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1.
An. bras. dermatol ; 92(5): 682-685, Sept.-Oct. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-887043

RESUMO

Abstract: Inflammatory linear verrucous epidermal nevus and linear psoriasis are sometimes hard to differentiate clinically and pathologically. Although immunohistochemical expression of keratin 10 (K10), K16, Ki-67, and involucrin may be useful for differentiating both entities, these results have been reported in only a few cases. We collected data from 8 patients with inflammatory linear verrucous epidermal nevus, 11 with psoriasis vulgaris, and 8 healthy controls and evaluated immunohistochemical expression of Ki-67, K16, involucrin, and filaggrin among them. Ki-67 and K16 overexpression was similar in inflammatory linear verrucous epidermal nevus and psoriasis vulgaris compared with normal skin. Although staining for involucrin showed discontinuous expression in parakeratotic regions in 4 inflammatory linear verrucous epidermal nevus cases, it was continuous in the other 4 cases and in all psoriasis vulgaris cases. Filaggrin expression was present in hyperkeratotic regions but scarce in parakeratotic areas in both inflammatory linear verrucous epidermal nevus and psoriasis vulgaris. The immunostaining pattern of Ki-67, K16, involucrin, and filaggrin may be insufficient to discriminate inflammatory linear verrucous epidermal nevus from psoriasis vulgaris.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Precursores de Proteínas/análise , Psoríase/diagnóstico , Antígeno Ki-67/análise , Queratina-16/análise , Nevo Sebáceo de Jadassohn/diagnóstico , Proteínas de Filamentos Intermediários/análise , Psoríase/patologia , Imuno-Histoquímica , Biomarcadores/análise , Estudos de Casos e Controles , Diagnóstico Diferencial , Nevo Sebáceo de Jadassohn/patologia
2.
Acta cir. bras ; 32(7): 568-575, July 2017. tab
Artigo em Inglês | LILACS | ID: biblio-886221

RESUMO

Abstract Purpose: To evaluate the possibility of using peripheral-blood presurfactant protein B (Pro-SFTPB) for screening non-small cell lung cancer (NSCLC). Methods: A total of 873 healthy volunteers and 165 lung cancer patients hospitalized in the Fifth People's Hospital of Dalian were tested Pro-SFTPB once every half year from January 2014 to September 2015. The healthy volunteers were also conducted spiral computed tomography (CT) examination once every year. The data were then com-pared and statistically analyzed. Results: The positive expression rate of Pro-SFTPB in NSCLC was significantly higher than that in healthy volunteers, and significantly higher in lung adenocarcinoma than in squamous cell carcinoma; additionally, the expression rate was increased with the in-crease of smoking index, and the intergroup differences showed statistical signifi-cance (p≤0.05). The positive rate of newly diagnosed lung cancer was 29.55%, higher than healthy volunteers (22.34%), but there was no significant difference (p>0.05). Conclusion: Pro-SFTPB is over expressed in non-small cell lung cancer, especially in lung adeno-carcinoma, but it can't be used as a clinical screening tool for lung cancer.


Assuntos
Humanos , Masculino , Feminino , Idoso , Precursores de Proteínas/sangue , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/sangue , Proteínas Associadas a Surfactantes Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/sangue , Biomarcadores Tumorais/sangue , Estudos de Casos e Controles , Programas de Rastreamento , Sensibilidade e Especificidade
3.
Braz. oral res. (Online) ; 31: e19, 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-839527

