Night fasting as an alternative to improve nutritional support and glycaemic control in hospitalised patients with exclusive enteral nutrition.

BACKGROUND: Enteral nutrition (EN) assists in the nutritional status of hospitalised patients unable to feed orally. The aim of this study was to determine which method-continuous EN or discontinuous EN, a diet in which the infusion is discontinued for 4h during the night,-is more effective in meeting nutrient recommendations and improving glycaemic control and biochemical parameters related to protein anabolism. METHODS: Patients were divided into two groups: discontinuous (EN administered in mL/h, 18h/day, 4-h night fasting) and continuous (EN administered in mL/h, 22h/day). All patients with EN receive the diet over a 22-h daily period, in which the diet is suspended for two hours/day for daily hospital routines such as bathing, and physiotherapy, and followed for seven days. Evaluated data: prescribed and administered volume, calories, protein, and fibre; capillary blood glucose; erythrogram; serum albumin. RESULTS: 52 patients were followed-up, with 23 (44.2%) in the discontinuous group and 29 (55.8%) in the continuous group. Compared with the continuous group, the discontinuous group received volumes closer to those prescribed, equal or higher calories, and more protein. The capillary glucose values were within the reference range in the discontinuous group, while the continuous group presented elevated values. Both groups presented hypoalbuminaemia, haemoglobin, and haematocrit below the reference values; however, in the discontinuous group, the serum albumin values improved during hospitalisation relative to the continuous. CONCLUSIONS: The method involving discontinuation of EN for 4h was more effective in meeting nutrient recommendations compared with the continuous method. Additionally, in the discontinuous group, we observed a better control of glycaemia when compared to that of the continuous group.

Low Food Consumption Interferes with the Nutritional Status of Surgical Patients with Neoplasia of the Gastrointestinal Tract.

Nutritional support strongly influence the nutritional status of the surgical neoplastic patients. This study aimed to evaluate the influence of food consumption on the perioperative nutritional status of hospitalized patients with neoplasia of the upper (UGIT) and lower (LGIT) gastrointestinal tract. METHOD: Observational, longitudinal, and prospective study. Data collected: food consumption, Subjective Global Assessment, anthropometry, laboratory tests. RESULTS: Eighty patients were followed up: 43 (54%) in the UGIT and 37 (46%) in the LGIT. The consumption in the perioperative period was lower than the usual consumption in the UGIT and LGIT groups, respectively, of energy (14.2 ± 6.5; 22.8 ± 11.2 Kcal/kg/d, p < 0.001; 13.6 ± 1.2; 19.0 ± 2.0 Kcal/kg/d; p = 0.014), protein (1.1 ± 0.7; 0.6 ± 0.3 g/kg/d, p < 0.001; 0.8 ± 0.1; 0.5 ± 0.1 g/kg/d; p = 0.058), selenium, zinc and copper. Most patients presented in the UGIT and LGIT groups, respectively, worsening malnutrition and muscle depletion according to the Subjective Global Assessment (61.9%; 51.4%) and hypoalbuminemia, mainly in the UGIT in the postoperative. CONCLUSION: Low food consumption during the perioperative period associated with prolongation of the postoperative fasting period worsens the nutritional status of patients undergoing surgery of the gastrointestinal tract for neoplasia, especially in the UGIT group.

Adherence to safety barriers in medication administration: patients' perception.

OBJECTIVE: to analyze the perception of patients about health professionals' adherence to safety barriers in medication administration. METHOD: cross-sectional and correlational study carried out in a hospital in the countryside of São Paulo, with a total of 249 adult patients admitted to the medical clinic. An electronic form developed by the researcher was used. Quantitative variables were analyzed in mean, median and standard deviation. Likert-type variables were calculated according to the perception score and the Bayesian Information criterion was used. The cutoff point for positive assessment of the patients' perception was 0.75. RESULTS: the average perception score was 0.29 and, of the 15 barriers analyzed, eight are never adhered by professionals, in the opinion of most patients. Also, age was the only variable with statistical significance. CONCLUSION: the younger the patient, the better their perception of health professionals' adherence to safety barriers in medication administration.

