Hematological malignancies immunotherapy-related coagulopathy and laboratory tests / 中华检验医学杂志

Immunotherapy has been one of the most promising approaches in tumor-treating fields, including immune checkpoint inhibitors, bispecific antibodies, and CAR-T therapy, etc. It has achieved major breakthroughs in the treatment of hematological and other malignancies. However, related safety management issues are becoming increasingly prominent, especially the diagnosis and treatment of coagulopathy deserves the attention of clinical and laboratory physicians. Therefore, this review summarizes immunotherapy-related coagulopathy from the perspectives of epidemiology, pathogenesis and laboratory indicators and provides guidance for early clinical identification, diagnosis and intervention.

Create a disease centered closed-loop coagulation test solution / 中华检验医学杂志

Thrombosis and hemostasis, related to many clinical disciplines, are common causes of death observed in clinics. An effective clinical management strategy is composed of effective clinical diagnosis and treatment. Because thrombosis and hemorrhagic diseases is primarily identified through diagnostic testing, improving capacity of clinical laboratory testing plays a key role in supporting clinical diagnosis and treatment. The major considerations for improving coagulation diagnostic testing in the future include closely following news on the global progress in thrombosis and hemostasis area, strengthening the inter-expert communications to reach consensus on the standardization of coagulation testing, and transitioning from test-centric model to disease-centric model for providing holistic and integrated vision to facilitate the improvement of clinical experimental diagnosis. Relevant multi-disciplinary function areas are encouraged to consistently cooperate, in collaboration with government, pharmaceutical industry, academia, research institution and health care provider, to create a healthy environment for the development of Chinese hemagglutination therapy paradigm.

Laboratory profile after mining dam breach: Brumadinho Health Project results / Perfil laboratorial após rompimento de barragem de mineração: resultados do Projeto Saúde Brumadinho

ABSTRACT Objective: To evaluate changes in selected laboratory tests in the population included in the Brumadinho Health Project, according to the exposure to the dam failure. Methods: Cross-sectional study carried out on representative sample of residents (≥12 years) in Brumadinho, Minas Gerais, including: 1) non-exposed; 2) directly affected by tailings sludge; 3) residents in mining area. The prevalence of abnormal results of blood count, total, HDL and LDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, estimate of glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) were estimated. The Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) of having an abnormal laboratory finding were estimated using Generalized Linear Models with Poisson probability distribution. Crude and adjusted models were estimated for age range, gender, diabetes, body mass index, smoking, hypertension. Results: After adjusting, there was no difference in PR between the three populations for most tests, with the exception of the population residing in an area with mining activity and not directly affected by the mud, with a lower chance of having altered total cholesterol (PR: 0.84; 95%CI 0.74-0.95) and a higher chance of having altered HDL cholesterol (PR: 1.26; 95%CI 1.07-1.50), hs-CRP (PR: 1.19; 95%CI 1.04-1.37), and eGFR <60mL/min/1,73 m2 (PR: 1.51; 95%CI 1.05-2.19). Conclusion: No significant differences were found in the prevalence of biochemical and hematological alterations between the populations directly exposed and not exposed to tailings. Only the group residing in the mining area had a higher prevalence of alterations related dyslipidemia, renal disease, and inflammation.

RESUMO Objetivo: Avaliar alterações em parâmetros laboratoriais na população do Projeto Saúde Brumadinho, segundo exposição ao rompimento da barragem. Métodos: Estudo transversal realizado em amostra representativa de residentes (≥12 anos) em Brumadinho, Minas Gerais, incluindo: não expostos (grupo referência); diretamente atingidos pela lama de rejeitos; e residentes em área de mineração. Foram estimadas as prevalências de resultados alterados de hemograma, colesterol total, colesterol lipoproteína de alta densidade (HDL), colesterol lipoproteína de baixa densidade (LDL), triglicérides, aspartato aminotransferase, alanina aminotransferase, creatinina, ureia, estimativa da taxa de filtração glomerular (TFGe) e proteína C-reativa ultrassensível (PCRus). As razões de prevalência (RP) e os intervalos de confiança de 95% (IC95%) de ter o exame alterado foram estimados por meio de modelos lineares generalizados com distribuição de probabilidade Poisson. Estimaram-se modelos brutos e ajustados por faixa etária, sexo, diabetes, índice de massa corporal, tabagismo, hipertensão. Resultados: Após ajustes, não se observou diferença nas RP entre as populações estudadas para a maioria dos testes, com exceção da população residente em área com atividade de mineração e não diretamente atingida pela lama, com menor chance de ter colesterol total alterado (RP=0,84; IC95% 0,74-0,95) e maior chance de ter colesterol HDL (RP=1,26; IC95% 1,07-1,50) e PCRus (RP=1,19; IC95% 1,04-1,37) alterado e TFGe<60 mL/min/1,73 m2 (RP=1,51; IC95% 1,05-2,19). Conclusão: Não foram encontradas diferenças significativas na prevalência de alterações bioquímicas e hematológicas entre a população diretamente exposta aos rejeitos e a população não exposta. Apenas o grupo residente em área de mineração apresentou maior prevalência de alterações relacionadas com dislipidemia, disfunção renal e inflamação.

