Albúmina en cirrosis: perspectiva inflamatoria / Albumin in cirrhosis: inflammatory perspective

La albúmina sérica humana es la proteína más abundante en el plasma, su estructura molecular le confiere estabilidad, pero también flexibilidad para ligar y transportar un amplio rango de moléculas. Su función oncótica es la propiedad más reconocida que la lleva a introducirse en la terapéutica médica como un expansor de volumen. Sin embargo, en los últimos años se le han adicionado funciones con carácter antioxidante, inmunomodulador y de estabilización endotelial, que hacen presumir que su impacto terapéutico está más allá de sus funciones volumétricas. En los últimos años, específicamente en la cirrosis y la falla hepática aguda sobre crónica, se ha tenido un cambio en el paradigma fisiológico, desde una perspectiva netamente hemodinámica hacia una perspectiva inflamatoria, en donde las funciones oncóticas y no oncóticas de la albúmina están alteradas y tienen un carácter pronóstico en estas entidades. Este conocimiento creciente, desde una perspectiva inflamatoria, hace que se fortalezca el uso terapéutico de la albúmina sérica humana desde las indicaciones tradicionales como prevención de la disfunción circulatoria posparacentesis, prevención y tratamiento de lesión renal aguda, hasta las discusiones para administración a largo plazo en pacientes cirróticos con ascitis.

Human serum albumin is the most abundant protein in plasma, with a molecular structure that provides stability while also allowing flexibility to bind and transport a wide range of molecules. Its oncotic function is the most recognized property, leading to its introduction in medical therapy as a volume expander. However, in recent years, additional functions with antioxidant, immunomodulatory, and endothelial stabilization properties have been identified, suggesting that its therapeutic impact extends beyond its volumetric functions. Specifically, in cirrhosis and acute-on-chronic liver failure, there has been a shift in the pathophysiological paradigm from a purely hemodynamic perspective to an inflammatory perspective, where both oncotic and non-oncotic functions of albumin are altered and have prognostic significance in these conditions. This growing understanding from an inflammatory perspective strengthens the therapeutic use of human serum albumin, not only for traditional indications such as the prevention of post-paracentesis circulatory disfunction, prevention and treatment of acute kidney injury, but also for discussions regarding long-term administration in cirrhotic patients with ascites.

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.

Albúmina sérica predictor de resultados intrahospitalarios en pacientes admitidos a la UCIN del Hospital de la Mujer / Serum albumin predicator of intrahospital outcomes in patients admitted to the NICU of the women's hospital

INTRODUCCIÓN: En el estrés metabólico existe una sobreproducción proteica de reactantes positivos de la fase aguda y en el hígado, se frena la síntesis de otras proteínas, incluyendo la albúmina, denominadas Reactantes Negativos de la Fase Aguda. Los rangos de referencia precisos para la hipoalbuminemia patológica han resultado difíciles de determinar en los recién nacidos. MATERIAL Y MÉTODOS: Descriptivo de corte transversal en 494 recién nacidos. Se realizó un análisis exploratorio de los datos con estadística descriptiva mediante el paquete estadístico SPSS v.20. RESULTADOS: 494 neonatos fueron seleccionados, 39% fueron prematuros tardíos, 27% reportó hipoalbuminemia en sus diferentes grados que se correlacionaron con los días de internación en UCIN (p=0,0001), necesidad y tiempo en ventilador mecánico (p=0,001), con la mortalidad (p=0,001) y patología infecciosa (p=0,001). DISCUSIÓN: La incidencia acumulada de sepsis no confirmada por hemocultivo fue de 54%, La hipoalbuminemia tiene asociaciones importantes con la evolución y pronóstico en pacientes pediátricos. La PCR no tiene correlación en el estudio (p=0,232) y solo fue reactiva en 4 pacientes (0,8%). CONCLUSIONES: El nivel de albúmina sérica reportada en las primeras 24 horas de ingreso a la UCIN es un predictor para los resultados intrahospitalarios (tiempo y requerimiento de ventilación mecánica), mortalidad neonatal, sepsis neonatal y enfermedad de membrana hialina. Su determinación sérica debe ser incluida en la lista de exámenes de laboratorio solicitados a su admisión y la PCR al ingreso debe ser excluida por su pobre sensibilidad como sugiere la SIBEN.

INTRODUCTION: In metabolic stress, there is a protein overproduction of positive acute phase reactants and in the liver, the synthesis of other proteins, including albumin, called negative acute phase reactants is slowed down. Precise reference ranges for pathologic hypoalbuminemia have proven difficult to determine in neonates. MATERIAL AND METHODS: Descriptive cross section in 494 newborns. An exploratory analysis of the data with descriptive statistics was carried out using the statistical package SPSS v.20. RESULTS: 494 neonates were selected, 39% were late preterm, 27% reported hypoalbuminemia in its different degrees that correlated with the days of hospitalization in the NICU (p=0.0001), need and time on a mechanical ventilator (p=0.001), with mortality (p=0.001) and infectious pathology (p=0.001). DISCUSSION: The cumulative incidence of sepsis not confirmed by blood culture was 54%. Hypoalbuminemia has important associations with outcome and prognosis in pediatric patients. CRP does not correlate the study (p=0.232) and was only reactive in 4 patients (0.8%). CONCLUSIONS: Serum albumin level reported in the first 24 hours of NICU admission is a predictor for in-hospital outcomes (time and requirement of mechanical ventilation), neonatal mortality, neonatal sepsis, and hyaline membrane disease. Its serum determination should be included in the list of laboratory tests requested upon admission and the PCR upon admission should be excluded due to its poor sensitivity, as suggested by SIBEN.

