Transient elastography and APRI score: looking at false positives and false negatives. Diagnostic performance and association to fibrosis staging in chronic hepatitis C

Although long regarded as the gold standard for liver fibrosis staging in chronic hepatitis C (CHC), liver biopsy (LB) implies both the risk of an invasive procedure and significant variability. The aim of this study was to evaluate the diagnostic performance for transient elastography (TE) and aspartate aminotransferase to platelet index (APRI) used alone and in combination compared to liver biopsy and to analyze false positive/negative results. Patients with CHC, and no previous clinical diagnosis of cirrhosis were enrolled to undergo liver biopsy, TE and APRI. A total of 182 adult patients with a median age of 55 years and median body mass index of 26.71 kg/m2 were analyzed. On LB, 56% of patients had significant levels of fibrosis (METAVIR F≥2) and 28% had advanced fibrosis (F3/F4). The strongest performance for both tests was observed for exclusion of advanced fibrosis with good negative predictive values (89 and 86%, respectively). Low necroinflammatory activity on LB was associated with false negative TE. False positives were associated with NASH and smaller LB fragments. Correlation between APRI and Fibroscan for F≥2 was 100% and 84% for F≥3 and remained high in both false negative and false positive instances, correctly identifying F<2 in 71% of cases and F<3 in 78% (and potentially foregoing up to 84% of LB). We concluded that low individual performance indicators could be attributable to limitations of LB. Poorer differentiation of lower levels of fibrosis is a known issue for LB and remains so for noninvasive tests. Good predictability is possible, however, for advanced fibrosis.

Osteossíntese de úmero em pombos domésticos (Columba livia) associando-se pinos metálicos e polimetilmetacrilato intramedulares após osteotomia diafisária / Humerus osteosynthesis using intramedullary pins and polymethylmethacrylate in domestic pigeons (Columba livia)

Foram utilizadas 28 aves adultas, separadas aleatoriamente em quatro grupos. Os pombos foram anestesiados com isoflurano para a realização da osteotomia diafisária transversa do úmero direito. No grupo I, a osteossíntese foi realizada associando-se dois pinos de Kirschner e polimetilmetacrilato, intramedulares; no grupo II, os pinos de Kirschner foram substituídos por pinos de Schanz; no grupo III, foram utilizados apenas dois pinos de Kirschner; e, no grupo IV, apenas dois pinos de Shanz. Os tempos médios para a consolidação óssea foram de 29±4,04 dias no grupo I; 24±5,29 dias no grupo II; 33±3,74 dias no grupo III; e 32,9±5,21 dias no grupo IV. Foi observada migração dos pinos em 42,9 por cento dos animais do grupo I, em 0 por cento nos do grupo II, em 85,7 por cento nos do grupo III, e em 28,6 por cento nos do grupo IV. Em duas aves dos grupos I, III e IV notou-se incapacidade de voar. Os resultados demonstram que a associação de dois pinos de Schanz e polimetilmetacrilato, ambos intramedulares, é um método efetivo para osteossíntese de úmero em pombos domésticos (Columba livia), proporcionando rápida consolidação óssea e mínimas complicações.

Twenty-eight adult domestic pigeons (Columba livia) were randomly divided into four groups of seven birds each. Anesthesia was performed with isoflurane and oxygen, and an osteotomy of the right humerus midshaft was performed with an electric cutter. On the sequence, one of the following treatments was chosen: group I, two Kirschner pins and polymethylmethacrylate intramedullary; group II, two Schanz pins and polymethylmethacrylate intramedullary; group III, two Kirschner pins only; and group IV, two Schanz pins only. The mean time ± standard deviation for fracture healing was 29±4.04 days in group I; 24±5.29 days in group II; 33±3.74 days in group III; 32.9±5.21 days in group IV. Pin migration was observed in 42.9 percent of the group I animals, 0 percent of group II, 85.7 percent of group III, and 28.6 percent of group IV. Two pigeons of groups I, III, and IV presented flight incapability. The results suggest that two Schanz pins and polymethylmethacrylate intramedullary are an effective method of humeral ostheosynthesis in domestic pigeons (Columba livia), resulting in faster fracture healing with minimal complications.

Soroprevalência de brucelose canina na cidade de Alfenas, MG. dados preliminares / Serum prevalence of canine brucellosis in Alfenas city MG, Brazil, Preliminary data

One hundred and two blood serum samples from dogs referred to the Veterinary Teaching Hospital of Alfenas University, were submitted to the agarose immune diffusion and to the fast serum-agglutination tests addressed to find antibodies anti-Brucella canis and B. abortus, respectively. Five samples (4.9 percent) were positives for B.canis and none for B. abortus. This prevalence is considered by some as an alert for an epidemiologic and public healthy problems, considering the serious zoonotic aspect of canine brucellosis