Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention.

In patients with severe forms of COVID-19, thromboelastometry has been reported to display a hypercoagulant pattern. However, an algorithm to differentiate severe COVID-19 patients from nonsevere patients and healthy controls based on thromboelastometry parameters has not been developed. Forty-one patients over 18 years of age with positive qRT-PCR for SARS-CoV-2 were classified according to the severity of the disease: nonsevere (NS, n = 20) or severe (S, n = 21). A healthy control (HC, n = 9) group was also examined. Blood samples from all participants were tested by extrinsic (EXTEM), intrinsic (INTEM), non-activated (NATEM) and functional assessment of fibrinogen (FIBTEM) assays of thromboelastometry. The thrombodynamic potential index (TPI) was also calculated. Severe COVID-19 patients exhibited a thromboelastometry profile with clear hypercoagulability, which was significantly different from the NS and HC groups. Nonsevere COVID-19 cases showed a trend to thrombotic pole. The NATEM test suggested that nonsevere and severe COVID-19 patients presented endogenous coagulation activation (reduced clotting time and clot formation time). TPI data were significantly different between the NS and S groups. The maximum clot firmness profile obtained by FIBTEM showed moderate/elevated accuracy to differentiate severe patients from NS and HC. A decision tree algorithm based on the FIBTEM-MCF profile was proposed to differentiate S from HC and NS. Thromboelastometric parameters are a useful tool to differentiate the coagulation profile of nonsevere and severe COVID-19 patients for therapeutic intervention purposes.

Molecular and Cellular Biomarkers of COVID-19 Prognosis: Protocol for the Prospective Cohort TARGET Study.

BACKGROUND: Since the beginning of the COVID-19 pandemic, the world's attention has been focused on better understanding the relation between the human host and the SARS-CoV-2 virus, as its action has led to hundreds of thousands of deaths. OBJECTIVE: In this context, we decided to study certain consequences of the abundant cytokine release over the innate and adaptive immune systems, inflammation, and hemostasis, comparing mild and severe forms of COVID-19. METHODS: To accomplish these aims, we will analyze demographic characteristics, biochemical tests, immune biomarkers, leukocyte phenotyping, immunoglobulin profile, hormonal release (cortisol and prolactin), gene expression, thromboelastometry, neutralizing antibodies, metabolic profile, and neutrophil function (reactive oxygen species production, neutrophil extracellular trap production, phagocytosis, migration, gene expression, and proteomics). A total of 200 reverse transcription polymerase chain reaction-confirmed patients will be enrolled and divided into two groups: mild/moderate or severe/critical forms of COVID-19. Blood samples will be collected at different times: at inclusion and after 9 and 18 days, with an additional 3-day sample for severe patients. We believe that this information will provide more knowledge for future studies that will provide more robust and useful clinical information that may allow for better decisions at the front lines of health care. RESULTS: The recruitment began in June 2020 and is still in progress. It is expected to continue until February 2021. Data analysis is scheduled to start after all data have been collected. The coagulation study branch is complete and is already in the analysis phase. CONCLUSIONS: This study is original in terms of the different parameters analyzed in the same sample of patients with COVID-19. The project, which is currently in the data collection phase, was approved by the Brazilian Committee of Ethics in Human Research (CAAE 30846920.7.0000.0008). TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-62zdkk; https://ensaiosclinicos.gov.br/rg/RBR-62zdkk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24211.

The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy.

Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.

Opportunistic tropical infections in immunosuppressed patients.

Autoimmune and autoinflammatory diseases are associated with severe morbidity, and represent an impactful health and economic burden worldwide. The treatment of these diseases can include a course with detrimental side effects. Immunosuppression increases the risk of opportunistic infections, but in some cases, the abrupt discontinuation of these medications can result in immune reconstitution inflammatory syndrome. Special attention must be directed to endemic tropical infections, such as leishmaniasis, Chagas disease, malaria, arbovirosis, yellow fever, leprosy, paracoccidioidomycosis, disseminated strongyloidiasis, and ectoparasitosis. These endemic diseases of developing countries can be considered as possible emerging diseases in developed regions partially because of environmental factors and migration. In the present article, we aim to review the evidence-based aspects of the most important opportunistic tropical infections in immunosuppressed patients. We also aim to review the important aspects of vaccination, chemical prophylaxis, and treatment for these infections in people with medication-induced immunosuppression.

