VI Brazilian consensus guidelines for detection of anti-cell autoantibodies on HEp-2 cells

Abstract Background: The VI Brazilian Consensus on Autoantibodies against HEp-2 cells for determination of autoantibodies against cellular constituents on HEp-2 cells was held on September, 2019, in Fortaleza (CE, Brazil). The guidelines in this edition were formulated by the group of Brazilian experts discussing the classification of complex patterns, the classification of the nuclear discrete dots (few and multiple), the identification of the discrete fine speckled pattern (AC-4a) and improvements on the ANA report. Mainbody: Sixteen Brazilian researchers and experts from universities and clinical laboratories representing the various geographical regions of Brazil participated in the meeting. Four main topics were discussed: (1) How to classify patterns with fluorescence in more than one cell compartment considering three relevant categoris: composite patterns, mixed patterns and multiple patterns; (2) The splitting of the discrete nuclear dots pattern into the multiple discrete nuclear dots (AC-6) and few discrete nuclear dots (AC-7) patterns, respectively; (3) Inclusion of a novel nuclear pattern characterized by discrete fine speckled pattern highly associated with antibodies to SS-A/Ro60, classified as AC-4a. In addition, adjustments on the Brazilian Consensus nomenclature were implemented aiming to harmonize the designation of some patterns with the International Consensus on ANA Patterns (ICAP). Furthermore, the designations of the PCNA-like pattern (AC-13), CENP-F-like pattern (AC-14) and Topo I-like pattern (AC-29) were adjusted in accordance to ICAP. Finally, there was a recommendation for adjustment in the test report in order to address the status of nuclear envelope staining. For all topics, the aim was to establish specific guidelines for laboratories and clinicians. All recommendations were based on consensus among participants. All recommendations from the V Consensus were maintained and there was relevant progress in the BCA/HEp-2 guidelines and further harmonization with ICAP. Conclusion: The VI BCA/HEp-2 edition was successful in establishing important recommendations regarding the classification of complex patterns, in supporting the identification of a novel pattern within the AC-4 group and in the harmonization process with the ICAP terminology.

Canine endogenous adrenocorticotrophic hormone preanalytical stability after sample shipping in dry ice or recyclable ice bars / Estabilidade pré-analítica do hormônio adrenocorticotrófico endógeno canino após remessa de amostras em gelo seco ou com barras de gelo reciclável

ABSTRACT: Endogenous adrenocorticotrophic hormone (eACTH) measurement is useful in hypercortisolism and hypoadrenocorticism investigation; however, since the hormone is highly unstable, blood samples require proper processing and storage, as well as shipping is often a step limiting since few laboratories offer this assay in Brazil. The aim of this note was to compare overnight dog´s eACTH preanalytical stability when frozen samples were shipped in dry ice (DI), or with recyclable ice bars (RIB). A total of 56 paired samples for eACTH measurement were analyzed. Blood samples were properly handled, plasma aliquots transferred into plastic microtubes, and stored at -80ºC. The fifty-six paired samples were overnight shipped in two thermic isolated boxes with DI or involved by RIB. Despite there was a high correlation between results from both shipping methods (r Spearman = 0.958, P<0.001), the Wilcoxon matched-pairs rank test showed that the shipping method may influence results (P<0.001). However, this difference does not affect results interpretation. By this way, when DI shipping was not possible, RIB shipping may represent a risk to eACTH preanalytical stability.

RESUMO: A mensuração do hormônio adrenocorticotrófico endógeno (ACTHe) é útil na investigação do hipercortisolismo e hipoadrenocorticismo. No entanto, como o hormônio é bastante instável, as amostras de sangue necessitam um manejo adequado no processamento e armazenamento, assim como o envio para laboratórios pode ser um passo limitante, uma vez que poucos laboratórios oferecem este ensaio no Brasil. O objetivo deste trabalho foi comparar a estabilidade pré-analítica do ACTHe durante longo período de envio de amostras congeladas em gelo seco (GS), ou com barras de gelo reciclável (BGR). Um total de 56 amostras pareadas para mensuração de ACTHe foram analisadas. As amostras de sangue foram adequadamente manejadas, sendo o plasma transferido para micro tubos plásticos estocados a -80ºC. Os 56 pares de amostras foram enviados à tarde para chegada ao laboratório na manhã seguinte em dois isopores, um com GS e outro com BGR. Apesar de uma alta correlação entre os resultados dos diferentes métodos de envio (r Spearman = 0,958, P<0,001), o teste de Wilcoxon para amostras pareadas mostrou que o método de envio influencia os resultados P<0,001). Apesar desta diferença, os resultados não afetaram a interpretação dos resultados. Desta forma, quando o envio em gelo seco não for possível, o envio das amostras com barras de gelo reciclável pode representar um risco à estabilidade pré-analítica do ACTHe.

Rheumatologist perspective of the Brazilian consensus for detection of auto antibodies in HEp-2 CELLS

Abstract Objective: To evaluate the perception of rheumatologists regarding the recommendations of the Brazilian Consensus for detection of Autoantibodies (BCA) on HEp-2 Cells by Indirect Immunofluorescence assay (IFA) and how BCA recommendations help in clinical practice. Methodology: A structured questionnaire regarding the BCA recommendations for detection and interpretations of autoantibodies in HEp-2 cells was applied to randomly selected rheumatologists. The results were tabulated using the Microsoft® Excel program, expressed as a simple percentage and the dichotomous data were analyzed using the Chi-square test and the Epi Info® program. Results: Four hundred fuorteen rheumatologists participated in the study: 70% of them considered their knowledge of the HEp-2 IFA test satisfactory or excellent, and 43% said they knew the BCA recommendations in general, without distinguishing the edition of the BCA to which they refer. The Revista Brasileira de Rheumatologia/ Advances in Rheumatology was the means of dissemination most consulted by specialists (50%). According to the rheumatologists' opinion, the most relevant pattern was the homogeneous nuclear (78%) and 65% stated they were satisfied with the BCA recommendations at a level of satisfaction greater than or equal to 80%. There was no significant difference in the perception of rheumatologists from the several Brazilian geographic regions. Conclusion: Brazilian rheumatologists are aware of the BCA guidelines and most are satisfied with the content published, considering that the BCA recommendations assist positively in the clinical practice. Most rheumatologists recognize the patterns associated with rheumatic autoimmune diseases and have used BCA recommendations to interpret the results of the HEp-2 IFA test.

