Métodos no invasivos sobre diagnóstico de esteatosis hepática no alcohólica: descripción de su sensibilidad y especificidad / Noninvasive methods on diagnosis of nonalcoholic hepatic steatosis: description of their sensitivity and specificity / Métodos não invasivos para o diagnóstico de esteatose hepática não alcoólica: descrição de sua sensibilidade e especificidade

El hígado graso no alcohólico es una patología de distribución mundial, siendo su evolución hepática crónica la más común. El objetivo de esta investigación consiste en actualizar y describir la sensibilidad y especificidad de los métodos no invasivos para el diagnóstico de esteatosis hepática priorizando las pruebas bioquímicas utilizadas para NAFLD, aplicando un enfoque de tipo documental a través de revisión sistemática y, empleando como metodología, las normas PRISMA y la herramienta QUADAS-2 para el filtro y selección de artículos. En total, se obtuvieron 441 artículos relacionados al tema de investigación mediante bases de datos como PubMed, Scopus, Web Of Science, Science Direct, Scielo y otros, de los cuales 13 fueron seleccionados. Se encontró que factores relacionados a la presencia o no de comorbilidades como el síndrome metabólico, diabetes, HTA, etnia, peso y raza influyen en la NAFLD; por otro lado, las enzimas hepáticas no son predictores sensibles de la enfermedad. Se evidencia también que la esteatosis hepática está directamente relacionada con el aumento del IMC, triglicéridos, HDL, ALT y GGT.

Non-alcoholic fatty liver disease is a pathology of worldwide distribution, being its chronic hepatic evolution the most common. The research aims to update and describe the sensitivity and specificity of noninvasive methods for the diagnosis of hepatic steatosis, prioritizing the biochemical tests used for NAFLD, applying a documentary approach through a systematic review, and using as methodology the PRISMA standards and the QUADAS-2 tool for the filter and selection of articles. In total, 441 articles related to the research topic were obtained through databases such as PubMed, Scopus, Web of Science, Science Direct, Scielo and others, of which 13 were selected. It was found that factors related to the presence or not of comorbidities such as metabolic syndrome, diabetes, AHT, ethnicity, weight, and race influence NAFLD; on the other hand, liver enzymes are not sensitive predictors of the disease. It is also evidenced that hepatic steatosis is directly related to increased BMI, triglycerides, HDL, ALT and GGT.

O fígado gordo não alcoólico é uma patologia com distribuição mundial, sendo a sua evolução hepática crónica a mais comum. O objetivo desta pesquisa é atualizar e descrever a sensibilidade e especificidade dos métodos não invasivos para o diagnóstico da esteatose hepática, priorizando os exames bioquímicos utilizados para DHGNA, aplicando uma abordagem do tipo documental por meio de revisão sistemática e, utilizando como metodologia, a Normas PRISMA e a ferramenta QUADAS-2 para filtragem e seleção de artigos. No total, 441 artigos relacionados ao tema de pesquisa foram obtidos por meio de bases de dados como PubMed, Scopus, Web Of Science, Science Direct, Scielo e outras, dos quais 13 foram selecionados. Constatou-se que fatores relacionados à presença ou não de comorbidades como síndrome metabólica, diabetes, hipertensão, etnia, peso e raça influenciam a DHGNA; por outro lado, as enzimas hepáticas não são preditores sensíveis de doença. Fica evidente também que a esteatose hepática está diretamente relacionada ao aumento do IMC, triglicerídeos, HDL, ALT e GGT.

Comparación de tres metodologías para estimar el porcentaje de estatura adulta en niños y niñas de 7 a 16 años / Comparison of three methodologies for estimating percentage of adult height in children from 7 to 16 years