Exámenes clínicos preoperatorios para la cirugía de catarata / Routine preoperative clinical tests for cataract surgery

La catarata senil es la primera causa de ceguera reversible en el mundo y la cirugía constituye el único método para solucionar esta enfermedad, con alto nivel de seguridad y elevada mejoría en calidad visual y de vida. Por ser una afectación que ocurre en pacientes de la tercera edad, con frecuencia presentan enfermedades sistémicas como hipertensión arterial, diabetes mellitus, enfermedades cardiovasculares, entre otras. Hasta esta fecha se indican exámenes de laboratorio de rutina en el preoperatorio que para algunas instituciones son innecesarios por el bajo riesgo de esta técnica quirúrgica. Se realizó una búsqueda bibliográfica en Pubmed, Cochrane y Google Académico con el objetivo de revisar lo relacionado con la necesidad de efectuar estos exámenes de laboratorio como rutina antes de la cirugía de catarata. Existen pocos artículos referentes al tema, por lo que se seleccionaron los de mayor evidencia científica. Se pudo concluir que no hay evidencia sobre los requerimientos y necesidades de estudios de laboratorio en el preoperatorio, ya que sus resultados no aportan la capacidad de predecir la morbilidad o de cambiar la conducta relacionada con el proceder quirúrgico o anestésico(AU)

Senile cataract is the leading cause of reversible blindness worldwide. Surgery is the only method available to heal this condition, with a high level of safety and considerable improvement in visual quality and quality of life. Being as it is a condition occurring in elderly patients, systemic diseases such as hypertension, diabetes mellitus and cardiovascular diseases, among others, are usually present. Routine preoperative laboratory tests are customarily indicated which some institutions consider unnecessary due to the low risk of this surgical procedure. A bibliographic search was conducted in PubMed, Cochrane and Google Scholar with the purpose of reviewing published information about the need to conduct these laboratory tests as routine practice before cataract surgery. Since few papers about the topic were available, a selection was made of the ones providing the most relevant scientific evidence. It was concluded that no evidence exists about the requirements of and need for preoperative laboratory studies, since their results do not contribute to the ability to predict morbidity or change the conduct related to the surgical or anesthetic procedure(AU)

Inborn Errors of Immunity: how to diagnose them?

Abstract Objectives: Inborn Errors of Immunity are characterized by infectious conditions and manifestations of immune dysregulation. The diversity of clinical phenotypes can make it difficult to direct the laboratory investigation. This article aims to update the investigation of immunological competence in the context of primary defects of the immune system. Source of data: Searches were carried out on Pubmed to review articles published in the last five years, in English, French or Spanish, using the terms "diagnosis" OR "investigation" AND "immunodeficiency" or "primary immunodeficiency" or "inborn errors of immunity" NOT "HIV". Recent textbook editions have also been consulted. Summary of findings: The immune system competence investigation should be started based on clinical phenotypes. Relevant data are: characterization of infectious conditions (location, recurrence, types of infectious agents, response to treatment), age during symptom onset and associated manifestations (growth impairment, allergy, autoimmunity, malignancies, fever and signs of inflammation without the identification of infection or autoimmunity) and family history. These data contribute to the selection of tests to be performed. Conclusions: The diagnostic investigation of Inborn Errors of Immunity should be guided by the clinical characterization of patients, aiming to optimize the use of complementary tests. Many diagnoses are attained only through genetic tests, which are not always available. However, the absence of a diagnosis of certainty should never delay the implementation of therapeutic measures that preserve patient life and health.

Suspected infection, absenteeism at work and testing for COVID-19 among nursing professionals / Sospecha de infección, ausentismo laboral y pruebas de detección de COVID-19 entre profesionais de enfermería / Suspeita de infecção, abstenção no trabalho e testagem para COVID-19 entre profissionais de enfermagem

ABSTRACT Objective: to identify the occurrence of the factors associated with: (1) suspected infection by the virus that causes COVID-19; (2) absenteeism at work due to suspected infection or diagnosis of infection by the virus that causes COVID-19; and (3) performance of tests for the screening of infection by the virus that causes COVID-19 among Nursing professionals. Method: a cross-sectional study conducted with 890 nurses in June and July 2020. The associations between the outcomes and the other variables were explored using Poisson regression models with robust variance estimators. Results: occurrence of the outcomes was (1) 35.5%, (2) 16.2% and (3) 38.2%, respectively. For suspected infection, associations were observed with assessment of the working conditions as deficient (RR: 1.55; 95% CI: 1.21-1.99) and with lack of Personal Protective Equipment (RR: 1.27; 95% CI: 1.06-1.51). Absenteeism at work was associated with the adoption of moderate social distancing (RR: 1.49; 95% CI: 1.00-2.21). To perform the screening tests, the associations with links to outpatient (RR: 2.47; 95% CI: 1.52-4.01) and hospital (RR: 2.49; 95% CI: 1.60-3.89) services stood out, in addition to direct contact with patients with confirmed COVID-19 diagnoses (RR: 1.65; 95% CI: 1.33-2.05). Conclusion: despite the high occurrence of suspected infection and a considerable incidence of absenteeism at work among professionals from the various services under study, disparity in access to the screening tests was evidenced, especially with regard to the professionals who work in Primary Care.