Effects of rocuronium, sugammadex and rocuronium-sugammadex complex on coagulation in rats / Efeitos do rocurônio, sugamadex e complexo rocurônio-sugamadex sobre a coagulação em ratos

Abstract Background and objectives: Sugammadex is an alternative pharmacological drug capable of reversing neuromuscular blockades without the limitations that are presented by anticholinesterase drugs. Coagulation disorders that are related to treatment with sugammadex were reported. The exact mechanism of the effects on coagulation are not fully understood. The objective of this research is to evaluate the effects of rocuronium, sugammadex and the rocuronium-sugammadex complex on coagulation in an experimental model in rats. Methods: This is an experimental randomized animal study. Wistar rats were randomly assigned into the following groups: the Control Group; the Ssal Group - 0.5 mL of intravenous saline; the Sugammadex Group - intravenous sugammadex (100 mg kg−1); and the Rocuronium-Sugammadex Group - intravenous solution with rocuronium (3.75 mg kg−1) and sugammadex (100 mg kg−1). Anesthesia was performed by using isoflurane with controlled ventilation. Coagulation factors were measured 10 minutes after the end of the preoperative preparation and 30 minutes after the administration of the drugs in accordance with the chosen groups. Results: Platelet counts, prothrombin times, and activated partial thromboplastin times were similar between the groups and between the moments within each group. There were reductions in the plasma fibrinogen levels between sample times 1 and 2 in the Rocuronium-Sugammadex group (p = 0.035). Conclusions: The rocuronium-sugammadex complex promoted reductions in plasma fibrinogen counts, although the levels were still within normal limits.

Resumo Introdução e objetivos: O sugamadex é uma substância farmacológica alternativa capaz de reverter o bloqueio neuromuscular sem as limitações apresentadas pelos anticolinesterásicos. Entretanto, há relatos de transtornos de coagulação relacionados ao tratamento com sugamadex sem que mecanismos exatos de seus efeitos sobre a coagulação sejam totalmente compreendidos. O objetivo da presente pesquisa foi avaliar os efeitos do rocurônio, sugamadex e do complexo rocurônio-sugamadex sobre a coagulação em um modelo experimental com ratos. Métodos: Este é um estudo randomizado experimental animal. Ratos Wistar foram aleatoriamente designados aos seguintes grupos: grupo controle; Grupo Ssal - 0,5 mL de solução salina intravenosa; Grupo sugamadex - sugamadex intravenoso (100 mg.kg-1); e Grupo rocurônio-sugamadex - solução intravenosa com rocurônio (3,75 mg.kg-1) e sugamadex (100 mg.kg-1). A anestesia foi realizada utilizando-se isoflurano com ventilação controlada. Os fatores de coagulação foram medidos 10 minutos após o final do preparo pré-operatório e 30 minutos após a administração de drogas de acordo com os grupos escolhidos. Resultados: Contagem de plaquetas, tempo de protrombina e tempo de tromboplastina parcial ativada foram semelhantes entre os grupos e entre os momentos dentro de cada grupo. Houve redução nos níveis de fibrinogênio plasmático entre os tempos 1 e 2 no grupo rocurônio-sugamadex (p = 0,035). Conclusões: O complexo rocurônio-sugamadex promoveu reduções na contagem de fibrinogênio plasmático, apesar de os níveis continuarem dentro dos limites normais.

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

V Brazilian consensus guidelines for detection of anti-cell autoantibodies on hep-2 cells

Abstract Background: The V Brazilian Consensus for determination of autoantibodies against cellular constituents on HEp-2 cells, held in Brasilia (DF, Brazil) on August 27, 2016, discussed the harmonization between the Brazilian Consensus on ANA (BCA) guidelines and the International Consensus on ANA Patterns (ICAP) recommendations (www.anapatterns.org). Initial guidelines were formulated by the group of Brazilian experts with the purpose of guiding and enabling Brazilian clinical laboratories to adopt recommendations and to provide a common standard for national and international consensuses. Mainbody: Twenty Brazilian researchers and experts from universities and clinical laboratories representing the various geographical regions of the country participated in the meeting. Three main topics were discussed, namely the harmonization between the BCA guidelines and latest recommendations of the ICAP initiative, the adjustment of the terminology and report on HEp-2 patterns, and a reassessment of quality assurance parameters. For the three topics, our aim was to establish specific guidelines. All recommendations were based on consensus among participants. There was concrete progress in the adjustment of the BCA guidelines to match the ICAP guidelines. To a certain extent, this derives from the fact that ICAP recommendations were largely based on the algorithm and recommendations of the IV Brazilian ANA Consensus, as consistently recognized in the ICAP publications and presentations. However, although there is great overlap between the two Consensuses, there are some point divergences. These specific items were individually and extensively discussed, and it was acknowledged that in several points ICAP improved recommendations previously issued by the Brazilian ANA Consensus and these changes were readily implemented. Regarding some specific topics, the BCA panel of experts felt that the previously issued recommendations remained relevant and possibly will require further discussion with ICAP. The term anti-cell antibodies was adopted as the recommended designation, recognizing that the assay addresses antibodies against antigens in the nucleus and in other cell compartments. However, the acronym ANA HEp-2 was maintained due to historical and regulatory reasons. It was also signalized that the latest trend in ICAP is to adopt the term Indirect Immunofluorescent Assay on HEp-2 cell substrate (HEp-2 IIFA). In addition, the quality assurance strategies previously presented were ratified and emphasized. Conclusion: The V BCA edition was successful in establishing an overall harmonization with the ICAP recommendations for interpretation of the HEp-2 IIFA test, pinpointing the perspectives in filling the remaining gaps between both initiatives.

