Prevalence of serological ineligibility among blood donors of a Hemotherapy Center in Caxias do Sul, southern Brazil

Introduction: Blood donation should be voluntary, anonymous and altruistic, and the donor should not, directly or indirectly, receive any remuneration or benefit by virtue of donating blood. Like any other therapeutic method, transfusion procedures are not risk free and can expose the patient to a several complications. Serological screening is of great importance to ensure transfusion safety. The present study aimed to estimate the prevalence of serological ineligibility among blood donors from a Hemotherapy Center in Caxias do Sul (RS). Method: An exploratory, descriptive and quantitative study was conducted on data from July 2010 to December 2015 collected at a Hemotherapy Center in Caxias do Sul (RS). Results: During the study period, 14,267 blood donors attended the Hemotherapy Center, of which 9,332 (65.40%) were males and 4,935 (34.60%) were female. Considering only the suitable donors, 12,702 blood donations were performed, 144 (1.13%) presented positive serological tests. The most prevalent positive serology was for hepatitis B (anti-HBc) with 98 cases (0.77%), followed by syphilis with 19 cases (0.15%); Chagas disease, with 10 (0.08%); hepatitis C, with nine (0.07%); and HIV and HTLV, with four (0.03%) reactive samples each. Conclusion: The results presented are important for health surveillance and make it possible to take measures to ensure safe blood stocks (AU)

Transplante cardíaco na Doença de Chagas / Heart transplantation in Chagas Disease

A doença de Chagas afeta 16 a 18 milhões de pessoas na América Latina. No Brasil, estima-se a existência de 5 a 7 milhões de chagásicos, encontrados em quase todos os estados brasileiros. Aproximadamente 30% dos infectados desenvolvem a forma crônica da doença, com elevadas taxas de morbidade e mortalidade pelo envolvimento cardíaco, e a miocardiopatia chagásica apresenta pior prognóstico quando comparada a outras etiologias da insuficiência cardíaca. Em nosso meio, aproximadamente 30% dos pacientes com insuficiência cardíaca crônica refratária ao tratamento clínico, encaminhados para transplante cardíaco têm como etiologia a doença de Chagas. A experiência acumulada no Brasil demonstra que, a despeito de elevadas taxas da reativação da infecção pelo T. cruzi em decorrência da imunossupressão, os resultados do transplante cardíaco na doença de Chagas são altamente satisfatórios e com evolução pós-transplante a médio e longo prazo semelhante aos resultados do transplante cardíaco em pacientes não chagásicos. Esses resultados colocam o transplante cardíaco como uma excelente opção terapêutica nos casos de pacientes chagásicos com grave comprometimento funcional ou com arritmias malignas.

Chagas disease affects 16 to 18 million people in Latin America. In Brazil, the estimate is that there are 5-7 million people infected, located in almost all Brazilian states. Approximately 30% of those infected develop the chronic form of the disease, with high morbidity and mortality rates due to cardiac involvement, and Chagas cardiomyopathy has worse prognosis when compared to other causes of heart failure. In Brazil, approximately 30% of patients with chronic heart failure refractory to medical treatment, referred for heart transplantation have Chagas disease as etiology. The cumulative experience in Brazil shows that despite high rates of reactivation of infection with T. cruzi due to immunosuppression, the results of heart transplantation in Chagas disease are highly satisfactory and the results post-transplant in medium and long-term are similar to those of heart transplantation in patients without Chagas disease. These results make heart transplantation an excellent therapeutic option in cases of patients with Chagas disease with severe functional impairment or malignant arrhythmias.

Clinical characteristics and outcomes in diffuse large B cell lymphoma patients aged 70 years and older: a single-center experience with a literature review