Pork-cat syndrome as cause of anaphylactic reaction to well-cooked meat / Síndrome gato-porco como causa de reação anafilática à carne cozida

Pork-cat syndrome is a rare clinical syndrome that can cause lifethreatening reactions. Occuring in patients allergic to cat dander, it involves cross-reactivity between cat and pig serum albumin. Cat allergy usually precedes food allergies, suggesting primary sensitization to cat serum albumin. Since these proteins are thermolabile, the reaction tends to be more severe in undercooked meat. A 27-year-old woman with persistent moderate-to-severe rhinoconjunctivitis since childhood reported 2 immediate mucocutaneous reactions after eating small amounts of pork. Skin prick tests with commercial extracts showed sensitization to pork, and prick-to-prick tests confirmed sensitization to raw pork and raw beef. Specific IgE was positive for pork, and ISAC microarray also showed sensitization to Fel d 2. SDS-PAGE and IgE immunoblotting assays were performed with raw and cooked pork extract and detected in a 60 kDa band. In the immunoblotting-inhibition assays, cat serum albumin completely inhibited IgE binding to pork extract. The patient underwent 2 oral food challenges with well-cooked pork and beef, both causing an anaphylactic reaction. The patient's history and in-vivo and in-vitro tests led to a diagnosis of pork-cat syndrome with clinical cross-reactivity to another mammalian serum albumin. This case should stimulate oral food challenges with other well-cooked mammalian meats in patients with this syndrome to establish a tolerance threshold and avoid possible unexpected anaphylactic reactions.

A síndrome gato-porco é rara e ocorre em doentes alérgicos ao pêlo de gato, envolvendo reatividade cruzada entre as albuminas séricas (AS) de gato e de porco. Normalmente, a doença respiratória a pêlo de gato precede a alergia alimentar, sugerindo uma sensibilização primária à albumina sérica de gato. Uma vez que estas proteínas são termolábeis, as reações tendem a ser mais graves com carnes menos cozidas. Mulher de 27 anos com rinoconjuntivite persistente moderada a grave desde a infância que refere duas reações imediatas mucocutâneas após ingestão de pequenas quantidades de carne de porco. Os testes cutâneos por picada com extratos comerciais mostraram sensibilização à carne de porco e os testes prick-to-prick confirmaram sensibilização à carne de porco e de vaca cruas. A IgE específica (sIgE) foi positiva para carne de porco, e o ensaio ISAC mostrou sensibilização a Fel d 2. Foram realizados ensaios de immunoblotting SDS-PAGE IgE com extratos de carne de porco crua e cozidas que detectaram uma banda de 60 kDA. Nos ensaios de inibição por immunoblotting a albumina sérica de gato produziu uma inibição total da ligação da IgE ao extrato de carne de porco. A doente realizou duas provas de provocação oral com carne de porco e de vaca cozidas, ambas positivas com desenvolvimento de reação anafilática. A história clínica, os testes in-vivo e in-vitro levaram ao diagnóstico de síndrome gato-porco com reatividade cruzada clínica a outras albuminas séricas de mamíferos. A síndrome gato-porco é rara e pode causar reações fatais. Este caso frisa a importância da realização de provas de provocação oral com outras carnes de mamíferos bem cozidas em doentes com esta síndrome, de forma a estabelecer um limiar de tolerância e evitar possíveis reações anafiláticas inesperadas.

Proteinuria y síndrome nefrótico / Proteinuria and Nephrotic Syndrome

Introducción: El síndrome nefrótico es una patología que afecta el complejo glomerular del riñón, se caracteriza por una proteinuria mayor 3500 mg/d. De acuerdo a la respuesta de los esteroides se puede clasificar en síndrome nefrótico en esteroide resistente o esteroide sensible. Objetivo: Determinar la relación que existe entre la proteinuria y las variantes del síndrome nefrótico en adultos. Métodos: Se realizó un estudio descriptivo, retrospectivo, tipo serie de casos, con una población de 28 pacientes. Se recolectaron y se procesaron los datos a través del software Epi-Info 7,2TM; la frecuencia simple, la media estadística, prueba t de Student, y el coeficiente de correlación de Pearson. Resultados: En el análisis combinatorio de los fármacos adyuvantes para síndrome nefrótico, el grupo que utilizó antiproteinúricos pero no estatinas, demostró una diferencia estadísticamente significativa entre la proteinuria postratamiento media del grupo de síndrome nefrótico esteroideo resistente (6202 mg/d) vs síndrome nefrótico esteroideo sensible (65,9 mg/d) (valor de p 0,418). Existe una correlación negativa entre los niveles proteinuria postratamiento y el nivel de albúmina sérica postratamiento (r = - 0,7 valor de p < 0,00001). Conclusiones: Se demostró la ausencia de asociación entre la proteinuria inicial y las variantes de síndrome nefrótico esteroide sensible y esteroide resistente (valor de p = 0,8)(AU)

Introduction: Nephrotic syndrome is a pathology that affects the glomerular complex of the kidney, characterized by proteinuria greater than 3500 mg/d. According to the response to steroids, nephrotic syndrome can be classified as steroid-resistant or steroid-sensitive. Objective: To determine the relationship between proteinuria and the variants of the nephrotic syndrome in adults. Methods: A descriptive, retrospective, case series type study was carried out with a population of 28 patients. The data was collected and processed through Epi-Info 7.2TM software; simple frequency, statistical mean, student's t-test, and Pearson's correlation coefficient. Results: The statistically significant difference was obtained in the antiproteinuric and non-statin group, between the mean post-treatment proteinuria of the steroid resistant nephrotic syndrome group (6202 mg/d) in comparison to steroid sensitive nephrotic syndrome (65.9 mg/d) (p value 0.0418). There is negative correlation between post-treatment proteinuria levels and post-treatment serum albumin level (r= -0.7 p value <0.00001). Conclusions: The absence of association between initial proteinuria and steroid-sensitive and steroid-resistant variants of nephrotic syndrome was demonstrated (p value=0.8)(AU)

Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática / Long-term use of albumin in the cirrhotic patient. Systematic review