The challenge of concomitant infections in the coronavirus disease 2019 pandemic era: Severe acute respiratory syndrome coronavirus 2 infection in a patient with chronic Chagas disease and dimorphic leprosy

Abstract Coronavirus disease 2019 (COVID-19) was first officially described in Brazil on February 26th, 2020. The accumulation of reports of concomitant infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pathogens that cause diseases endemic to tropical countries, such as dengue and chikungunya fever, has started to draw attention. Chagas disease and leprosy remain public health problems in many developing countries, such as Brazil. In this manuscript, we describe a case of concomitant leprosy, Chagas disease, and COVID-19, highlighting the cutaneous manifestations of SARS-CoV-2 infection and the clinical behavior of household contacts who previously received prophylactic Bacillus Calmette-Guérin vaccines.

Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil.

INTRODUCTION AND OBJECTIVES: Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. MATERIALS AND METHODS: All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). RESULTS: 3939 patients (60% males, mean age 58±10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. CONCLUSION: SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries.

Association between the IL28B rs12979860 POLYMORPHISM and therapy response in patients infected with genotype 1 of hepatitis c virus in central Brazil

Single nucleotide polymorphisms (SNPs) upstream of the IL28B gene have been associated with the spontaneous clearance of hepatitis C virus (HCV) and with a sustained virological response (SVR) to HCV infection treatment. This study aimed to investigate the association between IL28B SNP rs12979860 and SVR in patients with hepatitis C in Central Brazil. A total of 101 HCV genotype 1 mono-infected chronic patients treated with pegylated interferon and ribavirin (PEG-IFN/RBV) were studied in the City of Goiânia, Central Brazil. Analysis of rs12979860 showed that the most prevalent genotype was CT (57.4%), followed by CC (23.8%) and TT (18.8%). An overall SVR rate of 28.7% (95% CI: 20.4-38.7) was found in the study population. In a multivariate analysis, only IL28B rs12979860 CC genotype (OR: 3.77; 95% CI: 1.13-12.60; p = 0.031) was associated with SVR. These findings show that IL28B SNP rs12979860 is a strong predictor of SVR in the PEG-IFN/RBV treatment in patients infected with genotype 1 of HCV in Central Brazil

Overt and occult hepatitis B virus infection among treatment-naïve HIV-infected patients in Brazil.

Although hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection is common, only few data are available on HBV among HIV patients including occult hepatitis B infection (OBI), regardless of serological markers. This study aims to determine the prevalence of OBI and overall HBV infection, associated factors, HBV genotypes, and surface (S) gene mutations in a population of treatment-naïve HIV-infected patients in Brazil. A cross-sectional study was conducted in treatment-naïve HIV-infected patients in Central Brazil. All samples were tested for HBV serological markers and HBV DNA. Sequence analysis of the S gene and overlapping polymerase gene was preformed. Overall, 25.1% (127/505) of the patients had markers of current or previous HBV infection, which was associated with age over 40 years, history of injection drug use, and homosexual sex. The hepatitis B surface antigen (HBsAg) seroprevalence was 4.9% (25/505). HBV DNA was detected in 39 out of 505 patients: 20 of them were HBsAg-positive and 19 were HBsAg-negative, resulting in an OBI prevalence of 3.8%. Patients with OBI had significantly higher HCV seropositivity rate compared to HBsAg-positive patients. Sequencing of the S gene revealed Y100C, T131N, and D144A mutations. One patient had the M204I and L180M drug-resistance mutations (polymerase). HBV genotypes A (A1, A2), D (D2, D3), and F (F2) were identified. In conclusion, OBI represented almost half of all HBV infections with detectable HBV DNA, suggesting that hepatitis B diagnosis in HIV patients should include in addition to serological markers the detection of HBV DNA.

