Prevalence of chronic pulmonary aspergillosis regarding time of tuberculosis diagnosis in Brazil.

BACKGROUND: Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. OBJECTIVES: To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS: A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination-culture for fungi and smears for direct mycology; (d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and (e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS: The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS: The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.

Evidence of hepatitis E virus infections among persons who use crack cocaine from the Midwest region of Brazil.

The current study aimed to determine the seroprevalence of hepatitis E virus (HEV) infection among persons who use crack from Midwest region of Brazil. Sera samples from 698 users of crack, collected from November 2013 to July 2015 were tested for anti-HEV immunoglobulin G (IgG) and immunoglobulin M (IgM) markers. Of the 698 serum samples, 99 (14.2%) were positive for anti-HEV IgG. Two samples were positive for anti-HEV IgM but both were negative for HEV RNA. The variables independently associated with anti-HEV positivity were increasing age and absence of stable partnership. This study showed high prevalence of past hepatitis E virus infection among persons who use crack.

Spontaneous pneumothorax in paracoccidioidomycosis patients from an endemic area in Midwestern Brazil.

Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas.

Analysis of the school anxiety inventory in Brazil using the Rasch rating scale model.

This study assessed the quality of the items of the School Anxiety Inventory using the Rating-Scale Rasch model. The Inventory was administered to 253 grade school pupils, ranging in age from 9 to 12 yr. (M = 10.2 yr., SD = 0.98); most were girls (52.8%). The results showed that the items and participants adequately fit the Rasch model. The average anxiety of these children was 0.32 logits (SD = 1.60). The inventory items revealed good reliability (Item Reliability Index = 0.98; Cronbach's α = .74), and the fit indicators for the response categories were adequate for 50% of the items, while the other items revealed dichotomous responses. No item functioned differentially for boys and girls. The psychometric properties of the inventory were good enough to encourage plans for further development.

Accumulation, elimination, and effects of parenteral exposure to aluminum in newborn and adult rats.

Aluminum (Al) delivered to preterm infants via parenteral nutrition may exceed the limit of 5 µg/kg/day set by the US Food and Drug Administration. This study evaluated the effect of the administration of an equivalent amount of Al (0.12 mg/kg/day) to newborn rats. The study included the administration of a higher amount of Al (24.8 mg/kg/day) not only to newborn rats but also to adult (2- and 4-month-old) rats. Aluminum was intraperitoneally administered for a period of 10 days. Newborn animals were evaluated for developmental changes every day starting from the second day after birth. Twenty days after the last administration, 10 animals were killed and their organs were removed; the remainders were killed on day 40. A dosage of 24.8 mg/kg/day was administered to the two groups of adult rats, which were killed following the same protocol after 20 and 40 days. The results of physical parameters and developmental and behavioral tests were not conclusive and no significant differences were observed between the lower and higher Al dose and control groups. The group that received 0.12 mg/kg/day showed significant differences in Al accumulation only in the liver and muscle. The groups that received a higher dose of Al showed an accumulation in all tissues among all age groups studied, but the newborn group showed the greatest accumulation (results for day 20). After 40 days, Al content in all tissues decreased more than 50% in this group, whereas among the adults, the Al content increased or remained constant. An increase in age correlated with a lower elimination rate. Considering the ongoing human Al exposure, along with its age-related elimination rate, Al accumulation in the body may be long-lasting.

Moderate prevalence of transmitted drug resistance mutations among antiretroviral-naive HIV-infected pregnant women in Rio de Janeiro, Brazil.

