoprotein E and PAI-1 gene polymorphisms and no association with arterial ischemic stroke and peripheral arterial disease manifestations / Polimorfismos nos genes da apolipoproteína E e do PAI-1 e não associação com as manifestações de acidente vascular cerebral e doença arterial periférica

ABSTRACT Introduction: Arterial thrombosis is considered a multifactorial disease, resulting from the interaction of genetic and acquired risk factors. Objectives: The aim of this study was to investigate the presence of the polymorphism in inhibitor of plasminogen activator type 1 (PAI-1) and apolipoprotein E (ApoE) genes and its interactions with PAI-1 levels and lipids and apolipoprotein profiles, respectively, as well as the frequencies of these polymorphisms and their association with thrombosis. Methods: Ninety-seven patients [48 with arterial ischemic stroke (IS) and 49 with peripheral arterial disease (PAD)], treated at the hematology medical service were included in this study. Polymorphisms were also investigated in 201 control subjects. Polymorphisms were investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: For the PAI-1 polymorphism, there were 54.2% heterozygous (HT) genotypes and 12.5% homozygous (HM) genotypes in the patients' group, and 52.7% HT genotypes and 21.3% HM genotypes in the controls. For the ApoE polymorphism, there were 56.3% (ε3ε3), 6.3% (ε4ε4), 8.3% (ε2ε3), 4.2% (ε2ε4) and 24.9% (ε3ε4) in the patients, and 61.2% (ε3ε3), 4.5% (ε4ε4), 8% (ε2ε3), 4.5% (ε2ε4) and 21.8% (ε3ε4) in the controls. Conclusion: No significant difference was observed by comparing patients and controls. In this study, no association was found between the presence of the evaluated polymorphisms and the occurrence of thrombotic events.

RESUMO Introdução: A trombose arterial é considerada uma doença multifatorial, resultante da interação de fatores de risco genéticos e adquiridos. Objetivos: O objetivo deste estudo foi investigar a presença dos polimorfismos nos genes do inibidor da ativação do plasminogênio tipo 1 (PAI-1) e da apolipoproteína E (ApoE), bem como suas interações com níveis de PAI-1 e lipídios e perfis de apolipoproteína, respectivamente, além das frequências desses polimorfismos e sua associação com trombose. Métodos: Noventa e sete pacientes [48 com acidente vascular cerebral isquêmico arterial (AVC) e 49 com doença arterial periférica (DAP)], tratados no serviço médico de hematologia, foram incluídos neste estudo. Os polimorfismos também foram investigados em 201 indivíduos-controle. Os polimorfismos foram investigados por reação em cadeia da polimerase-fragmento de restrição polimorfismo (PCR-RFLP). Resultados: Para o polimorfismo PAI-1, havia 54,2% genótipos heterozigotos (HT) e 12,5% genótipos de homozigoto (HM) no grupo dos pacientes, e 52,7% genótipos HT e 21,3% genótipos HM nos grupos-controle. Para o polimorfismo da ApoE, havia 56,3% (ε3ε3), 6,3% (ε4ε4), 8,3% (ε2ε3), 4,2% (ε2ε4) e 24,9% (ε3ε4) nos pacientes, e 61,2% (ε3ε3), 4,5% (ε4ε4), 8% (ε2ε3), 4,5% (ε2ε4) e 21,8% (ε3ε4) nos controles. Conclusão: Nenhuma diferença significativa foi observada comparando pacientes e controles. Neste estudo, não foi encontrada associação entre a presença dos polimorfismos avaliados e a ocorrência de eventos trombóticos.

OxLDL plasma levels in patients with Alzheimer's disease / Níveis plasmáticos de LDL-ox em pacientes com doença de Alzheimer

ABSTRACT Objective: The objective of this study was to characterize the conventional lipid profile, oxLDL levels and ApoE polymorphism in patients with Alzheimer's disease (AD) and in elderly individuals without cognitive impairment. Methods: Eighty elderly individuals were selected and the levels of oxLDL were determined using the ELISA kit, and ApoE gene polymorphism was investigated using polymerase chain reaction-restriction fragment length polymorphism. Results: Significantly reduced levels of oxLDL were observed in patients with AD compared to the control group. A higher frequency of the ApoE ε4 allele was observed in patients with AD compared to controls. No difference was observed for total cholesterol, HDL-C, and LDL-C levels between the two groups, while triglyceride levels were higher in controls compared with patients with AD. Conclusion: The data analyzed together did not reveal significant differences in lipid profiles, including oxLDL levels. However, the importance of lipid changes in the genesis of the disease cannot be ruled out. Nevertheless, the ApoE ε4 allele was significantly more frequent in patients with Alzheimer's dementia in agreement with previous findings in the literature, but this genetic component did not change the levels of oxLDL.