Adele Bloch-Bauer (1881-1925): Possible diagnoses for Gustav Klimt's Lady in Gold.

One of the most famous works by the Austrian symbolist painter Gustav Klimt and one of the most widely reproduced works of art worldwide, Adele Bloch-Bauer I which portrays the beautiful wife of Austrian magnate Ferdinand Bloch-Bauer. Adele was the only woman painted by Klimt on more than one occasion. Apart from the beauty and value of the painting, the daring sea of gold that surrounds Adele and the gentle intimacy with which her fragile figure is portrayed have shrouded the history of this painting in mystery. Beyond speculation as to a special bond between artist and model, observation of the painting with a keener, clinical gaze yields evidence of potential illness in the model: facial erythema which, if not produced artificially by makeup, could represent a malar rash; pallor or cyanosis of the hands; and her draped fingers, which seemingly attempt to hide a deformity. This paper seeks to provide a biographical review both of the painter, Gustav Klimt, and of the subject, Adele Bloch-Bauer; to analyse Klimt's two portrayals of her in a search for evidence of a potential intimate relationship between artist and muse and, finally, to compile clinical evidence of possible diagnoses for the Lady in Gold.

Pre-operative anesthetic assessment of patients with rheumatoid arthritis.

The management and surgical interventions of problems directly or indirectly arising from rheumatoid arthritis vary drastically. Anesthesiologists and rheumatologists should be aware of the peculiarities of the anesthetic preoperative assessment of these patients, including the assessment of possible disorders of the airways, in addition to the intra-operative management and analysis of relevant pharmacological parameters. It is critical that the anesthetist is familiar with the peculiarities of the disease and the specific characteristics of drugs used in its treatment: thus, he/she will be able to plan the best possible anesthetic technique for the surgery in question, offering safety and comfort to his/her patient. It is up to the rheumatologist to know the procedure to which the patient will be submitted to and be aware of the most appropriate anesthetic technique in each case. This will allow a better interaction between the rheumatologist and the anesthesiologist in the pre-anesthetic evaluation, through the sharing of relevant information on the articular and systemic involvement by the disease that might interfere with preoperative and intraoperative management. Furthermore, the information on the pre-anesthetic assessment and the choice of anesthetic technique will enable the rheumatologist to clarify any doubts that his/her patient and family may have, as well as to guide them as to whether or not the medications in use should be maintained, and eventually about the need for a supplemental dose of corticosteroid. The objective of this review is to acquaint the rheumatologist with key concepts related to the anesthetic preoperative assessment of patients diagnosed with RA, mainly including general notions that dictate the choice of the anesthetic technique.

Avaliação anestésica pré-operatória de pacientes com artrite reumatoide / Pre-operative anesthetic assessment of patients with rheumatoid arthritis

O manejo e as intervenções cirúrgicas de problemas decorrentes direta ou indiretamente da artrite reumatoide variam drasticamente. O anestesiologista e o reumatologista devem estar atentos às peculiaridades da avaliação anestésica pré-operatória desses pacientes, incluindo a avaliação de possíveis distúrbios das vias aéreas, além do manejo intraoperatório e da análise dos parâmetros farmacológicos pertinentes. É essencial que o médico anestesiologista esteja familiarizado com as peculiaridades da doença e com as características específicas dos medicamentos usados no seu tratamento, pois, assim, ele poderá planejar da melhor forma possível a técnica anestésica para o ato cirúrgico em questão, oferecendo segurança e conforto ao paciente. Ao reumatologista, cabe conhecer o procedimento a que o paciente será submetido e ter noção da técnica anestésica mais indicada em cada caso. Isso permitirá melhor interação entre o reumatologista e o anestesiologista na avaliação pré-anestésica, através do compartilhamento de informações relevantes sobre o acometimento articular e sistêmico pela doença que possam interferir com o manejo pré e intraoperatório. Além disso, as informações sobre a avaliação pré-anestésica e a escolha da técnica de anestesia contribuirão para que o reumatologista possa esclarecer dúvidas que o paciente e seus familiares porventura apresentem, bem como orientá-los quanto à manutenção ou não das medicações em uso e, eventualmente, da necessidade de suplementação da dose do corticosteroide. O objetivo desta revisão é familiarizar o reumatologista com os principais conceitos relacionados à avaliação anestésica pré-operatória de pacientes com diagnóstico de AR, incluindo, principalmente, as noções gerais que ditam a escolha da técnica anestésica.