BACKGROUND/AIMS: Among diffuse large B cell lymphoma (DLBCL) patients, determining the appropriate dose and chemotherapy schedule to balance toxicity and efficacy is harder in elderly than in younger patients. Moreover, there are no currently available clinical factors that consistently identify patients who are unfit to receive chemotherapy. Therefore, the clinical characteristics and outcomes of elderly patients with DLBCL and the causes of treatment-related death were investigated in this study. METHODS: The clinical characteristics and outcomes of 44 elderly (> or = 70 years of age) patients diagnosed with DLBCL between January 2005 and June 2013 were evaluated. Variable clinical data along with the response rate, overall survival (OS), and causes of treatment-related death or treatment interruption were investigated. RESULTS: The median OS was 18.6 months, and 19 patients completed curative treatment. The mean average relative dose intensity of adriamycin in patients who completed chemotherapy was 0.617, and of these patients, 16 achieved complete remission. Chemotherapy incompletion, infectious complications, ex tranoda l involvement, high lactate dehydrogenase, poor performance status, and low albumin level at diagnosis were related to a shorter OS. However, multivariate analysis revealed that only infections and chemotherapy incompletion were significantly related to poor prognosis. The most common cause of treatment-related death was infection, and patients who had experienced infectious complications tended to have lower albumin levels than those of patients without such complications. CONCLUSIONS: In the treatment of elderly lymphoma patients, the dose intensity of adriamycin is not as important as it is in young patients. However, in elderly patients, infections are particularly dangerous, especially in patients with low albumin levels.

De los estudios locales a una perspectiva regional: análisis integrado de datos secundarios en un proyecto colaborativo sobre vulnerabilidades asociadas al uso de drogas en Argentina, Brasil y Uruguay (1998-2004) / From local studies to a regional perspective: pooled analysis of secondary data in a collaborative project on vulnerabilities associated with drug use in Argentina, Brazil and Uruguay (1998-2004)

Este artículo desarrolla los fundamentos metodológicos del diseño de análisis integrado a partir de su empleo para el estudio de situaciones de vulnerabilidad entre usuarios de drogas a nivel regional. Se integraron datos de trece estudios transversales realizados en Argentina, Brasil y Uruguay entre 1998 y 2004. Una revisión crítica del concepto de matriz de datos, que distingue cuatro componentes estructurales, permitió: definir las unidades de análisis abarcando las distintas poblaciones originales; identificar un núcleo común de variables (características sociodemográficas, uso de drogas, prácticas sexuales, serologías de infecciones de transmisión sexual y sanguínea) con sus respectivos valores; examinar los indicadores, las dimensiones y procedimientos empleados para la medición de las variables; y establecer su compatibilidad mediante un análisis comparativo y temático de los instrumentos. Se obtuvo una nueva matriz de 3.534 casos. La colaboración multidisciplinaria entre equipos e instituciones de los tres países hizo posible maximizar las fuentes disponibles para el análisis de características locales y de la región en su conjunto.

This paper develops the methodological principles of pooled analysis design, using it to study situations of vulnerability among drug users at a regional level. Data from thirteen cross-sectional studies carried out in Argentina, Brazil and Uruguay between 1998 and 2004 were integrated. A critical review of the concept of data matrix which identifies four structural components, allowed us to: define the units of analysis spanning the different original populations; identify a core of common variables (social and demographic characteristics, drug use, sexual practices, serology of blood-borne and sexually transmitted diseases) with their respective values; examine the indicators, dimensions and procedures used to measure the variables; and establish their compatibility with a thematic and comparative analysis of data collection tools. The main result was a new data matrix with 3,534 cases. Multidisciplinary collaboration between teams and institutions from the three countries made it possible to maximize the available sources in order to analyze characteristics of the local contexts and of the overall regional.

Prevalência de anticorpos anti-neospora caninum (Apicomplexa: Sarcocystidae) em bovinos leiteiros de propriedades rurais em três microrregiões no estado do Maranhão / Prevalence of anti-neospora caninum (Apicomplexa: Sarcocystidae) antibodies in dairy cattle in rural properties of three microrregions of Maranhão, Brazil

Objetivou-se, no presente estudo, pesquisar a prevalência de anticorpos anti-Neospora caninum em 812 amostras de soros sangüíneos de bovinos leiteiros procedentes de propriedades rurais de sete municípios das microrregiões de Itapecuru-Mirim, Médio Mearim e Presidente Dutra, estado do Maranhão, Brasil. Para o cálculo do tamanho da amostra, considerou-se um soroprevalência de 34,7 por cento para N. caninum, com erro máximo de 9,5 por cento e intervalo de confiança de 95 por cento. Para a detecção da presença de anticorpos da classe IgG, utilizou-se a técnica de Imunofluorescência Indireta (IFI), com ponto de corte 1:200, usando como antígeno, taquizoítos da cepa NC-1, mantida em cultura celular no Laboratório de Diagnóstico das Parasitoses dos Animais da Escola de Medicina Veterinária da UFBA. Do total de amostras analisadas, encontrou-se uma prevalência de 50,74 por cento. Os títulos variaram de 1:200 a 1:6400, assim distribuídos: 108 (26,21 por cento) amostras de soro apresentaram título de 1:200; 132 (32,04 por cento) 1:400; 94 (22,81 por cento) 1:800; 46 (11,16 por cento) 1:1600; 23 (5,58 por cento) 1:3200 e nove (2,18 por cento) com títulos de 1:6400. Dentre as microrregiões, a Itapecuru-Mirim apresentou o menor percentual de animais soropositivos (20,69 por cento) e Presidente Dutra o maior (47,66 por cento). Com relação à variável sexo, observou-se maior prevalência de sororreagentes nas fêmeas (46,80 por cento) do que nos machos (52,46 por cento). Não se verificou diferença significativa (P>0,05) para as variáveis microrregiões, sexo e idade. Conclui-se que os bovinos leiteiros das regiões estudadas estão expostos à infecção por N. caninum.