El porcentaje de estatura adulta (PEA) es un indicador del estado de maduración, que refleja la variación en la tasa y progreso de crecimiento. Existen diversos métodos para estimar la estatura adulta, sin haberse documentado en la literatura de manera concreta sus similitudes o diferencias. Los objetivos del presente trabajo fueron comparar tres métodos de estimación del PEA, identificar cambios seculares en niños y adolescentes y establecer valores de referencia del PEA para población portuguesa. Se midieron en 799 niños y 736 niñas, de 7,0 a 16,49 años, la edad ósea, el peso y la estatura, para estimar el porcentaje de estatura adulta por las metodologías TW3, KR y RWT. Los valores del método TW3 del presente estudio, fueron comparados con los reportados en décadas atrás para identificar cambios seculares. Se utilizó un ANOVA de medidas repetidas para estimar las diferencias entre los métodos en el presente estudio, así como gráficas de Bland y Altman. Se utilizó la prueba de Kruskal-Wallis para analizar las diferencias entre los valores encontrados en la presente investigación y los presentados en décadas atrás en otros estudios. No se encontraron diferencias entre los métodos TW3 y KR en los diferentes grupos de edad cuando se clasificaron los sujetos por edad cronológica, en ambos sexos (P>0,05). Así mismo, no se observaron cambios seculares en el PEA (P>0.05). Los métodos TW3 y KR pueden ser intercambiables entre sí, debido a que no presentan diferencias en la estimación a diferentes edades y en ambos sexos. Además, no existió cambio secular en la estimación de PEA por estas metodologías, lo que las hace útiles en la actualidad.

The adult height percentage (AHP) is an indicator of maturity state, which reflects variation in growth rate. Several methods estimates adult height; however, its similarities or differences have not been documented in a concrete way in literature. The aims of the present work were to compare three common methods of AHP estimation, to identify children and adolescents secular changes and to develop AHP reference values in Portuguese population. Skeletal age, weight and height were measure in 799 children and 736 girls from 7.0 to 16.5 years; in addition, parents height was self-reported by them to estimate the AHP by TW3, RWT and KR methods. ANOVA was used to estimate differences between TW3, KR and RWT methods, as well as Bland-Altman graphs. Also, Kruskal-Wallis test was applied. No differences were found between TW3 and KR methods in all age groups, in both sexes, when subjects were classified by chronological age (P> 0.05). Likewise, no secular changes were observed in AHP (P> 0.05). Not only TW3 and KR protocols can be interchangeable each other because they did not present differences in the AHP estimation at different ages and in both sexes. However, secular changes were not observed in AHP estimation by these methods.

Evaluation of new non-invasive & conventional invasive methods of haemoglobin estimation in blood donors

Background & objectives: The non-invasive method of haemoglobin (Hb) estimation has unique advantages of exemption of finger prick and associated pain, over invasive methods. This study was done to compare invasive and non-invasive methods of Hb estimation in blood donors keeping haematology analyzer (HA) as a reference method. Methods: The blood donors selected or deferred on the basis of CuSO4method (Hb ?12.5 g/dl), were included in the study. Hb values of the donors were estimated by HemoCue and then by OrSense methods. An immediate post-donation venous sample was drawn for analysis on HA. Results: The mean Hb value was 13.98�27 g/dl on HA, 14.87�03 g/dl on OrSense and 15.03�31 g/dl on HemoCue. CuSO4, HemoCue and OrSense demonstrated sensitivities of 18.7, 18.7 and 13.1 per cent, positive predictive values (PPV) of 64.5, 83.3 and 60.9 per cent and specificities of 98.9, 99.6 and 99.1 per cent, respectively. The intra-class correlation coefficient for OrSense was 0.726 while that for HemoCue was 0.851. Bland-Altman plots demonstrated 2SD difference of >2.0 g/dl in Hb estimations between HA and HemoCue/OrSense. Interpretation & conclusions: The non-invasive modality may provide the near-ideal pre-donation Hb screening platform if an improvement can be done in the sensitivity and PPV of the non-invasive method keeping in view its unique advantages.

A cross sectional study of clinical profile and evaluation of pulmonary hypertension in Chronic Obstructive Pulmonary Disease patients in a tertiary care hospital of Mangalore, India