RESUMEN Objetivo: identificar la incidencia y los factores asociados con: (1) sospecha de infección por el virus que causa COVID-19; (2) ausencia laboral debido a sospecha o diagnóstico de infección por el virus que causa COVID-19; y (3) pruebas para detectar la infección por el virus que causa COVID-19 entre profesionales de Enfermería. Método: estudio transversal realizado con 890 profesionales de Enfermería durante los meses de junio y julio de 2020. Las asociaciones entre los resultados y las demás variables se estudiaron por medio de modelos de regresión de Poisson con estimadores robustos de varianza. Resultados: la incidencia de los resultados fue: (1) 35,5%, (2) 16,2% y (3) 38,2%. Para la sospecha de infección, se observaron asociaciones con condiciones de trabajo evaluadas como deficientes (RR: 1,55; IC 95%: 1,21-1,99) y con la falta de Equipos de Protección Personal (RR: 1,27; IC 95%: 1,06-1,51). La ausencia laboral se asoció con la adopción de distanciamiento social moderado (RR: 1,49; IC 95%: 1,00-2,21). Para llevar adelante las pruebas de detección, se destacaron las asociaciones con la vinculación a servicios ambulatorios (RR: 2,47; IC 95%: 1,52-4,01) y hospitalarios (RR: 2,49; IC 95%: 1,60-3,89), además del contacto directo con pacientes con diagnósticos confirmados da COVID-19 (RR: 1,65; IC 95%: 1,33-2,05). Conclusión: pese a la elevada incidencia de sospechas de infección y una considerable cantidad de ausencias laborales entre profesionales de los diversos servicios estudiados, se evidenció cierta disparidad en el acceso a las pruebas de detección, especialmente en lo que se refiere a los profesionales de Atención Primaria.

RESUMO Objetivo: identificar a ocorrência e os fatores associados a: (1) suspeita de infecção pelo vírus causador da COVID-19; (2) abstenção no trabalho devido a suspeita ou ao diagnóstico de infecção pelo vírus causador da COVID-19 e (3) realização de testes para o rastreio de infecção pelo vírus causador da COVID-19 entre profissionais de Enfermagem. Método: estudo transversal realizado com 890 enfermeiros entre os meses de junho e julho de 2020. As associações entre os desfechos e as demais variáveis foram exploradas com a utilização de modelos de regressão de Poisson com estimadores robustos de variância. Resultados: a ocorrência dos desfechos foi de (1) 35,5%, (2) 16,2% e (3) 38,2%. Para a suspeita de infecção, foram observadas associações com a avaliação das condições de trabalho como ruins (RR: 1,55; IC 95%: 1,21-1,99) e a falta de equipamentos de proteção individual (RR: 1,27; IC 95%: 1,06-1,51). A abstenção do trabalho esteve associada com a adoção de distanciamento social moderado (RR: 1,49; IC 95%: 1,00-2,21). Para a realização de testes de rastreio, destacam-se as associações com a vinculação a serviços ambulatoriais (RR: 2,47; IC 95%: 1,52-4,01) e hospitalares (RR: 2,49; IC 95%: 1,60-3,89), além do contato direto com pacientes confirmadamente acometidos pela COVID-19 (RR: 1,65; IC 95%: 1,33-2,05). Conclusão: apesar da elevada ocorrência de suspeitas de infecção e um número considerável de abstenção do trabalho entre profissionais dos diversos serviços estudados, foi evidenciada uma disparidade no acesso aos testes de rastreio, especialmente no que se refere aos profissionais da Atenção Primária.