The objective in the present study was to research the prevalence of anti-Neospora caninum in 812 samples of blood serum of dairy cattle from farms of seven municipalities of microrregions of Itapecuru-Mirim, Middle Mearim and President Dutra, state of Maranhão, Brazil. For the calculation of sample size, it was considered a seroprevalence of 34.7 percent for N. caninum, with a maximum error of 9.5 percent and a confidence interval of 95 percent. To detect antibodies, it was used the technique of Indirect Immunofluorescence (IFI), with the cut-off of 1:200, using as antigen, tachyzoites strain NC-1, maintained in cell culture in the Laboratory of Diagnosis of Parasitism of the Animals, School of Veterinary Medicine of the Federal University of Bahia, Brazil. Of the total samples, it was obtained a prevalence of 50.74 percent. The titles ranged from 1:200 to 1:6400, distributed as follows: 108 (26.21 percent) serum samples showed title of 1:200; 132 (32.04 percent) 1:400; 94 (22.81 percent) 1:800; 46 (11.16 percent) of 1:1600; 23 (5.58 percent) of 1:3200 and nine (2.18 percent) with titers of 1:6400. Among the microrregiões the Itapecuru-Mirim showed the lowest percentage of animals seropositive (20.69 percent) and President Dutra the largest (47.66 percent). It was observed higher prevalence of seropositives in females (46.80 percent) than in males (52.46 percent). There was no significant difference (P> 0.05) for the microrregions variables, sex and age. Concluded that the dairy cattle of the regions studied are exposed to infection by N. caninum.

Evaluación de la persistencia de una formulación comercial de Bacillus sphaericus en criaderos naturales de anofelinos vectores de malaria en estado Bolívar, Venezuela / Evaluation of the persistence of a comercial formulation of Bacillus sphaericus in malaria vectors anopheline larval hábitats in Bolívar state, Venezuela

El municipio Sifontes del estado Bolívar es la principal área endémica a malaria de Venezuela. Durante los últimos cinco años se ha reportado en este municipio un promedio anual cercano a 15 mil casos, alcanzándose durante 2009 la cifra de 20.282, lo que constituye una situación de epidemia. En este municipio se evaluó la persistencia de una formulación comercial de Bacillus sphaericus Neide (Vectolex CG 7,5%) en criaderos naturales de Anopheles marajoara, An. triannulatus y An. braziliensis. Para ello se realizaron dos experimentos en los cuales se evaluaron las dosis de 2 y 3 gr/m2 durante 60 y 90 días. Los resultados indican que hay diferencias en la persistencia por tipo de criadero y especie de anofelino. La tendencia general para todas las especies indica que el porcentaje de reducción de la población larvaria fue de 100% durante la primera semana, luego disminuyó paulatinamente hasta más o menos 40% después de los 28 días, para luego recuperarse a alrededor de 60% a los 45 días, manteniéndose así hasta el día 90 con ambas dosis. Este comportamiento es más evidente para An. marajoara, mientras que con An. triannulatus la eficacia se mantiene alrededor de 80% durante 90 días con 3 gr/m2. Sobre An. braziliensis, la eficacia se mantiene en 100% hasta el día 14 con ambas concentraciones, para luego caer abruptamente sin recuperación. Es la primera vez que se evalúa B. sphaericus sobre estas especies de anofelinos en Venezuela, considerándose estos resultados muy prometedores para el control de vectores

