Lineamientos técnicos para el diagnóstico y control de la tuberculosis en el laboratorio clínico / Technical guidelines for the diagnosis and control of tuberculosis in the clinical laboratory

El trabajo desarrollado en los laboratorios, es importante no solo por su rol en el diagnóstico de las enfermedades transmisibles como la tuberculosis, sino también en el control de la evolución del tratamiento de los pacientes, así como la evaluación epidemiológica y operacional. Tiene como función principal, la detección de fuentes de infección tuberculosa a través de métodos como pruebas moleculares, cultivo, baciloscopia y prueba de flujo lateral para lipoarabinomanano (LF-LAM). La elección de la técnica más conveniente y su estandarización permite la obtención de resultados comparables a lo largo de todo el país, además de facilitar la capacitación, así como la ampliación de la cobertura. El propósito de los presentes lineamientos, es proporcionar al personal de laboratorio clínico del Sistema Nacional Integrado de Salud (SNIS) y de otras instituciones prestadoras de servicios de salud, información sobre los procedimientos técnicos aplicables para el diagnóstico bacteriológico de la tuberculosis

The work carried out in the laboratories is important not only for its role in the diagnosis of communicable diseases such as tuberculosis, but also in the control of the evolution of the treatment of patients, as well as the epidemiological and operational evaluation. Its main function is to detect sources of tuberculosis infection through methods such as molecular tests, culture, bacilloscopy and lateral flow test for lipoarabinomanan (LF-LAM). The choice of the most appropriate technique and its standardization allows for comparable results throughout the country, in addition to facilitating training, as well as expanding coverage. The purpose of these guidelines is to provide clinical laboratory staff with

Lembrar, reconhecer, reverenciar: lugares de memória para os trabalhadores técnicos da Fiocruz / Remember, recognize, revere: spaces for the memory of the technical staff at Fiocruz

Resumo O artigo reflete sobre as justificativas do projeto "Lugar de memória: história e vida dos trabalhadores técnicos da Fiocruz", uma iniciativa de educação patrimonial que relaciona o patrimônio arquitetônico do campus Manguinhos com a memória e as muitas histórias dos auxiliares de laboratório que atuaram no Instituto Oswaldo Cruz em seus trinta primeiros anos de existência. O propósito do projeto foi estabelecer um lugar de memória para os trabalhadores técnicos da instituição, compondo um diálogo entre passado e presente da história da Fiocruz e integrando espaços virtuais a ambientes históricos.

Abstract This article reflects on the justifications for the "Lugares de Memória: história e vida dos trabalhadores técnicos da Fiocruz" project, a heritage education initiative linking the architectural heritage of the Manguinhos campus to the memory and many histories of the laboratory assistants who worked at the Oswaldo Cruz Institute (Fiocruz) during its first thirty years of existence. The objective was to establish a space for memory for the institution's technical staff by creating a dialog between the past and present in the history of Fiocruz and integrating virtual spaces and historical environments.

Medical laboratory practice in Malawi ­ Current status

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Monitoring of Insecticides resistance against cotton Jassid (Amrasca biguttutla biguttutla) under laboratory conditions / Monitoramento da resistência de inseticidas contra o algodão Jassid (Amrasca biguttutla biguttutla) em condições laboratoriais

Abstract Development of insecticides resistance mainly hinge with managements techniques for the control of Jassid, Amrasca biguttutla biguttutla. Five insecticides were applied against field collected and laboratory rared jassid populations during the years of 2017 to 2019 to profile their resistance level against field population of jassid through leaf dip method. Very low resistance level was found in jassid against confidor whereas high level of resistance was observed by pyriproxyfen against other test insecticides. Gradual resistance was observed against diafenthiuron. It is concluded that for the management of Jassid repetition of same insecticide should be avoided. The use of confidor may be reduced to overcome resistance against Jassid.

