Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique

Abstract This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.

Qualidade de vida, sintomas de depressão e adesão ao tratamento em pacientes com trantorno depressivo maior / Quality of life, depression symptoms and adherence to treatment in patients with major depressive disorder / Calidad de vida, síntomas depresión y adhesión al tratamiento en pacientes con trastorno depresivo mayor

Introdução:Pacientes com depressão maior geralmente respondem ao tratamento com medicamentos antidepressivos, no entanto em 10% a 30% dos casos há apenas uma resposta parcial ou nenhuma resposta, entre os fatores que podem influenciar encontra-se o perfil das enzimas hepáticas metabolizadoras dos antidepressivos, tal como a CYP2C19.Objetivo:Caracterizar os indivíduos quanto ao perfil genético dospolimorfismos CYP2C19*2 ou CYP2C19*17 em pacientes com transtorno depressivo maior (TDM) tratados com citalopram ou escitalopram e compará-los em relação a adesão ao tratamento, sintomas de depressão e qualidade de vida.Metodologia:Trata-se de um estudo transversal realizado com 29 pacientes com TDM. Amostras de sangue foram coletadas para genotipagem de CYP2C19 por discriminação alélica TaqMan®. Após caracterização do perfil genético, os indivíduos foram comparados quanto aos dados demográfico e socioeconômico, adesão ao tratamento (TestedeMorisky-Green),sintomas de depressão (escala de Hamilton) e qualidade de vida (WHOQoL-BREF).Resultados:Quatro pacientes (13.8%) apresentaram polimorfismo para CYP2C19*2 e 10 pacientes (34.4%) para CYP2C19*17, com maior prevalência de CYP2C19*17 (p>0.05). Nenhuma associação significativa de características socioeconômicas, demográficas e clínicas entre os genótipos do CYP2C19.No TestedeMorisky-Green, aadesão moderada ao tratamento foi predominante nos pacientes CYP2C19*2 e CYP2C19*17 (p>0.05). Não foi observada associação entre sintomas de depressão e polimorfismos genéticos (p>0.05). Uma associação significativa entre o genótipo polimórfico CC do CYP2C19*17 com a satisfação com a saúde, enquanto o genótipo CT foi associado ao estado "nem satisfeito/nem insatisfeito" (p<0.05). A maioria dos indivíduos CYP2C19*2 e CYP2C19*17 relatou "necessidade de melhorar" em relação aos domínios de qualidade de vida físico, psicológico, social e ambiental (p>0.05).Conclusões:Os pacientes apresentaram maior prevalência do polimorfismo CYP2C19*17, com moderada adesão ao tratamento. Alguns pacientes, mesmo sob efeito da medicação, apresentaram sintomas de depressão moderado a intenso e relataram uma indefinição na satisfação da sua qualidade de vida (AU).

Introduction:Patients with major depression usually respond to treatment with antidepressant drugs, however in 10% to 30% of cases there is only a partial response or no response, among the factors that can influence is the profile of liver enzymes metabolizing antidepressants, such as CYP2C19.Objective:To characterize the individuals regarding the genetic profile ofCYP2C19*2or CYP2C19*17 polymorphisms in patients with major depressive disorder (MDD) treated with citalopram or escitalopram, and to compare themaccording to treatment adherence, symptoms of depression and quality of life.Methodology:This is cross-sectionalstudy carried out with 29 patients with MDD. Blood samples were collected for CYP2C19 genotyping by TaqMan® allelic discrimination. After characterization of the genetic profile, the individuals were compared regarding the demographic and socioeconomic data, treatment adherence (Morisky-GreenTest), symptoms of depression (Hamilton scale) and quality of life (WHOQoL-BREF).Results:Four patients showed (13.8%) CYP219*2 and 10 patients (34.4%) CYP219*17 polymorphisms.,withhigher prevalence of CYP219*17 (p>0.05). No association between socioeconomic, demographic, and clinical features with CYP2C19 genotypes was observed. In Morisky-GreenTest, moderate adherence to treatment was predominant for CYP2C19*2 and CYP219*17 patients (p>0.05). No statistically significant association was observed between symptoms of depression and genetic polymorphisms (p>0.05). A significant association between polymorphic CC genotype of CYP219*17 with health satisfaction, while the CT genotype was associated with "neither satisfied/nor dissatisfied" status (p<0.05). Most of the CYP2C19*2 and CYP2C19*17 subjects reported "need to improve" or "regular" regarding physical, psychological, social, and environmental domainsof quality of life(p>0.05).Conclusions:The patients showed a higher prevalence of CYP219*17 polymorphism, with moderate treatment adherence. Some subjects, even under the effect of the medication, presented moderate to intense symptoms of depression, and reported a lack of definition in the satisfaction of their quality of life (AU).