Sifontes municipality in Bolivar state is the main malaria endemic area in Venezuela. During the last five years an annual average of 14,000 cases has been reported, reaching 13,450 during 2008, resulting in an epidemic situation. A commercial formulation of Bacillus sphaericus Neide (Vectolex CG 7.5%), was evaluated in larval habitats of Anopheles marajoara, An. triannulatus and An. braziliensis. Two experiments were carried out in a lagoon and a pasture inundated area, 2 and 3 gr/m2 doses were evaluated during 60 and 90 days. The results point out that there are differences in the persistence depending on the type of larval habitat and anopheline species. The general trend indicated that for all the species the persistence of the Vectolex, therefore the reduction of the larval population was 100% during the first week. However, it felt under 40% after day 28, then recovered by day 45, and remaining around 40% for 90 days with both doses. A similar pattern was observed for An. marajoara, whereas for An. triannulatus the efficacy remained around 80% during 90 days only at 3 gr/m2. With An. braziliensis there was 100% persistence until day 14 with both doses, for then felt abruptly without recovering. This is the first time that B. sphaericus was evaluated for these anopheline species in Venezuela, considering these results promissory for the malaria control program

Cambios en conocimientos, actitudes y aptitudes sobre bioseguridad en estudiantes de los últimos años de Medicina / Biosecurity knowledge, aptitude and attitude among medical students in the last years of medical school

Objetivo: Determinar el conocimiento, aptitud y actitud sobre enfermedades transmisibles por sangre y las precauciones universales de bioseguridad en estudiantes de medicina de los últimos años de estudios. Material y Métodos: Se realizó una encuesta a estudiantes de medicina del quinto año, (Grupo A), en diciembre del 2005 y luego a estudiantes de medicina del último año (grupo B), de enero a agosto del 2006. Resultados: Se realizaron 214 encuestas: 110 pertenecían al grupo A y 104 pertenecían al grupo B. El grupo A tuvo una edad promedio de 23 años (22,24) y el grupo B de 24 años (23,25). El 54,13 por ciento del grupo A fueron varones y del grupo B fueron 56,73 por ciento. El 61,73 por ciento de grupo B obtuvo calificación aprobatoria en la encuesta en comparación con 38,27 por ciento del grupo A (p=0,003). El grupo B tuvo 70 por ciento más probabilidad de tener buena información en comparación con el grupo A. Asimismo el grupo B tuvo 5,32 veces más accidentes que el grupo A. Conclusiones: Se encontró que tener mayor experiencia en la práctica clínica predice mayor conocimiento de bioseguridad. Se observó menor aplicación de medidas de bioseguridad en el uso de material de protección en los estudiantes con mayor experiencia.

Objective: To determine the change in the knowledge, aptitude and attitude towards transmissible diseases caused by blood, and universal biosafety precautions in medical students. Materials and Methods: In December of 2005, the students of the 5th year (Group A) were evaluated by means of a survey elaborated to collect information about knowledge, aptitude and attitude in biosafety norms. Afterwards this survey was taken by last year medical students (Group B) from January to august of 2006. Results: A total of 214 surveys were obtained. 110 belonging to group A and 104 to group B. Group A had an average age of 23 (22.24) and group B and average of 24 (23,25). 54,13 per cent of group A were male and 56,73 per cent in group B. 61,73 per cent of group B obtained good results in the survey compared to the 38,27 per cent of group A (p=0,003). Group B had 70 per cent more chances of getting good information in comparison to group A. Moreover group B had 5,32 times more accidents than group A. Conclusion: To have more experience in clinical practice predicts a better knowledge in biosafety. Students with more experience in clinical practice were more careless using protective materials.

Elegibilidad para la donación de sange: recomendaciones para la educación y la selección de donantes potenciales de sangre / Elegibilidad for the donation of blood: recommendations for the education and the selection of potential donors of sangre

El documento recopila en forma razonada los parámetros y condiciones que deben ser tomados en consideración en la educación y selección de los donantes de sangre, con un nivel de detalle que permitirá su comprensión al personal de los servicios de sangre, a los voluntarios de la comunidad y a los donantes de sangre. Como ilustación de cómo se aplica estos parámetros en varios países, se presentan a modo de ejemplo los criterios de selección de la Asociación Americana de Bancos de sangre, etc. Finalmente, el documento incluye recomendaciones de la OPS para las autoridades nacionales de salud y los programas nacionales de sangre con el propósito de promover un abordaje multidisciplinario y coordinado para la promoción de la salud, de la educación pública.

Infectious disease pattern and serum albumin levels in elderly people hospitalized at Dr. Moewardi Hospital Surakarta during 2004.