Resumo Desenvolvimento da resistência a inseticidas principalmente em dobradiça com técnicas de manejo para o controle de jassid, Amrasca biguttutla biguttutla. Cinco inseticidas foram aplicados contra populações de jassídeos coletados em campo e em laboratório durante os anos de 2017 a 2019 para traçar o perfil de seu nível de resistência contra populações de jassídeos em campo através do método de imersão nas folhas. Nível de resistência muito baixo foi encontrado em jassid contra confidor, enquanto alto nível de resistência foi observado por piriproxifeno contra outros inseticidas de teste. Resistência gradual foi observada contra o diafenthiuron. Conclui-se que, para o manejo do jassid, a repetição do mesmo inseticida deve ser evitada. O uso de confidor pode ser reduzido para superar a resistência contra jassid.

A new approach to mark termites (Cornitermes cumulans (Kollar) Blattodea: Isoptera) for laboratory bioassays / Uma nova abordagem de marcador tópico em cupins para bioensaios de laboratório

Abstract Behavioral lab bioassays involving termites must be promptly performed to allow intended observations prior to death from dissecation, typical of these soft-bodied insects. To this end, topic markers have been proposed as an alternative to histological stains which, while not always toxic are inevitably lengthy to apply. Among recommended topic markers, gouache is easy to apply, dries out quickly, but it is known affect termites in the long run, being suitable only to short-term bioassays. Its alternative, colored glue, is also easy to apply, but it takes long to dry and it is too dense and heavy, being thus prone to affect termite walking patterns. Here we tested a mix of gouache and colored glue aiming to combine the qualities of both into a suitable topical marker for Cornitermes cumulans termites. Similar patterns of survival presented by marked and unmarked termites ruled out concerns about toxicity of this mixture. Such results were consistent across distinct group densities evidencing that the mixture does not interfere with, nor it is affected by, crowding effects. Because crowding regulates interindividual interactions and these underlie most behaviors, the mixture can be thought to be suitable to behavioral studies. We argue that this 1:2 glue:gouache mixture is an excellent alternative to mark termites for lab bioassays. Being atoxic, cheap, easy to apply, and non-invasive, this mixture may happen to be useful not only for termites but also in bioassaying other similarly soft-bodied insects.

Resumo Bioensaios comportamentais em laboratório com cupins devem ser realizados rapidamente a fim de garantir observações antes da morte por dissecação, típico desses insetos de corpo mole. Para este fim, marcadores tópicos têm sido propostos como uma alternativa para marcadores histológicos que, embora nem sempre tóxico, possuem uma aplicação demorada. Entre os marcadores tópicos recomendados, tinta guache é de fácil aplicação, rápida secagem, porém afeta os cupins em bioensaios longos, sendo adequado apenas para bioensaios curtos. Sua alternativa, cola colorida, também é de fácil aplicação mas leva muito tempo para secar e é muito denso e pesado, afetando os padrões de caminhamento dos cupins. No presente estudo, nós testamos uma mistura de tinta guache e cola colorida objetivando combinar as qualidades de ambos os marcadores tópicos em um marcador tópico adequado para Cornitermes cumulans. Padrões similares de sobrevivência entre cupins marcados e controle indicam a ausência de toxicidade na mistura de tinta guache e cola colorida. Tais resultados são consistentes em grupos de densidades distintas, o que comprova que a mistura não interfere, nem sofre efeitos de aglomeração. Uma vez que a aglomeração regula as interações inter-individuais e afetam a maioria dos comportamentos, a mistura pode ser adequada para estudos comportamentais. Nós argumentamos que a mistura de tinta guache e cola (1:2) é uma excelente alternativa como marcador tópico em cupins para bioensaios em laboratório. Sendo atóxico, barato, fácil de aplicar e não invasivo, esta mistura pode ser útil não só para os cupins, mas também em bioensaios com outros insetos de corpo mole.