Transmission of drug-resistant HIV-1 strains has been gaining attention and is becoming a growing problem throughout the world. The aim of this study was to determine the prevalence of transmitted drug resistance mutations (TDRM) among antiretroviral (ARV)-naive HIV-infected pregnant women in Rio de Janeiro, Brazil. ARV-naive pregnant women were recruited at Hospital Geral de Nova Iguacu (HGNI), Rio de Janeiro, from 2005 to 2008. HIV genotyping was carried out using ViroSeq (Abbott v. 2.0). TDRM were detected using the Calibrated Population Resistance Tool-CPR v. 6.0.The prevalence of mutations associated with resistance in the protease and reverse transcriptase regions of the HIV genome were assessed in samples collected prior to initiation of ARV prophylaxis or treatment. Among 238 eligible specimens that were collected, 197 samples were successfully amplified using reverse transcription polymerase chain reaction. Eighty-one percent of women were infected with HIV subtype B, 10% with subtype F1 viruses, 1.0% with subtype C virus, and 8.0% with recombinant forms of the virus. The prevalence of HIV TDRM was 5.6% for nucleoside reverse transcriptase inhibitors, 2.0% for nonnucleoside reverse transcriptase inhibitors, and 3.0% for protease inhibitors. The overall prevalence of any drug resistance was 10.7%. There were no multiclass resistant strains identified in the analyzed samples. The prevalence of HIV TDRM among the pregnant women in our cohort was moderate. Resistance testing should be encouraged in Rio de Janeiro, among other locations, for all HIV-infected pregnant women prior to prevention of mother-to-child transmission of HIV.

Previous exposure to cigarette smoke aggravates experimental cyclosporine-induced nephrotoxicity.

BACKGROUND/AIMS: The effects of cigarette smoke (CS) on cyclosporine (CsA)-induced nephrotoxicity are poorly studied. This study aims to assess the effects of previous exposure to CS on CsA nephrotoxicity. METHODS: Rats were either exposed to CS or sham (S) procedures for 10 min twice a day for 20 weeks. From the 16th to the 20th week, they received a low-salt diet. Beginning with the 17th week, they were given 2.5 mg/day CsA or vehicle (VH) for 3 weeks. The final groups were VH/CS, CsA/CS, VH/S, and CsA/S. On day 141, glomerular filtration rate (GFR), renal blood flow (RBF), renal vascular resistance (RVR), tubulointerstitial fibrosis, and CsA blood levels were measured and immunohistochemistry was analyzed for renal α-smooth muscle actin (SMA), nitrotyrosine, and vimentin. RESULTS: CsA decrease in GFR was enhanced by CS exposure. CsA associated with CS induced higher periglomerular α-SMA and renal nitrotyrosine expression. CsA decreased RBF, but increased RVR, tubulointerstitial fibrosis, and α-SMA and renal vimentin expression. These changes and the CsA blood levels were not affected by CS exposure. CONCLUSION: CS aggravated the CsA-induced impairment of GFR and CS associated with CsA caused the development of periglomerular structural lesions and oxidative stress in a rat model of CsA nephrotoxicity.

Aluminum loading in preterm neonates revisited.

Preterm neonates receiving parenteral nutrition are at risk of aluminum (Al) overload because of the presence of Al as a contaminant in parenteral formulations. Despite US Food and Drug Administration regulation, commercial products continue to present Al contamination. To reassess Al exposure in the premature neonatal population, the present study evaluated the Al balance (intake vs urinary excretion) in a group of preterm neonates during the period in which they stayed in the intensive care unit (NICU) under total parenteral nutrition. For the 10 patients selected, daily infusion solutions (nutrition and medication) were collected and the level of Al contamination was measured. From the urine collected daily, an aliquot was taken for Al determination. Blood was also collected for Al determination on the first and last day in the NICU. The measurements were carried out by atomic absorption spectrometry. The difference between Al administered and excreted revealed that 56.2% +/- 22.7% of the Al intake was not eliminated. The mean serum Al levels from the first to the last day decreased from 41.2 +/- 23.3 to 23.5 +/- 11.2 microg/L. The resulting mean Al daily intake of the 10 patients was 15.2 +/- 8.0 microg x kg(-1) x day(-1). Because Al intake was higher than that excreted and Al in serum decreased to practically half during the period in the NICU (+/-7.3 days), some amount of Al deposition occurred. Moreover, premature neonates were receiving, on average, 3 times the amount of 5 microg x kg(-1) x day(-1), considered by the Food and Drug Administration as a safe limit.

Salivary gland homogenates of Lutzomyia longipalpis and its vasodilatory peptide maxadilan cause plasma leakage via PAC1 receptor activation.