Laboratory biosafety measures in receiving, preparation and processing of pathology specimens in suspected and positive coronavirus infection

COVID-19, caused by SARS-CoV-2 virus which is declared as a pandemic by the WHO on March 2020 has made a huge difference in the practice and daily activities of the laboratory services. There are high chances of receiving potentially infectious samples to the laboratory for various tests. Authors propose a few biosafety measures in the preparation and processing of various pathology specimens received to the lab during this pandemic time in correlation with guidelines given by WHO. These safety measures aim at protecting and safe guarding the laboratory staff, trainees, and pathologists by minimizing the exposure to COVID-19.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy / Sensibilidade, especificidade e concordância do método point of care: um estudo de precisão diagnóstica

Abstract The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Resumo O uso de novas tecnologias pode melhorar o screening em comunidades de difícil acesso à saúde. O objetivo deste artigo é avaliar a sensibilidade, especificidade e concordância do teste de point of care em comparação com método laboratorial para dosagem de Glicose (GLI), Triglicerídeo (TG) e Colesterol total (CT). Estudo prospectivo com dados de população de adultos remanescentes de quilombolas no Brasil. Exames laboratoriais convencionais para análise foram obtidos por venopunção, utilizados como método padrão para mensuração das concentrações de GLI (mg/dL), TG (mg/dL) e CT (mg/dL) e comparados a mensuração por meio de técnica de ponta de dedo (point of care). Tabelas de contingência (2x2) foram utilizadas para estimar sensibilidade e especificidade dos métodos e o coeficiente de Lin e análises de Bland & Altman foram métodos de concordância com nível de significância de 5%. Houve concordância substancial entre os métodos para mensuração de TG e fraca concordância para mensuração de CT e GLI. Os coeficientes de Bland & Altman indicam que o método de ponta de dedo não apresentou boa mensuração. O método point of care não apresentou boa capacidade de mensuração de Glicose, Triglicerídeo e Colesterol total tendo como referência o método laboratorial.

Longitudinal analysis of laboratory tests in a population-based study / Análise longitudinal da qualidade dos exames laboratoriais em um estudo de base populacional

ABSTRACT Clinical laboratories must have quality management systems that guarantee the reliability of their results. Furthermore, in longitudinal studies, it is important that the generated data be analyzed over time, as an additional measure of quality control (QC), seeking to identify fluctuations not explainable by biological variables. Applying this strategy to the SHIP-Brazil study was the aim of this work. Thus, we analyzed the results of fasting glucose, post-load glucose and glycated hemoglobin in the participants of the SHIP-Brazil study, from July 2014 to November 2016, in relation to the following aspects: difference of each individual's results from the mean of the month over time, mean and median of results over time, and percentage of results above the reference values over time, with trend line. According to the observed data, in order to guarantee the correct association of laboratory parameters with different health and disease conditions, the fasting blood glucose and post-load glucose measurements in the samples collected during the first months of the study are consistent, despite being performed in two different facilities. This QC strategy has proved very useful, and may even be used by clinical laboratories in their routine, observing result fluctuations of their population in the course of time, being capable of eventually detect bias even before the routine practices of internal and external quality control.

RESUMEN Los laboratorios clínicos deben tener sistemas de gestión de calidad que garanticen la fiabilidad de los resultados. Además, en estudios longitudinales, es importante que los datos generados sean analizados a lo largo del tempo, como medida adicional de control de calidad (QC), buscando identificar fluctuaciones no explicables por variables biológicas. Aplicar esa estrategia al estudio SHIP-Brasil es el objetivo de este trabajo. Analizamos los resultados de glucemia en ayunas, prueba de sobrecarga de glucosa y hemoglobina glucada en los participantes del estudio SHIP-Brasil, en el período de julio de 2014 a noviembre de 2016, acerca de los siguientes aspectos: diferencia de los resultados de cada individuo con respecto a la media del mes con el tiempo; media y mediana de los valores con el tiempo; y porcentaje de resultados por encima de los valores de referencia con el tempo, con línea de tendencia. Según los datos observados, las mediciones de glucemia en ayunas y tras una sobrecarga de glucosa, en las muestras recolectadas en los primeros meses de estudio, resultan consistentes, a pesar de haber sido realizadas en dos laboratorios distintos. Esa estrategia de QC se presentó muy útil y puede, incluso, ser utilizada por laboratorios clínicos en su rutina, observando fluctuaciones de resultados de su población a lo largo del tiempo, detectando, eventualmente, desviaciones aún antes de las prácticas rutinarias de control interno y externo de calidad.

RESUMO Os laboratórios clínicos devem ter sistemas de gestão da qualidade que garantam a fidedignidade dos resultados. Ainda, em estudos longitudinais, é importante que os dados gerados sejam analisados ao longo do tempo, como medida adicional de controle de qualidade (CQ), buscando identificar flutuações não explicáveis por variáveis biológicas. Aplicar essa estratégia ao estudo SHIP-Brasil foi o objetivo deste trabalho. Analisamos os resultados de glicemia em jejum, glicemia pós-sobrecarga e hemoglobina glicada nos participantes do estudo SHIP-Brasil, no período de julho de 2014 a novembro de 2016, em relação aos seguintes aspectos: diferença dos resultados de cada indivíduo em relação à média do mês ao longo do tempo; média e mediana dos valores ao longo do tempo; e porcentagem de resultados acima dos valores de referência ao longo do tempo, com linha de tendência. De acordo com os dados observados, as dosagens de glicemia em jejum e glicemia pós-sobrecarga, nas amostras coletadas nos primeiros meses de estudo, apresentam-se consistentes, mesmo tendo sido realizadas em dois laboratórios distintos. Essa estratégia de CQ mostrou-se bastante útil e pode, inclusive, ser utilizada pelos laboratórios clínicos em sua rotina, observando as flutuações de resultados de sua população ao longo do tempo, detectando, eventualmente, desvios antes mesmo das práticas rotineiras de controle interno e externo da qualidade.