Characteristics of serum bile acids among healthy children in Zhejiang province / 中华儿科杂志

Objective: To characterize the serum bile acid profiles of healthy children in Zhejiang Province. Methods: A cross-sectional study was conducted on 245 healthy children who underwent imaging and laboratory biochemical tests during routine physical examinations at the Children's Hospital of Zhejiang University School of Medicine from January 2020 to July 2022. Overnight fasting venous blood samples were collected, and the concentrations of 18 individual bile acids in the serum were accurately quantitated using tandem mass spectrometry. The concentration difference of bile acid were compared between different genders and to explore the correlation between age and bile acid levels. Used the Mann-Whitney U test for intergroup comparison and Spearman test to correlation analysis. Results: A total of 245 health children with a age of 10 (8, 12) years including 125 boys and 120 girls. There were no significant differences in levels of total bile acids, primary and secondary bile acids, free and conjugated bile acids between the two gender groups (all P>0.05). The serum concentrations of ursodeoxycholic acid and glycoursodeoxycholic acid in girls were significantly higher than those in boys (199.0 (66.9, 276.5) vs. 154.7 (49.3, 205.0) nmol/L, 274.0 (64.8, 308.0) vs. 181.0 (43.8, 209.3) nmol/L, Z=2.06, 2.71, both P<0.05). The serum taurolithocholic acid in both boys and girls were positively correlated with age (r=0.31, 0.32, both P<0.05). The serum chenodeoxycholic acid and glycochenodeoxycholic acid in the boys group were positively correlated with age (r=0.20, 0.23, both P<0.05), whereas the serum tauroursodeoxycholic acid in the girls group was negatively correlated with age (r=-0.27, P<0.05), and the serum cholic acid was positively correlated with age (r=0.34, P<0.05). Conclusions: The total bile acid levels are relatively stable in healthy children in Zhejiang province. However, individual bile acids showed gender differences and were correlated with age.

Study on Influencing Factors of Artificial Hip Joint Test Quality Based on ISO/IEC 17025 and GLP / 中国医疗器械杂志

OBJECTIVE@#Taking artificial hip joint test as the object, integrating ISO/IEC 17025 and GLP, and establishing a new set of management requirements for test influence factors.@*METHODS@#The requirements of ISO/IEC 17025 and GLP regulations for influencing factors were compared and analyzed, the similarities and differences were found, and the two were integrated to formulate new management requirements for each influencing factor.@*RESULTS@#From the personnel, equipment, materials, methods, reports, filing and other factors, a set of management requirements in line with ISO/IEC 17025 and GLP was formulated, so that the laboratory can provide the objective, real and accurate test data for medical equipment manufacturers and regulatory authorities.@*CONCLUSIONS@#It can improve the test quality of the laboratory and ensure the authenticity and reliability of the test data and conclusions.

Statistical process control of manufacturing tablets for antiretroviral therapy

Abstract In this study, the manufacturing process of lamivudine (3TC) and zidovudine (AZT) tablets (150+300 mg respectively) was evaluated using statistical process control (SPC) tools. These medicines are manufactured by the Fundação para o Remédio Popular "Chopin Tavares de Lima" (FURP) laboratory, and are distributed free of charge to patients infected with HIV by the Ministry of Health DST/AIDS national program. Data of 529 batches manufactured from 2012 to 2015 were collected. The critical quality attributes of weight variation, uniformity of dosage units, and dissolution were evaluated. Process stability was assessed using control charts, and the capability indices Cp, Cpk, Pp, and Ppk (process capability; process capability adjusted for non-centered distribution; potential or global capability of the process; and potential process capability adjusted for non-centered distribution, respectively) were evaluated. 3TC dissolution data from 2013 revealed a non-centered process and lack of consistency compared to the other years, showing Cpk and Ppk lower than 1.0 and the chance of failure of 2,483 in 1,000,000 tablets. Dissolution data from 2015 showed process improvement, revealed by Cpk and Ppk equal to 2.19 and 1.99, respectively. Overall, the control charts and capability indices showed the variability of the process and special causes. Additionally, it was possible to point out the opportunities for process changes, which are fundamental for understanding and supporting a continuous improvement environment.