Introducción. La cirrosis constituye la etapa final de la enfermedad hepática crónica, con una alta mortalidad, y puede deberse a diferentes etiologías. La albúmina tiene tres indicaciones bien establecidas: la prevención de la disfunción circulatoria inducida por paracentesis, la peritonitis bacteriana espontánea y el síndrome hepatorrenal, sin embargo, su uso a largo plazo es controvertido. El objetivo de esta revisión fue identificar si el uso prolongado de la albúmina tiene efectos beneficiosos en el tratamiento de pacientes cirróticos. Metodología. Se realizaron búsquedas en la base de datos de PubMed, empleando los siguientes términos: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Se excluyeron los artículos que no cumplieron con la temática y aquellos que tenían más de 5 años de antigüedad, a excepción de aquellos relevantes para la revisión. Resultados. Se ha demos-trado en varios estudios realizados en los últimos 4 años, que la administración prolongada de albúmina reduce la mortalidad en el paciente cirrótico. Además, resulta en una disminución en ingresos hospitalarios por complicaciones de la cirrosis, disminución de la necesidad de para-centesis y menor uso de albúmina para otras indicaciones ya establecidas, lo que contrarresta los costos derivados de la terapia. Conclusión. Se concluye con base en la evidencia presenta-da, que el uso de albúmina a largo plazo podría resultar beneficioso en pacientes con cirrosis hepática descompensada. No obstante, es necesario abordar otros aspectos de la terapia en estudios posteriores

Introduction. Cirrhosis is the final stage of chronic liver disease, has a high mortality and can be due to different etiologies. Albumin has three well-established indications: prevention of circulatorydysfunction induced by paracentesis, spontaneous bacterial peritonitis, and hepatorenal syndrome, however, its long-term use is controversial. The objective of this review was to identify if the prolonged use of albumin has beneficial effects in the treatment of cirrhotic patients. Methodology. PubMed database was searched using the following terms: ("Liver Cirrhosis"[Mesh]) AND ("Serum Albumin"[Mesh] OR "Serum Albumin, Human"[Mesh]). Articles that did not meet the topic and those that were more than 5 years old were excluded, except for those relevant to the review. Results.It has been shown in several studies within the previous 4 years, that prolonged administration of albumin reduces mortality in cirrhotic patients. In addition, it results in a decrease in hospital ad-missions due to complications of cirrhosis, a decrease in the need for paracentesis and less use of albumin for other established indications, which offsets the costs derived from therapy. Conclusion. It is concluded based on the evidence presented, that the long-term use of albumin could be beneficial in patients with decompensated liver cirrhosis. However, other aspects of the therapy need to be addressed in further studies

C-reactive protein/albumin ratio (CAR) as a marker for detecting acute severe ulcerative colitis in Egyptian patients.

INTRODUCTION AND AIM: The C-reactive protein/albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many diseases. Our aim in the present study was to investigate the diagnostic performance of the CAR in determining the clinical severity of acute severe ulcerative colitis (ASUC). MATERIALS AND METHODS: A retrospective study on 200 UC patients that were admitted to the Gastroenterology unit of the Alexandria University, over an 8-year period from January 2012 to January 2020, was conducted. Patient demographic data, laboratory values, and clinical and endoscopic disease activity scores were evaluated. C-reactive protein (CRP) and albumin levels were recorded. The CAR was calculated to determine clinical severity. RESULTS: Of the 200 patients, 135 (67.5%) were men and 65 (32.5%) were women. Mean age was 43.5 ±â€¯9.8 years. Patients were divided into groups with mild, moderate, or severe disease activity and there were statistically significant differences in the CAR, the erythrocyte sedimentation rate (ESR), CRP levels, and albumin levels (p = 0.001; p < 0.05). With a cut-off value of 0.6, the CAR performed best in defining patients with severe disease, with an area under the curve (AUC) of 0.985, 98% sensitivity, 100% specificity, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 97%, p < 0.001. AUC values for the diagnosis of severe disease were 0.985, 0.88, 0.72, and 0.65 for the CAR, CRP, albumin, and the ESR, respectively. CONCLUSION: There was a statistically significant association between the CAR and clinical disease activity in patients with UC. The CAR is a reliable and practical tool for detecting ASUC.

Early postoperative serum albumin levels as predictors of surgical outcomes in head and neck squamous cell carcinoma / Níveis de albumina sérica no pós‐operatório imediato como preditivo de resultados cirúrgicos em carcinoma de células escamosas de cabeça e pescoço

Abstract Background Malnutrition is a common issue in patients with head and neck squamous cell carcinoma and has a negative effect on surgical outcomes. Objective We attempted to determine which malnutrition diagnostic variables can be used as predictors of postoperative complications in patients with head and neck squamous cell carcinoma. Methods Forty-one patients undergoing surgery for head and neck squamous cell carcinoma were submitted to a prospective evaluation. Biochemical data, anthropometric measurements and evaluation of body composition were used in the nutritional analysis. Results Twenty-two patients (53.6%) developed complications. Serum albumin measured on the first postoperative day was the only variable that significantly differed between groups. A cut-off value of 2.8 g/dL distinguished between patients with a complicated and uncomplicated postoperative course. Normalization of albumin levels occurred more frequently and more rapidly in the noncomplicated group. Conclusion Serum albumin measured on the first postoperative day was the only variable that was a predicter of postoperative complications after major head and neck squamous cell carcinoma surgery.

Resumo Introdução A desnutrição é um problema comum em pacientes com carcinoma de células escamosas de cabeça e pescoço e tem um efeito negativo nos resultados cirúrgicos. Objetivo Tentamos determinar quais variáveis diagnósticas de desnutrição podem ser usadas como preditivos de complicações pós‐operatórias em pacientes com carcinoma de células escamosas de cabeça e pescoço. Método Quarenta e um pacientes submetidos à cirurgia de carcinoma de células escamosas de cabeça e pescoço foram submetidos a uma avaliação prospectiva. Dados bioquímicos, medidas antropométricas e avaliação da composição corporal foram usados na análise nutricional. Resultados Vinte e dois pacientes (53,6%) desenvolveram complicações. A dosagem de albumina sérica no primeiro dia pós‐operatório foi a única variável que diferiu significantemente entre os grupos. Um valor de corte de 2,8 g/dL distinguiu os pacientes com uma evolução pós‐operatória complicada e não complicada. A normalização dos níveis de albumina ocorreu mais frequentemente e mais rapidamente no grupo sem complicação pós‐operatória. Conclusão A albumina sérica medida no primeiro dia pós‐operatório foi a única variável capaz de predizer complicações pós‐operatórias após cirurgia de carcinoma de células escamosas de cabeça e pescoço de grande porte.