Herbicides selectivity in pre-budded seedlings of sugarcane / Seletividade de herbicidas em mudas pré-brotadas de cana-de-açúcar

Herbicides are expected to show selectivity towards cultivated plants, i.e., they ought to control weeds without jeopardizing the development and productivity of crops. The objective of this project was to evaluate the selectivity of herbicides applied in pre-planting of three sugar cane cultivars which were planted according to the system of pre-budded seedlings (PBS) under climatic natural conditions, between September and November of 2013. The experiment was set according to a completely random design with four replications. The treatments were distributed according to a factorial scheme of 3 × 8, in which factor A was the cultivar (CTC14, CTC7, and RB966928), and factor B was the herbicide (in g.ha-1): S-metolachlor (2,640), clomazone (1,000), sulfentrazone (800), diclosulam (200), metribuzin (1,920), diuron + hexazione (1,170 + 330), S-metolachlor + sulfentrazone (2,640 + 800), and a no treatment. The visual symptoms of intoxication were evaluated 14, 28, 35, 42, 49, 56, and 63 days after application (DAA), the height and number of tillers 14, 35, 49, 56, and 63 DAA, the dry weight of shoot (DWS), and the dry weight of root (DWR) 63 DAA. Under the conditions of the experiment, the herbicides S-metolachlor, clomazone, metribuzin, diuron + hexazinone, and S-metolachlor + sulfentrazone were selective towards the presprouted sugar-cane plantlets. Diclosulam was the less selective herbicide, followed by sulfentrazone. Cultivar CTC14 was visually the less tolerant to the herbicides diclosulam and sulfentrazone.(AU)

Os herbicidas devem apresentar seletividade às culturas agrícolas, ou seja, controlar as plantas daninhas sem comprometer o desenvolvimento nem a produtividade da cultura. O objetivo deste trabalho foi avaliar a seletividade de herbicidas aplicados em pré-plantio de três cultivares de cana-de-açúcar plantados pelo sistema de mudas pré-brotadas (MPB). O experimento foi desenvolvido na Usina São Martinho, próximo ao município de Pradópolis (SP), sob condições naturais de clima, no período de setembro a novembro de 2013. O delineamento experimental utilizado foi o inteiramente casualizado, com quatro repetições. Os tratamentos foram distribuídos em esquema fatorial (3 × 8), sendo o fator A composto de três cultivares: CTC14, CTC7 e RB966928; e o fator B por sete herbicidas (em g.ha-1): S-metolachlor (2,640); clomazone (1,000); sulfentrazone (800); diclosulam (200); metribuzin (1,920); diuron + hexazinone (1,170 + 330); S-metolachlor + sulfentrazone (2,640 + 800); mais uma testemunha sem aplicação de herbicidas. Foram avaliados os sintomas visuais de fitointoxicação aos 14, 28, 35, 42, 49, 56 e 63 dias após aplicação (DAA), a altura e o número de perfilhos dos cultivares aos 14, 35, 49 e 63 DAA, a massa seca da parte aérea (DWS) e a massa seca do sistema radicular (MSSR) aos 63 DAA. Nas condições em que o experimento foi conduzido, os herbicidas S-metolachlor, clomazone, metribuzin, diuron + hexazinone e S-metolachlor + sulfentrazone foram seletivos às mudas pré-brotadas de cana-de-açúcar. O herbicida diclosulam foi o menos seletivo, seguido do sulfentrazone. O cultivar CTC14 apresentou-se visualmente menos tolerante aos herbicidas diclosulam e sulfentrazone.(AU)

Herbicides selectivity in pre-budded seedlings of sugarcane / Seletividade de herbicidas em mudas pré-brotadas de cana-de-açúcar

Herbicides are expected to show selectivity towards cultivated plants, i.e., they ought to control weeds without jeopardizing the development and productivity of crops. The objective of this project was to evaluate the selectivity of herbicides applied in pre-planting of three sugar cane cultivars which were planted according to the system of pre-budded seedlings (PBS) under climatic natural conditions, between September and November of 2013. The experiment was set according to a completely random design with four replications. The treatments were distributed according to a factorial scheme of 3 × 8, in which factor A was the cultivar (CTC14, CTC7, and RB966928), and factor B was the herbicide (in g.ha-1): S-metolachlor (2,640), clomazone (1,000), sulfentrazone (800), diclosulam (200), metribuzin (1,920), diuron + hexazione (1,170 + 330), S-metolachlor + sulfentrazone (2,640 + 800), and a no treatment. The visual symptoms of intoxication were evaluated 14, 28, 35, 42, 49, 56, and 63 days after application (DAA), the height and number of tillers 14, 35, 49, 56, and 63 DAA, the dry weight of shoot (DWS), and the dry weight of root (DWR) 63 DAA. Under the conditions of the experiment, the herbicides S-metolachlor, clomazone, metribuzin, diuron + hexazinone, and S-metolachlor + sulfentrazone were selective towards the presprouted sugar-cane plantlets. Diclosulam was the less selective herbicide, followed by sulfentrazone. Cultivar CTC14 was visually the less tolerant to the herbicides diclosulam and sulfentrazone.

Os herbicidas devem apresentar seletividade às culturas agrícolas, ou seja, controlar as plantas daninhas sem comprometer o desenvolvimento nem a produtividade da cultura. O objetivo deste trabalho foi avaliar a seletividade de herbicidas aplicados em pré-plantio de três cultivares de cana-de-açúcar plantados pelo sistema de mudas pré-brotadas (MPB). O experimento foi desenvolvido na Usina São Martinho, próximo ao município de Pradópolis (SP), sob condições naturais de clima, no período de setembro a novembro de 2013. O delineamento experimental utilizado foi o inteiramente casualizado, com quatro repetições. Os tratamentos foram distribuídos em esquema fatorial (3 × 8), sendo o fator A composto de três cultivares: CTC14, CTC7 e RB966928; e o fator B por sete herbicidas (em g.ha-1): S-metolachlor (2,640); clomazone (1,000); sulfentrazone (800); diclosulam (200); metribuzin (1,920); diuron + hexazinone (1,170 + 330); S-metolachlor + sulfentrazone (2,640 + 800); mais uma testemunha sem aplicação de herbicidas. Foram avaliados os sintomas visuais de fitointoxicação aos 14, 28, 35, 42, 49, 56 e 63 dias após aplicação (DAA), a altura e o número de perfilhos dos cultivares aos 14, 35, 49 e 63 DAA, a massa seca da parte aérea (DWS) e a massa seca do sistema radicular (MSSR) aos 63 DAA. Nas condições em que o experimento foi conduzido, os herbicidas S-metolachlor, clomazone, metribuzin, diuron + hexazinone e S-metolachlor + sulfentrazone foram seletivos às mudas pré-brotadas de cana-de-açúcar. O herbicida diclosulam foi o menos seletivo, seguido do sulfentrazone. O cultivar CTC14 apresentou-se visualmente menos tolerante aos herbicidas diclosulam e sulfentrazone.