Manual de bioseguridad y biocustodia del Instituto Nacional de Salud / Manual of biosafety and biosecurity of the National Institute of Health

La publicación describe las medidas de bioseguridad y biocustodia para la protección de la salud del personal de los laboratorios, áreas de apoyo, áreas de experimentación animal y bioterios mediante medidas y recomendaciones en bioseguridad y biocustodia

O FeliciLab, a inovação e a pandemia de covid-19 / FeliciLab, innovation and the covid-19 pandemic / El FeliciLab, la innovación y la pandemia de covid-19

Com o fim de propiciar um ambiente que possibilite decisões ágeis, criativas e efetivas no sistema de saúde, o Laboratório de Inovações no SUS do Ceará (FeliciLab) tem adotado o uso de métodos inovadores de gestão de projetos. Este relato de experiência tem como objetivo apresentar como a Escola de Saúde Pública do Ceará (ESP/CE) conseguiu, através do FeliciLab, orquestrar um conjunto de pessoas, métodos e tecnologias capazes de provocar uma quebra em padrões até então apresentados no mercado de tecnologias direcionadas para o sistema de saúde, diante da crise sanitária ocasionada pela pandemia de covid-19. Com adoção de metodologias mais ágeis de condução de trabalho e gerenciamento de crises, ampliou-se a percepção de valor da tecnologia da informação (TI) da ESP/CE, nutrida pela compreensão de que inovar é mais do que produzir e implantar tecnologias: trata-se de transformar os modos de criar e consumir soluções, de forma a impactar os contextos e as experiências das pessoas.

In order to provide an environment with agile, creative, and effective decisions in the health system, the Felicilab laboratory has been adopting the use of innovative project management methods. This experience report aims to present how the Escola de Saúde Pública do Ceará (ESP/CE), Brazil, had managed to orchestrate, through FeliciLab, a set of people, methods, and technologies from a disruptive perspective of standards hitherto presented in the market of technologies directed to the health system, in face of the health crisis caused by the covid-19 pandemic. With the adoption of more agile methodologies for conducting work and managing crisis, the perception of the value of the Information technology (IT) used at ESP/CE was expanded, understanding that innovating is more than producing and implementing technologies: it means transforming the ways of creating and consume solutions in order to impact on personal experiences and their context.

A fin de propiciar un ambiente con decisiones ágiles, creativas y efectivas en el sistema de salud, el Laboratório de Inovações no SUS do Ceará (FeliciLab) tiene adoptado el uso de métodos innovadores de gestión de proyectos. Este relato de experiencia tiene como objetivo presentar cómo la Escola de Saúde Pública do Ceará (ESP/CE), a través del FeliciLab, ha conseguido orquestar un conjunto de personas,nmétodos y tecnologías capaces para quebrar estándares hasta entonces presentados en el mercado de tecnologías dirigidas al sistema de salud, frente a la crisis de salud provocada por la pandemia de Covid-19. Con la adopción de metodologías más ágiles para la realización del trabajo y la gestión de crisis, se amplió la percepción del valor de la tecnología de la información (TI) ESP/CE, alimentada por el entendimiento de que innovar es más que producir e implementar tecnologías: se trata de transformar formas de crear y consumir soluciones para impactar los contextos y las experiencias de las personas.