RESUMO

Abstract To assess the immunocytochemical and immunohistochemical correlation of adhesion (E-cadherin) and cell differentiation (involucrin) molecules in oral leukoplakia and oral squamous cell carcinoma. Cytological samples and biopsies were obtained from male and female patients aged over 30 years with oral leukoplakia (n = 30) and oral squamous cell carcinoma (n = 22). Cell scrapings and the biopsy were performed at the site of the lesion and histological slides were prepared for the immunocytochemical analysis of exfoliated oral mucosal cells and for the immunohistochemical analysis of biopsy tissues using E-cadherin and involucrin. Spearman’s correlation and kappa coefficients were used to assess the correlation and level of agreement between the techniques. Immunostaining for E-cadherin and involucrin by both techniques was similar in the superficial layers of the histological sections compared with cell scrapings. However, there was no statistical correlation and agreement regarding the immunocytochemical and immunohistochemical expression of E-cadherin and involucrin in oral leukoplakia (R = 0.01, p = 0.958) (Kappa = 0.017, p = 0.92) or in oral squamous cell carcinoma (R = 0.26, p = 0.206) (Kappa = 0.36, p = 0.07). The immunoexpression of E-cadherin and involucrin in tissues is consistent with the expression patterns observed in exfoliated oral mucosal cells, despite the lack of a statistically significant correlation. There is an association of the histopathological characteristics of leukoplakia with the expression E-cadherin and of the microscopic aspects of oral squamous cell carcinoma with immunohistochemical expression of involucrin.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Caderinas/metabolismo , Carcinoma de Células Escamosas/metabolismo , Leucoplasia Oral/metabolismo , Neoplasias Bucais/metabolismo , Precursores de Proteínas/metabolismo , Biomarcadores Tumorais/metabolismo , Biópsia , Imuno-Histoquímica , Valores de Referência , Estatísticas não Paramétricas
4.
Arch. endocrinol. metab. (Online) ; 59(6): 554-558, Dec. 2015. tab
Artigo em Inglês | LILACS | ID: lil-767928

RESUMO

Diabetes insipidus is a disease in which large volumes of dilute urine (polyuria) are excreted due to vasopressin (AVP) deficiency [central diabetes insipidus (CDI)] or to AVP resistance (nephrogenic diabetes insipidus). In the majority of patients, the occurrence of CDI is related to the destruction or degeneration of neurons of the hypothalamic supraoptic and paraventricular nuclei. The most common and well recognized causes include local inflammatory or autoimmune diseases, vascular disorders, Langerhans cell histiocytosis (LCH), sarcoidosis, tumors such as germinoma/craniopharyngioma or metastases, traumatic brain injuries, intracranial surgery, and midline cerebral and cranial malformations. Here we have the opportunity to describe an unusual case of female patient who developed autoimmune CDI following ureaplasma urealyticum infection and to review the literature on this uncommon feature. Moreover, we also discussed the potential mechanisms by which ureaplasma urealyticum might favor the development of autoimmune CDI.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Artrite Reativa/imunologia , Doenças Autoimunes/microbiologia , Diabetes Insípido Neurogênico/microbiologia , Ureaplasma urealyticum , Infecções por Ureaplasma/imunologia , Autoanticorpos , Artrite Reativa/microbiologia , Doenças Autoimunes/etiologia , Diabetes Insípido Neurogênico/etiologia , Diabetes Insípido Neurogênico/imunologia , Neurofisinas/imunologia , Precursores de Proteínas/imunologia , Infecções por Ureaplasma/complicações , Vasopressinas/imunologia
5.
Acta cir. bras ; 30(10): 691-703, tab
Artigo em Inglês | LILACS | ID: lil-764391

RESUMO

PURPOSE: To evaluate and compare clinical and inflammatory responses to the surgical trauma caused by cholecystectomy via several access approaches: single-port umbilical incision (SILS), transvaginal natural orifice transluminal endoscopic surgery (NOTES), laparoscopy, and Laparotomy.METHODS: Twenty-eight female pigs were equally divided into four groups and submitted to cholecystectomy by single-port umbilical incision, transvaginal NOTES, laparoscopy, or Laparotomy. An additional five animals served as controls (sham group). Animals were monitored perioperatively regarding anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, C-reactive protein (CRP), and AQUI feron-gamma (IFN-γ) measurements were performed before surgery and immediately, two days, and seven days after surgery. Animals were sacrificed and necropsied at seven days after surgery.RESULTS: All procedures were successfully performed as proposed in each group. Only minor complications, such as gallbladder perforation and bleeding from the liver bed, were observed during surgery in all groups. The vaginal NOTES group showed higher anesthesia and surgical procedure times compared to the other groups (p<0.001). No other between-group differences in perioperative or postoperative times, clinical evolution, or serum inflammatory markers were observed. Only adhesions were found on necropsy, with no differences between groups.CONCLUSION: The single-port umbilical and transvaginal NOTES access approaches were feasible and safe compared to laparoscopic and laparotomy for cholecystectomy.