Effect of electrical and controlled atmosphere stunning methods on broiler chicken behavior at slaughter, blood stress indicators and meat traits / Efeito da eletronarcose e do método de insensibilização por atmosfera controlada no comportamento das aves ao abate, nos indicadores sanguíneos de estresse e nas características da carne

Brazil is the world's largest exporter and third largest producer of chicken meat. To maintain competitiveness, the productive sector must always be alert to consumer demands, and concern about animal welfare is a growing tendency. Aspects involving animal welfare are especially critical in the slaughter of broiler chickens. This study evaluated the stunning of chickens in a CO2- enriched atmosphere chamber to reduce bird stress, comparing with electrical water bath stunning, the most usual desensitization method used in chicken slaughter. The reaction of birds when exposed to a high CO2 concentration (30%) and to a 10% initial CO2 level, gradually elevated to 30% was compared. The effect of mixing argon with CO2 was also evaluated, always aiming to reduce the discomfort of birds. In all the gas stunning parameters evaluated, evident discomfort reactions before stunning were observed in about two thirds of the birds, but the blood levels of corticosterone and glucose, used as stress indicators, indicated that gas increased the birds' welfare. Gas exposure time required to stun the birds and time to regain consciousness after exiting the gas chamber presented a wide variation. Controlled atmosphere stunning method facilitated bird handling during slaughter, but more studies will be necessary to develop this technological alternative and make it viable for industrial use.(AU)

O Brasil é o maior exportador e terceiro maior produtor mundial de carne de frango. A fim de manter a competitividade, o setor produtivo deve estar sempre alerta às exigências dos consumidores e a preocupação com o bem-estar animal é uma tendência crescente. Aspectos envolvendo bem-estar animal são particularmente críticos no abate de frangos de corte. Este estudo avaliou a insensibilização de frangos em uma câmara com atmosfera enriquecida deCO2para reduzir o estresse das aves, em comparação com a insensibilização elétrica em cuba d'água, o método de atordoamento mais usual no abate de frangos. Foi comparada a reação das aves quando expostas a uma alta concentração de CO2 (30%) ou a uma concentração inicial de 10% de CO2, elevada gradualmente até 30%. O efeito da mistura de argônio com CO2 também foi avaliado, sempre visando a redução das reações de desconforto das aves. Cerca de dois terços das aves apresentaram reações evidentes de desconforto antes do atordoamento, em todos os parâmetros de insensibilização gasosa utilizados, porém, as concentrações sanguíneas de corticosterona e glicose, usados como indicadores de estresse, indicaram que a insensibilização com CO2 promoveu o bem-estar das aves. O tempo de exposição ao CO2 necessário para o atordoamento das aves e o tempo de recuperação da consciência após a saída da câmara de gás apresentou ampla variação. A insensibilização por atmosfera controlada de CO2 facilitou o manejo das aves durante o abate, mas serão necessários mais estudos para desenvolver essa alternativa tecnológica, de forma a torná-la viável para aplicação industrial.(AU)

Cardiocirculatory, biochemical and hemostatic evaluation of dogs with hyperadrenocorticism at diagnosis and after treatment

Hyperadrenocorticism (HAC) is a common endocrinopathy among dogs that causes multisystemic signs. This study was conducted to evaluate cardiocirculatory, biochemical, and hemostatic parameters in dogs with HAC at diagnosis, in addition to verifying whether abnormal parameters could be controlled by initial treatment with trilostane. Fifteen dogs with HAC were assessed by systolic blood pressure measurement, electrocardiography, Doppler echocardiography, serum concentration of troponin I, and biochemical and hemostatic profile at diagnosis and after trilostane therapy. Unlike biochemical parameters, hemostatic and cardiocirculatory parameters were not significantly influenced by the onset of treatment. The authors believe that clinical treatment with trilostane for 3 to 4 months might not be sufficient for the stabilization of cardiocirculatory abnormalities such as hypertension. Therefore, dogs with HAC must receive cardiocirculatory monitoring at diagnosis and during drug treatment.

Ajuste preciso do nível de energia na dieta de frangos de corte para controle do desempenho e da composição lipídica da carne / Accurate adjustment of energy level in broiler chickens diet for controlling the performance and the lipid composition of meat

O objetivo deste experimento foi avaliar a influência da variação do nível de energia metabolizável na dieta de frangos de corte, associada a uma variação proporcional da densidade nutricional da ração, sobre o desempenho das aves e sobre a composição da fração lipídica da carne. Foram avaliados separadamente machos e fêmeas da linhagem Cobb 500. Para análise de desempenho, foi utilizado um delineamento inteiramente casualizado em esquema fatorial 6x3, sendo seis níveis de energia metabolizável na ração (2.800, 2.900, 3.000, 3.100, 3.200 e 3.300kcal kg-1) e três idades ao abate (42, 49 e 56 dias). Foi utilizada a metodologia de superfície de resposta para estabelecer um modelo matemático, explicando o comportamento do peso vivo, do consumo de ração e da conversão alimentar. Para a avaliação da composição da fração lipídica da carne, determinou-se o teor de lipídeos totais e de colesterol na carne do peito, na coxa com pele e na coxa sem pele, seguindo um delineamento inteiramente casualizado em esquema fatorial 3x3x2, sendo três níveis de energia metabolizável na ração (2.800, 3.000 e 3.300kcal kg-1 de ração), três idades ao abate (42, 49 e 56 dias) e dois sexos. A redução da energia metabolizável da ração até valores próximos de 3.000kcal kg-1 não afetou o peso vivo, mas, reduzindo a energia da ração abaixo desse valor, o peso vivo diminui. O consumo de ração foi menor quando o nível energético da ração foi mais alto. A conversão alimentar melhorou de forma proporcional ao aumento do nível energético da ração. O desempenho de todas as aves ficou dentro da faixa considerada adequada para a linhagem. A carne de peito apresentou ...