Directrices de laboratorio para la detección y el diagnóstico de la infección por el virus de la viruela del mono / Laboratory Guidelines for the Detection and Diagnosis of Monkeypox Virus Infection

Este documento está basado en la guía provisional de la Organización Mundial de la Salud sobre las pruebas de laboratorio para el virus de la viruela del mono, 23 de mayo de 2022, y tiene por objeto proporcionar orientación a los Laboratorios Nacionales de Referencia sobre la detección del virus de la viruela del mono

This document is based on World Health Organization interim guidance on Laboratory testing for monkeypox virus, 23 May 2022, and is intended to provide guidance to National Reference Laboratories on monkeypox virus laboratory detection

Alternativa rápida de extracción de ADN en quistes de Acanthamoeba para uso en el laboratorio de análisis clínicos / Rapid DNA extraction alternative in cysts of Acanthamoeba for use in clinical analysis laboratory

Resumen El objetivo del estudio fue comparar la extracción de ADN de quistes de Acanthamoeba sp. con un método disponible comercialmente y cuatro no comerciales utilizando tratamiento térmico y ultrasonido para la amplificación por una reacción en cadena de la polimerasa (PCR) convencional, reduciendo tiempos de preparación y extracción de las muestras, como una herramienta para el diagnóstico en el laboratorio clínico. Se utilizó una cepa de Acanthamoeba, genotipo T4, cultivada en agar no nutritivo. Los quistes para analizar, en tres períodos de enquistamiento, se almacenaron a temperatura ambiente. Se extrajo ADN mediante cinco métodos: pretratamiento térmico, ultrasonido y combinaciones de ellos. La PCR se llevó a cabo utilizando cebadores específicos JDP1/JDP2. La concentración y pureza del ADN extraído con los protocolos evaluados revelaron diferencias estadísticamente significativas (p<0,0001). El método E (comercial), el A (térmico) y el B (ultrasonido) lograron los mejores rendimientos en la amplificación del fragmento específico de Acanthamoeba sp. por la PCR convencional.

Abstract The objective of the study was to compare the DNA extraction of Acanthamoeba sp. cysts with a commercially available method and four non-commercial ones, with heat and ultrasound treatment that allows amplification by conventional polymerase chain reaction (PCR), reducing sample preparation and extraction times, such as a tool for diagnosis in the clinical laboratory. To this aim, a strain of Acanthamoeba T4 grown on non-nutrient agar was used. Plates with cysts at three different encystation times were stored at room temperature until the study was carried out. DNA was extracted with five methods that included pretreatments (thermal and ultrasound) or combinations of them. PCR was performed using specific primers JDP1/JDP2. Concentration and purity of DNA revealed statistically significant differences (p<0.0001) between methods. Method E (commercial), method A (thermal) and B (ultrasound) got the best yields in amplifying the specific fragment of Acanthamoeba sp. by conventional PCR.

Resumo O objetivo do estudo foi comparar a extração de DNA de cistos de Acanthamoeba sp. com um método comercialmente disponível e quatro não comerciais utilizando tratamento térmico e ultrassom para amplificação por reação em cadeia da polimerase (PCR) convencional, reduzindo os tempos de preparo e extração das amostras, como ferramenta para o diagnóstico no laboratório clínico. Foi utilizada uma cepa de Acanthamoeba, genótipo T4, cultivada em ágar não nutritivo. Os cistos para analisar foram armazenados em temperatura ambiente, correspondendo a três períodos de encistamento. O DNA foi extraído por cinco métodos: pré-tratamento térmico, ultrassom e combinações deles. A PCR foi realizada usando iniciadores específicos JDP1/JDP2. A concentração e a pureza do DNA extraído com os protocolos avaliados revelaram diferenças estatisticamente significativas (p<0,0001). Os métodos E (comercial), A (térmico) e B (ultrassom) alcançaram os melhores rendimentos na amplificação do fragmento específico de Acanthamoeba sp. por PCR convencional.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Presentación atípica de celulitis orbitaria en recién nacido / Typical Orbital Cellulitis Presentation in Newborn