Community based study of reproductive tract infections among women of the reproductive age group in a rural community of Eastern India

Background: RTI/STIs have a profound impact on sexual and reproductive health worldwide, the symptoms of which often goes unnoticed and women suffers from devastating consequences. The present study was conducted to analyse the prevalence of RTIs based on a syndromic approach among women of 15 to 49 years age, supported by both laboratory and clinical diagnosis to measure the actual magnitude of morbidity associated with RTIs among the study population. The objective of the study were to study the prevalence of reproductive tract infection among the women of reproductive age group (15-49 years), to find out the etiological diagnosis and to assess the socio-demographic profile of the study population.Methods: A cross-sectional study was carried out among 312 women aged 15-44 years in a rural area in West Bengal, using the WHO-Syndromic Approach for diagnosis and management of RTIs/STIs.Results: The prevalence of RTIs among the reproductive age group women was 43.6% based on their symptoms of RTI, with majority having abnormal vaginal discharge. According to laboratory investigations the most common cause of RTI was bacterial vaginosis which was 67.4% (using Amsel’s criteria) and 31.7% (as per Nugent’s score), followed by Vulvovaginal candidiasis which was found in 12.4%.Conclusions: RTI among women of reproductive age is quite a common morbidity.It is the need of the hour to educate women about reproductive health issues and encourage them to seek treatment for their problems and wherever possible both clinical and laboratory findings should corroborate self reported morbidity to know the exact prevalence of any disease in the community.

Avaliação de marcadores sorológicos treponêmicos e não-treponêmicos em doadores inaptos para sífilis atendidos em um hemocentro brasileiro / Evaluation of treponemal and non-treponemal serological markers in unfit blood donors for syphilis in a brazilian blood center

Introdução: A sífilis é uma doença infecciosa sistêmica de evolução crônica, causada pela bactéria Treponema pallidum, que pode ser transmitida por transfusões de sangue. A avaliação dos marcadores sorológicos na triagem para sífilis em doadores de sangue é fundamental para confirmar se o sangue doado pode estar contaminado com T. pallidum ou se há descarte por reações inespecíficas. Métodos: A população foi composta por doadores de sangue atendidos em todas as unidades do Hemopa, que atenderam aos critérios do estudo. Houve análise dos resultados obtidos através do VDRL e ELISA e informações socioeconômicas sobre a população: sexo, idade, escolaridade e estado civil, obtidos a partir do registro de doadores. Resultados: Durante o período do estudo, houve 103.187 doações de sangue. Um total de 883 doadores foram considerados inaptos para sífilis no teste de triagem (0,86%) e 271 pessoas (30,69%) compareceram ao hemocentro para realização de testes confirmatórios: 50,6% homens; 49,4% mulheres; idade média de 34 anos. Mais da metade declarou ter ensino médio completo e a maioria (75,6%) relatou ser solteiros. Mais de 50% dos doadores apresentaram titulação menor que 1/16; 91,5% também apresentou reatividade em ELISA. 15 pessoas (5,5%) apresentaram outro resultado reagente além da sífilis. Conclusão: Houve mais de 90% de resultados concordantes entre teste treponêmico e não treponêmico em nossa triagem laboratorial. Esses resultados podem auxiliar instituições na estratégia de triagem para sífilis em doadores de sangue. (AU)

Introduction: Syphilis is a chronic systemic infectious disease caused by Treponema pallidum, which can be transmitted by blood transfusions. The evaluation of serological markers for syphilis screening in blood donors is crucial to confirm whether the donated blood may be contaminated with T. pallidum or if it is discarded by nonspecific reactions. The aim of this study was to describe results obtained between nontreponemal and treponemal serological tests and sociodemographic profile of blood donors in a Brazilian blood center. Methods: The population consisted of all blood donors attended at Fundação Hemopa, who met the study criteria. The results obtained through the VDRL and ELISA tests, as well as socioeconomic information about the population ­ gender, age, education and marital status ­ were analyzed. Results: During the study period, there were 103,187 blood donations. 883 donors were considered unfit for syphilis in the screening test (0.86%) and 271 of these (30.69%) attended the blood center for confirmatory testing: 50.6% men; 49.4% women; average age 34 years. More than half reported having completed high school and 75.6% reported being single. More than 50% of donors had titers less than 1/16; 91.5% also had ELISA reactivity. Fifteen people (5.5%) presented another reagent result in serological screening besides syphilis. Conclusions: There were more than 90% concordant results between treponemal and non-treponemal testing in our laboratory screening. These results may assist institutions in the screening strategy for syphilis in blood donors. (AU)