The purpose of this experiment was to investigate the influence of changes in dietary metabolizable energy level, associated with a proportional nutrient density variation, on broiler chickens performance and on the lipid composition of meat. Males and females Cobb 500 broilers were evaluated separately. Performance evaluation followed a completely randomized design with factorial 6x3 arrangement - six energy levels (2,800, 2,900, 3,000, 3,100, 3,200 and 3,300kcal kg-1) and three slaughter ages (42, 49 and 56 days). Response surface methodology was used to establish a mathematical model to explain live weight, feed intake and feed conversion behavior. Total lipids and cholesterol were determined in breast meat and in thigh meat, with and without skin. For lipid composition analysis, a 3x3x2 factorial arrangement in a completely randomized design - three ration's metabolizable energy levels (2,800, 3,000 and 3,300kcal kg-1), three slaughter ages (42, 49 and 56 days) and two sexes - was used. The reduction in the diet metabolizable energy close to 3,000kcal kg-1 did not affect live weight, but below this value, live weight decreased. Feed intake was lower when the dietary energy level was higher. Feed conversion was favored in a direct proportion to the increase of the energy level of the diet. The performance of all birds was within the range considered appropriate for the lineage. Breast meat had less total lipids and cholesterol than thigh meat. Thigh with skin had more than the double of the amount of total lipids than skinless thigh, but the cholesterol content did not differ with the removal of the skin. Intramuscular fat content was lower in the meat from birds fed with lower energy level ration. This information may help to define the most appropriate nutritional management. Despite the decrease in bird's productive performance, the restriction of energy in broiler chickens feed may be a viable alternative, if the consumers are ...

IV Consenso Brasileiro para pesquisa de autoanticorpos em celulas HEp-2 / IV Brazilian Guidelines for autoantibodies on HEp-2 cells

Objetivo: O IV Consenso Brasileiro para Pesquisa de Autoanticorpos em Células HEp-2 (FAN) realizado em Vitória (ES), no dia 18 de setembro de 2012, objetivou discutir estratégias e recomendações relacionadas ao procedimento técnico, à padronização e à interpretação dos resultados da pesquisa de autoanticorpos em células HEp-2. Métodos: Participaram do evento 23 pesquisadores e especialistas de Universidades e laboratórios brasileiros. Foram abordados diferentes tópicos, discutidos amplamente a fim de se estabelecer recomendações específicas. Resultados e conclusão: O IV Consenso integrou à árvore de decisão o padrão citoplasmático em Anéis e Bastões, o padrão nuclear pontilhado Quasi-homogêneo (QH) e o padrão misto CENP-F. Discutiu-se ainda a necessidade de atenção para a classificação do padrão misto relacionado à presença de anticorpos anti-DNA topoisomerase I (Scl70), compreendendo os componentes nuclear pontilhado fino, nucleolar homogêneo, NOR na placa metafásica e citoplasmático pontilhado fino. Foram sugeridas diretrizes para o controle de qualidade do teste, diluição de triagem e diluição de esgotamento, e foi emitido alerta quanto à necessidade de atenção em relação à heterogeneidade de substratos disponíveis no mercado e a utilização de metodologias automatizadas para detecção de autoanticorpos. .

Objective: The Fourth Brazilian Consensus for Autoantibodies Screening in HEp-2 Cells (ANA) was held in Vitória, Espírito Santo, and aimed to discuss strategies and recommendations about the technique, standardization, interpretation and quality control of the indirect immunofluorescence reaction on HEp-2 cells. Methods: Twenty three ANA experts from university centers and private laboratories in different areas from Brazil discussed and agreed upon recommendations for the fourth edition of the Brazilian Consensus for Autoantibodies Screening in HEp-2 Cells. Results and conclusion: The 4th ANA Consensus included three novel patterns into the existing algorithm (cytoplasmic Rods and Rings, nuclear Quasi-homogeneous, and CENP-F). Emphasis was given to the need of attention in describing the peculiar mixed pattern elicited by anti-DNA topoisomerase I (Scl-70) autoantibodies, comprising nuclear fine specked, nucleolar homogeneous pattern, NOR staining in metaphase plates, and cytoplasmic fine speckled patterns. The group also emphasized the need for continuous quality control in indirect immunofluorescence assays, the establishment of screening dilutions, as well as conjugate titration. An alert was made regarding the heterogeneity of commercial kits in defining patterns and the use of solid phase methodologies to determine the presence of autoantibodies. .

Variability in the recognition of distinctive immunofluorescence patterns in different brands of HEp-2 cell slides / Variabilidade no reconhecimento de padrões de imunofluorescência indireta em diferentes marcas de lâminas HEp-2

INTRODUCTION: Indirect immunofluorescence on HEp-2 cells is considered the gold standard for the detection of autoantibodies against cellular antigens. However, the culture conditions, cell fixation and permeabilization processes interfere directly in the preservation and spatial distribution of antigens. Therefore, one can assume that certain peculiarities in the processing of cellular substrate may affect the recognition of indirect immunofluorescence patterns associated with several autoantibodies. OBJECTIVE: To evaluate a panel of serum samples representing nuclear, nucleolar, cytoplasmic, mitotic apparatus, and chromosome plate patterns on HEp-2 cell substrates from different suppliers. MATERIALS AND METHODS: Seven blinded observers, independent from the three selected reference centers, evaluated 17 samples yielding different nuclear, nucleolar, cytoplasmic and mitotic apparatus patterns on HEp-2 cell slides from eight different brands. The slides were coded to maintain confidentiality of both brands and participating centers. RESULTS: The 17 HEp-2 cell patterns were identified on most substrates. Nonetheless, some slides showed deficit in the expression of several patterns: nuclear coarse speckled/U1-ribonucleoprotein associated with antibodies against RNP (U1RNP), centromeric protein F (CENP-F), proliferating cell nuclear antigen (PCNA), cytoplasmic fine speckled associated with anti-Jo-1 antibodies (histidyl synthetase), nuclear mitotic apparatus protein 1 (NuMA-1) and nuclear mitotic apparatus protein 2 (NuMA-2). CONCLUSION: Despite the overall good quality of the assessed HEp-2 substrates, there was considerable inconsistency in results among different commercial substrates. The variations may be due to the evaluated batches, hence generalizations cannot be made as to the respective brands. It is recommended that each new batch or new brand be tested with a panel of reference sera representing the various patterns.