La celulitis orbitaria representa una causa frecuente de inflamación de la órbita, constituyendo una urgencia médica que requiere un manejo multidisciplinario. Se presenta caso de una recién nacida con clínica de aumento de volumen en región bipalpebral derecha y fiebre de 24 horas de evolución. Al examen físico se evidencia proptosis de ojo derecho, aumento de volumen bipalpebral que impide la apertura del globo ocular en su totalidad con signos de flogosis y secreción purulenta en borde palpebral. Los laboratorios reportan leucocitosis y trombocitosis reactiva; tomografía de orbita muestra tumefacción y edema periorbitario derecho, aumento difuso de densidad grasa post-septal extra e intraconal, hallazgos sugestivos de celulitis orbitaria derecha. Se indica antibioticoterapia con vancomicina y cefotaxime, ameritando además drenaje de absceso, obteniéndose secreción purulenta, en la que se aísla Estafilococo aureus meticilino resistente. Siendo una patología inusual en este grupo etario, se recomienda la publicación de este caso(AU)

Orbital cellulitis represents a frequent cause of inflammation of the orbit, constituting a medical emergency that requires multidisciplinary management. We present a case of a newborn with clinic of volume increase in right bipalpebral region and fever of 24 hours of evolution. Physical examination reveals proptosis of right eye, increase of bipalpebral volume that prevents the opening of the eyeball in its entirety with signs of flushing and purulent eyelid margin secretion. Laboratories report leukocytosis and reactive thrombosis; orbital tomography scan shows right periorbital swelling and edema, diffuse increase of extra and intraconal post-septal fat density, suggestive findings of right orbital cellulitis, covered with vancomycin and cefotaxime; subsequently requires abscess drainage where Staphylococcus aureus methycilin- resistant is isolated. Being an unusual pathology in this age group, the publication of this case is recommended(AU)

Utilidad de la plasmaféresis terapéutica en pacientes críticos con disfunción orgánica / Usefulness of therapeutic plasmapheresis in critical patients with organ dysfunction

Introducción: La aféresis terapéutica es el procedimiento que separa y remueve el plasma de la sangre total, con el objetivo de eliminar componentes considerados responsables patógenos de una enfermedad o de sus manifestaciones clínicas Objetivos: Analizar los aspectos generales de la aplicación de la técnica de plasmaféresis como alternativa de tratamiento en pacientes críticos con disfunción orgánica. Métodos: Se realizó una investigación bibliográfica-documental acerca del tema. Se consultaron fundamentalmente las bases de datos de SciELO y Pubmed de los últimos diez años. Análisis y síntesis de la información: Se describen los aspectos de la plasmaféresis, desde sus criterios de indicación; así como la aplicación del procedimiento en los pacientes con disfunción orgánica y sus resultados en la evolución del paciente. Conclusiones: Con la utilización de la plasmaféresis se encontró mejoría de los parámetros clínicos y de laboratorio en la mayoría de los pacientes en disfunción orgánica al egreso de la unidad de cuidados intensivos(AU)

Introduction: Therapeutic apheresis is the procedure that separates and removes plasma from whole blood, thus eliminating components considered pathogenic of a disease or its clinical manifestations. Objectives: To analyze the general aspects of de application of the plasmapheresis technique as an alternative treatment in oncohematological patients wish organic dysfunction. Methods: A bibliographic- documentary investigation was carried out on de subject The Scielo and Pubmed data bases were consulted. Analysis and synthesis of information: The technical aspects of plasmapheresis are described, based on its indication criteria, as well as the application of de technique in patients with organic dysfunction and its results in the evolution of the patient. Conclusions: With the use of the plasmapheresis technique improvement in clinical and laboratory parameters was found in the majority of organ dysfunction patients upon discharge from the intensive care unit(AU)

Retratos do cotidiano em Manguinhos / Portraits of everyday activities at Manguinhos