Alterações hidroeletrolíticas em pessoas com cirrose / Hydroelectrolytic alterations in cirrhotic patients

O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)

The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)

Lupus eritematoso sistémico en actividad y cociente albúmina/globulina invertido, ¿hallazgo propio de la enfermedad?

Introducción:El lupus eritematoso sistémico es el modelo clásico de enfermedad autoinmune. En el desarrollo de la enfermedad intervienen varios tipos de inmunoglobulinas, con predominio de la IgG, IgM e IgA.Objetivo:Describir la utilidad del cociente albúmina/globulina como un indicador de actividad en el lupus eritematoso sistémico.Desarrollo:Se estima que el 50 porciento de los pacientes con lupus eritematoso sistémico muestran una hipoalbuminemia con una hipergammaglobulinemia. La hipoalbuminemia en mayor medida está relacionada con la presencia de nefritis lúpica. La mitad de los pacientes con nefritis lúpica presentan proteinuria en el orden del síndrome nefrótico. Esta proteinuria iguala o invierte parcialmente el valor del cociente albúmina/globulina. El cociente albúmina/globulina invertido por sí solo es insuficiente para afirmar la presencia de actividad en el lupus eritematoso sistémico. Se deben excluir otras entidades clínicas causantes de hipergammaglobulinemia policlonal. Los criterios de actividad del lupus eritematoso sistémico incrementan la sensibilidad del cociente albúmina/globulina invertido.Conclusiones:La interpretación del cociente albúmina/globulina debe ir aparejada a la estimación de actividad por los criterios clínicos de mayor uso (SLICC, SLEDAI, BILAG). No en todos los pacientes con lupus eritematoso sistémico puede interpretarse como criterio de actividad, por lo que es necesario excluir otras entidades clínicas.[AU]

Influence of different protein supplements on the recovery and in vitro maturation of bovine oocytes / Influencia de diferentes suplementos proteicos en la recuperación y maduración in vitro de ovocitos bovinos / Influência de diferentes suplementações proteicas sobre a recuperação e maturação in vitro de oócitos bovinos

Abstract Background: Oocyte quality and maturation are influenced by protein supplementation. Objective: To evaluate the influence of fetal bovine serum (FBS) and bovine serum albumin (BSA) concentrations on the recovery and in vitro maturation (IVM) of bovine oocytes. Methods: The study was divided into Stage 1 (oocyte recovery), and Stage 2 (IVM). In the first stage, three experiments were conducted according to the recovery (R) medium used: (R1) 10 vs. 20% FBS; (R2) 5 vs. 10% BSA; and (R3) the best results from R1, R2, and the combination of FBS+BSA (5+5%). Within the second stage, the maturation medium was supplemented according to three experiments: (M1) 5 vs. 10% FBS; (M2) 0.4 vs. 0.8% BSA; and (M3) better results of M1, M2, and the combination of FBS+BSA (5+0.8%). Results: In Stage 1 (R1 and R2), the media with 10% FBS and 10% BSA showed better oocyte quality results and were defined for experiment R3. In R3, the 10% FBS and the combination of FBS+BSA (5+5%) allowed recovery of better-quality oocytes. In Stage 2 (M1 and M2), media with both levels of FBS (5 and 10%) and 0.8% BSA were defined as better according to the maturation and viability rates of cumulus cells, so they were defined for experiment M3. In M3, no difference was noted among the supplements. Conclusions: For oocyte recovery, 10% FBS and the combination of FBS+BSA (5+5%) can be used to obtain immature oocytes. For the in vitro maturation, FBS (both levels, 5 and 10%) and BSA (0.8%) can be used alone or in combination.

Resumen Antecedentes: La calidad y maduración de los ovocitos son influenciados por la suplementación proteica. Objetivo: Evaluar la influencia de concentraciones de suero fetal bovino (FBS) y albúmina sérica bovina (BSA) en la recuperación y maduración in vitro (IVM) de ovocitos bovinos. Métodos: El estudio se dividió en Etapa 1 (recuperación de ovocitos) y Etapa 2 (IVM). En la primera etapa, tres experimentos se realizaron de acuerdo con el medio de recuperación: (R1) 10 vs. 20% FBS; (R2) 5 vs. 10% BSA; y (R3) los mejores resultados de R1, R2 y la combinación de FBS+BSA (5+5%). En la segunda etapa, el medio de maduración fue suplementado para tres experimentos: (M1) 5 vs. 10% FBS; (M2) 0,4 vs. 0,8% BSA; y (M3) mejores resultados de M1, M2 y la combinación de FBS+BSA (5+0,8%). Resultados: En la Etapa 1 (R1 y R2), los medios con 10% FBS y 10% BSA mostraron mejores resultados de calidad oocitaria y fueron definidos para el experimento R3. En R3, 10% FBS y la combinación de FBS+BSA (5+5%) permitieron la recuperación de ovocitos de mejor calidad. En la Etapa 2 (M1 y M2), los medios con ambos niveles de FBS (5 y 10%) y 0,8% de BSA se definieron como mejores de acuerdo con las tasas de maduración y viabilidad de las células del cumulus, por lo que se definieron para el experimento M3. En M3, no se observó diferencia entre los suplementos. Conclusiones: Para la recuperación de ovocitos, se puede utilizar 10% de FBS y la combinación de FBS+BSA (5+5%) para obtener ovocitos inmaduros. Para la maduración in vitro, FBS (ambos niveles, 5 y 10%) y BSA (0,8%) se pueden usar solos o en combinación.