OBJECTIVES: Experiments were designed to determine if salivary gland homogenates (SGH) of the sand fly Lutzomyia longipalpis, the vasodilatory peptides maxadilan and pituitary adenylate cyclase-activating peptide (PACAP-38) may cause plasma leakage and to what extent these effects could be due to PAC1 receptor stimulation. METHODS: Using FITC-dextran as a plasma marker, intravital microscopy of the hamster cheek pouch (HCP) and a digital camera were used to assess arteriolar diameter and fluorescence of a selected area (5 mm(2)) representative of the HCP microcirculation. RESULTS: Cheek pouches prepared for intravital microscopy and exposed to topical application of SGH, maxadilan or PACAP-38 developed maximal dilation of arterioles in the range of 20-60 mum within 10 min, and this effect lasted for 30-90 min. The increase in fluorescence intensity induced by each of these compounds was due to plasma leakage from postcapillary venules. The mutant peptide of maxadilan (M-65), a PAC1 receptor antagonist, inhibited both dilation and plasma leakage induced by SGH or maxadilan. Plasma leakage induced by SGH was modestly inhibited by the bradykinin B(2) receptor antagonist HOE-140, but not by the antihistamine mepyramine or the nitric oxide synthase inhibitor L-NA. CONCLUSIONS: SGH of L. longipalpis and its vasodilatory peptide maxadilan caused long-lasting arteriolar dilation and plasma leakage in the cheek pouch via PAC1 receptor activation.

Role of medication in the level of aluminium in the blood of chronic haemodialysis patients.

BACKGROUND: Although dialysis facilities provide high-quality water, abnormal aluminium levels among patients on haemodialysis have still been reported. Since patients with chronic kidney disease are often on multiple medications, medicines may be an extra source of aluminium for them. The degree to which ingesting contaminated medication influenced the level of aluminium in the patients' blood was investigated. METHODS: All medications consumed by a group of patients on regular dialysis treatment were analysed and the total aluminium ingested by each patient was calculated. At the same time, the patients' blood was collected and aluminium was measured. The analyses were carried out by atomic absorption spectrometry. RESULTS: For all drugs consumed, the amount of aluminium ingested versus the blood aluminium level presented no correlation. Since a high level of contamination was presented by injectable iron, insulin and erythropoietin (EPO), another group of patients that received a reduced amount of oral medication was selected. Among them, eight did not receive any injectable drug, five received only EPO and seven injectable iron, EPO and insulin. With these restricted groups, it was possible to show that the injectable administration of contaminated medication increased the Al level in the patients' blood, mainly in relation to iron formulations. CONCLUSION: Among the medications investigated, the injectables are the most significant source of aluminium for patients with renal insufficiency. This extra aluminium intake is reflected in higher aluminium levels in the patients' blood.

Study on the bacterial midgut microbiota associated to different Brazilian populations of Lutzomyia longipalpis (Lutz & Neiva) (Diptera: Psychodidae).

The bacterial community associated with the midgut of three Brazilian Lutzomyia longipalpis (Lutz & Neiva) populations, two from endemic areas for visceral leishmaniasis (Jacobina, Bahia State and São Luís, Maranhão State) and one from a non-endemic area (Lapinha Cave, Minas Gerais State), was identified. Five groups, 35 females each, from each population were separated; a total of 175 females per collecting area were analyzed. The species identification was based on molecular and traditional bacteriological methods. All bacteria were either affiliated to non-Enterobacteriaceae, such as Acinetobacter, Burkholderia, Flavimonas, Pseudomonas and Stenotrophomonas, or and to Enterobacteriaceae, such as Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella and Weeksella. Stenotrophomonas was found to be associated with all three populations studied. In addition, Serratia spp., which are well documented as laboratory contaminant of insects, were detected only in the Jacobina population. We also discuss the impact of the colonization of insect gut by bacteria on the development and transmission of pathogens.