Adherence to safety barriers in medication administration: patients' perception / Adhesión a las barreras de seguridad en la administración de medicamentos: percepción del paciente / Adesão às barreiras de segurança na administração de medicamentos: percepção do paciente

Objective: to analyze the perception of patients about health professionals' adherence to safety barriers in medication administration. Method: cross-sectional and correlational study carried out in a hospital in the countryside of São Paulo, with a total of 249 adult patients admitted to the medical clinic. An electronic form developed by the researcher was used. Quantitative variables were analyzed in mean, median and standard deviation. Likert-type variables were calculated according to the perception score and the Bayesian Information criterion was used. The cutoff point for positive assessment of the patients' perception was 0.75. Results: the average perception score was 0.29 and, of the 15 barriers analyzed, eight are never adhered by professionals, in the opinion of most patients. Also, age was the only variable with statistical significance. Conclusion: the younger the patient, the better their perception of health professionals' adherence to safety barriers in medication administration.

Objetivo: analizar la percepción de pacientes sobre la adhesión de los profesionales de salud a las barreras de seguridad en la administración de medicamentos. Método: estudio transversal y correlacional realizado en un hospital del interior de São Paulo, con 249 pacientes adultos hospitalizados en la clínica médica. Se utilizó un formulario electrónico desarrollado por la investigadora. Las variables cuantitativas se analizaron en términos de media, mediana y desviación estándar. Las variables tipo Likert se calcularon según el puntaje de percepción y se utilizó el criterio de Información Bayesiana. El punto de corte para la evaluación positiva de la percepción del paciente fue 0,75. Resultados: el puntaje de percepción promedio fue de 0,29 y, de las 15 barreras analizadas, ocho nunca son adheridas por los profesionales, en la opinión de la mayoría de los pacientes. Además, la edad fue la única variable con significación estadística. Conclusión: cuanto más joven es el paciente, mejor es su percepción de la adhesión de los profesionales de salud a las barreras de seguridad en la administración de medicamentos.

Objetivo: analisar a percepção de pacientes sobre a adesão dos profissionais de saúde às barreiras de segurança na administração de medicamentos. Método: estudo transversal e correlacional, realizado em um hospital do interior de São Paulo, com 249 pacientes adultos internados na clínica médica. Utilizou-se um formulário eletrônico desenvolvido pela pesquisadora. As variáveis quantitativas foram analisadas em termos de média, mediana e desvio-padrão. As variáveis do tipo Likert foram calculadas de acordo com o escore de percepção, utilizando-se o critério de Informação Bayesiana. O ponto de corte à apreciação positiva da percepção do paciente foi 0,75. Resultados: a média do escore de percepção foi 0,29, sendo que, das 15 barreiras analisadas, oito nunca são aderidas pelos profissionais, na visão da maioria dos pacientes. Além disso, a idade foi a única variável com significância estatística. Conclusão: Quanto mais jovem o paciente, melhor a sua percepção sobre a adesão dos profissionais de saúde às barreiras de segurança na administração de medicamentos.

Biochemical and nutritional profile of patients with exclusive enteral nutrition during hospitalization / Perfil bioquímico y nutricional de pacientes con nutrición enteral exclusiva durante hospitalización

BACKGROUND: Enteral nutrition therapy (ENT) is intended to restore the nutritional status of patients. OBJECTIVE: The objective of this study was to evaluate the biochemical and nutritional profile of hospitalized patients with exclusive enteral nutrition. METHODS: It is a longitudinal study, with a sample of 42 hospitalized young and elder adults, with exclusive ENT, for at least seven days. The patients were submitted to nutritional, anthropometric (Body Mass Index, corrected arm muscle area and arm muscle circumference) and biochemical evaluation as albumin, hemoglobin, C-reactive protein, vitamin C, Iron, Zinc and Copper serum. Results and DISCUSSION: It was observed that anthropometric parameters such as weight, BMI, muscle area and circumference increased during hospitalization time only in the elderly (P= 0.016; P=0.018; P = 0.021; P = 0.020). The percentage of adequacy in energy, protein and micronutrients with vitamin C, iron, zinc and copper were adequate during hospitalization for both age groups, according to the estimated average needs. Serum levels of these micronutrients were within normal values for both age groups, with the exception of zinc, which decreased during hospitalization in the elderly. This may be associated with the greater need for this mineral in this age group or with a implicate in its absorption. CONCLUSION: The ENT influence the weight and muscle mass gain in hospitalized elderly patients and, although the appropriate administration of micronutrients, the absorption of zinc was affected. Therefore, monitoring of enteral nutrition is essential in order to avoid worsening nutritional status during hospitalization