The management and surgical interventions of problems directly or indirectly arising from rheumatoid arthritis vary drastically. Anesthesiologists and rheumatologists should be aware of the peculiarities of the anesthetic preoperative assessment of these patients, including the assessment of possible disorders of the airways, in addition to the intra-operative management and analysis of relevant pharmacological parameters. It is critical that the anesthetist is familiar with the peculiarities of the disease and the specific characteristics of drugs used in its treatment: thus, he/she will be able to plan the best possible anesthetic technique for the surgery in question, offering safety and comfort to his/her patient. It is up to the rheumatologist to know the procedure to which the patient will be submitted to and be aware of the most appropriate anesthetic technique in each case. This will allow a better interaction between the rheumatologist and the anesthesiologist in the pre-anesthetic evaluation, through the sharing of relevant information on the articular and systemic involvement by the disease that might interfere with preoperative and intraoperative management. Furthermore, the information on the pre-anesthetic assessment and the choice of anesthetic technique will enable the rheumatologist to clarify any doubts that his/her patient and family may have, as well as to guide them as to whether or not the medications in use should be maintained, and eventually about the need for a supplemental dose of corticosteroid. The objective of this review is to acquaint the rheumatologist with key concepts related to the anesthetic preoperative assessment of patients diagnosed with RA, mainly including general notions that dictate the choice of the anesthetic technique.

A tool for selecting patients with a high probability of sustained virological response to peginterferon alfa-2a (40kD)/ribavirin.

BACKGROUND & AIMS: Pretreatment identification of patients likely to achieve a sustained virological response (SVR) with peginterferon alfa-2a/ribavirin would be useful for individualizing treatment choices. The aim of this analysis was to devise a simple scoring system to identify patients with high probability of achieving an SVR with peginterferon alfa-2a/ribavirin. METHODS: Using data from 2109 Caucasian treatment-naive hepatitis C virus (HCV) genotype 1 mono-infected patients from the PROPHESYS cohorts, the relationship between favourable baseline characteristics and SVR was explored using generalized additive model analysis, and a scoring system was devised to predict SVR. RESULTS: Points were assigned for: age (years) (≤35: 2; >35, ≤45: 1; >45: 0); body mass index (kg/m(2)) (≤20: 2; >20, ≤22: 1; >22: 0); HCV RNA (IU/ml) (≤100,000: 3; >100,000-400,000: 2; >400,000-800,000: 1; >800,000: 0); platelets (>150 ×10(9)/l: 1; ≤150 ×10(9)/l: 0); alanine aminotransferase [×upper limit of normal (ULN)] (>3: 1; ≤3: 0); serum aspartate aminotransferase (×ULN) (≤1: 1; >1: 0). 1029, 698 and 382 patients had scores of 0-2, 3-4 and ≥5, respectively, among whom SVR rates were 35.0, 54.9 and 76.7%. SVR in patients with scores ≥5 and undetectable HCV RNA by week 4 was 86.7%. The score was tested against two databases of patients who received peginterferon alfa-2a/ribavirin in other clinical trials; similar high SVR rates in patients with scores ≥5 were reported. CONCLUSIONS: The scoring system can reliably identify treatment-naive HCV genotype 1 mono-infected Caucasian patients who have a high probability of achieving an SVR with peginterferon alfa-2a/ribavirin and will be particularly useful where protease inhibitors are not readily available.

Predictive value of FIB-4 and APRI versus METAVIR on sustained virologic response in genotype 1 hepatitis C patients.