Background: The objectives was to study the clinical profile of COPD patients and to evaluate pulmonary hypertension in COPD patients by non-invasive methods.Methods: A prospective observational study of patients who satisfy all inclusion and exclusion criteria in OPD or admitted in medical wards of AJIMS Mangalore. The study was conducted from October 2017 to October 2018 with the sample size of 90 subjectsResults: Out of 90 subjects 53 (58.8%) of them had pulmonary hypertension. Among the subjects who had pulmonary hypertension 29 (54.72%) of them had moderate pulmonary hypertension, 17 (32.08%) of them had severe pulmonary hypertension and 7 (13.20%) of them had mild pulmonary hypertension. Mean age among the subjects who had pulmonary hypertension was 64.24+7.62yrs and mean age among the subjects who didn’t had pulmonary hypertension was 51.87+8.97yrs. There was a statistically significant difference found between mean age and pulmonary hypertension. Mean duration of diseases among the subjects who had pulmonary hypertension was 8.13+1.74yrs and Mean duration of diseases among the subjects who didn’t had pulmonary hypertension was 5.36+1.98yrs. There was a statistically significant difference found between mean duration of disease and pulmonary hypertension.Conclusions: Due to high prevalence of pulmonary hypertension we suggest screening for the all COPD patients for cardiac complications. This will help in identifying the individual who requires close monitoring and also in reducing the mortality.

Non-invasive hair sampling of Neotropical otters / Coleta não invasiva de pelos de lontra Neotropical

Abstract: Sampling wild animal populations using non-invasive techniques is advised when dealing with threatened species. Hair samples provide ecological information like species and individual identification. However, hair trapping is scarcely used in otters, due to their aquatic habits. Most studies are with captive individuals, so there is the need to test non-invasive hair trapping methods in otters in the wild. The aim of this study was to develop a simple and cost-effective method to collect hair from otter species in a non-invasive way. The study was carried out in the Paranapanema River, São Paulo State, Brazil, with the Neotropical otter (Lontra longicaudis Olfers, 1818), a protected species. Hair traps (wooden sticks and tree roots with adhesive tape or wax bands) were set during six nights on river banks, otter trails and scent-marking sites. Traps were baited with otter fresh spraints from other river locations. From the 23 traps, 10 (43.7%) were successful in collecting otter hairs, mostly guard-hair. The sticks were much more efficient than the roots at capturing otter hair (70.6.% vs. 0%) as well as adhesive tape when compared to wax (71.4% vs. 0%). Method simplicity and efficiency suggest that it can be a cost-effective way for collecting otter hairs without the need for capturing individuals. This method can be used for: assessment of local otter distribution; collecting otter hair samples for sex and individual identification (by molecular analysis), trophic ecology (by isotopic analyses), ecotoxicology (by contamination analysis) or behaviour ecology (by hormonal and stress levels analysis). More trapping campaigns should be implemented to further test the method's efficiency.

Resumo: O uso de técnicas de amostragem não-invasivas é aconselhado quando se trabalha com espécies ameaçadas de animais selvagens. Amostras de pelo fornecem informações ecológicas, como a identificação ao nível da espécie e do indivíduo. No entanto, a coleta de pelo é pouco usada em lontras, devido aos seus hábitos aquáticos. A maioria dos estudos é feita com indivíduos em cativeiro, existindo por isso a necessidade de testar métodos não invasivos de coleta de pelos de lontras na natureza. O objetivo deste estudo foi desenvolver um método simples e com uma boa relação custo-benefício para coletar pelos de espécies de lontra de maneira não invasiva. O estudo foi realizado no rio Paranapanema, Estado de São Paulo, Brasil, com a lontra Neotropical (Lontra longicaudis Olfers, 1818), uma espécie protegida. Armadilhas de pelo (estacas de madeira e raízes de árvores com fita adesiva ou bandas de cera depilatória) foram colocadas durante seis noites nas margens do rio, em trilhas e locais de marcação de lontra. As armadilhas foram iscadas com dejetos frescos de lontra de outros locais do rio. Das 23 armadilhas, 10 (43.7%) foram eficazes na coleta de pelos de lontra, maioritariamente pelos-guarda. As estacas foram muito mais eficientes que as raízes na captura de pelos de lontra (70.6.% vs. 0%) tal como a fita adesiva quando comparada com a cera (71,4% vs. 0%). A simplicidade e a eficiência do método sugerem que esta pode ser uma maneira econômica de coletar pelo de lontra sem a necessidade de capturar indivíduos. Este método pode ser usado para: levantamento da distribuição local da lontra; coleta de amostras de pelo de lontra para identificação sexual e individual (por meio de análise molecular); ecologia trófica (por meio de análise isotópica); ecotoxicologia (por meio de análise de contaminantes); e ecologia comportamental (por meio da determinação de níveis hormonais reprodutivos e ligados ao estresse). Mais campanhas de armadilhagem devem ser implementadas para melhor avaliar a eficiência do método.