Interpretación de las pruebas diagnósticas de sífilis en gestantes / Interpretación de las pruebas diagnósticas de sífilis en gestantes Interpretation of diagnostic tests for syphilis in pregnant women

In much of the American continent and particularly in Peru, gestational syphilis is a public health problem, which is particularly important because of the risk of infection to the fetus. Because of this, it is essential to use commonly used immunological tests that are vital to define the diagnosis and timely administration of the antibiotic treatment. The objective of this review is to disseminate the general characteristics of these tests, and their correct use and interpretation, according to current protocols.

En gran parte del continente americano y en el Perú en particular, la sífilis gestacional es un problema de salud pública, que adquiere particular importancia por el riesgo de la infección al feto, por lo que es indispensable la adecuada utilización de las pruebas inmunológicas de uso común, que son vitales para definir el diagnóstico y la administración oportuna del tratamiento antibiótico. El objetivo de esta revisión es difundir las características generales de dichas pruebas y su correcto empleo e interpretación, según los protocolos vigentes.

Neurosífilis: un problema antiguo que no pierde actualidad / Neurosyphilis: an Age-old Problem that is Still Relevant Today

Resumen La neurosífilis es una presentación clínica de la sífilis y puede suceder en estadios tempranos o tardíos de la infección. Aunque el tratamiento específico para todas las formas clínicas de la sífilis existe desde hace mucho tiempo, los estadios avanzados de la enfermedad aún son prevalentes, con las secuelas neurológicas irreversibles que ocasionan. Este artículo revisa la evidencia actual, los métodos diagnósticos y el tratamiento específico para la sífilis terciaria.

Abstract Neurosyphilis is the clinical manifestation of syphilis that can arise during either the early or late stages of infection. Even though dedicated treatment for all clinical forms of syphilis has been available for many years, the advanced stages of the disease are still prevalent, with irreversible sequelae. This article reviews the current evidence, diagnostic methods and specific treatment for tertiary syphilis.

Pruebas bioquímicas para el diagnóstico de anemia megaloblástica / Biochemical tests for diagnosis of megaloblastic anemias / Testes bioquímicos para o diagnóstico de anemia megaloblástica

Es intención de este trabajo hacer un breve repaso sobre el metabolismo de la Vitamina B12 y del Folato o Vitamina B9. Estas dos vitaminas hidrosolubles juegan un papel importante en el metabolismo celular. Son cofactores de reacciones metabólicas de transferencia de grupos monocarbonados, esenciales para el mantenimiento de la vida. Además se describen las nuevas determinaciones de laboratorio, se evalúan cuáles son los estudios necesarios para arribar a un correcto diagnóstico del paciente con Anemia Macrocítica (AM), su etiología y cómo muchas drogas de uso frecuente en medicina producen AM. Se realiza también la evaluación del conjunto de metodologías que se pueden efectuar como rutina en el laboratorio especializado en hematología y se propone un algoritmo para el diagnóstico del paciente con AM.

The aim of this article is to make a little review on Vitamin B12 and Folate or Vitamin B9 metabolism. These hydrosoluble vitamins have a very important role in cell metabolism. They are cofactors in metabolic reactions of methyl group transfer, essential for life maintaining. Furthermore, new laboratory tests are described, and it is evaluated which the necessary studies are to arrive at a correct diagnosis for macrocytic anemia (MA) patients, their etiology, and how many drugs frequently used in medicine originate MA. Also, the set of methodologies that can be carried out routinely in the laboratory specialized in hematology is evaluated. Finally, a diagnosis algorithm to detect MA in patients is proposed.

Este trabalho visa a realizar uma breve revisão sobre o metabolismo da Vitamina B12 e do Folato ou Vitamina B9. Estas duas vitaminas hidrossolúveis têm um papel importante no metabolismo celular. São cofatores de reações metabólicas de transferência de grupos monocarbonados, essenciais para manter a vida. Também são descritas novas determinações de laboratório, avaliam-se quais são os estudos necessários para chegar a um diagnóstico correto do paciente com Anemia Macrocítica (AM), sua etiologia e de qué maneira muitas drogas de uso frequente em medicina produzem AM. Realiza-se também a avaliação do conjunto de metodologias que podem realizar-se como rotina no laboratório especializado em hematologia e se propõe um algoritmo para o diagnóstico do paciente com AM.