AIM: to have the picture of infectious disease pattern and serum albumin level in elderly people with respiratory tract infection hospitalized at the Internal Medicine Ward, Dr. Moewardi Hospital Surakarta. METHODS: descriptive-retrospective study. Sample was taken from the medical records of patients hospitalized at the Internal Medicine Ward DR. Moewardi Hospital from January to December 2004. Infectious disease includes the ones at the respiratory tract (pulmonary tuberculosis (TB), pneumonia, chronic obstructive pulmonary disease (COPD)), urinary tract infection (UTI), digestive tract infection (gastroenteritis, typhoid fever), and tetanus. Serum albumin level data of patients with respiratory tract infection were taken from the hospital's laboratory results. RESULTS: from 337 elderly patients hospitalized at the Internal Medicine Ward DR. Moewardi Hospital Surakarta, proportion of patients aged 70 years or above was 39.17%, aged 60-64 years old were 37.09%, and 66-69 years were 23.74%. Distribution of diseases according to frequency is respiratory tract infection (66.77%), urinary tract infection (15.73 %), digestive tract infection (15.43%) (12.17%) and tetanus (2.07 %). From 57 elderly with respiratory tract infection, we found 45 individuals (78.95%) with hypoalbuminemia. CONCLUSION: the most common infectious disease found in the elderly hospitalized at Dr. Moewardi Hospital Surakarta is respiratory tract infection. Hypoalbuminemia was found in 78.95% of 57 elderly with respiratory tract infection.

Alteration of serum glucose level in infection and surgical stress.

The present study was conducted to see the alteration of serum glucose level in infection and surgical stress. For this purpose a total number of 37 subjects in the age range (18 - 55) years were selected from Mymensingh Medical College Hospital from July 2003 to June 2004. Subjects were grouped as follows: control (n=13), infection (n=14) and surgery (n=10). Fasting serum glucose levels were estimated from all subjects by enzymatic calorimetric (GOD-PAP) method. A distinct and statistically significant increase in serum glucose level was observed in infection and surgery group in comparison to control group (p< 0.001).

Indirect immunoperoxidase test for the diagnosis of leptospirosis.

Leptospirosis is a widespread zoonotic disease that affects all mammals, including humans, in different parts of the world. Clinical recognition of leptospirosis is challenging, and the definitive serologic diagnosis assay, the microscopic agglutination test (MAT), is time-consuming and difficult to conduct. In this study, an indirect immunoperoxidase (IIP) test to detect Leptospira-specific antibodies in human serum samples was developed. The efficacy of the IIP was compared with the indirect immunofluorescent assay (IFA) and MAT. A total of 368 human serum samples were analyzed by MAT, IFA, and IIP. Using a MAT titer of > or = 1:100 as the gold standard, the sensitivities for the detection of Leptospiral antibodies at a titer of 1:200 were 94.7% by IFA and 93.6% by IIP; specificities were 95.3% by IFA and 94.9% by IIP; and accuracies were 95.1% by IFA and 94.6% by IIP. With a titer of 1:400, the sensitivity, specificity, and accuracy were 86.2%, 98.9%, and 95.7% by IFA, respectively; whereas, for the IIP, the sensitivity was 85.1%, specificity 98.5%, and accuracy 95.1%. A further evaluation of this test with 80 unknown-febrile-disease sera was also included. We found that the sensitivity and specificity of this test were 100% and 76.8%, respectively. Therefore, the IIP test is a potentially valuable tool for the diagnosis of leptospirosis.

Manual técnico para investigação da trasmissão de doenças pelo sangue / Technical manual for investigation of diseases transmistted through blood transfusion

Este Manual proprõe uma sistematização do processo de investigação dos casos suspeitos, envolvendo ações inter-setoriais, visando à tomada de decisões e ao estabelecimento de ações estratégicas de hemovigilância e integrando as práticas de vigilância em saúde

Análise dos acidentes com agulhas em um hospital universitário: situacões de ocorrência e tendências / Analysis of needlestick injuries at a university hospital: occurrence situations and tendencies