PURPOSE: Advanced liver fibrosis is a negative predictor of virologic response in genotype 1 chronic hepatitis C (CHC) patients. Biopsy, however, is invasive, costly, and carries some risk of complications. METHODS: Using data from the prospective, international cohort study PROPHESYS, we assessed two alternative noninvasive measures of fibrosis, the FIB-4 and AST-to-platelet ratio index (APRI), to predict virologic response in CHC patients. RESULTS: CHC genotype 1, monoinfected, treatment-naive patients prescribed peginterferon alfa-2a (40 KD)/ribavirin in accordance with country-specific legal and regulatory requirements and who had baseline METAVIR, FIB-4, and APRI scores (N = 1,592) were included in this analysis. Patients were stratified according to the baseline METAVIR, FIB-4, or APRI score to assess virologic response [hepatitis C virus (HCV) RNA <50 IU/mL] by week 4 of treatment (rapid virologic response) and 24 weeks after untreated follow-up ]sustained virologic response (SVR)]. Baseline predictors of SVR were explored by multiple logistic regression, and the strength of the association between each fibrosis measure and SVR was evaluated. Both FIB-4 and APRI scores increased with increasing levels of biopsy-assessed fibrosis. The association between FIB-4 and SVR (p < 0.1 × 10(-30)) was stronger than that between METAVIR (p = 3.86 × 10(-13)) or APRI (p = 5.48 × 10(-6)) and SVR. Baseline factors significantly associated with SVR included male gender, lower HCV RNA, lower FIB-4 score, no steatosis, and higher alanine aminotransferase ratio. CONCLUSION: The FIB-4 index provides a valuable, noninvasive measure of fibrosis and can be used to predict virologic response in patients treated with peginterferon alfa-2a (40  KD)/ribavirin.

O papel da filosofia na educação médica / The role of philosophy in the medical education

O significado da Medicina variou grandemente ao longo da História, desde o caráter filosófico do período hipocrático ao cientificismo pragmático da atualidade. Acompanhando o desenvolvimento científico-tecnológico, que afastou a Medicina das ciências humanas, inserindo-a entre as ciências exatas e biológicas, o ensino médico tornou-se fragmentado e tecnicista. O surgimento de um novo tipo de médico, biologicista e especialista, não atendeu às necessidades da sociedade, que exige um profissional capaz de rempreender elação médico-paciente satisfatória. Nesse contexto, tornou-se importante discutir como humanizar, ou reumanizar, a Medicina. O ensino da Filosofia durante a formação médica é sugerido como uma das formas de humanização da Medicina. A compreensão por parte do médico das doutrinas filosóficas seria importante na formação de profissionais com visão reflexiva e crítica sobre a prática da Medicina. São apresentados exemplos de faculdades que incluíram disciplinas de Filosofia no currículo médico de graduação e os resultados dessas experiências. Citam-se ainda as limitações da escola médica como agente de humanização, uma vez que a formação humanística do indivíduo é um processo complexo e dependente do ambiente, dos valores e das vivências prévias.

The meaning of Medicine has drastically changed along History, from the philosophical feature of the hippocratic period to the pragmatic scientificism in the current days. Following the scientific-technological development that withdrew Medicine from human sciences has approximated it to the exact and biological sciences, the medical teaching became fragmented and technicist. The emergence of a new biologicist and specialized type of physician did not fulfill society?s demands, which requires not only a technically updated professional, but also someone capable of a have satisfactory physician-patient relationship. In this context the discussion on how to humanize or re-humanize Medicine becames important. Teaching Philosophy during the medical formation has been suggested as an alternative means to humanize Medicine. The comprehension of the philosophical principles would be important in the formation of these professionals with the objective of providing physicians with a critical and reflexive view of the clinical practice. Examples of medical schools that included Philosophy in the graduation medical curriculum and the results of these experiences are presented. The limitations of medical schools as humanization agents are also reported, since the individual?s humanistic formation is an extremely complex process and depends on environment, values and previous experiences.