Resumo Antecedentes: A qualidade e a maturação de oócitos são influenciadas pela suplementação proteica. Objetivo: Avaliar a influência de concentrações de soro fetal bovino (FBS) e albumina sérica bovina (BSA) sobre a recuperação e maturação in vitro (IVM) de oócitos bovinos. Métodos: O estudo foi dividido em Etapa 1 (recuperação de oócitos) e Etapa 2 (IVM). Na primeira etapa, três experimentos foram realizados de acordo com o meio de recuperação: (R1) 10 vs. 20% FBS; (R2) 5 vs. 10% BSA; e (R3) melhores resultados de R1, R2 e a combinação de FBS+BSA (5+5%). Na segunda etapa, o meio de maturação foi suplementado de acordo com três experimentos: (M1) 5 vs. 10% FBS; (M2) 0,4 vs. 0,8% BSA; e (M3) melhores resultados de M1, M2 e a combinação de FBS+BSA (5+0,8%). Resultados: Na Etapa 1 (R1 e R2), os meios com 10% FBS e 10% BSA mostraram melhores resultados de qualidade oocitária e foram definidos para o experimento R3. Em R3, 10% FBS e a combinação de FBS+BSA (5+5%) permitiram a recuperação de oócitos de melhor qualidade. Na segunda etapa (M1 e M2), meios com ambos os níveis de FBS (5 e 10%) e 0,8% BSA foram definidos como os melhores de acordo com as taxas de maturação e viabilidade de células do cumulus, então foram definidos para o experimento M3. No M3, não houve diferença entre os suplementos. Conclusões: Para a recuperação oocitária, 10% FBS e a combinação de FBS+BSA (5+5%) podem ser usados para obter oócitos imaturos. Para maturação in vitro, FBS (ambos os níveis, 5 e 10%) e BSA (0,8%) podem ser usados sozinhos ou em combinação.

Albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria / Seric albumin as prediction factor of multiple failures of organs in patients with secondary diffuse peritonitis

Introducción: La albúmina sérica constituye uno de los parámetros utilizados para predecir el riesgo de complicaciones en pacientes intervenidos quirúrgicamente. Objetivo: Evaluar la utilidad de la albúmina sérica como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria. Método: Se realizó un estudio observacional, analítico, de cohortes de 54 pacientes con peritonitis difusa secundaria atendidos en la Unidad de Cuidados Intensivos del Hospital General Universitario Carlos Manuel de Céspedes de Bayamo, de la provincia de Granma, durante el 2016. La variable marcadora del pronóstico fue el fallo múltiple de órganos, que se evaluó con la escala Secuencial Organ Failure Assessment. Resultados: En 37,7 % de los pacientes se desarrolló fallo múltiple de órganos; asimismo, el valor promedio de la albúmina sérica al ingreso (desviación estándar) fue 30,3 g/L (+ 3,4) en pacientes con dicha afectación y 33,2 g/L (+ 4,1) sin esta (p=0,012). El riesgo relativo de fallo múltiple de órganos resultó ser de 1,9 (IC: 95 % 1,1-3,2) con albúmina de 30 g/L o menos. En el análisis multivariado la albúmina sérica constituyó un factor independiente de fallo múltiple de órganos junto al índice de APACHE II; mientras que el área bajo la curva receptor operador presentó un valor de 0,7 cuando se estimó la capacidad discriminativa de la albúmina para predecir la no aparición de fallo múltiple de órganos y de 0,2 para predecir su desarrollo. Conclusiones: La albúmina sérica es útil como factor pronóstico de fallo múltiple de órganos en pacientes con peritonitis difusa secundaria.

Introduction: Seric albumin constitutes one of the parameters used to predict the risk of complications in patients surgically intervened. Objective: To evaluate the utility of seric albumin as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis. Method: An observational, cohorts analytic study of 54 patients with secondary diffuse peritonitis was carried out, they were assisted in the Intensive Cares Unit of Carlos Manuel de Céspedes University General Hospital in Bayamo, Granma, during 2016. The marker variable of prediction was the multiple failures of organs that was evaluated with the Sequential scale Organ Failure Assessment. Results: In the 37.7 % of patients multiple failure of organs was developed; also, the average value of seric albumin at admission (standard deviation) was 30.3 g/L (+ 3.4) in patients with this disorder and 33.2 g/L (+ 4.1) without this disorder (p=0.012). The relative risk of multiple failure of organs was 1.9 (CI: 95 % 1.1-3.2) with albumin of 30 g/L or less. In the multivariate analysis seric albumin constituted an independent factor of multiple failure of organs along with APACHE II index; while the area under the curve receiving operator presented a value of 0.7 when the discriminative capacity of the albumin was considered to predict if the multiple failure of organs was not present and 0.2 to predict its development. Conclusions: Seric albumin is useful as prediction factor of multiple failure of organs in patients with secondary diffuse peritonitis.

Lupus eritematoso sistémico en actividad y cociente albúmina/globulina invertido, ¿hallazgo propio de la enfermedad? / Systemic Erythematosus Lupus and Albumin-Globulin Index, a specific finding in lupus flares?

