Importância do ponto de corte dos exames sorológicos na indicação de biópsia intestinal para diagnóstico de doença celíaca / The importance of determining accurate cut-off point for serological assays before indicating intestinal biopsy forcoeliac disease diagnosis

Objetivo: comparar os resultados da determinação de anticorpos IgA e IgG antigliadina positivos em laboratórios privados com os resultados dos mesmos exames no Laboratório Central do Hospital das Clínicas da Universidade Federal de Minas Gerais. Métodos: foram encaminhados 101 pacientes ao Ambulatório de Gastroenterologia Pediátrica para avaliação de biópsia intestinal, com resultados de anticorpos IgA e/ou IgG antigliadina positivos. Foram obtidas novas amostras de sangue e realizados os mesmos exames pela técnica de ELISA in house, cujo ponto de corte foi estabelecido em estudos anteriores para nossa população. Resultados: dos 101 pacientes com resultados positivos em laboratórios privados, 73 apresentaram resultados negativos no Laboratório do HC. Nos outros 28 pacientes, houve concordância em 13 resultados, sendo um apenas IgA antigliadina positivo, nove IgG antigliadina positivo e três com ambos marcadores positivos. Os demais 15 pacientes apresentaram resultados divergentes. Conclusão: os marcadores sorológicos são de grande valia para a triagem dos pacientes a serem submetidos à biópsia intestinal para o diagnóstico definitivo de doença celíaca. No entanto, os pontos de corte devem ser estabelecidos para cada população estudada e para cada kitutilizado, devido à grande possibilidade de resultados falso-positivos, secundária à alta prevalência de outras enteropatias no nosso meio.

Objective: To compare the positive results for antigliadin IgA and IgG antibodies tested in private laboratories with those tested at the Central Lab of UFMG University Hospital. Methods: A total of 101 patients were referred to the Pediatric Gastroenterology Outpatient Center for intestinal biopsy upon positive test results for antiglidin IgA and/or IgG antibodies. New blood samples were collected to perform the same tests using in-house ELISA technique assuming the cut-off point established in previous studies for our population. Results: Out of the 101 patients with positive results in private laboratories, 73 had negative results in the tests carried out at UFMG University Hospital. Among the 28 remaining patients, results were consistent with previous test reports for 13: positive antiglidiadin IgA for one of them, positive antligliadin IgG for 9 of them, and positive results in both tests for three patients. The results of the other 15 patients were inconsistent with their previous reports. Conclusion: Serological markers are crucial to screen patients that should undergo intestinal biopsy for definitive diagnosis of coeliac disease. However, cut-off points should be determined specifically for each population studied and for each kit used, as the possibility of false positive results is great and influenced by the high prevalence of other enteropathies in our environment.

Anthelmintic resistance in a dairy cattle farm in the State of Minas Gerais.

Eighty-four half-blood Gir × Holstein (F1) calves aged six months who were naturally infected by gastrointestinal helminths and maintained in rotational grazing received different anthelmintic treatments. Group A received anthelmintics according to the usual management in the property (eight treatments, seven including a macrocyclic lactone agent). Group B received strategic treatment (ivermectin 3.15%) at the beginning and at the end of the rainy period. Eggs per gram of feces (EPG) counts and genus of larvae from fecal cultures were determined on a monthly basis from April 2002 to December 2003. There was no significant reduction (p > 0.05) in EPG counts in any group after anthelminthic treatment, and the larvae in fecal cultures observed were Cooperia, Haemonchus, Oesophagostomum and a few Trichostrongylus. Cooperia was the most prevalent genus in the first four months of the experiment and Haemonchus in the following months. In 2003, tracer calves were introduced onto the pastures monthly and they showed high nematode burden many times throughout the year, and Cooperia punctata and Haemonchus contortus were the main species identified. The results suggest that there is anthelminthic resistance in this farm, mainly to macrocyclic lactones, and the development of immunity by crossbred animals was vital to reduce nematode burden.

Anthelmintic resistance in a dairy cattle farm in the State of Minas Gerais / Resistência anti-helmíntica em uma propriedade de bovinos leiteiros em Minas Gerais

Eighty-four half-blood Gir × Holstein (F1) calves aged six months who were naturally infected by gastrointestinal helminths and maintained in rotational grazing received different anthelmintic treatments. Group A received anthelmintics according to the usual management in the property (eight treatments, seven including a macrocyclic lactone agent). Group B received strategic treatment (ivermectin 3.15 percent) at the beginning and at the end of the rainy period. Eggs per gram of feces (EPG) counts and genus of larvae from fecal cultures were determined on a monthly basis from April 2002 to December 2003. There was no significant reduction (p > 0.05) in EPG counts in any group after anthelminthic treatment, and the larvae in fecal cultures observed were Cooperia, Haemonchus, Oesophagostomum and a few Trichostrongylus. Cooperia was the most prevalent genus in the first four months of the experiment and Haemonchus in the following months. In 2003, tracer calves were introduced onto the pastures monthly and they showed high nematode burden many times throughout the year, and Cooperia punctata and Haemonchus contortus were the main species identified. The results suggest that there is anthelminthic resistance in this farm, mainly to macrocyclic lactones, and the development of immunity by crossbred animals was vital to reduce nematode burden.