Introducción:Los pacientes con depresión mayor responder al tratamiento con antidepresivos, en 10% al 30% de los casos existe una respuesta parcial o nula, entre los factores que pueden influir se encuentra el perfil de enzimas hepáticas metabolizadoras de antidepresivos, como CYP2C19.Objetivo: Caracterizar a los individuos en cuanto al perfil genético depolimorfismos CYP2C19 *2 o CYP2C19 * 17 en pacientes con trastorno depresivo mayor (TDM) tratados con citalopram o escitalopram y compararlos en relaciónpara la adherencia al tratamiento, síntomas de depresión y la calidad de vida.Metodología: Estudio transversalcon 29 pacientes con TDM. Se recogieron muestras de sangre para la determinación del genotipo CYP2C19 mediante discriminación alélica TaqMan®, los individuos fueron comparados en cuanto a los datosdemográficosy socioeconómicos, adherencia (Prueba de Morisky-Green), síntomas de depresión (escala de Hamilton) y calidad de vida (WHOQoL-BREF).Resultados: Cuatro pacientes (13,8%) con polimorfismo CYP2C19*2 y 10 (34,4%) con CYP2C19 * 17,(p> 0,05). No existe una asociación significativa de las características socioeconómicas, demográficas y clínicas con los genotipos CYP2C19. La adherencia moderada al tratamiento fue predominante en los pacientes con CYP2C19*2 y CYP2C19*17 (p> 0,05). No hubo asociación entre síntomas de depresión y polimorfismos genéticos (p> 0.05). Una asociación significativa entre el genotipo polimórfico CYP2C19 * 17 CC con la satisfacción con la salud, mientras que el genotipo CT se asoció con el estado "ni satisfecho / no insatisfecho" (p <0.05). La mayoría de CYP2C19 * 2 y CYP2C19 * 17 individuos informaron "necesidad de mejorar" en relación con los dominios físico, psicológico, social y ambientalde calidad de vida(p> 0,05).Conclusiones: Los pacients mostraron una mayor prevalencia del CYP2C19 * 17, con adherencia moderada al tratamiento, síntomas de depresión moderada a intensay informaron una falta de definición en la satisfacción de su calidad de vida (AU).

Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology

Abstract: Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.

Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology

Abstract: Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology

Abstract: BACKGROUND: Atopic dermatitis is a highly prevalent inflammatory and pruritic dermatosis with a multifactorial etiology, which includes skin barrier defects, immune dysfunction, and microbiome alterations. Atopic dermatitis is mediated by genetic, environmental, and psychological factors and requires therapeutic management that covers all the aspects of its complex pathogenesis. OBJECTIVES: The aim of this article is to present the experience, opinions, and recommendations of Brazilian dermatology experts regarding the therapeutic management of atopic dermatitis. METHODS: Eighteen experts from 10 university hospitals with experience in atopic dermatitis were appointed by the Brazilian Society of Dermatology to organize a consensus on the therapeutic management of atopic dermatitis. The 18 experts answered an online questionnaire with 14 questions related to the treatment of atopic dermatitis. Afterwards, they analyzed the recent international guidelines on atopic dermatitis of the American Academy of Dermatology, published in 2014, and of the European Academy of Dermatology and Venereology, published in 2018. Consensus was defined as approval by at least 70% of the panel. RESULTS/CONCLUSION: The experts stated that the therapeutic management of atopic dermatitis is based on skin hydration, topical anti-inflammatory agents, avoidance of triggering factors, and educational programs. Systemic therapy, based on immunosuppressive agents, is only indicated for severe refractory disease and after failure of topical therapy. Early detection and treatment of secondary bacterial and viral infections is mandatory, and hospitalization may be needed to control atopic dermatitis flares. Novel target-oriented drugs such as immunobiologicals are invaluable therapeutic agents for atopic dermatitis.