Introducción: El lupus eritematoso sistémico es el modelo clásico de enfermedad autoinmune. En el desarrollo de la enfermedad intervienen varios tipos de inmunoglobulinas, con predominio de la IgG, IgM e IgA. Objetivo: Describir la utilidad del cociente albúmina/globulina como un indicador de actividad en el lupus eritematoso sistémico. Desarrollo: Se estima que el 50 por ciento de los pacientes con lupus eritematoso sistémico muestran una hipoalbuminemia con una hipergammaglobulinemia. La hipoalbuminemia en mayor medida está relacionada con la presencia de nefritis lúpica. La mitad de los pacientes con nefritis lúpica presentan proteinuria en el orden del síndrome nefrótico. Esta proteinuria iguala o invierte parcialmente el valor del cociente albúmina/globulina. El cociente albúmina/globulina invertido por sí solo es insuficiente para afirmar la presencia de actividad en el lupus eritematoso sistémico. Se deben excluir otras entidades clínicas causantes de hipergammaglobulinemia policlonal. Los criterios de actividad del lupus eritematoso sistémico incrementan la sensibilidad del cociente albúmina/globulina invertido. Conclusiones: La interpretación del cociente albúmina/globulina debe ir aparejada a la estimación de actividad por los criterios clínicos de mayor uso (SLICC, SLEDAI, BILAG). No en todos los pacientes con lupus eritematoso sistémico puede interpretarse como criterio de actividad, por lo que es necesario excluir otras entidades clínicas(AU)

Introduction: Systemic lupus erythematosus is the model of autoimmune disease. Several types of immunoglobulins are involved in the development of the disease, mainly IgG, IgM and IgA. Objective: To describe the potential use of the albumin/globulin ratio as an indicator of activity in systemic lupus erythematosus. Development: fifty percent of patients with systemic lupus erythematosus exhibit hypoalbuminemia with hypergammaglobulinemia. Hypoalbuminemia is mainly related to the presence of lupus nephritis. The half of patients with lupus nephritis develops proteinuria with values of nephrotic syndrome. The proteinuria equals or partially reverses the albumin/globulin ratio. The inverted albumin/globulin ratio is insufficient to establish the presence of lupus activity. Other clinical entities producing polyclonal hypergammaglobulinaemia should be excluded. The systemic lupus erythematosus activity criteria increase the sensitivity of the inverted albumin/globulin ratio. Conclusions: The interpretation of the albumin/globulin ratio requires the activity estimation by different clinical criteria (SLICC, SLEDAI, BILAG). The inverted albumin/globulin ratio cannot be interpreted as a stand-alone indicator of disease activity in every systemic lupus erythematosus patients(AU)

Valoración e intervenciones nutricionales en pacientes en hemodiálisis / Assesment and nutrition intervention in hemodialysis patients

INTRODUCCIÓN: La desnutrición en pacientes dializados es altamente frecuente siendo de etiología multifactorial. OBJETIVO: Realizar diagnóstico de situación y evolución de Parámetros luego de la intervención nutricional. Metas esperadas a los 6 meses: evaluación nutricional en 100% de pacientes; 70% con valoración global subjetiva (VGS) tipo A; 80% con albúmina ≥3.5 g/dl; 70% con ingesta proteica (nPNA) >0.8 g/kg/día. MATERIAL Y MÉTODOS: Se evaluaron pacientes en diálisis con más de 90 días de tratamiento durante marzo y abril (etapa diagnóstica) y noviembre y diciembre de 2016 (evolución de parámetros); registrando datos personales, antropométricos y de laboratorio, anamnesis alimentaria y VGS. Las acciones nutricionales fueron entrevistas a pacientes y familiares, educación a través de charlas grupales e indicación de suplementos hiperproteicos a pacientes seleccionados según apetito, pérdida de peso y albúmina. RESULTADOS: En etapa diagnóstica se evaluaron 35 pacientes; 18 (51%) tenían IMC >23 y <35, 9 (26%) con nPNA >0.8 g/kg/día. Albúmina ≥3.5 g/dl 24 pacientes (69%). VGS tipo A 16 pacientes (46%), tipo B 12 (34%) y tipo C 7 (20%). Se suplementaron 5 pacientes (14%). En etapa posterior se valoraron 28 pacientes; 11 (39%) IMC >23 y <35. nPNA >0.8 g/kg/día 27 pacientes (96%). Albúmina ≥3.5 g/dl 23 pacientes (82%). VGS tipo A 18 (64%), tipo B 9 (32%) y tipo C 1 (4%). 100% de los suplementados lograron las metas esperadas. CONCLUSIÓN: La valoración nutricional periódica, las intervenciones y la suplementación mejoran los objetivos nutricionales a corto plazo de la población en diálisis

INTRODUCTION: Malnutrition, being a condition with a multifactorial etiology, is very frequent in dialysis patients. OBJECTIVE: TO make a diagnosis of the situation and the evolution of parameters following nutrition intervention. Expected goals after six months: nutritional assessment of 100% of patients; 70% with type A subjective global assessment (SGA); 80% with ≥3.5 g/dL albumin levels, and 70% with >0.8 g/kg/day protein intake (nPNA). METHODS: Patients undergoing dialysis for more than 90 days were evaluated during March and April (diagnostic stage) and November and December 2016 (evolution of parameters), recording personal, anthropometric and laboratory data, food history and SGA. The nutritional actions were: interviews to patients and relatives, education through group talks and indication of hyperproteic supplements to patients selected according to appetite, weight loss and albumin. RESULTS: In the diagnostic stage, 35 patients were evaluated; 18 (51%) had BMI > 23 and < 35; 9 (26%) with nPNA > 0.8 g/kg/day. Albumin was ≥3.5 g/dL in 24 patients (69%). Type A SGA in 16 patients(46%); type B in 12 of them (34%) and type C in 7 (20%). Five patients received supplements (14%). In a later stage, 28 patients were evaluated; 11 (39%) with BMI > 23 and < 35. nPNA; > 0.8 g/kg/day in 27 patients (96%). Albumin was ≥3.5 g/dL in 23 patients (82%). Type A SGA in 18 patients (64%); type B in 9 of them (32%) and type C in 1 (4%). 100% of the supplemented subjects achieved the expected goals. CONCLUSION: Periodic nutritional assessment, interventions and supplementation improve the short-term nutritional goals of the dialysis population

Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis / Albúmina sérica preoperatoria como un predictor de complicaciones posterior al reemplazo total de cadera en pacientes con artritis reumatoide

Abstract: Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. Methods: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. Results: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). Conclusion: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