Oitenta e quatro bezerras meio sangue Gir × holandês (F1) com seis meses de idade, naturalmente infectadas por helmintos gastrintestinais e mantidas em pastejo rotacionado receberam diferentes tratamentos anti-helmínticos. O grupo A recebeu anti-helmínticos segundo manejo empregado na propriedade (oito tratamentos, sete com produtos à base de lactonas macrocíclicas). O grupo B recebeu tratamento estratégico (ivermectina 3,15 por cento) no inicio e final de período chuvoso. Mensalmente, no período de abril de 2002 a dezembro de 2003, foram realizadas contagens de ovos por grama de fezes (OPG) e coproculturas. Não houve redução significativa (p > 0,05) nas contagens de OPG em nenhum dos grupos após os tratamentos anti-helmínticos, e as larvas encontradas na coprocultura foram Cooperia, Haemonchus, Oesophagostomum e poucos Trichostrongylus, com predominância de Cooperia nos quatro meses iniciais e Haemonchus nos meses seguintes. No ano de 2003, bezerros traçadores foram alocados mensalmente nos pastos, apresentando altas cargas parasitárias na maioria dos meses do ano, sendo as principais espécies identificadas: Cooperia punctata e Haemonchus contortus. Os resultados indicam que os nematódeos da fazenda apresentam resistência anti-helmíntica, principalmente às lactonas macrocíclicas, e o desenvolvimento de imunidade foi primordial para reduzir a carga parasitária dos animais mestiços.

Coagulação intravascular disseminada na gravidez - considerações, diagnóstico e manejo / Disseminated intravascular coagulation in pregnancy - considerations, diagnosis and manegement

A Síndrome de Coagulação Intravascular Disseminada (CIVD) é caracterizada por alteração das vias de ativação e controle da coagulação sanguínea gerando acúmulos de fibrina na micro-vasculatura, com consumo de plaquetas e fatores de coagulação. Pode resultar em falência orgânica múltipla e sangramento anormal. A gravidez caracterizase por estado de hipercoagulabilidade e por complicações como descolamento prematuro de placenta, pré-eclâmpsia e síndrome HELLP que representam algumas das condições associadas à CIVD. Seu diagnóstico é feito baseado na suspeita clínica, conhecendo-se os fatores de risco associados e apoiando-se na propedêutica sugestiva de coagulopatia. A abordagem terapêutica consiste principalmente em tratar a anormalidade obstétrica de base. Mas podem ser necessárias as medidas de suporte e de reposição de elementos sanguíneos para a normalização da função hemostática. A CIVD, apesar de rara, figura como complicação obstétrica grave, que pode cursar com hemorragia intensa e levar a paciente ao óbito. Esta revisão propõe-se a sistematizar o conhecimento da CIVD para ajudar em seu manejo eficiente e estratégico.

Disseminated Intravascular Coagulation (DIC) is a syndrome characterized by altered activation and control of blood coagulation pathways causing accumulation of fibrin in the micro-vasculature, consumption of platelets and coagulation factors, which may result in organ failure and abnormal bleeding. Pregnancy is known to be a hypercoagulable state and complications such as placental abruption, pre-eclampsia and HELLP syndrome are some of the conditions associated to the onset of DIC. The diagnosis is based on clinical suspicion and investigation of associated risk factors and supported by lab tests results suggestive of coagulopathy. Primary therapeutic management includes addressing the underlying obstetric disorder. However, additional supportive treatment and blood transfusion may be necessary to repair haemostatic function. Therefore, despite its rare incidence, DIC figures as a very serious obstetric complication that can cause massive bleeding and lead to patient´s death. This review aims to systematize the knowledge of this entity to allow an efficient and strategic management.

Leucemia linfoblástica aguda diagnosticada na vigência de parto, simulando síndrome Hellp / Acute lymphoblastic leukemia diagnosed in delivery force, simulating Hellp syndrome

Este artigo relata a necessidade de realização de cesariana de emergência em paciente de 15 anos de idade, com 29 semanas de gestação, portadora de Leucemia linfoblástica aguda (LLA), pré-eclampsia e suspeita de síndrome HELLP. Possui a LLA baixa incidência durante a gravidez sendo, em geral, sua possibilidade diagnóstica pouco aventada. Neste relato, o diagnóstico de LLA não foi realizado de forma precoce no pré-natal, só tardiamente no pré-operatório da cesariana. A paciente evoluiu com instabilidade hemodinâmica, necessitando de terapia intensiva.

The ALL (acute lymphoblastic leukemia) is a disease with low incidence during pregnancy. This case report an emergency caesarean section in a patient of 15 years with 29 weeks of gestation, ALL, pré-eclâmpsia and suspect of HELLP Syndrome. It was difficult to diagnose ALL during prenatal and pre-operative period, which may be associated with low incidence of this disease during pregnancy. The patient developed hemodynamic instability, had to stay in the ICU and the ALL was diagnosed in the postoperative period. This study shows the differential diagnosis in ALL, the difficulties to the diagnosis, clinical reasoning and the therapeutic.