Repetition of biochemistry tests in a laboratory of public hospital in southwest of Bahia, Brazil, and associated cost / Repetição de exames de bioquímica no laboratório de um hospital público do sudoeste da Bahia, Brasil, e custo associado

ABSTRACT Introduction: Test repetitions are an age-old practice common to clinical laboratories used primarily for confirmation of results. However, knowing the history of patients, the repetitions become avoidable. They impair the time to release results, increase input consumption, and cost of services. Objectives: to evaluate the difference between the results of the laboratory tests repetitions and the expenditure generated by each additional test. Materials and methods: Data from repeated tests from September to November 2015 were used in the laboratory of a public hospital in the state of Bahia, Brazil. The classification of necessary or unnecessary repetition of these tests was performed according to international criteria, with subsequent cost estimation. Results: A total of 1,350 samples were analyzed, with a total of 1,429 repetitions; 1,162 (81.31%) were classified as unnecessary repetitions, generating an additional cost of R$ 1,198.00 to the service. The repetitions that made up the study generated a cost of R$ 1,488.61, the expense should be only R$ 290.61, an increase of 80.47%, an estimated annual impact of R$ 4,792.00. In addition to the impact on cost, the impact on turnaround time was evident, which consequently affects the speed in patient care. Conclusion: It was observed that most of the repetitions performed in the laboratory were classified as unnecessary when evaluated by the criteria used. These repetitions generated a potentially avoidable laboratory cost increase, negatively impacting the time to release the results.

RESUMO Introdução: A repetição de exames é uma prática antiga comum aos laboratórios clínicos, usada basicamente para confirmação de resultados. No entanto, ao conhecer a história dos pacientes, as repetições tornam-se evitáveis. Elas prejudicam o tempo de liberação de resultados, aumentam consumo de insumos e geram custo aos serviços. Objetivos: Avaliar a diferença entre os resultados das repetições de exames laboratoriais e o dispêndio gerado por cada teste adicional. Materiais e métodos: Foram utilizados dados de exames repetidos de setembro a novembro de 2015 no laboratório de um hospital público do estado da Bahia, Brasil. Procedeu-se a classificação de repetição necessária ou desnecessária desses exames seguindo critérios internacionais, com posterior estimativa de custo. Resultados: Um total de 1.350 amostras foram analisadas, com 1.429 repetições ao todo; 1.162 (81,31%) foram classificadas como repetições desnecessárias, gerando um custo adicional ao serviço no valor de R$ 1.198,00. As repetições que compuseram o estudo geraram um custo de R$ 1.488,61, o gasto deveria ser de apenas R$ 290,61, ou seja, um acréscimo de 80,47%, um impacto anual estimado em R$ 4.792,00. Além do impacto no custo, ficou evidente o impacto no tempo de resposta, o que consequentemente afeta a celeridade na assistência aos pacientes. Conclusão: Observou-se que a maioria das repetições realizadas no laboratório foi classificada como desnecessária quando avaliada pelos critérios utilizados. Essas repetições geraram ao serviço um acréscimo de custo laboratorial potencialmente evitável, impactando negativamente no tempo para liberação dos resultados.

Pre and Post Analytical Factors Affecting Laboratory Results

The results of laboratory tests have a substantial role in the diagnosis and management of disease. However, laboratory results do not always correspond with the patient's clinical status. Unexpected results may arise from factors other than disease. The total testing process consists of 3 separate phases — pre-analytical, analytical, and post-analytical. The accuracy and reliability of a laboratory result depend on the quality of each phase. In this article, the common variables in the pre-analytical and post-analytical phases and their effect on test result quality in primary care are reviewed.

Insecticidal Exposure may be the Cause of Progression of Immune Disorders and Inflammatory Diseases through Dys-regulation of Cytokines

Industrial revolution has dangerously increased the load of environmental or environmentally induced diseases. Recently, the insecticides (a class of pesticides killing various insects) have become one of the most important environmental pollutants. This Review discusses the association of insecticides, cytokines dys-regulation and the development of immuno-regulatory disorders and chronic inflammatory conditions. In spite of abundant reviewing and reporting of various immuno-inflammatory diseases individually, efforts lack to understand the central pathological mechanism underlying these diseases collectively. The cytokines are extensively involved in inter-cellular communications; they are regarded attractive markers for risk stratification or patient prognosis. In this Review, an understanding has been generated about the role of various receptors, genes and signaling pathways etc. in the trianglular link of cytokines, immuno-inflammatory diseases and insecticides. Such role, in a number of instances, had been those of (1) a receptor tyrosine kinase designated as c-kit or SCF receptor and (2) NFκB, the most excellently described transcription factor. The conclusion of the Review is that insecticides are linked with increasing susceptibility to various diseases especially any type of chronic inflammation through cytokine dys-regulation. Moreover, insecticidal toxicity can cause deviations in certain parameters of diagnosis. So insecticide applicators must be stressed to ensure only recommended doses and formulations of insecticides if really necessary.