INTRODUCCIÓN: La terapia de nutrición enteral (TNE) tiene la finalidad de recuperar el estado nutricional de los pacientes. Objectivo: Se evaluó el perfil bioquímico y nutricional de pacientes hospitalizados con nutrición enteral exclusiva. MÉTODOS: Estudio longitudinal, con muestra compuesta por 42 adultos y ancianos hospitalizados, con TNE exclusiva, por lo menos siete días. Los pacientes fueron sometidos a evaluación nutricional, antropométrica (Índice de Masa Corporal, área muscular del brazo corregida y circunferencia del brazo) y bioquímica como albúmina, proteína C-reactiva, vitamina C, hierro zinc y cobre sérico. Resultados y DISCUSIÓN: Se observó que los parámetros antropométricos como el peso, IMC, área y circunferencia muscular del brazo aumentaron durante el tiempo de internación solo en los ancianos (P= 0.016; P=0.018; P = 0.021; P = 0.020). El porcentaje de adecuación de energía, proteica y micronutrientes como vitamina C, hierro, zinc y cobre fueron adecuados durante el tiempo de internación para ambos grupos de edad, de acuerdo con las necesidades medias estimadas. Los niveles séricos de estos micronutrientes se mantuvieron dentro de los valores normales para ambos grupos de edad, a excepción del zinc, que disminuyó durante la hospitalización en ancianos. Esto puede asociarse a la mayor necesidad de este mineral en este grupo de edad o a un deterioro en su absorción. CONCLUSIÓN: La TNE influye en el aumento de peso y la masa muscular en ancianos y, apesar de la administración adecuada de micronutrientes, se observó un deterioro en la absorción de zinc. Por lo tanto, el monitoreo de la nutrición enteral es esencial para evitar el empeoramiento del estado nutricional durante la hospitalización

Percepção do paciente sobre adesão dos profissionais de saúde às barreiras de prevenção de erros na administração de medicamentos / Patient's perception of the compliance of healthcare professionals with the barriers to error prevention in drug delivery