O aumento do produto interno bruto per capita não melhorou os indicadores de saúde no Brasil / The increase on the per capita gross domestic product did not improve health status indicators in Brazil

Objetivo. Estabelecer se houve correlação entre o aumento do produto interno bruto per capita e possível melhoria dos indicadores básicos para a saúde no Brasil. Método. Estudo observacional ecológico, com utilização da base de dados do Departamento de Informática do Sistema Único de Saúde. Foram correlacionados ao produto interno bruto per capita outros indicadores socioeconômicos (razão de renda e proporção de pobres), de recursos, cobertura, morbidade, fatores de risco e mortalidade, referentes ao Brasil, ao Distrito Federal e ao Maranhão, unidades da Federação com maior e menor renda per capita, respectivamente, no período de 1996 a 2004. Foi feito o cálculo do coeficiente de correlação parcial de Pearson, ajustado para o tempo e medido pelo ano, com nível de significância corrigido pelo método de Bonferroni. Resultados. Houve aumento do produto interno bruto per capita em todos os locais avaliados, mas o gastocom saúde como proporção desse produto interno se manteve constante. Eliminando-se o efeito de ano, não foi observada evidência significativa de associação entre o aumento do referido produto e qualquer um dos indicadores socioeconômicos e básicos para a atenção à saúde analisados, exceto quanto ao número de leitos hospitalares doSistema Único de Saúde por mil habitantes no Maranhão, que se reduziu de forma significante (p < 0,0001). Conclusão. O aumento do produto interno bruto no Brasil não diminuiu a pobreza ou a desigualdade social,nem melhorou o desempenho dos indicadores básicos para a saúde.

Objective. To verify the correlation between increase on the per capita gross domestic product and possible improvement of health status indicators in Brazil. Method. Ecological observational study using the database of the Department of Informatics ? of the Public Health System. Other socioeconomic indicators were correlated to the per capita gross domestic product (income ratio and poverty proportion) such as resources, coverage, morbidity, risk factors and mortality rate in the DistritoFederal and state of Maranhão, localities with the highest and lowest per capita income, respectively, in the period from 1996 to 2004. The Pearson?s partial correlation coefficient was calculated and adjusted to time, which was yearly measured with significance level corrected by the Bonferroni?s method. Results. An increase on the per capita gross domestic product was observed for all localities evaluated; however,investments in health as the mentioned domestic product proportion remained constant. Except for the year effect, no significant evidence of association between increased gross domestic product and any socioeconomic and basic health status indicators was observed. Otherwise, a significant reduction on the number of public hospital bedsper 1,000 inhabitants in the state of Maranhão was observed (p < 0.0001).Conclusion. The increase on the Brazilian gross domestic product did not reduce poverty or social inequity or improve the performance of basic health indicators.

Differing phagocytic function of monocytes and neutrophils in Chagas' cardiopathy according to the presence or absence of congestive heart failure

A função fagocitária e a produção de radicais microbicidas de oxigênio pelos monócitos e neutrófilos foram avaliadas em 9 pacientes com cardiopatia chagásica com insuficiência cardíaca congestiva e 9 sem a síndrome em comparação com 11 indivíduos controles normais pelo teste de fagocitose de Saccharomyces cerevisiae e redução do nitroblue tetrazolium pelos fagócitos do sangue periférico. O índice fagocitário dos monócitos dos chagásicos sem insuficiência cardíaca foi significantemente 6,7 e 10,6 vezes menor do que o dos controles e chagásicos com a síndrome congestiva, respectivamente, devido ao menor envolvimento na fagocitose e a menor capacidade destas células de ingerirem partículas. Nos chagásicos sem insuficiência cardíaca os neutrófilos também apresentaram o IF 11,2 e 19,8 vezes menor que os controles e chagásicos com insuficiência cardíaca, respectivamente. A porcentagem de redução do NBT foi normal e similar para os três grupos. Efeitos opostos equilibrados das disfunções devidas às alterações cardiovasculares e imunes podem ter atuado nos pacientes chagásicos com insuficiência cardíaca paradoxalmente recuperando a função fagocitária alterada.

Differing phagocytic function of monocytes and neutrophils in Chagas' cardiopathy according to the presence or absence of congestive heart failure.