Manifestaciones clínicas y laboratoriales en el lupus eritematoso sistémico - LES / Clinical and laboratory manifstations in systemic Lupus erythematosus

El Lupus eritematoso sistémico (LES) es una enfermedad autoinmune compleja que se caracteriza por su capacidad de afectar a diversos órganos, lo que determina las diferentes manifestaciones clínicas objetivadas durante la evolución de la enfermedad. De forma asociada se ha descrito que estas manifestaciones presentan una variación geográfica o étnica, siendo por lo general menos grave en pacientes con ascendencia europea que en aquellos que presentan ascendencia africana, asiática o hispana. Alteraciones, tanto del sistema inmune adaptativo (células T y B) como del innato (Toll like receptorx-TLR), contribuyen al desarrollo del LES. Las células B tienen su papel en la producción de los autoanticuerpos (i.e. anticuerpos anti-ADN y anticuerpos anti-nucleosoma) y de determiandas citocinas. Las pruebas de laboratorio son de gran valor cuando se evalúa a un paciente con sospecha de enfermedad autoinmune. Los resultados pueden confirmar el diagnóstico, estimar la severidad de la enfermedad, evaluar el pronóstico y son de suma utilidad para el seguimiento de la actividad del LES.

Systemic Lupus Erythematosus (SLE) is a complex autoimmnune disease characterizedby its ability to affect different organs, which determines different clinical manifestationsobserved during the course of the disease. It has been described that thesemanifestations have geographic or ethnic varations being generally less serious in patientsof European descent than in those with African, Asian or Hispanic descents. Alterations ofboth the adaptative (T and B cells) and innate (Toll like receptorx-TLR) immnune systemscontribute to the development of SLE. B cells have a role in the production of autoantibodies(i.e. anti-DNA and anti-nucleosome antibodies) and some cytokines. Laboratorytests are invaluable when evaluating a patient with suspected autoimmune disease. Theresults can confirm the diagnosis, estimate the severity of the disease, assess prognosisand are extremely useful for monitoring the activity of SLE.

Autoverification of the automated blood cell counter (CBC) in a reference laboratory in Bogota, Colombia / Autoverificação do contador de células automatizado de sangue (CBC) em um laboratório de referência em Bogotá, Colômbia

ABSTRACT Introduction: The clinical laboratory is part of the group of actors in health systems that are under increasing pressure by users and administrators to increase their productivity in order to respond efficiently to the increased volume of patients, optimizing costs and professional time. This pressure forced laboratories to perform a full review of their procedures and develop technical, logistical and computational tools to enable excellent response times. Objective: This study aimed to evaluate the implementation of the automated blood cell counter autoverification process and its impact on the safety of patients. Methods: Verification rules were designed in the connectivity software, based on manual validation criteria for laboratory professionals, according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI) Guideline Auto10-A and the International Consensus Group for Hematology Review (ISLH). The autoverification percentage was established, and non-conforming product (NCP) percentages were estimated before and after the procedure. Pilot tests were also performed in different days so as to adjust the process. Results: 53.4% of automated blood cell counters autoverification were achieved, and, subsequently in the audit of 18 months, 60% was reached due to verification adjustments in the delta programmed filter. The NCPs rose from 0.065% to 0.0036% from the beginning to the end of the process. Conclusion: The autoverification process enabled to reduce the variability associated with human intervention, therefore the professional is able to focus on the pathological report analysis, reducing the risk of errors and advocating greater importance on patient safety.

RESUMO Introdução: O laboratório clínico é parte do grupo de atores nos sistemas de saúde, que são cada vez mais pressionados por usuários e administradores para aumentar sua produtividade a fim de responder de forma eficiente ao aumento do volume de pacientes, otimizando custos e tempo dos funcionários. Essa pressão forçou laboratórios para efetuar uma revisão completa de seus procedimentos, bem como desenvolver instrumentos técnicos, logísticos e computacionais para permitir excelentes tempos de resposta. Objetivo: Neste estudo, a implementação do processo automatizado de autoverificação do hemograma e seu impacto sobre a segurança do paciente são avaliados. Métodos: Regras de verificação foram construídas no software de conectividade com base em critérios de validação manual dos profissionais de laboratório, de acordo com as orientações do Clinical and Laboratory Standards Institute (CLSI) de Guideline Auto10-A e do International Consensus Group for Hematology Review (ISLH). A percentagem de autoensaio foi estabelecida e as de produtos não conformes (PNC), estimadas antes e depois do procedimento. Testes piloto foram realizados em dias diferentes para ajustar o processo. Resultados: Cinquenta e três por cento da autoverificação dos hemogramas automatizados foram alcançados e, posteriormente, na auditoria dos 18 meses, foram obtidos 60% devido a ajustes na verificação do filtro delta programado. Os PNCs aumentaram de 0,065% a 0,0036% desde o início até ao final do processo. Conclusão: O processo do autoverificação ajudou a reduzir a variabilidade associada à intervenção humana, portanto o profissional pode concentrar-se na análise de relatórios patológicos, reduzindo o risco de erros e dando maior importância para a segurança do paciente.