Study on the bacterial midgut microbiota associated to different Brazilian populations of Lutzomyia longipalpis (Lutz & Neiva) (Diptera: Psychodidae) / Estudo sobre as bactérias da microbiota intestinal de diferentes populações brasileiras de Lutzomyia Longipalpis (Lutz & Neiva) (Diptera: Psychodidae)

A flora bacteriana encontrada no intestino de populações brasileiras de Lutzomyia longipalpis (Lutz & Neiva) provenientes de duas áreas endêmicas para leishmaniose visceral (Jacobina, BA e São Luís, MA) e de uma área não endêmica (Gruta da Lapinha, MG) é descrita. Cinco grupos de 35 fêmeas de cada população foram separados, no total de 175 fêmeas analisadas por área de coleta. A identificação das espécies foi baseada em métodos moleculares e em métodos bacteriológicos tradicionais. As bactérias encontradas foram classificadas como pertencentes ao grupo das não-Enterobacteriaceae, como Acinetobacter, Burkholderia, Flavimonas, Pseudomonas, ou ao grupo das Enterobacteriaceae, como Stenotrophomonas, Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella e Weeksella. Stenotrophomonas esteve presente nas três populações analisadas. Além disso, Serratia spp., grupo bem documentado como contaminante laboratorial de insetos, foi detectado apenas na população de Jacobina. O impacto da colonização do intestino de insetos por bactérias no desenvolvimento e transmissão de patógenos é discutido.

The bacterial community associated with the midgut of three Brazilian Lutzomyia longipalpis (Lutz & Neiva) populations, two from endemic areas for visceral leishmaniasis (Jacobina, Bahia State and São Luís, Maranhão State) and one from a non-endemic area (Lapinha Cave, Minas Gerais State), was identified. Five groups, 35 females each, from each population were separated; a total of 175 females per collecting area were analyzed. The species identification was based on molecular and traditional bacteriological methods. All bacteria were either affiliated to non-Enterobacteriaceae, such as Acinetobacter, Burkholderia, Flavimonas, Pseudomonas and Stenotrophomonas, or and to Enterobacteriaceae, such as Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella and Weeksella. Stenotrophomonas was found to be associated with all three populations studied. In addition, Serratia spp., which are well documented as laboratory contaminant of insects, were detected only in the Jacobina population. We also discuss the impact of the colonization of insect gut by bacteria on the development and transmission of pathogens.

Single and concomitant experimental infectionsby Endotrypanum spp. and Leishmania (Viannia) guyanensis (Kinetoplastida: Trypanosomatidae) in the Neotropical sand fly Lutzomyia longipalpis (Diptera: Psychodidae)

Lutzomyia longipalpis females received single and mixed infections with Endotrypanum and Leishmania. Two biological parameters were analyzed: the percentage of infected females and the distribution of flagellates in the gut of the females. The principal comparisons were performed between (1) two strains of Endotrypanum, (2) cloned versus primary sample of one strain of Endotrypanum, (3) Endotrypanum versus Leishmania guyanensis, and (4) the pattern of flagellates behaviour by optical microscopy in females with single or mixed infection versus the identification of parasites isolated from digestive tracts by isoenzyme electrophoresis. Flagellates of Endotrypanum showed distinct patterns of infection suggesting that there is variation between and within strains. The distribution of Endotrypanum and L. guyanensis differed significantly in relation to the colonization of the stomodeal valve. In co-infection with L. guyanensis, a large number of flagellates were seen to be plentifully infecting the stomodeal valve in significantly more specimens than in females infected by Endotrypanum only. However, the electrophoretic profiles of isoenzymes of parasites recovered from all co-infected specimens corresponded to Endotrypanum. This suggests that the mere correlation sand fly infection-biochemical analysis of isolates may induce parasitological incorrect consideration.

Single and concomitant experimental infections by Endotrypanum spp. and Leishmania (Viannia) guyanensis (Kinetoplastida: Trypanosomatidae) in the neotropical sand fly Lutzomyia longipalpis (Diptera: Psychodidae).