Síndrome de ovario poliquístico: casos confirmados y tratamiento en consulta externa del Hospital Escuela Universitario / Polycystic ovary syndrome: confirmed cases and treatment in the outpatient clinic of ̈Hospital Escuela Universitario

El síndrome de ovario poliquísticoes unaendocrinopatía frecuente en la mujer en edad fértil, causado por exceso de andrógenos y es causa de infertilidad anovulatoria. Actualmente uno de los criterios utilizados para el diagnóstico, son los de Rotterdam y para esto se necesita de la clínica (hiperandrogenismo y disfunción ovulatoria), exámenes de laboratorio (hiperandrogenismo) y/o ultrasonido característico de dicho síndrome. Objetivo:determinar el síndrome de ovario poliquístico confirmado por métodos laboratoriales e imágenes y tratamiento indicado en consulta externa del Hospital Escuela Universitario. Material y métodos: estudio retrospectivo, transversal, no aleatorio. Se revisaron 56 expedientes de pacientes con el diagnóstico de síndrome de ovario poliquístico valorados mediante criterios de Rotterdam, 31(55.4%) tenian diagnóstico ultrasonográfico. Se utilizó un instrumento de recolección de datos tipo cuestionario registrandose lo siguiente: edad, sintomatología, exámenes laboratoriales, diagnóstico con descripción ultrasonográficas y tratamiento farmacológico. Resultados: con el diagnóstico de síndrome ovario poliquístico, 31(55.4%) teníandiagnósticos1 Médico especialista en ginecología y obstetricia, Hospital Escuela Universitario2Estudiante de sexto año, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras.Autor de correspondencia: Silder Moncada Correo electrónico: silderjavier78@gmail.comRecibido: 19/09/2017Aceptado: 07/02/2019ultrasonográficos, en 26(83.9%) pacientes no se encontró consignado en el expediente síntomas de hiperandrogenismo, se consignó acantosis nigricans en 2(6.5%), alopecia y acné 3(9.7%), respectivamente como signo hiperandrogénico. Los fármacos utilizados para tratar síndrome de ovario poliquístico fueron metformina y anticonceptivos orales. Conclusión: el diagnóstico y tratamiento de síndrome de ovario poliquístico no sigue protocolos estandarizados, ya que de los 31 expedientes con resultado por ultrasonido, solo 5(16.1%) reunían los criterios para el diagnóstico de dicha patología...(AU)

Profile of dermatological consultations in Brazil (2018)

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Metaloproteinasas de la matriz extracelular y su participación en el proceso de cicatrización / Matrix metalloproteinases and their participation in the healing process

RESUMEN Introducción: las metaloproteinasas son enzimas fundamentales para el mantenimiento estructural de la matriz extracelular, así como para su degradación en situaciones donde se requiere un proceso de reparación tisular. Objetivo: realizar una revisión de los aspectos más actuales de las metaloproteinasas y su papel en la cicatrización. Metodología de búsqueda: se realizó una revisión de 95 artículos, durante el período comprendido entre el 18 de julio de 2015 y 20 de septiembre de 2016 se utilizó las bases de datos Medline, Scopus, Scielo y Science Direct. Resultados: existen seis subfamilias de metaloproteinasas: colagenasas, estromalisinas, elastasas, gelatinasas, matrilisinas y las metaloproteinasas asociadas a la membrana plasmática. Las células endoteliales vasculares las secretan en donde hay daño epitelial y se requiere de un proceso de cicatrización. Conclusiones: las metaloproteinasas son endopeptidasas dependientes de zinc fundamentales para el mantenimiento y degradación de la matriz extracelular. Cuando el mecanismo de regulación falla y las metaloproteinasas tienen una sobreexpresión, ocurren procesos de cicatrización deficientes, condicionando la aparición de heridas crónicas, cicatrices hipertróficas o queloides, pterigión, fibrosis pulmonar y hepática, entre otras condiciones. MÉD.UIS. 2017;30(2):55-62.