Resumo O texto aqui comentado reconstitui o cotidiano no Instituto Oswaldo Cruz no começo do século XX com base em depoimentos de antigos funcionários. "Os escravos são as mãos e os pés do senhor do engenho" - escreveu Antonil em 1711. Cada laboratório do instituto era como um pequeno engenho onde as mãos e os pés dos pesquisadores eram seus serventes, que executavam desde as tarefas mais desqualificadas até operações bem delicadas da pesquisa científica, atualmente confiadas a técnicos formados em escolas próprias. As habilidades dos primitivos técnicos, muitos recrutados ainda meninos nas oficinas da instituição, eram adquiridas empiricamente. O instituto era moderno por suas atividades, mas as relações de trabalho traziam as marcas de uma sociedade agrária e patriarcal, recém-egressa da escravidão.

Abstract This text reconstructs everyday routines at the Oswaldo Cruz Institute in the early twentieth century based on statements from staff at that time. As Antonil wrote in 1711, "Slaves are the hands and feet of the sugar-mill owner." The researchers' assistants fulfilled a similar role in the laboratories; their work ranged from unskilled tasks to extremely delicate scientific research that today requires specialized training. These early technicians, many recruited as boys in the institution's workshops, acquired their skills empirically. While the institute carried out modern activities, labor relations there still bore the marks of an agrarian and patriarchal society that had only recently abandoned slavery.

Laboratorios tradicionales versus nuevas tecnologías para el estudio de anatomía humana en estudiantes de medicina: revisión sistemática y meta análisis / Traditional laboratories versus new technologies for the study of human anatomy in medical students: a systematic review and meta-analysis

RESUMEN: El estudio de la anatomía humana, ha transcendido con diversos recursos y escenarios. El objetivo fue compararlos estudios publicados sobre prácticas de laboratorio tradicionales con nuevas tecnologías para el estudio del cuerpo humano en estudiantes de medicina. Se realizó revisión sistemática y meta-análisis. Cuatro revisores efectuaron búsqueda sistemática y exhaustiva de la literatura, a partir de la localización y selección de 54 estudios primarios publicados en diez bases de datos, tres revisores cegados evaluaron calidad metodológica de 33 estudios, con listas de chequeo para la evaluación crítica de la validez interna, según tipo de estudio y el cuarto revisor cegado, calculó grado de acuerdo entre revisores con Kappa de Fleiss y valoró riesgo de sesgo, sensibilidad, heterogeneidad y análisis combinado a través del Software RevMan 5.4. Se obtuvo revisión sistemática cualitativa y combinación mediante métodos estadísticos de los resultados con meta-análisis de siete estudios primarios, con muestra de 465 participantes, 260 expuestos a laboratorios tradicionales y 205 a nuevas tecnologías. Encontrando satisfacción del proceso y resultados positivos de aprendizaje comprensión y aplicación con favorabilidad inicial a las prácticas tradicionales no significativa al valorar los intervalos de confianza. Así, el contraste entre métodos para estas prácticas reveló desenlaces relacionados con reacciones físico-emocionales, focalización en el constructo rendimiento académico y con los procesos de aprendizaje. Concluyendo que los laboratorios con nuevas tecnologías para estudio de anatomía, no impactan en forma prerrogativa a los estudiantes, dada su experiencia favorable con los laboratorios tradicionales, y pueden emplearse como una estrategia útil complementaria.

SUMMARY: The study of human anatomy has transcended with various resources and scenarios. The objective was to compare published studies on traditional laboratory practices with new technologies for the study of the human body in medical students. A systematic review and meta-analysis were carried out. Four reviewers carried out a systematic and exhaustive search of the literature, based on the location and selection of 54 primary studies published in ten databases, three reviewers evaluated the methodological quality of 33 studies, with checklists for the critical evaluation of internal validity, according to type of study. The fourth blinded reviewer, calculated degree of agreement between reviewers with Kappa de Fleiss and assessed risk of bias, sensitivity, heterogeneity and combined analysis using RevMan 5.4. A qualitative systematic review and combination by statistical methods of the results were obtained with meta-analysis of seven primary studies, with a sample of 465 participants, 260 exposed to traditional laboratories and 205 to new technologies. Finding satisfaction with the process and positive results of learning, understanding and application, with initial favorability to traditional practices not significant when assessing the confidence intervals. Thus, the contrast between methods for these practices revealed outcomes related to physical-emotional reactions, focus on the academic performance construct and with the learning processes. Concluding that laboratories with new technologies for the study of anatomy do not prerogatively impact students, given their favorable experience with traditional laboratories, and can be used as a useful complementary strategy.