We evaluated the in vitro phagocytic function and the production of microbicidal oxygen radicals by monocytes and neutrophils of 9 Chagas' heart disease subjects with heart failure and 9 without the syndrome in comparison with 11 healthy subjects, by assessing phagocytosis of Saccharomyces cerevisiae and NBT reduction by peripheral blood phagocytes. Phagocytic index of monocytes of chagasics without heart failure was significantly 6.7 and 10.6 times lower than those of controls and chagasics with the congestive syndrome, respectively, due to a lesser engagement in phagocytosis and to an inability of these cells to ingest particles. Neutrophils also show in chagasics without heart failure PI 11.2 and 19.8 times lower than that of controls and chagasics with heart failure, respectively. The percent of NBT reduction was normal and similar for the three groups. Balanced opposite effects of cardiovascular and immune disturbances may be acting in Chagas' disease subjects with heart failure paradoxically recovering the altered phagocytic function.

Digitalis inhibits and furosemide does not change the in vitro phagocytic function of neutrophils of healthy subjects.

This work evaluated the in vitro influence of digitalis and furosemide on the phagocytic function of neutrophils of healthy individuals. Phagocytosis of Saccharomyces cerevisiae by peripheral blood neutrophils of 20 healthy individuals was assessed in the absence or presence of deslanoside or furosemide. The Wilcoxon test was employed to compare the data expressed as median and extreme values. Digitalis reduced the number of yeasts ingested by neutrophils (2.23, 1.23-4.01 versus 1.89, 0.87-2.79; p = 0.019). It did not influence the percentage of these cells engaged in phagocytosis, although there was a tendency for reduction (71%, 23-95% versus 57%, 8-93%; p = 0.11), which resulted in decreasing the phagocytic index from 192 (30-381) to 125 (10-218) (p = 0.028). Furosemide had no significant influence on the number of S. cerevisiae phagocytosed (2.23, 1.23-4.01 versus 1.96, 0.70-4.45; p = 0.89), the percent of phagocytosing neutrophils (71%, 23-95% versus 73%, 9-96%; p = 0.86) and the phagocytic index (192, 30-381 versus 152, 10-428; p = 0.95). These findings indicate the inhibitory influence of digitalis on in vitro neutrophil phagocytic function of healthy subjects, and suggest that this effect might impair the innate immune defense response. On this basis, they could contribute to improve digitalis therapy and advise that this drug class should not be associated with other drugs that may also impair the immune function, or might be used with caution or even avoided in subjects with infections.

Correlaçäo dos níveis de ALT com a prevalência de marcadores dos vírus das hepatites B e C em doadores de sangue do Hospital das Clínicas da UFG (Goiânia) / Correlation among ALT serum levels and hepatitis B and C markers in blood donors from Hospital das Clinicas da UFG (Goiânia, Central Brazil)

O vírus da hepatite C (HCV) está envolvido em cerca de 90 por cento das hepatites pós-transfusionais. Até recentemente, níveis de ALT acima do normal, isoladamente, eram considerados como teste sugestivo de infecçao por vírus NANB. Com o objetivo de avaliar a correlaçao entre os níveis elevados de ALT com a presença de marcadores virais, estudamos 966 doadores do Banco de Sangue (BS) do HC-UFG, no período de fevereiro a agosto/94. Foram considerados os seguintes testes dentro da rotina do BS: anti-HBs, HBsAg (RIA) e anti-HCV (ELISA de segunda geraçao). Cinqüenta e oito doadores apresentavam ALT acima de 39 UI/L, dos quais três eram positivos para o anti-HCV, três para o HBsAg, seis para anti-HBc isolado e os 46 restantes nao apresentavam marcadores para nenhum dos vírus. Nossos resultados confirmam dados prévios de que a ALT nao é substituto para o anti-HCV e que seus níveis séricos nao se correlacionam com presença ou ausência do marcador viral; entretanto, sua dosagem deve ser mantida no BS, pois pode detectar a fase aguda soronegativa da infecçao pelo HCV.