Lutzomyia longipalpis females received single and mixed infections with Endotrypanum and Leishmania. Two biological parameters were analyzed: the percentage of infected females and the distribution of flagellates in the gut of the females. The principal comparisons were performed between (1) two strains of Endotrypanum, (2) cloned versus primary sample of one strain of Endotrypanum, (3) Endotrypanum versus Leishmania guyanensis, and (4) the pattern of flagellates behaviour by optical microscopy in females with single or mixed infection versus the identification of parasites isolated from digestive tracts by isoenzyme electrophoresis. Flagellates of Endotrypanum showed distinct patterns of infection suggesting that there is variation between and within strains. The distribution of Endotrypanum and L. guyanensis differed significantly in relation to the colonization of the stomodeal valve. In co-infection with L. guyanensis, a large number of flagellates were seen to be plentifully infecting the stomodeal valve in significantly more specimens than in females infected by Endotrypanum only. However, the electrophoretic profiles of isoenzymes of parasites recovered from all co-infected specimens corresponded to Endotrypanum. This suggests that the mere correlation sand fly infection-biochemical analysis of isolates may induce parasitological incorrect consideration.

Nível sérico de alumínio: influência da agua e de alimentos ingeridos por pacientes com insuficiência renal crônica mantidos em hemodiálise / Serum aluminium: influence of water and food consumed by patients with chronic renal insuficiency on regular hemodialysis treatment

Objetivo: O alumínio é muito comum na natureza e pode se acumular nos pacientes com insuficiência renal terminal em tratamento dialítico. É necessário,neste grupo de pacientes, a monitorização sérica e identificação de toxicidade, especialmente óssea. Este trabalho descreve a pesquisa realizada junto apacientes com insuficiência renal crônica, submetidos a tratamento dialítico na Casa de Saúde de Santa Maria, RS, com a finalidade de verificar se háinfluência da água e de alimentos ingeridos pelos pacientes nos níveis de alumínio sérico. Pacientes e Métodos: Os pacientes responderam a um questionáriosobre hábitos alimentares e, de acordo com as respostas, os alimentos de uso mais freqüente foram selecionados e analisados para a quantificaçãodo alumínio. Amostras da água utilizadas em suas residências e de sangue dos pacientes foram coletadas para quantificar o alumínio. O alumíniofoi dosado por espectrometria de absorção atômica. Para avaliar a quantidade de alumínio ingerida através dos alimentos padronizou-se o consumo atravésde porções básicas convertidas em massa. A partir deste cálculo foi possível determinar o alumínio ingerido por dia, por cada paciente em função dos alimentosconsumidos. Para a água considerou-se o consumo diário de 1 litro e, portanto, a ingestão da quantidade de alumínio contida neste volume. Umtotal de 133 pacientes participou do estudo, 82 amostras de água tratada, de poço artesiano e mineral foram analisadas, provenientes de Santa Maria, RSe outras cidades da região. Foram analisados 27 tipos de alimentos incluindo grãos, frutas, verduras, bebidas, pão e açúcar. Resultados: As amostras deágua apresentaram níveis de alumínio entre 3 e 439µg/L, considerando as três fontes mencionadas. Entre os alimentos, os maiores níveis foram encontradosno arroz, 92µg/g, na alface, 48µg/g, e no leite, 1700µg/L. Sucos artificiais e refrigerantes também apresentaram níveis elevados de alumínio, entre60 e 257µg/L. Conclusões: Não foi observada relação entre os níveis de alumínio sérico e o nível de alumínio presente nas águas ingeridas pelospacientes, porém foi encontrada relação entre o nível de alumínio e a concentração em alguns alimentos.

Structure and distribution of sensilla on maxillary palps and labella of Lutzomyia longipalpis (Diptera: Psychodidae) sand flies.

The typology, number, size, and distribution pattern of labellar and palpal sensilla of male and female Lutzomyia longipalpis (Lutz and Neiva, 1912) sand flies were analyzed by scanning electron and light microscopy, contributing to the construction of a gustatory and olfactory map in this important vector species. About 35 trichoid sensilla, sorted into three different classes according to their lengths, are present on the two labellar lobes. Five distinct structures are observed in the maxillary palps, which could be classified as noninnervated (microtrichia and scales) or the following innervated structures: 1) campaniform sensilla, found near the distal end of palpal segments II and III; 2) multiporous capitate peg sensilla, found in reduced number (1-6) on segment II, but located in a group of 15-25 on the distal third part of segment III; and 3) trichoid sensilla, distributed linearly on segment IV and spirally on segment V. Light microscopy analysis of silver-stained specimens indicated the presence of pores in the trichoid sensilla and their chemosensory function is discussed, as well as the possible function of the other sensilla.