Genetic diversity of the pampas deer (Ozotoceros bezoarticus) population in the Brazilian Pantanal assessed by combining fresh fecal DNA analysis and a set of heterologous microsatellite loci

Abstract The pampas deer (Ozotoceros bezoarticus) is close to being classified as 'globally threatened', with the largest population occurring in the Brazilian Pantanal. Since capture is stressful to these animals, non-invasive sampling methods such as the use of feces can provide reliable sources of DNA. The aim of this study was to use fecal samples to evaluate the genetic variability of the Brazilian Pantanal population of pampas deer. Six heterologous microsatellite markers were used to screen 142 stool specimens. Seventy-four deer were identified, of which 50 adults were used to determine the genetic characteristics of the population. The Pantanal population showed high genetic diversity (mean number of alleles per locus = 11.5, expected heterozygosity = 0.75). This is the first investigation to characterize a South American deer species using fecal DNA and demonstrates the usefulness and efficiency of this approach, as well as the feasibility of obtaining information that could not have been easily obtained by traditional DNA sampling. Our findings suggest that management strategies for this species may be much more effective if applied now when the population still shows high genetic variability.

Transient Elastography vs Aspartate Aminotransferase to Platelet Ratio Index in Hepatitis C: A Meta-Analysis

ABSTRACT Background and rationale. Many different non-invasive methods have been studied with the purpose of staging liver fibrosis. The objective of this study was verifying if transient elastography is superior to aspartate aminotransferase to platelet ratio index for staging fibrosis in patients with chronic hepatitis C. Material and methods. A systematic review with meta-analysis of studies which evaluated both non-invasive tests and used biopsy as the reference standard was performed. A random-effects model was used, anticipating heterogeneity among studies. Diagnostic odds ratio was the main effect measure, and summary receiver operating characteristic curves were created. A sensitivity analysis was planned, in which the meta-analysis would be repeated excluding each study at a time. Results. Eight studies were included in the meta-analysis. Regarding the prediction of significant fibrosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 11.70 (95% confidence interval = 7.13-19.21) and 8.56 (95% confidence interval = 4.90-14.94) respectively. Concerning the prediction of cirrhosis, transient elastography and aspartate aminotransferase to platelet ratio index had diagnostic odds ratios of 66.49 (95% confidence interval = 23.71- 186.48) and 7.47 (95% confidence interval = 4.88-11.43) respectively. Conclusion. In conclusion, there was no evidence of significant superiority of transient elastography over aspartate aminotransferase to platelet ratio index regarding the prediction of significant fibrosis, but the former proved to be better than the latter concerning prediction of cirrhosis.

ELF (Enhanced Liver Fibrosis) como marcador não invasivo de fibrose hepática na hepatite C crônica / ELF (Enhanced Liver Fibrosis) as a non invasive predictor of liver fibrosis in hepatitis C

A fibrose hepática é o aspecto mais relevante e o mais importante determinante de morbimortalidade na hepatite C crônica (HCC). Historicamente, a biópsia hepática é o método de referência para avaliação da fibrose causada pela HCC, apesar de apresentar limitações. O estudo de marcadores não invasivos, que possam obviar a necessidade da biópsia, é uma área de constante interesse na hepatologia. Idealmente, a avaliação da fibrose hepática deveria ser acurada, simples, prontamente disponível, de baixo custo e informar sobre o prognóstico da patologia. Os marcadores não invasivos mais estudados são a elastografia hepática transitória (EHT) e os laboratoriais. A EHT já foi extensamente validada na HCC e está inserida na rotina de avaliação destes pacientes. Dentre os laboratoriais, existem diversos testes em continua experimentação e, até o momento, nenhum foi integrado à prática clínica no Brasil, embora já aplicados rotineiramente em outros países. O Enhanced Liver Fibrosis (ELF), um teste que dosa no soro ácido hialurônico, pró-peptídeo amino-terminal do colágeno tipo III e inibidor tissular da metaloproteinase 1, tem se mostrado bastante eficaz na detecção de fibrose hepática significativa e de cirrose na HCC. Neste estudo o ELF teve o seu desempenho avaliado em relação a biópsia hepática e demonstrou apresentar boa acurácia na detecção tanto de fibrose significativa quanto de cirrose. Na comparação com a EHT apresentou acurácia semelhante para estes mesmos desfechos, com significância estatística. No entanto, foi observada uma superestimação da fibrose com a utilização dos pontos de corte propostos pelo fabricante. Este achado está em acordo com a literatura, onde não há consenso sobre o melhor ponto de corte a ser empregado na prática clínica. Com a ampliação da casuística foi possível propor novos pontos de corte, através da análise clássica, com a biópsia hepática como padrão ouro...