Resumen: Introducción: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. Métodos: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. Resultados: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). Conclusión: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

Relação entre eficiência da hemodiálise e estado nutricional em pacientes com doença renal crônica / Relationship between dialytic efficiency and nutritional status of patients with chronic kidney disease on hemodialysis

OBJETIVOS: Verificar as relações entre índice de eficiência dialítica (Kt/V) e parâmetros de estado nutricional de indivíduos com doença renal crônica em hemodiálise. MÉTODOS: Foi realizado um estudo retrospectivo em um instituto de hemodiálise. Foram coletados dados dos prontuários sobre sexo, idade, exames bioquímicos, peso seco, altura, circunferência do braço (CB) e prega cutânea tricipital (PCT). Foram calculados índice de risco nutricional (IRN), índice de massa corporal (IMC), circunferência muscular do braço (CMB), área muscular do braço corrigida (AMBc), Kt/V e taxa de redução da ureia (urea reduction rate ­ URR). Para a análise estatística foram empregados o teste de Mann-Whitney e a Correlação de Spearman, sendo considerados significativos valores de p<0,05. RESULTADOS: Foram avaliados 164 pacientes, com média de idade de 58±14,4 anos, sendo 96 (59%) do sexo masculino. A mediana do tempo em que os pacientes se encontravam em hemodiálise foi 35,0 (5-234) meses. Entre os 164 pacientes, 60 (37%) apresentavam risco nutricional. Na avaliação do estado nutricional, os valores médios obtidos foram de 25,0±4,5kg/m2 para o IMC, 99,0±12,3% para a adequação da CB, 86,7±14,5% para a adequação da CMB, 122,9±66,8% para a adequação da AMBc e 1,4±0,4 para o Kt/V. A mediana de adequação para PCT foi de 107,8% (11,5%-305,4%). Observou-se ausência de correlação do Kt/V com albumina sérica, CB, CMB, AMBc e IRN. O Kt/V apresentou correlação positiva baixa com o tempo em hemodiálise (r=0,2197) e correlação negativa baixa com a PCT (r=-0,1692) e com o IMC (r=-01970). A correlação entre Kt/V e peso seco foi negativa moderada (r=-0,3710) e entre Kt/V e URR foi positiva forte (r=0,81129). CONCLUSÕES: Verificou-se adequada eficiência dialítica e bom estado nutricional na maioria da amostra avaliada, com correlações significativas entre eficiência dialítica e parâmetros de avaliação do estado nutricional.

AIMS: To verify the relationships between the dialysis adequacy index (Kt/V) and nutritional parameters of individuals with chronic renal disease on hemodialysis. METHODS: A retrospective study was performed at a hemodialysis institute. Data on sex, age, biochemical tests, dry weight, height, arm circumference (AC) and triceps skin fold (TSF) were collected from the medical charts. Nutritional risk index (NRI), body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (AMAc), Kt/V and urea reduction rate (URR). The Mann-Whitney test and the Spearman correlation were used for the statistical analysis, and a p<0.05 was considered significant. RESULTS: A total of 164 patients were evaluated, with a mean age of 58±14.4 years, of which 96 (59%) were male. The median time on hemodialysis was 35.0 (5-234) months. Among the 164 patients, 60 (37%) presented nutritional risk. In the evaluation of nutritional status, the mean values obtained were 25.0±4.5 kg/m2 for BMI, 99.0±12.3% for CB adequacy, 86.7±14.5% for WBC adequacy, 122.9±66.8% for CBA adequacy and 1.4±0.4 for Kt/V. The median adequacy for PCT was 107.8% (11.5%-305.4%). There was no correlation of Kt/V with serum albumin, CB, CMB, AMAc and NRI. Kt/V had a low positive correlation with time on hemodialysis (r=0.2197) and a low negative correlation with PCT (r=-0.1692) and with BMI (r=-01970). The correlation between Kt/V and dry weight was moderate and negative (r=-0.3710) and between Kt/V and URR the correlation was strongly positive (r=0.81129). CONCLUSIONS: Adequate dialysis efficiency and good nutritional status were observed in most patients of the evaluated sample, with significant correlations between dialysis adequacy and parameters of nutritional status assessment.

Correlation between nutritional status and clinical results in patients undergoing spinal surgery / Correlação entre estado nutricional e resultados clínicos em pacientes submetidos à cirurgia da coluna vertebral / Correlación entre estado nutricional y resultados clínicos en pacientes sometidos a cirugía de la columna vertebral

ABSTRACT Objective: To investigate the relationship between preoperative vitamin D and albumin levels and postoperative quality of life in patients undergoing spinal surgery. Methods: Patients undergoing thoracic and lumbar spine surgery were evaluated in this prospective study. Their vitamin D and albumin levels were assessed before surgery and quality of life was measured by two questionnaires, Oswestry Disability Index (ODI) and Scoliosis Research Society - 22 (SRS-22), one year after the procedure. Data on infection occurrence and healing time were collected. Preoperative nutritional values and patients' quality of life were analyzed using the chi-square test and ANOVA for albumin and vitamin D, respectively. The relationship among nutritional status, healing time, and the occurrence of infection was evaluated by the Pearson correlation coefficient. Results: Forty-six patients were included and their mean nutritional values were 19.1 (6.6) ng/mL for vitamin D and 3.9 (0.6) g/dL for albumin [mean (standard deviation)]. No association was found between vitamin D and quality of life of patients measured by ODI (p=0.534) and SRS-22 (p=0.739) questionnaires. There was also no association between albumin levels and quality of life measured by ODI (p=0.259) and SRS-22 (p=0.076) questionnaires. No correlation was found between the healing time or occurrence of infection and nutritional values. Conclusions: There was no association between vitamin D and albumin levels and the surgical result, according to the patient's perception, besides the occurrence of complications with the surgical wound.