ustificativa: Em âmbito global, práticas inseguras no processo de medicação e erros de medicação estão entre as principais causas de lesões e danos evitáveis nos sistemas de saúde. Apesar de os erros ocorrerem em todas as etapas do processo de utilização dos medicamentos, os erros de administração são um dos mais comuns e os mais difíceis de serem interceptados. Neste contexto, barreiras sistêmicas têm sido amplamente implementadas nos hospitais com a finalidade de reduzir os riscos. Contudo, a adesão das equipes de saúde a essas barreiras permanece um desafio. Ademais, a percepção dos pacientes sobre a adesão dos profissionais de saúde às barreiras de prevenção de erros na administração de medicamentos é fundamental para garantir qualidade e segurança nesse processo. Objetivo: analisar a percepção do paciente sobre adesão dos profissionais de saúde às barreiras existentes no hospital para prevenir erros na administração de medicamentos e as variáveis associadas. Método: estudo com delineamento quantitativo, do tipo correlacional, conduzido em um hospital geral, localizado no interior do Estado de São Paulo, no período de junho a setembro de 2019. A amostra foi constituída por 249 pacientes adultos e internados na clínica médica. Os dados foram coletados por meio de um formulário eletrônico, desenvolvido para os propósitos deste estudo, com o auxílio de um dispositivo móvel. O formulário continha variáveis demográficas e clínicas e mais 15 questões com escala do tipo Likert de cinco pontos, as quais estavam relacionadas à percepção do paciente sobre barreiras de prevenção de erros na administração de medicamentos. Os dados foram inseridos na plataforma on-line Survey Monkey® e, posteriormente, transferidos para planilhas do Programa Microsoft Excel®. Foi efetuado o cálculo da média do escore de percepção dos pacientes, no qual o valor resultante encontra-se no intervalo entre zero e um. Para calcular o escore total da percepção, a seleção da distribuição da variável resposta foi efetuada através do critério de Informação Bayesiana. Para avaliar a adequação da variável resposta selecionada, foi aplicado, sobre os resíduos do ajuste, o teste de Normalidade de Shapiro-Wilk. Estabeleceu-se o valor de 0,75 como ponto de corte à apreciação positiva da percepção do paciente sobre adesão dos profissionais de saúde às barreiras existentes no hospital para prevenir erros na administração de medicamentos. As análises foram realizadas por meio do programa R, e foi adotado nível de significância de 5%. Resultados: a maioria dos pacientes era do sexo masculino (51,0%), com 5 a 8 anos de escolaridade (36,1%) e histórico de internações anteriores (92,4%). Apresentou média de 5,97 anos da última internação e média de 8,05 dias de internação no momento da coleta de dados. As doenças respiratórias foram as mais frequentes (33,3%) e a maioria dos pacientes (71,89%) apresentava comorbidades. Grande parte (72,3%) afirmou não ter sido indagada sobre o uso regular de medicamentos no domicílio no momento da admissão. A média do escore total de percepção dos pacientes sobre a adesão dos profissionais de saúde às barreiras existentes no hospital para prevenir erros na administração de medicamentos foi de 0,29, considerada baixa. Ainda, independente do sexo, da faixa etária e da história anterior de internação, o escore geral de percepção também foi abaixo de 0,75. Em 4,5% das respostas às 15 questões contidas no formulário, os participantes declararam não perceber a adesão dos profissionais de saúde a qualquer barreira implantada no hospital para reduzir potenciais riscos de erros na administração de medicamentos. Na análise de regressão beta inflacionado para as variáveis independentes idade, sexo, escolaridade e história de internação anterior, somente a variável idade apresentou significância estatística na média do escore de percepção, em ambos modelos. Conclusão e implicações para a prática: Os resultados evidenciam que quanto mais novo o paciente, melhor a sua percepção sobre a adesão dos profissionais de saúde às barreiras existentes no hospital para prevenir erros na administração de medicamentos. Pacientes são testemunhas privilegiadas dos cuidados prestados e, por esse motivo, essas pessoas têm um importante papel a desempenhar na redução dos erros na administração de medicamentos. Os resultados deste estudo podem auxiliar gestores e equipes de saúde na determinação de estratégias de engajamento dos pacientes e de seus familiares na detecção dos riscos, de capacitação dos pacientes e de seus familiares para garantir a administração segura de medicamentos; e na determinação de estratégias de envolvimento dessas pessoas na prevenção de erros na administração de medicamentos como um meio de melhorar a cultura de segurança nos hospitais.