Os acidentes com agulhas constituem um dos principais riscos de transmissão ocupacional de infeccões por via sangüínea (AIDS, hepatite B e C). É prioritário, portanto, discutir estratégias de intervencão baseadas nas fontes de risco. O objetivo deste estudo foi analisar os acidentes com agulhas ocorridos em um hospital universitário. A construcão de um banco dados dos acidentes notificados, entre 1990 e 1996, permitiu identificar as situacões de ocorrência e as tendências ao longo dos anos. Os resultados indicam que a maioria dos acidentes estava relacionada à realizacão ou auxílio de procedimentos. A implantacão das primeiras medidas preventivas (precaucões universais) aponta para a reducão no total de acidentes com perfuracões. Não foram observadas alteracões nas taxas de acidentes relacionados à prática de reencapar agulhas. Discute-se o uso de diferentes estratégias de intervencão: introducão de materiais de design seguro; mudanca de enfoque no treinamento e reorganizacão do ambiente e das práticas de trabalho

Unidad de sangre excluida confidencialmente y prevalencia de marcadores serológicos / Confidential exclusion of a blood unit: importance of serological markers

La unidad de sangre excluida confidencial (USEC) es recomendada por la Administración de Drogas y Alimentos de los Estados Unidos de América con el fin de reducir el riesgo de enfermedades infecciosas transmitidas por la sangre durante el período de incubación o "ventana"; sin embargo se encuentran en la literatura médica especializada detractores y defensores del procedimiento. El objetivo de este artículo es analizar los resultados de la aplicación de USEC en 17.229 donantes seleccionados. Se clasificaron como USEC-, cuando no fue excluida, 16.763 (97,3 por ciento), y como USEC las excluidas (466, 2,7 por ciento), donde se incluyeron además los protocolos dejados en blanco y los anulados o dudosos. En todos los casos se estudiaron los marcadores serológicos (MS) habituales con los siguientes resultados: anti-HIV-1,2, 68 (0,39 por ciento), HBsAg 216 (1,25 por ciento), anti-HVC 206 (1,23 por ciento), VDRL 208 (1,21 por ciento). El total de MS positivos fue de 778 (4,5 por ciento). En los clasificados como USEC-: 66 (0,45 por ciento) para anti-HIV-1,2, 216 (1,28 por ciento) para HBsAg, 279 (1,66 por ciento) anti-HVC, 206 (1,23 por ciento) VDRL. El total de MS en este grupo fue de 767 (4,58 por ciento). Los USEC+:2(0,45 por ciento) anti-HIV-1,2, ninguno en el HBsAg, 7 (1,50 por ciento) para el HVC, 2 (0,43 por ciento) VDRL y el total de MS 11 (2,3 por ciento). La positividad del total de MS fue semejante a otras publicacioes y se encuentra dentro del rango encontrado en América Central y América del Sur. Se plantea que la implementación de la USEC no tiene el impacto esperado en la seguridad de la transfusión en nuestro medio, lo que estaría relacionado con la educación sanitaria de los donantes altruistas, la vigilancia epidemiológica y sus acciones con las poblaciones de riesgo, que persuadirían a los posibles donantes que pueden clasificarse como USEC+ a diferir su donación; no obstante, se recomienda mantener y perfeccionar en todos sus aspectos la aplicación de la USEC y evaluar periódicamente los resultados, además del seguimiento de los donantes con protocolos USEC+, con el fin de detectar su seroconversión en algunos de los MS utilizados.

Serum copper and zinc levels in Thai patients with various diseases.

This study was conducted to evaluate the possible alteration of serum Cu and Zn levels in 118 medical inpatients (53 women and 65 men) in Ramathibodi Hospital. Patients were classified according to their main clinical diseases: pulmonary (n = 12), renal (14), infectious (30), malignant (9), cardiovascular (22), GI & hepatic (13) and hematological (18) diseases. Significantly increased serum Cu concentrations were found in patients with pulmonary, malignant, cardiovascular and infectious diseases; moreover, 75, 75, 50 and 37 per cent of these diseases, respectively, had serum levels greater than the normal mean + 2SD (23.6 mumol/L). Besides, 5 per cent of patients (3 in renal, 1 in infectious and 2 in GI & hepatic diseases) had low serum Cu levels suggestive of Cu depletion. By contrast, significantly decreased serum Zn concentrations were found in patients with GI & hepatic, infectious, renal, cardiovascular and malignant diseases. Serum Zn levels below the normal mean - 2SD (8.1 mumol/L) were presented in 46, 37, 29, 23 and 22 per cent of cases, respectively. It was found that serum Cu/Zn ratio in our patients not only with cancer but also with other diseases were statistically significant from the normal group. Hence, the use of serum Cu/Zn ratios as markers for the diagnosis of cancer or for staging tumors must be interpreted cautiously.