RESUMO Objetivo: Investigar a relação entre os níveis de vitamina D e albumina pré-operatórios e qualidade de vida pós-operatória em pacientes submetidos a cirurgia de coluna. Métodos: Pacientes submetidos a cirurgia de coluna nos níveis torácico e lombar foram avaliados neste estudo prospectivo. Seus níveis de vitamina D e albumina foram avaliados antes da cirurgia e a qualidade de vida foi medida por meio de dois questionários, Oswestry Disability Index (ODI) e Scoliosis Research Society - 22 (SRS-22), um ano após o procedimento. Os dados sobre ocorrência de infecção e tempo de cicatrização foram coletados. Os valores nutricionais pré-operatórios e a qualidade de vida dos pacientes foram analisados usando o teste de qui-quadrado e ANOVA para albumina e vitamina D, respectivamente. A relação entre o estado nutricional e o tempo de cicatrização e a ocorrência de infecção foram avaliados pelo coeficiente de Pearson. Resultados: Quarenta e seis pacientes foram incluídos e seus valores nutricionais médios foram 19,1 (6,6) ng/ml para vitamina D e 3,9 (0,6) g/dl para albumina [média (desvio-padrão)]. Não foi encontrada associação entre os níveis de vitamina D e qualidade de vida dos pacientes medidos pelos questionários ODI (p = 0,534) e SRS-22 (p = 0,739). Também não houve associação entre níveis de albumina e qualidade de vida medidos pelos questionários ODI (p = 0,259) e SRS-22 (p = 0,076). Não foi encontrada correlação entre o tempo de cicatrização ou ocorrência de infecção e valores nutricionais. Conclusões: Não se constatou associação entre os níveis de vitamina D e albumina e o resultado cirúrgico, conforme a percepção dos próprios pacientes, além da ocorrência de complicações com a ferida operatória.

RESUMEN Objetivo: Investigar la relación entre los niveles preoperatorios de vitamina D y albúmina y la calidad de vida postoperatoria en pacientes sometidos a cirugía de columna. Métodos: Pacientes sometidos a cirugía de columna en los niveles torácico y lumbar fueron evaluados en este estudio prospectivo. Sus niveles de vitamina D y albúmina se evaluaron antes de la cirugía y la calidad de vida se midió a través de dos cuestionarios, Oswestry Disability Index (ODI) y Scoliosis Research Society - 22 (SRS-22), un año después del procedimiento. Los datos sobre la ocurrencia de infección y el tiempo de cicatrización fueron recolectados. Los valores nutricionales preoperatorios y la calidad de vida de los pacientes se analizaron mediante la prueba de chi-cuadrado y ANOVA para la albúmina y la vitamina D, respectivamente. La relación entre el estado nutricional y el tiempo de cicatrización y la ocurrencia de infección fue evaluada mediante el coeficiente de Pearson. Resultados: Cuarenta y seis pacientes fueron incluidos y sus valores nutricionales promedios fueron 19,1 (6,6) ng/ml para la vitamina D y 3,9 (0,6) g/dl para la albúmina [media (desviación estándar)]. No se encontró asociación entre los niveles de vitamina D y la calidad de vida de los pacientes medidos por los cuestionarios ODI (p = 0,534) y SRS-22 (p = 0,739). También no hubo asociación entre los niveles de albúmina y la calidad de vida medidos por los cuestionarios ODI (p = 0,259) y SRS-22 (p = 0,076). No se encontró correlación entre el tiempo de cicatrización o la ocurrencia de infección y los valores nutricionales. Conclusiones: No se constató asociación entre los niveles de vitamina D y albúmina y el resultado quirúrgico, según la percepción de los propios pacientes, además de la ocurrencia de complicaciones con la herida operatoria.

Mean platelet volume is decreased in adults with active lupus disease.

BACKGROUND: Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. OBJECTIVE: We investigated the association between MPV and disease activity in adult patients with SLE. METHODS: In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. RESULTS: MPV was significantly decreased with respect to those of inactive patients (7.16±1.39 vs. 8.16±1.50, p=0.005). At a cutoff level of 8.32fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r=0.407, p=0.001), which in turn is inversely associated with disease activity. CONCLUSIONS: In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

Mean platelet volume is decreased in adults with active lupus disease / O volume plaquetário médio está reduzido em adultos com lúpus ativo

ABSTRACT Background: Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. Objective: We investigated the association between MPV and disease activity in adult patients with SLE. Methods: In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. Results: MPV was significantly decreased with respect to those of inactive patients (7.16 ± 1.39 vs. 8.16 ± 1.50, p = 0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r = 0.407, p = 0.001), which in turn is inversely associated with disease activity. Conclusions: In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

RESUMO Antecedentes: Existem poucos biomarcadores disponíveis para avaliar a atividade da doença no lúpus eritematoso sistêmico (LES). O volume plaquetário médio (VPM) foi recentemente estudado como um biomarcador inflamatório. Atualmente não está claro se o VPM também pode desempenhar um papel como um biomarcador da atividade da doença em pacientes adultos com LES. Objetivo: Investigou-se a associação entre o VPM e a atividade da doença em pacientes adultos com LES. Métodos: Neste estudo retrospectivo, compararam-se dois grupos de pacientes adultos divididos de acordo com a atividade da doença (36 por grupo). Os indivíduos foram pareados por idade e gênero. Resultados: O VPM esteve significativamente diminuído nos pacientes com doença ativa em comparação com os níveis em pacientes com doença inativa (7,16 ± 1,39 versus 8,16 ± 1,50, p = 0,005). Em um nível de corte de 8,32 fL, o VPM tem uma sensibilidade de 86% e uma especificidade de 41% para a detecção da atividade da doença. Encontrou-se uma correlação positiva modesta entre o VPM e a albumina (r = 0,407, p = 0,001), que por sua vez está inversamente associada à atividade da doença. Conclusões: Em resumo, o VPM está diminuído em pacientes adultos com lúpus ativo e positivamente correlacionado com a albumina, outro biomarcador da atividade da doença. São necessários estudos prospectivos para avaliar o valor prognóstico desse biomarcador.