Justification: On a global level, unsafe practices in the medication process and medication errors are among the main causes of avoidable injury and harm in health systems. While errors occur at every stage of the medication use process, errors of administration are one of the most common and the most difficult to intercept. In this context, systemic barriers have been extensively implemented in hospitals in order to reduce risks. Nevertheless, the adherence of health care teams to these barriers remains a challenge. In addition, patients' perceptions about the adherence of health care professionals to barriers to prevent errors in drug administration are critical to ensure quality and safety in this process. Objective: to analyse the patient's perception of health professionals' adherence to the existing barriers in the hospital to prevent errors in drug administration and the associated variables. Method: A study with a correlational quantitative design conducted in a general hospital located in the interior of São Paulo State, from June to September 2019. The sample consisted in 249 adult patients admitted to the medical clinic. Data were collected using an electronic form, developed for the purposes of this study, with the aid of a mobile device. The form contained demographic and clinical variables and 15 more questions with a five-point Likert-type scale, which were related to the patient's perception of barriers to error prevention in drug administration. The data was entered into the online Survey Monkey® platform and later transferred to Microsoft Excel® spreadsheets. The average patient perception score was calculated, in which the resultant value is in the interval between zero and one. To calculate the total perception score, the selection of the response variable distribution was made through the Bayesian Information criterion. To evaluate the adequacy of the selected response variable, the Shapiro-Wilk Normality test was applied on the adjustment residues. The value of 0.75 was established as a cutoff point for a positive assessment of the patient's perception regarding the adherence of health professionals to the barriers existing in the hospital to prevent errors in drug administration. The analyses were performed using the R program, and a 5% significance level was adopted. Results: the majority of the patients were male (51.0%), with 5 to 8 years of schooling (36.1%) and a history of previous admissions (92.4%). The patient presented a mean of 5.97 years of last hospitalization and a mean of 8.05 days of hospitalization at the time of data collection. Respiratory diseases were the most frequent (33.3%) and most patients (71.89%) had comorbidities. Most (72.3%) also said they had not been asked about the regular use of medication at home at the time of admission. The average total score of patients' perception about health professionals' adherence to existing barriers in the hospital to prevent errors in drug administration was 0.29, considered low. Also, regardless of gender, age group and previous history of hospitalization, the overall perception score was also below 0.75. In 4.5% of the answers to the 15 questions contained in the form, the participants declared that they did not perceive the adherence of health professionals to any barrier implanted in the hospital to reduce potential risks of errors in medication administration. In the analysis of inflated beta regression for the independent variables age, gender, education and previous hospitalization history, only the variable age showed statistically significant mean perception score in both models. Conclusion and implications for practice: The results show that younger patients, their perception of adherence by health professionals to hospital barriers to prevent errors in drug administration is improved. Patients are privileged witnesses to the care provided and, for this reason, these people have an important role to play in the reduction of medication administration errors. The results of this study can help managers and health care teams to determine strategies for engaging patients and their families to detect risks, to train patients and their families to ensure safe medication administration; and to determine strategies for involving these people in the prevention of medication errors as a means to improve the safety culture in hospitals.

Montelukast potentiates the anticonvulsant effect of phenobarbital in mice: an isobolographic analysis.

Although leukotrienes have been implicated in seizures, no study has systematically investigated whether the blockade of CysLT1 receptors synergistically increases the anticonvulsant action of classic antiepileptics. In this study, behavioral and electroencephalographic methods, as well as isobolographic analysis, are used to show that the CysLT1 inverse agonist montelukast synergistically increases the anticonvulsant action of phenobarbital against pentylenetetrazole-induced seizures. Moreover, it is shown that LTD4 reverses the effect of montelukast. The experimentally derived ED50mix value for a fixed-ratio combination (1:1 proportion) of montelukast plus phenobarbital was 0.06±0.02 µmol, whereas the additively calculated ED50add value was 0.49±0.03 µmol. The calculated interaction index was 0.12, indicating a synergistic interaction. The association of montelukast significantly decreased the antiseizure ED50 for phenobarbital (0.74 and 0.04 µmol in the absence and presence of montelukast, respectively) and, consequently, phenobarbital-induced sedation at equieffective doses. The demonstration of a strong synergism between montelukast and phenobarbital is particularly relevant because both drugs are already used in the clinics, foreseeing an immediate translational application for epileptic patients who have drug-resistant seizures.

E-NTPDase and E-ADA activities are altered in lymphocytes of patients with indeterminate form of Chagas' disease.

Trypanosoma cruzi infection triggers a chronic inflammatory process in human host and purinergic system ecto-enzymes play an important role in modulating the inflammatory and immune responses. In this study, it was investigated ecto-nucleoside triphosphate diphosphohydrolase (E-NTPDase; EC 3.6.1.5; CD39) and ecto-adenosine deaminase (E-ADA; EC 3.5.4.4) activities in lymphocytes from patients with indeterminate form of Chagas' disease (IFCD). Twenty-five IFCD patients and 25 healthy subjects (control group) were selected. The peripheral lymphocytes were isolated and E-NTPDase and E-ADA activities were determined. Adenine nucleotides and adenosine levels were determined in serum by HPLC and the E-NTPDase1 expression in lymphocytes by Western blot analysis. E-NTPDase (ATP and ADP as substrates) and E-ADA (adenosine as substrate) activities were decreased in lymphocytes from IFCD patients (P<0.05 and P<0.01, respectively), while the E-NTPDase1 expression presented no changes in these patients. Serum ATP levels showed to be decreased (P<0.05) and both AMP (P<0.01) and adenosine (P<0.001) levels were increased in the IFCD group. The enzymatic alterations observed are in agreement with the immune response against T. cruzi infection in IFCD patients, since the decreased extracellular ATP and the increased adenosine levels trigger a Th2 anti-inflammatory response, which it is associated to adaptation of host to parasite, preventing clinical progress of disease.