ABSTRACT Introduction: Matrix metalloproteinases are essential for structural maintenance of extracellular matrix enzymes, as well as degradation in situations where tissue repair process is warranted. Objective: To review the most current aspects of matrix metalloproteinases and their role in the healing process. Research Methodology: A review of about 95 papers was conducted during the period from July 18, 2015 to September 20, 2016; PubMed, Scopus, Scielo and Science Direct were used. Results: There are six subfamilies of metalloproteinases: collagenases, stromalysins, elastases, gelatinases, matrilysins and metalloproteinases associated with the plasma membrane. Vascular endothelial cells secrete them where there is epithelial damage and a healing process is required. Conclusions: Metalloproteinases are zinc dependent endopeptidases that are essential for the maintenance and degradation of the extracellular matrix. When the adjustment mechanism fails and matrix metalloproteinases are overexpressed, poor healing processes occur, causing problems such as liver chronic wounds, keloids or hypertrophic scars, pterygium, pulmonary and liver fibrosis, among other clinical conditions. MÉD.UIS. 2017;30(2):55-62.

Prevalência do uso de drogas psicotrópicas em unidades da polícia militar / Prevalence of psychotropic drug use in military police units

Este trabalho objetivou verificar a prevalência do uso de drogas psicoativas (anfetamina, metanfetamina, canabinoides, cocaína, opioides e benzodiazepínicos) entre policiais militares do Estado de Goiás. Os dados foram obtidos a partir de amostras de urina cedidas voluntariamente pelos policiais participantes da pesquisa, os quais foram esclarecidos em relação à metodologia do estudo e assinaram o TCLE. As amostras foram submetidas à análise de triagem por imunocromatografia (Multi-DrugOneStep Test®) e, aquelas positivas, foram confirmadas por cromatografia em fase gasosa acoplada à espectrometria de massa. Os dados foram analisados por estatística descritiva. Os resultados apontaram a presença das seguintes drogas: anfetaminas (0,33%); canabinoides (0,67%); benzodiazepínicos (1,34%); 97,66% foram resultados negativos. A distribuição dos casos positivos foi: benzodiazepínicos (57,1%); canabinoides (28,6%) e anfetaminas (14,3%). Conclui-se que os achados de substâncias psicoativas na amostra de policiais militares voluntários chama a atenção sobre a necessidade da implantação de testes de drogas no efetivo da polícia militar e de políticas públicas preventivas, que visem evitar as consequências do consumo abusivo de psicotrópicos.

The present study aimed to verify the prevalence of psychoactive drug use (amphetamines, methamphetamines, cannabinoids, cocaine, opioids and benzodiazepines) among military police officers in the state of Goiás. Data were obtained from urine samples voluntarily provided by the officers participating in the study, who were informed of the study methods and signed a free and informed consent form. The samples were subject to screening analysis by immunochromatography (Multi-DrugOneStep Test®), with positive tests confirmed by gas chromatography– mass spectrometry (GC-MS) and data analyzed by descriptive statistics. The results indicated the presence of the following drugs: amphetamines (0.33%), cannabinoids (0.67%) and benzodiazepines (1.34%); 97.66% showed negative results. The positive cases were distributed as follows: benzodiazepines (57.1%); cannabinoids (28.6%) and amphetamines (14.3%). In conclusion, the detection of psychoactive substances in voluntary sampling of military police officers indicates the need to implement drug testing among active military officers and preventive public policies aimed at eliminating the abusive consumption of psychotropic drugs.

Epimastigogénesis de Trypanosoma cruzi Dm28c en medio ML15-HA: Análisis proteico, glicoproteico y antigénico / Trypanosoma cruzi Dm28c Epimastigogenesis in ML15-HA medium: protein, glycoprotein and antigen analyses