INTRODUÇÃO: A imunofluorescência indireta (IFI) utilizando células HEp-2 como substrato antigênico é o teste padrão-ouro para a pesquisa de autoanticorpos contra antígenos celulares. Contudo, as condições de cultivo, fixação e permeabilização celular interferem diretamente na preservação e na distribuição espacial dos antígenos. Portanto, pode-se presumir que distintas condições no preparo das células possam interferir no reconhecimento dos padrões de imunofluorescência associados aos diversos autoanticorpos. OBJETIVO: Avaliar um painel de amostras de soro representativo de padrões nuclear, nucleolar, citoplasmático, de aparelho mitótico e de placa cromossômica em substratos de células HEp-2 de diferentes fornecedores. MATERIAIS E MÉTODOS: Sete observadores blindados e independentes de três centros de referência avaliaram 17 amostras que apresentavam diferentes padrões nucleares, nucleolares, citoplasmáticos e associados ao aparelho mitótico em lâminas com células HEp-2 de oito procedências. As lâminas foram codificadas para manter a confidencialidade das marcas, bem como dos centros participantes. RESULTADOS: Os 17 padrões de imunofluorescência em células HEp-2 foram reconhecidos na maioria dos substratos. No entanto, alguns substratos mostraram déficit na apresentação de alguns padrões (nuclear pontilhado grosso/U1-ribonucleoprotein associado a anticorpos contra o RNP (U1 ribonucleoproteína), sugestivo da presença de anticorpos anti-CENP-F (proteína centromérica F), sugestivo de anticorpos contra antígenos de célula em proliferação (proliferating cell nuclear antigen [PCNA]), citoplasmático pontilhado fino associado a anticorpos anti-Jo-1 (histidil sintetase), anti-NuMA-1 (nuclear mitotic apparatus protein 1) e anti-NuMA-2 (nuclear mitotic apparatus protein 2). CONCLUSÃO: Em que pese a boa qualidade geral dos substratos avaliados, existe divergência nos resultados obtidos entre os diferentes substratos comerciais. As variações observadas podem ser devidas aos lotes avaliados, portanto não se pode generalizar para as respectivas marcas. Recomenda-se que cada novo lote ou marca de lâmina sejam testados com diferentes soros referência representativos dos diversos padrões.

Sífilis em parturientes: aspectos relacionados ao parceiro sexual / Syphilis in parturients: aspects related to the sex partner

OBJETIVOS: Analisar o perfil sociodemográfico e comportamental dos parceiros sexuais, a proporção daqueles inadequadamente tratados e os motivos da não realização do tratamento. MÉTODOS: Estudo quantitativo cuja coleta de dados ocorreu de maio a outubro de 2008, em cinco maternidades públicas de Fortaleza, Ceará. Foram aplicados questionários às parturientes internadas com sífilis que informaram ter parceiro sexual fixo. Foram analisadas as variáveis sociodemográficas e as relacionadas à comunicação, diagnóstico e tratamento dos parceiros sexuais. Os dados foram digitados no programa Statistical Package for the Social Sciences e foram analisados por meio de distribuições de frequências, de medidas de tendência central e de dispersão. RESULTADOS: Participaram do estudo 56 parturientes. Os parceiros sexuais tinham média de idade de 29 anos, menos de 7 anos de estudo (50%), atividade laboral (82,1%), renda familiar inferior a 1 salário-mínimo (6,4%). Eram o pai da criança 92,9 e 69,6% moravam com a parturiente. Faziam uso de álcool e drogas 50 e 12%, respectivamente. Foram comunicados do diagnóstico 75,0% parceiros, a comunicação foi feita pela própria mulher em 78,6% casos e ficaram sabendo do resultado do exame de VDRL antes ou durante o pré-natal, 59,5%. Não revelaram o diagnóstico 25,0% mulheres e os motivos alegados foram: desconhecer a importância do tratamento do parceiro (50,0%), não ter estado com este parceiro após o diagnóstico (42,9%) e estar brigada (7,1%). Dos que souberam do diagnóstico antes ou durante o pré-natal, 56,0% foram tratados e 6 (42,8%) foram considerados adequadamente tratados. Dentre os que não receberam tratamento, 63,6% se recusaram por não se sentir doentes, não acreditar no tratamento e medo de injeção. CONCLUSÕES: Os parceiros são comunicados do diagnóstico de sífilis da gestante; entretanto, poucos são adequadamente tratados.

PURPOSES: To analyze the sociodemographic and behavioral profile of sex partners, the proportion of those inadequately treated as well as to verify how many of them were inadequately treated and why some were not treated. METHODS: Quantitative study with data collected from May to October, 2008 at five public maternities in Fortaleza, Ceará. A survey was carried out with parturients who were hospitalized with syphilis and had a stable sex partner. We analyzed sociodemographic variables and those related to communication, diagnosis and treatment of sex partners. The data were entered into the Statistical Package for the Social Sciences and were analyzed using frequency distributions, measures of central tendency and dispersion. RESULTS: The study included 56 pregnant women. Most sexual partners were young adults aged on average 29 years, 50% of them had studied for less than seven years, 82.1 worked and 46.4% had a family income of less than a minimum wage. Of all the partners, 92.9% were the child's father and 69.6% lived with the women. Fifty percent and 12% were alcohol and drug users, respectively. Most partners (75.0%) were told about the diagnosis by the women, and in 78.6% of cases they were aware of the VDRL result before or during the prenatal period. However, 25.0% of the women did not communicate the result to their partners for the following reasons: not knowing the importance of the partner's treatment (50.0%), not being together after the diagnosis (42.9%) and having a quarrel (7.1%). Of the partners who were informed about the result before or during the prenatal period, 56.0% were treated and six (42.8%) were considered to have been properly treated. Among the ones who did not receive treatment, 63.6% refused it because they did not feel sick, because they did not believe in the treatment and because they were afraid of injections. CONCLUSIONS: Partners are told about the syphilis diagnosis of the pregnant women; however, only a few are properly treated.