Purinergic system ecto-enzymes participate in the thromboregulation of patients with indeterminate form of Chagas disease.

Chagas disease (CD) is a chronic and endemic illness caused by the parasite Trypanosoma cruzi. Microvascular disturbances play an important role in the progress of the disease. The purinergic signaling system participates in regulatory functions, such as immunomodulation, neuroprotection, and thromboregulation. This study aimed to investigate the activities of purinergic system ecto-enzymes present on the platelet surface and the platelet aggregation profile from patients with indeterminate form of Chagas disease (IFCD). Thirty patients diagnosed with IFCD and 30 healthy subjects were selected. Ecto-nucleoside triphosphate diphosphohydrolase (E-NTPDase), ecto-nucleotide pyrophosphatase/phosphodiesterase (E-NPP), ecto-5'-nucleotidase (E-5'-NT) and ecto-adenosine deaminase (E-ADA) activities were measured in platelets isolated from these individuals as well as the platelet aggregation. Results demonstrated an increase of 21 % in the E-NPP activity and 30 % in the E-5'-NT activity in IFCD group (P < 0.05); however, a decrease of 34 % in the E-ADA activity was determined in the same group (P < 0.001). A significant decrease of 12.7 % and 12.8 % in the platelet aggregation of IFCD group in two different concentrations of ADP (5 and 10 µM) was observed, respectively (P < 0.05). Increased E-NPP and E-5-NT activities as well as decreased E-ADA activity in platelets of patients with IFCD contributed to decrease platelet aggregation, suggesting that the purinergic system is involved in the thromboregulation process in these patients, since adenosine (the final product of ATP hydrolysis) has cardioprotective and vasodilator effects that prevent the clinical progress of the disease.

Relevância clínica e frequência de padrões citoplasmático e pontilhado fino denso observados em FAN-HEp-2 / Clinical relevance and frequency of cytoplasmic and nuclear dense fine speckled patterns observed in ANA-HEp-2

OBJETIVOS: O presente estudo procurou determinar a frequência e relacionar o título sorológico dos padrões de imunofluorescência para citoplasma celular e nuclear pontilhado fino denso com possível correlação clínica. MÉTODOS: No período entre 2007 a 2009 foram avaliados os resultados de 2.788 testes sorológicos para pesquisa de autoanticorpos pela técnica de imunofluorescência indireta (IFI), utilizando como substrato células HEp-2, realizados no LAC-HUSM/UFSM. RESULTADOS: Entre as amostras analisadas, 1.998 resultaram não reagentes para a pesquisa de autoanticorpos. Entre as amostras reagentes (n = 790) foram encontradas 57 (7,2 por cento) amostras apresentando padrão de reatividade descrita como pontilhado fino denso (SFD) (3,8 por cento) ou fluorescência citoplasmática (Cit) (3,4 por cento). Nas amostras com padrão SFD (n = 29), nove apresentaram título < 1/160, onde apenas um paciente apresentava doença autoimune (DAI). Entre os pacientes com título > 1/160 apenas um não apresentava DAI. Entre as amostras com padrão Cit (n = 27), 20 apresentavam título < 1/160, onde apenas oito não tinham DAI associada. Todos os outros 7 pacientes com título > 1/160 tinham relato de DAI. CONCLUSÃO: Os resultados encontrados ratificam o valor de 1/160 como melhor ponto de corte para definição de presença de DAI, para qualquer um dos padrões de fluorescência avaliados. Contudo, deve-se prestar atenção a títulos inferiores, principalmente para IFI Cit, uma vez que apenas 40 por cento não apresentavam relato de DAI presente.