El medio ML15-HA permite simular in vitro los eventos morfogenéticos del ciclo vital de T. cruzi. Se ha evidenciado que los cambios morfológicos de la epimastigogénesis del clon Dm28c de T. cruzi en ML15-HA, ocurren más rápidamente que para otros aislados. Nuestro propósito fue investigar si los cambios macromoleculares ocurren concomitantemente con la rápida transformación morfológica. Tripomastigotas derivados de células infectadas se incubaron por diferentes tiempos en medio ML15-HA a 27ºC. Los cambios morfológicos se determinaron por microscopía de contraste de fases y coloración con Giemsa. Los perfiles peptídico y glicopeptídico se analizaron mediante SDS-PAGE y coloraciones específicas. Los cambios antigénicos se estudiaron mediante Western blot usando sueros anti-Tripomastigotas y anti-Epimastigotas. Los resultados muestran: (1) caída del porcentaje de tripomastigotas e incremento de amastigotas en las primeras 24 horas, con incremento gradual de epimastigotas a partir de 48 horas; (2) tres perfiles peptídicos y glicopeptídicos diferentes: tripomastigotas, epimastigotas a partir del día 4, y un perfil intermedio los días 2 y 3, demostrando la estrecha correlación entre los eventos morfológicos y los cambios proteicos y glicoproteicos; (3) los perfiles antigénicos revelaron estrecha relación entre los cambios morfológicos y la expresión de antígenos estadio-específicos. Los resultados obtenidos evidencian de manera concluyente que los cambios moleculares son más acelerados para el clon Dm28c en medio ML15-HA que en otros medios. Estos hallazgos abren la interrogante, sí la velocidad de la epimastigogénesis está determinada por la constitución genética del aislado o por la riqueza nutricional del medio de diferenciación.

The ML15-HA medium allows simulate in vitro morphogenetic events in the life cycle of T. cruzi. It has been demonstrated that the morphological changes of epimastigogenesis in ML15-HA of the T. cruzi clone Dm28c, occur faster than for other isolates. Our purpose was to investigate whether macromolecular changes occur concomitantly with rapid morphological transformation. Trypomastigotes derived from infected cells were incubated for different times in ML15-HA medium at 27°C. Morphological changes were determined by phase contrast microscopy and staining with Giemsa. Peptide and glycopeptide profiles were analyzed by SDS-PAGE and specific staining. Antigenic changes were studied by Western blot using serum anti-trypomastigotes and anti-epimastigotes. The results show: (1) decline in the percentage of trypomastigotes and amastigotes increased in the first 24 hours, epimastigotes gradually increases from 48 hours, (2) three peptide and glycopeptide profiles different: trypomastigotes, epimastigotes from the day 4 and an intermediate profile on days 2 and 3, showing the close correlation between morphological events and protein and glycoprotein changes, (3) antigenic profiles showed close relationship between the morphological changes and the expression of stage-specific antigens. The results show conclusively that the molecular changes are more rapid for clone Dm28c in ML15-HA medium than in other media. These findings open the question, if the epimastigogenesis speed is determined by the genetic constitution of isolated or nutritional wealth differentiation medium.

Evaluación nutricional y su repercusión en la capacidad funcional: Hemodiálisis, Hospital General "Abel Santamaría Cuadrado" / Nutritional assessment and its repercusion in the functional capacity: Hemodyalisis, "Abel Santamaría Cuadrado" General Hospital

La malnutrición es un problema frecuente con un mayor número de admisiones hospitalarias y compromiso de la capacidad funcional de los pacientes que reciben reemplazo renal por hemodiálisis. Objetivo: Describir el comportamiento del estado nutricional y la capacidad funcional de los pacientes que se hemodializan. Método: Se realizó un estudio analítico de corte transversal mediante la valoración global subjetiva y la escala de Karnofsky durante los meses de enero a mayo del año 2008, a 34 pacientes en hemodiálisis pertenecientes al servicio de Nefrología del Hospital "Abel Santamaría Cuadrado" de la ciudad de Pinar del Río con previo consentimiento. Se analizaron las variables como la edad, etiología de la insuficiencia renal crónica, el tiempo en hemodiálisis, estado nutricional y la capacidad funcional. La información se obtuvo por medio de encuestas y el libro de morbilidad y mortalidad del departamento de Nefrología. Se utilizó la técnica estadística de análisis de distribución de frecuencias para categoría de variables, además, se empleó el test de independencia para probar la hipótesis nula de asociación entre las variables; fijándose un nivel de significación a = 0.05. Resultados: Se evaluaron a 34 pacientes con una edad promedio de 48 años y con un tratamiento de hemodiálisis de 124 meses. El 66,67% de los enfermos mostraron estado nutricional y capacidad funcional normal, por otra parte, 6 de los estudiados se encontraban con evidentes signos de malnutrición de moderada a severa lo que se correspondía con la incapacidad de cuidarse al aplicársele la escala de Karnofsky. No se encontró correlación entre el estado nutricional y el tiempo en hemodiálisis en los pacientes con estadía en hemodiálisis superior a los 2 años.