Perfil sociodemográfico e obstétrico de puérperas assistidas no município de Iguatu - CE / Sociodemographic and obstetric profile from pregnant women assisted in Iguatu-CE

Objetivo: Avaliar o perfil sociodemográfico e obstétrico de puéperas assistidas no município de Iguatu-CE, Brasil. Métodos: Trata-se de um estudo descritivo com abordagem quantitativa, cuja amostra contemplou 178 puérperas residentes no município em estudo. Realizou-se a coleta de dados em uma maternidade de atendimento público, no período de agosto a setembro de 2008, por meio de entrevista. As variáveis foram submetidas à análise univariada dos dados pelo programa estatístico SPSS 11.0. Resultados: As puérperas apresentaram média de idade de 23,8 anos; 100 (56,2%) eram da zona urbana; 36 (20,27%) eram solteiras; 109 (61,2%) realizavam atividades do lar sem remuneração; 110 (62,3%) iniciaram o pré-natal no primeiro trimestre; 20 (11,2%) fumaram e 6 (3,4%) ingeriram bebidas alcoólicas durante a gestação. Quarenta e nove (28,2) participaram de alguma atividade educativa, 166 (96,6%) realizaram o exame VDRL e 108 (62,1%) realizaram o anti-HIV no pré-natal. Conclusão: O perfil sociodemográfico da população avaliada pode ser caracterizado por puérperas jovens, com alguma escolaridade, casadas ou em união estável e com renda familiar entre um e dois salários mínimos, que realizaram quantidade satisfatória de consultas pré-natais, tiveram acesso a exames complementares e a garantia da assistência ao parto em hospital municipal de referência.

Objective: To evaluate the sociodemographic and obstetric profile of puerperae assisted in Iguatu-CE, Brazil. Methods: This is a descriptive study with quantitative approach. The sample consisted of 178 postpartum women living in the city under study. Data collection was conducted in a public maternity care in the city, from August to September 2008, through interviews. The data were analyzed by SPSS 11.0. The variables were subjected to univariate analysis. Results: The mean age was 23.8 years, 100 (56.2%) were from urban areas, 36 (20.2%) were single, 109 (61.2%) of the household activities performed without pay, 110 (62.3%) began prenatal care in first quarter, 20 (11.2%) smoked and 6 (3.4%) drank alcohol during pregnancy, 49 (28.2%) participated in some educational activity, 166 (96.6%) were VDRL the first and 108 (62.1%) had anti-HIV during prenatal. Conclusion: The sociodemographic profile of the studied population can be characterized by young puerperae with some schooling, married or in stable relationships and family income between one and two minimum salaries, which made satisfactory amount of prenatal visits, had access to exams and had guarantee of delivery care in the public hospital of reference.

Prevalência da infecção pelo HIV em pacientes com tuberculose na atenção básica em Fortaleza, Ceará / Prevalence of HIV infection in tuberculosis patients treated at primary health care clinics in the city of Fortaleza, Brazil

O objetivo deste trabalho foi determinar a prevalência da infecção pelo HIV em indivíduos com > 15 anos de idade e diagnóstico confirmado de tuberculose, acompanhados em Centros de Saúde da Família de Fortaleza (CE). Uma amostra aleatória de 110 pacientes com diagnóstico de tuberculose de 26 Centros de Saúde da Família foi incluída no estudo, realizado entre os meses de janeiro e maio de 2009. Todos os participantes responderam a um questionário com dados sociodemográficos e clínicos e realizaram sorologia para o HIV. Nesta amostra, a prevalência de coinfecção tuberculose/HIV foi de 3,6% (IC95%: 0,2-7,0).

The objective of this study was to determine the prevalence of HIV infection among individuals > 15 years of age with a confirmed diagnosis of tuberculosis and treated at family health care clinics in the city of Fortaleza, Brazil. We evaluated a random sample of 110 patients with tuberculosis, treated at a total of 26 family health care clinics between January and May of 2009. All of the participants completed a questionnaire regarding sociodemographic and clinical data, and all underwent HIV testing. In this sample, the prevalence of tuberculosis/HIV co-infection was 3.6% (95% CI: 0.2-7.0).

Abdômen agudo em gestante tratada de obesidade por cirurgia bariátrica: relato de caso / Acute abdomen in pregnant woman treated for bariatric surgery for obesity: case report

A cirurgia bariátrica vem sendo considerada, na atualidade, uma alternativa ao tratamento de obesidade mórbida refratária a tratamentos clínicos convencionais. As cirurgias mais usadas, radicais e invasivas, apresentam resultados melhores e mais rápidos, porém estão mais sujeitas a complicações clínicas e cirúrgicas, como obstruções e suboclusões intestinais. Gestações em mulheres que se submetem a este tipo de cirurgia são cada vez mais frequentes e as complicações relacionadas cada vez mais descritas. Apresentamos o caso clínico de mulher grávida previamente submetida à cirurgia bariátrica que desenvolveu quadro de suboclusão com intussuscepção intestinal. Essa complicação extremamente grave requer muita atenção para seu diagnóstico, utilizando-se exames de imagem e laboratório não empregados usualmente durante a gravidez. A gestação confunde e dificulta sua interpretação, além de o único tratamento de bom resultado ser invasivo, a laparotomia exploradora, ser indesejável no período. A morbidade e mortalidade materna, fetal e perinatal costumam ser elevadas. No caso descrito, o parto ocorreu de forma espontânea nas primeiras horas de internação, antes de o procedimento cirúrgico ser executado. A evolução foi boa e paciente e recém-nascido, embora prematuro, evoluíram bem e tiveram alta em boas condições.