OBJECTIVES: This study aimed to determine the frequency and antibody titers of nuclear dense fine and cytoplasmic patterns with possible clinical correlation. METHODS: From 2007 to 2009, the results of 2,788 autoantibody serological tests were assessed by indirect immunofluorescence (IIF) at LAC-HUSM/UFSM, using as substrate HEp-2. RESULTS: Among the analyzed samples, 1,998 of them were negative for autoantibodies. Among the positive samples (n = 790), we found 57 (7.2 percent) showing reactivity pattern described as dense fine speckled (DFS) (3.8 percent), or cytoplasmic (Cit) fluorescence (3.4 percent). In samples with standard DFS (n = 29), nine had titers of 1/160, and only one patient had autoimmune disease (AID). Among patients with titers > 1/160, only one patient did not have AID. Among samples with standard Cit (n = 27), 20 had titers of 1/160, and only eight were not associated with AID. The other seven patients with titers > 1/160 reported AID. CONCLUSION: The results confirm the value of 1/160 as the best cut-off point for defining AID presence, for any of the fluorescence assessed patterns. However, attention should be given to lower titers, especially for Cit IIF, since only 40 percent did not report the presence of AID.

Enzymes that hydrolyze adenine nucleotides in lymphocytes and platelets of immunosuppressed rats.

NTPDase (EC 3.6.1.5) is an enzyme that hydrolyzes extracellular nucleoside tri-and/ or diphosphates to form ATP, which can serve as a substrate for ecto-5'- nucleotidase (EC 3.1.3.5), releasing adenosine, an inhibitor of platelet aggregation and an immunosuppressant agent. In this study, the activity of enzymes that hydrolyze adenine nucleotides was investigated in lymphocytes and platelets of immunosuppressed rats. NTPDase and ecto-5'-nucleotidase activities were determined by colorimetric assay with quantification of the inorganic phosphate released. A significant increase in NTPDase activity was observed in lymphocytes (about 30% in ATP hydrolysis and 80% in ADP hydrolysis, at p<0.05 and p<0.01, respectively). In platelets, there was a significant increase in 5'-nucleotidase activity in immunosuppressed rats (p<0.01) when compared with controls. These results suggest that the hydrolysis of adenine nucleotides is modified in the immunosuppressed state, possibly to compensate for alterations that occur and to avoid the adverse effects of therapy.

Clinical relevance and frequency of cytoplasmic and nuclear dense fine speckled patterns observed in ANA-HEp-2.

OBJECTIVES: This study aimed to determine the frequency and antibody titers of nuclear dense fine and cytoplasmic patterns with possible clinical correlation. METHODS: From 2007 to 2009, the results of 2,788 autoantibody serological tests were assessed by indirect immunofluorescence (IIF) at LAC-HUSM/UFSM, using as substrate HEp-2. RESULTS: Among the analyzed samples, 1,998 of them were negative for autoantibodies. Among the positive samples (n = 790), we found 57 (7.2%) showing reactivity pattern described as dense fine speckled (DFS) (3.8%), or cytoplasmic (Cit) fluorescence (3.4%). In samples with standard DFS (n = 29), nine had titers of 1/160, and only one patient had autoimmune disease (AID). Among patients with titers > 1/160, only one patient did not have AID. Among samples with standard Cit (n = 27), 20 had titers of 1/160, and only eight were not associated with AID. The other seven patients with titers > 1/160 reported AID. CONCLUSION: The results confirm the value of 1/160 as the best cut-off point for defining AID presence, for any of the fluorescence assessed patterns. However, attention should be given to lower titers, especially for Cit IIF, since only 40% did not report the presence of AID.

Taxa de probabilidade como guia de interpretação do FAN-HEp-2 na pesquisa de autoanticorpos no lúpus eritematoso sistêmico / Likelihood ratio used to interpretation of autoantibody screening test (FAN-HEp-2) in systemic lupus eritematosus