The 3A1-La monoclonal antibody reveals key features of Leishmania (L) amazonensis metacyclic promastigotes and inhibits procyclics attachment to the sand fly midgut.

In this work, we characterise metacyclic promastigotes of Leishmania amazonensis, the causative agent of cutaneous and diffuse cutaneous leishmaniasis in the New World. To purify metacyclics from stationary culture by negative selection, we used the monoclonal antibody 3A1-La produced against procyclic promastigotes. The purified forms named 3A1-La(-) promastigotes, present key metacyclic characteristics: slender cell body and long flagella, ultrastructural features, resistance to complement lysis, high infectivity for macrophages and mice and reduced capacity for binding to the sand fly midgut. Moreover, the epitope recognised by 3A1-La is important for the promastigote attachment to the insect vector midgut epithelium. These results further characterise 3A1-La(-) promastigotes as metacyclic forms of L. amazonensis.

A verificação da calibração dos manômetros e condições dos esfigmomanômetros aneroídes: um programa de educação continuada para enfermeiros supervisores do Hospital de Base / Evaluation the manometers calibration accuracy and conditions of the aneroid sphygmomanometers: a continuing coordinators program nursing education at Hospital de Base

A pressão arterial é a pressão exercida pelo sangue sobre as paredes das artérias. Mesmo considerando o aparecimento de aparelhos de grande precisão, os manômetros de mercúrio continuam sendo considerados os mais fidedignos para verificação da pressão arterial. No entanto, os aparelhos aneróides menos precisos são mais utilizados. Por esse motivo, recomenda-se que devam ser testadas contra o manômetros de mercúrio. Um paciente erroneamente rotulado de hipertenso será induzido a seguir um tratamento desnecessário, enquanto pacientes hipertensos não diagnosticados podem estar sendo excluídos dos benefícios do tratamento. O objetivo deste estudo é verificar a calibragem do manômetro aneróide, verificar as condições dos esfigmomanômetros e elaborar e implantar um programa de educação continuada. Trata-se de um estudo descritivo, onde participaram todos os enfermeiros supervisores do Ambulatório e do Hospital de Base de São José do Rio Preto/SP. Em relação a calibragem dos manômetros verificou-se: 87,5 por cento encontraram-se descalibrados no Hospital de Base e 44 por cento no Ambulatório. Quanto as condições gerais dos esfigmomanômetros, 95 por cento dos aparelhos estavam em boas condições de uso no Hospital em estudo, enquanto que, apenas 14,4 por cento dos aparelhos no Ambulatório estão nestas condições

Aspectos importantes na determinação do nível de alumínio no sangue de pacientes em tratamento regular de hemodiálise / Aluminium level in serum analysis and its importance in hemodialysis treatment

A elevada toxicidade do alumínio para pacientes com insuficiência renal está muito bem documentada na literatura. A ação tóxica deste elemento é tão elevada que um controle anual dos níveis de alumínio sérico dos pacientes submetidos regularmente ao tratamento de hemodiálise é exigida pela Agência Nacional de Vigilância Sanitária (ANVISA). Devido à ubiquidade do aluminio, a análise requer cuidados especiais com relação à contaminação. Neste trabalho são abordados os aspectos mais importantes, desde a coleta até a quantificação do alumínio propriamente dita, para evitar fontes externas de contaminação e conduzir análise com êxito. Os cuidados necessários tornam-se relevantes devido ao baixo limite que coloca o paciente em risco. Níveis de Al acima de 30ug/L já caracterizam intoxicação, e determinam tratamento com agente quelante para redução do nível de Al sérico. Como este tratamento não é isento de efeitos colaterais, é muito importante que resultados confiáveis seja obtidos na análise do alumínio sérico.