Eritrocitosis patológicas con niveles de eritropoyetina baja e incrementada: características clínicas y laboratoriales / Pathological erythrocytosis with low and increased erythropoietin levels: clinical and laboratory characteristics

RESUMEN: Introducción: Los pacientes con eritrocitosis patológicas en la altura, Eritrocitosis Secundaria o Eritrocitosis Patológica de Altura, ocasionalmente suelen presentar niveles de eritropoyetina (EPO) con variaciones notables respecto de los parámetros normales, reflejando ya sea concentraciones muy bajas o muy altas de EPO. Objetivo: Analizar la prevalencia de las eritrocitosis con EPO disminuida y de las eritrocitosis con EPO incrementada, así como, las características laboratoriales y clínicas inmiscuidas entre ellas. Material y Métodos: Se realizó un estudio descriptivo transversal de tipo retrospectivo. Se analizó historias clínicas de 44 pacientes eritrocíticos; de estos, 22 pacientes (5 mujeres, 17 varones) con registros de EPO sérica disminuida (100 mUI/ml) que constituyeron el Grupo 2. Todos ellos residentes a una altura >3650 m s. n. m. Se recolectó datos demográficos, clínicos y laboratoriales; asimismo, datos referentes a los tratamientos administrados, seguimiento y respectivas respuestas en ambos grupos. Resultados: La frecuencia de las eritrocitosis patológicas con EPO disminuida representó 5 % y de aquellas con EPO elevada 5 %.: Se debe considerar estudios específicos en pacientes eritrocíticos con EPO baja para descartar Policitemia Vera, asimismo, los pacientes con EPO incrementada implican mayor complejidad en el manejo médico.

ABSTRACT: Introduction: Patients with pathological erythrocytosis at high altitude, Secondary Erythrocytosis or High Altitude Pathological Erythrocytosis, occasionally present notable variations of erythropoietin (EPO) levels regarding normal parameters, reflecting either very low or very high EPO concentrations. Objective: To analyze the prevalence of erythrocytosis with decreased EPO and erythrocytosis with increased EPO, as well as the laboratory and clinical characteristics involved between them. Material and methods: A retrospective cross-sectional descriptive study was conducted. Clinical records of 44 patients with erythrocytosis were analyzed; of these, 22 (5 women, 17 men) with records of decreased serum EPO (100 mIU/ml) ml) specified as Group 2. All of them were high altitude dwellers (>3650 m a. s. l). Demographic, clinical and laboratory data were collected, including data about administered treatments, follow-up and responses in both groups. Results: Frequency of pathological erythrocytosis with decreased EPO was 5% and with elevated EPO 5%. There were no representative differences between both groups concerning the CBC variables. Patients with increased EPO showed more complications of erythrocytosis (27%) compared to those with decreased EPO (0%). Two types of treatment regimen were evidenced in each group: a) ATV+ASA, and b) ATV+ASA+HU. Erythrocytosis patients with decreased EPO receiving ATV+ASA had higher favorable responses 90% versus those with elevated EPO (80%). The ATV+ASA+HU regimen reflected better applicability in the increased EPO group. Conclusion: Specific studies should be considered in erythrocytosis patients with decreased EPO to rule out Polycythemia Vera, similarly, patients with increased EPO imply more complexity at medical management.