Bariatric surgery is currently considered as an alternative for the treatment of morbid obesity refractory to conventional clinical treatments. The surgeries more frequently used, which are radical and invasive, yield better and faster results, but are subject to clinical and surgical complications such as intestinal obstructions and subocclusions. Pregnancies in women submitted to this type of surgery are increasingly frequent, and the related complications have been increasingly reported. We present the case of a pregnant woman previously submitted to bariatric surgery who developed subocclusion with intestinal intussusception. This extremely serious complication requires attention for its diagnosis, i.e. , imaging and laboratory exams that are not usually employed during pregnancy. Gestation confuses and impairs their interpretation. In addition to the fact that the only treatment that reaches a good result is invasive, exploratory laparotomy is undesirable during this period. Maternal, fetal and perinatal mortality is usually high. In the present case, delivery occurred spontaneously during the first hours of hospitalization before the surgical procedure. Evolution was good and both mother and newborn, although premature, had good course and were discharged in good conditions.

Epidemiologia da sífilis gestacional em Fortaleza, Ceará, Brasil: um agravo sem controle / Epidemiology of gestational syphilis in Fortaleza, Ceará State, Brazil: an uncontrolled disease

O objetivo deste estudo transversal foi conhecer o perfil epidemiológico das gestantes com VDRL reagente, em Fortaleza, Ceará, Brasil, no ano de 2008. Foi verificado o percentual das gestantes com sífilis que foram consideradas inadequadamente tratadas e os motivos da inadequação, de acordo com as normas do Ministério da Saúde. Foram entrevistadas 58 gestantes no pós-parto imediato, internadas em cinco maternidades públicas do município, e consultadas as informações do prontuário e do cartão das gestantes. Foram avaliados dados sociodemográficos, obstétricos e variáveis relacionadas ao diagnóstico e tratamento da gestante e do parceiro. Apenas três (5,2 por cento; IC95 por cento: 1,8 por cento-14,1 por cento) gestantes foram consideradas adequadamente tratadas. O principal motivo da inadequação do tratamento foi a falta ou inadequação do tratamento do parceiro (88 por cento dos casos; IC95 por cento: 76,2 por cento-94,4 por cento). Foi possível constatar a necessidade de um segundo VDRL no terceiro trimestre de gestação. Os dados evidenciaram que o atendimento recebido pela gestante não foi suficiente para garantir o controle da sífilis congênita.

This cross-sectional study investigated the epidemiological profile of pregnant women with positive VDRL in Fortaleza, Ceará State, Brazil, in 2008. The study verified the proportion of pregnant women with syphilis that was classified as treated incorrectly according to Brazilian Ministry of Health guidelines, and assessed the reasons for inadequate treatment. Fifty-eight women who had given birth at five public maternity hospitals were interviewed consecutively following delivery. Data were also recovered from medical files and pregnancy cards. Sociodemographic and obstetric data and information related to the diagnosis and treatment of syphilis in both pregnant women and their partners were analyzed. Only three (5.2 percent; 95 percentCI: 1.8 percent-14.1 percent) pregnant women had received adequate treatment. The main reason for inadequate treatment was lack of partner treatment (88 percent of cases; 95 percentCI: 76.2 percent-94.4 percent). Medical care as currently provided does not guarantee the control of gestational syphilis in this sample.

Percepção de mães acerca da qualidade de vida de crianças com paralisia cerebral / Perception of mothers about the quality of life of children with cerebral palsy / Percepción de madres acerca de la calidad de vida de niños con parálisis cerebral

Estudo exploratório qualitativo com objetivo de conhecer a percepção de mães quanto à qualidade de vida do filho com paralisia cerebral. Os dados foram coletados por meio de entrevista semiestruturada com 20 mães de crianças na faixa etária de 2 a 7 anos que estavam em atendimento no Núcleo de Tratamento e Estimulação Precoce, local em que foi desenvolvida a pesquisa. Os resultados foram analisados a partir da técnicas de análise temática, emergindo as categorias Percepção de Qualidade de Vida e Qualidade de Vida do Filho com Paralisia Cerebral. Evidenciou-se que a percepção está associada a aspectos financeiros, bem como ao desenvolvimento de atividades da vida diária. As mães referenciam uma qualidade de vida ruim do filho, colocando-se como responsáveis; são afetados pelo preconceito e processo de negação da criança com deficiência, interferindo na assistência em âmbito familiar. O estudo contribui como reflexão aos estigmas impostos à criança com paralisia cerebral.

An exploratory qualitative study aiming to know mothers? perception of quality of life of the child with cerebral palsy was developed. Data were collected through semi-structured interviews with 20 mothers of children aged 2-7 years who were in attendance at the Center for Treatment and Early Stimulation, where this research was developed. The results were analyzed based on thematic analysis techniques, emerging the categories ?Perception of Quality of Life? and ?Quality of Life of the Son with Cerebral Palsy?. It was evident that the perception is associated with financial aspects, as well as the development of activities of daily living. Mothers refer to a poor quality of life of the child, placing themselves as responsible; they are affected by prejudice and denial process of the child with a disability, which interferes in care within the family. The study contributes as a reflection on the stigma imposed for children with cerebral palsy.

Estudio exploratorio cualitativo con objetivo de conocer la percepción de madres cuanto a la calidad de vida del hijo con parálisis cerebral. Los datos fueron recogidos por medio de entrevista semi-estructurada con 20 madres de niños en la faja etaria de 2 a 7 años que estaban en atendimiento en el Núcleo de Tratamiento y Estimulación Precoz, local en que fue desarrollada la investigación. Los resultados fueron analizados a partir de las técnicas de análisis temático, emergiendo las categorías Percepción de Calidad de Vida y Calidad de Vida del Hijo con Parálisis Cerebral. Se notó que la percepción está asociada a aspectos financieros, bien como al desarrollo de actividades de la vida diaria. Las madres referencian una calidad de vida ruin del hijo, colocándose como responsables; son afectados por el preconcepto y proceso de negación del niño con deficiencia, interfiriendo en la asistencia en el ámbito familiar. El estudio contribuye como reflexión a los estigmas impuestos al niño con parálisis cerebral.