Malnutritión is a frequent problem that represents a greater number of hospital admissions and compromise of the functional capacity of the patients that undergo a renal replacement hemodyalisis. Objective: Describe the nutritional status and the functional capacity of those patients that undergo hemodyalisis. Methods: A tranversal analytical study was carried out by means of a subjective comprehensive assessment and Karnofsky Scale during the months of January through May, 2008 . This study was conducted, with the due informed consent, on 34 patients in hemodyalisis who belong in the nephrological service of Abel Santamaria General Teaching Hospital of Pinar del Rio City. Variables like age, etiology of the chronic renal failure, time elapsed in hemodyalisis, nutritional status and functional capacity were included in the study. Information was gathered through surveys and from the the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. Furthermore, the independence test was also used so as to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: 34 patients were studied. The average age was 48 years and the hemodyalisis treatment under study was 124 months. 66,67% of patients showed a normal nutritional status and functional capacity. On the other hand, 6 out of the whole group had evident signs of malnutrition from moderate to severe, which had direct correspondence with evident compromise of the functional capacity according to the Karnofsky Scale. There was no correlation with the nutritional status and the time in hemodyalisis in the patients who had undergone more that two years of treatment.

Estudo comparativo da eficiência da eletroforese alcalina em acetato de celulose na identificação de hemoglobinas utilizando diferentes tampões / Comparative study of the alkaline electrophoresis on cellulose acetate efficiency to identify hemoglobins by using different buffers

As hemoglobinas podem apresentar alterações moleculares denominadas hemoglobinopatias caracterizadas pela ineficiência da produção das cadeias de globinas (alfa ou beta) ou por alterações estruturais na síntese destas cadeias. Tais alterações estruturais promovem a formação de hemoglobinas variantes (anômalas) e o desbalanceamento na síntese destas cadeias tem como consequência a talassemia. O diagnóstico das hemoglobinopatias é realizado essencialmente por avaliação eletroforética. Este trabalho teve como objetivo avaliar a influência de diferentes tampões de eletroforese na caracterização de hemoglobinas variantes por meio de técnica de eletroforese alcalina em acetato de celulose. Considerando as características de separação e nitidez das bandas obtidas concluímos que o tampão TEB (Tris base 0,090 M, Ácido bórico 0,090 M, EDTA0,002 M, pH 8,2) na concentração de 0,5X foi o mais eficiente na caracterização das hemoglobinas testadas. Este tampão além de permitir uma melhor separação eletroforética entre as diferentes hemoglobinas, também permitiu uma maior estabilidade da hemoglobina H, favorecendo a identificação mais eficaz dessa hemoglobina instável.

Avaliaçäo da atividade e caracterizaçäo de eritropoietina humana recombinante em produtos farmacêuticos / Activity evaluation and characterization of recombinant human erythropoietin in pharmaceutical products

Realizou-se a identificaçäo de eritropoietina humana recombinante em produtos farmacêuticos comerciais por eletroforese em gel de poliacrilamida e detecçäo com anticorpos específicos, demonstrando-se típica banda larga, semelhante ao padräo de rhEPO da Farmacopéia Européia. Igualmente por focalizaçäo isoelétrica e imunodetecçäo, observaram-se 5-6 isoformas características de acordo com o laboratório produtor. A avaliaçäo de potência efetuada através de ensaio biológico em camundongos normocitêmicos forneceu valores entre 67,6 por cento e 119,4 por cento em relaçäo à declarada. A precisäo dos ensaios combinados, calculada pela ponderaçäo, variou de 200 a 389. Os testes de endotoxinas bacterianas, toxicidade e pH apresentaram valores variáveis conforme o lote. Concluiu-se destacando a importância dos testes e ensaios de controle para assegurar a qualidade lote a lote e garantir a eficácia terapêutica dos produtos farmacêuticos