Liver fibrosis is the most relevant issue concerning chronic hepatitis C (CHC) and determines its prognosis. Historically, liver biopsy has been the reference method for evaluating fibrosis related to CHC, though it presents many drawbacks. There is a continuing interest in the development of non invasive markers capable of replacing liver biopsy. The ideal surrogate for fibrosis evaluation should be accurate, simple, low cost and yield prognostic information. So far, the most well known non invasive methods are transient hepatic elastography (TE) and laboratory panels. TE has already been extensively validated and is integrated in patients routine. There is plenty of laboratory panels in continuing evaluation and some are already integrated in daily practice abroad. In Brasil, until the present moment, it is not a reality. Enhanced Liver Fibrosis (ELF) panel comprises the serum concentration of hyaluronic acid, tissue inhibitor of matrix metalloproteinases-1, and aminoterminal propeptide of type III procollagen and has demonstrated good performance in detecting significant fibrosis and cirrhosis in CHC patients. In the present study ELF had it’s performance evaluated against liver biopsy and obtained satisfactory accuracy in detecting significant fibrosis and cirrhosis. In comparison to TE no statistically significant diference was observed, for the same endpoints mentioned before. However, the application of manufacturer’s cutoff points produced overestimation of fibrosis stages. These findings are in accordance with other author’s results, in that there is no consensus so far on the most adequate cutoff points for main clinical end points. Enlarging the data permited calculating new cutoff points, through the classical statistical approach, using liver biopsy as the gold standard...

A Study on an Evaluation tool for Post-anesthsia Recovery by Objective Non-invasive Methods / 성인간호학회지

This study was performed to examine the safety of the Aldrete Scoring system and the reliability of 8 objective non-invasive methods in the evaluation of post-anesthesia recovery. Aldrete Score(AS) and Maximum Inspiratory Force(MIF), Hand Muscle Grip Power(HMGP), Respiratory Frequency(RF), Tidal Volume(V(T)), Arterial Oxygen Saturation(SaO2), systolic blood pressure(sBP), heart rate(HR), and orientation were measured in the pre-anesthesia period, at the arrival in recovery room and using the AS 10, in 137 patients during a 3 month in 1998 at K hospital. Data obtained by the objective non-invasive methods of the AS 10 were compared with their relevant recovery criteria to the 8 objective non-invasive methods by the use of the t-test. The results were as follows: 1. The MIF of 63 patients using the AS 10 was below the discharge criteria from recovery room(DCrm), but the mean MIF(-34.6 +/- 23.4 cmH2O) was above the DCrm. Women, over 30 years of age or weighing below 60kg, showed significant differences from those whose MIF was below the DCrm(P<0.05). 2. V(T) of 118 patients at AS 10 was below their DCrm and the mean V(T)(3.5 +/- 1.4ml/kg) was significant 19 lower than difference below the DCrm(P<0.01). Women were more commonly present among those who V(T) was below the DCrm. 3. SaO2 of 2 patients using the AS 10 was below their DCrm, but the mean SaO2(98.0 +/- 0.8%) was above the DCrm. 4. HMGP and orientation using the AS 10 were above their DCrm. 5. RF, systolic blood pressure and pulse rate using the AS 10 were within the range of their DCrm. 6. V(T), MIF and SaO2 of some patients, who complained of general malaise or respiratory difficulty during the postanesthesia 24 hours, were less than DCrm. The Above results showed that AS 10 alone was not enough to fulfil the recovery discharge criteria of MIF, V(T) and SaO2, Hence some objective non-invasive monitorings such as SaO2, MIF and V(T) need to be adopted to secure the safe recovery in the recovery room.