INTRODUÇÃO: A magnitude de variação da probabilidade pré-teste de uma doença para uma nova probabilidade pós-teste pode ser determinada pelo cálculo da razão de verossimilhança ou likelihood ratio (LR) do teste, refletindo o valor clínico do resultado obtido no procedimento. OBJETIVO: Verificar o impacto clínico da pesquisa de autoanticorpos para o diagnóstico do lúpus eritematoso sistêmico (LES) e outras doenças autoimunes por meio das medidas de LR quando utilizadas células HEp-2 para triagem ou pesquisa do anticorpo específico anti-DNA de dupla hélice (anti-dsDNA), mostrando a importância de parâmetros como sensibilidade e especificidade dos testes. MATERIAL E MÉTODOS: Foram pesquisados autoanticorpos por imunofluorescência indireta (IFI), utilizando-se células HEp-2 e anti-DNA em Crithidia luciliae em amostras de soro de 47 indivíduos com diagnóstico de LES, 27 portadores de outra doença autoimune e 71 apresentando outra patologia. RESULTADOS: A presença de reatividade igual ou superior a 1/160 em células HEp-2 apresenta LR positiva com impacto significativo na probabilidade pós-teste de doença presente, mesmo na ausência de pesquisa complementar. Em soros com reatividade inferior a 1/160, a pesquisa de anti-dsDNA tem grande relevância na determinação do diagnóstico de LES, apresentando grande impacto na probabilidade pós-teste. DISCUSSÃO: Considerando a sensibilidade e a especificidade do teste de FAN para resultados distribuídos em diferentes intervalos, confirma-se que os resultados com baixo título não modificam significativamente a probabilidade pós-teste da ocorrência da doença. Testes complementares com alta especificidade têm grande valor clínico. O conhecimento de parâmetros como sensibilidade, especificidade e LR dos testes diagnósticos é crucial para uma avaliação clínica eficiente.

BACKGROUND: The magnitude of variation in pre-test probability of a certain disease to a new post-test probability may be determined through likelihood ratio (LR), which reflects the clinical value of the result obtained in the procedure. OBJECTIVES: To verify the clinical impact of autoantibody screening on the diagnosis of Systemic Lupus Erythematosus (SLE) and other autoimmune diseases through LR measurement when HEp-2 cells are used for screening or investigation into anti-Ds-DNA antibody, showing the importance of parameters such as sensitivity and specificity. MATERIAL AND METHOD: Autoantibodies were studied by indirect immunofluorescence using HEp-2 cells and Crithidia luciliae anti-DNA test in serum samples collected from 47 individuals diagnosed with SLE, 27 with other autoimmune diseases and 71 with other pathologies. RESULTS: The presence of reactivity > 1/160 in HEp-2 cells showed positive LR with significant impact on post-test probability even in the absence of complementary investigation. In serum samples with reactivity < 1/160, anti-dsDNA screening has great relevance to the diagnosis of SLE with a great impact on post-test probability. DISCUSSION: As to sensibility and specificity of FAN test for results grouped into different intervals, it was confirmed that results with low titer do not change post test probability of disease occurrence. Complementary tests with high specificity have major clinical value. Both the investigation of parameters such as sensibility /specificity and likelihood ratio of diagnostic tests have crucial importance in efficient clinical evaluation.

Importância do rastreamento pré-concepcional e pré-natal da infecção por T. gondii; prevalência sorológica em um hospital público / The importance of screening preconception and antenatal T. gondii infection serological prevalence in a public hospital

A infecção aguda pelo Toxoplasma gondii quando acomete a mulher durante a gestação pode trazer graves conseqüências para o recém-nascido, devido à possibilidade de transmissão placentária. A pesquisa de anticorpos IgG específicos para T.gondii em 553 mulheres atendidas em diferentes setores do Hospital Universitário ( UFSM) permitiu determinar a prevalência da infecção nesta população, que foi de 64 (355/553). A pesquisa de anticorpos IgM foi solicitada em 160 destas pacientes, onde 6,25 (10/160) apresentaram resultados reagentes com níveis deste anticorpo entre 2,8- 0,6 UI/ml, o que tanto pode sugerir presença de infecção aguda como anticorpos IgM residuais, resultantes de infecção passada recente.A taxa de 36 de mulheres suscetíveis, sujeitas a adquirir a infecção durante a gravidez, alerta para a importância do rastreamento desta infecção. O acompanhamento sorológico durante a rotina pré-natal permitirá a detecção precoce dos casos de infecção aguda, através da soroconversão, permitindo intervenção rápida, com instituição de medicação adequada. A pesquisa destes anticorpos, como rotina pré-concepcional, permitirá instituição de medidas preventivas através de informações higieno-dietéticas profiláticas, minimizando o risco de adquirir esta infecção durante o futuro da gravidez.