RESUMO Objetivo: O objetivo deste estudo foi caracterizar o perfil lipídico convencional, os níveis de LDL-ox e o polimorfismo da ApoE em pacientes com doença de Alzheimer (DA) e em indivíduos idosos sem comprometimento cognitivo. Métodos: Foram selecionados oitenta indivíduos idosos. Os níveis de LDL-ox foram determinados usando o kit ELISA e a investigação do polimorfismo do gene da ApoE por PCR-RFLP. Resultados: Níveis significativamente reduzidos de LDL-ox foram observados em pacientes com DA comparado ao grupo controle. Uma maior frequência do alelo ε4 da ApoE foi observada nos pacientes com DA em relação aos controles. Nenhuma diferença foi observada para os níveis de colesterol total, HDL-C e LDL-C entre os dois grupos, enquanto níveis de triglicérides foram mais altos em controles comparados aos pacientes com DA. Conclusão: Os dados analisados em conjunto não revelaram diferenças significativas no perfil lipídico, incluindo os níveis de LDL-ox. No entanto, não se pode excluir a importância de alterações lipídicas na gênese da doença. Não obstante, o alelo ε4 da ApoE foi signicativamente mais frequente nos pacientes com demência de Alzheimer em concordância com achados prévios da literatura, mas esse componente genético não interferiu nos níveis de LDL-ox.

Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

ABSTRACT Objective This study aimed to evaluate the association between different renal biomarkers with D-Dimer levels in diabetes mellitus (DM1) patients group classified as: low D-Dimer levels (< 318 ng/mL), which included first and second D-Dimer tertiles, and high D-Dimer levels (≥ 318 ng/mL), which included third D-Dimer tertile. Materials and methods D-Dimer and cystatin C were measured by ELISA. Creatinine and urea were determined by enzymatic method. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Albuminuria was assessed by immunoturbidimetry. Presence of renal disease was evaluated using each renal biomarker: creatinine, urea, cystatin C, eGFR and albuminuria. Bivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels and odds ratio was calculated. After, multivariate logistic regression analysis was performed to assess which renal biomarkers are associated with high D-Dimer levels (after adjusting for sex and age) and odds ratio was calculated. Results Cystatin C presented a better association [OR of 9.8 (3.8-25.5)] with high D-Dimer levels than albuminuria, creatinine, eGFR and urea [OR of 5.3 (2.2-12.9), 8.4 (2.5-25.4), 9.1 (2.6-31.4) and 3.5 (1.4-8.4), respectively] after adjusting for sex and age. All biomarkers showed a good association with D-Dimer levels, and consequently, with hypercoagulability status, and cystatin C showed the best association among them. Conclusion Therefore, cystatin C might be useful to detect patients with incipient diabetic kidney disease that present an increased risk of cardiovascular disease, contributing to an early adoption of reno and cardioprotective therapies.

Economy class syndrome: what is it and who are the individuals at risk?

Abstract The term 'economy class syndrome' refers to the occurrence of thrombotic events during long-haul flights that mainly occur in passengers in the economy class of the aircraft. This syndrome results from several factors related to the aircraft cabin (immobilization, hypobaric hypoxia and low humidity) and the passenger (body mass index, thrombophilia, oral contraceptives or hormone replacement therapy, cancer), acting together to predispose to excessive blood coagulation, which can result in venous thromboembolism. Several risk factors, both genetic and acquired, are associated with venous thromboembolism. The most important genetic risk factors are natural anticoagulant deficiencies (antithrombin, protein C and protein S), factor V Leiden, prothrombin and fibrinogen gene mutations and non-O blood group individuals. Acquired risk factors include age, pregnancy, surgery, obesity, cancer, hormonal contraceptives and hormone replacement therapy, antiphospholipid syndrome, infections, immobilization and smoking. People who have these risk factors are predisposed to hypercoagulability and are more susceptible to suffer venous thromboembolism during air travel. For these individuals, a suitable outfit for the trip, frequent walks, calf muscle exercises, elastic compression stockings and hydration are important preventive measures. Hence, it is essential to inform about economic class syndrome in an attempt to encourage Brazilian health and transport authorities to adopt measures, in partnership with the pharmaceutical industry, to prevent venous thromboembolism.