Assuntos
Animais , Feminino , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Proteína C-Reativa/análise , Calcitonina/sangue , Complicações Intraoperatórias , Interferon gama/sangue , Duração da Cirurgia , Complicações Pós-Operatórias , Precursores de Proteínas/sangue , Reprodutibilidade dos Testes , Suínos , Síndrome de Resposta Inflamatória Sistêmica/patologia , Aderências Teciduais/patologia , Umbigo/cirurgia , Vagina/cirurgia
6.
Clinics ; 70(9): 612-617, Sept. 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-759291

RESUMO

OBJECTIVE:Procalcitonin is a reliable biomarker of infection and sepsis. We aimed to determine whether tracheotomy influences the procalcitonin concentrations in patients without sepsis and assess whether operative duration and procedure affect the peak procalcitonin level.METHODS:A total of 38 non-septic patients who required a tracheotomy underwent either a percutaneous dilatational tracheotomy (n=19) or a surgical tracheotomy (n=19). Procalcitonin levels were measured at the beginning of the tracheotomy and at 2 h, 4 h, 8 h, 24 h, 48 h and 72 h after the procedure.RESULTS:The baseline procalcitonin concentration before the tracheotomy was 0.24±0.13 ng/mL. The postoperative levels increased rapidly, with a 4-fold elevation after 2 h, reaching a peak 4 h later with a 5-fold increase over baseline. Thereafter, the levels gradually returned to 2-fold greater than the baseline level within 72 h. The peak levels of procalcitonin showed a significant positive correlation with operative durations (r=0.710, p<0.001) and procedures (rho=0.670, p<0.001).CONCLUSION:In patients without sepsis, tracheotomy induces a rapid release of serum procalcitonin, and the operative duration and procedure have significant impacts on the peak procalcitonin levels. Thus, the nonspecific increase in procalcitonin levels following tracheotomy needs to be considered when this measure is used to evaluate infection.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Calcitonina/sangue , Precursores de Proteínas/sangue , Sepse/sangue , Traqueotomia , Biomarcadores/sangue , Técnicas Eletroquímicas , Medições Luminescentes , Duração da Cirurgia , Estudos Prospectivos , Fatores de Tempo
7.
Int. arch. otorhinolaryngol. (Impr.) ; 19(1): 93-95, Jan-Mar/2015. graf
Artigo em Inglês | LILACS | ID: lil-741535

RESUMO

Introduction Schwannoma of the olfactory groove is an extremely rare tumor that can share a differential diagnosis with meningioma or neuroblastoma. Objectives The authors present a case of giant schwannoma involving the anterior cranial fossa and ethmoid sinuses. Case Report The patient presented with a 30-month history of left nasal obstruction, anosmia, and sporadic ipsilateral bleeding. Computed tomography of the paranasal sinuses revealed expansive lesion on the left nasal cavity extending to nasopharynx up to ethmoid and sphenoid sinuses bilaterally with intraorbital and parasellar extension to the skull base. Magnetic resonance imaging scan confirmed the expansive tumor without dural penetration. Biopsy revealed no evidence of malignancy and probable neural cell. Bifrontal craniotomy was performed combined with lateral rhinotomy (Weber-Ferguson approach), and the lesion was totally removed. The tumor measured 8.0 4.3 3.7 cm and microscopically appeared as a schwannoma composed of interwoven bundles of elongated cells (Antoni A regions)mixed with less cellular regions (Antoni B). Immunohistochemical study stained intensively for vimentin and S-100. Conclusion Schwannomas of the olfactory groove are extremely rare, and the findings of origin of this tumor is still uncertain but recent studies point most probably to the meningeal branches of trigeminal nerve or anterior ethmoidal nerves. .


Assuntos
Animais , Feminino , Masculino , Camundongos , Permeabilidade da Membrana Celular/fisiologia , Células Ciliadas Auditivas/fisiologia , Canais Iônicos/fisiologia , Mecanotransdução Celular/fisiologia , Animais Recém-Nascidos , Caderinas/genética , Permeabilidade da Membrana Celular/genética , Quelantes/farmacologia , Sulfato de Di-Hidroestreptomicina/farmacologia , Embrião de Mamíferos , Ácido Egtázico/análogos & derivados , Ácido Egtázico/farmacologia , Células Ciliadas Auditivas/citologia , Células Ciliadas Auditivas/efeitos dos fármacos , Técnicas In Vitro , Canais Iônicos/efeitos dos fármacos , Camundongos Transgênicos , Mecanotransdução Celular/efeitos dos fármacos , Mecanotransdução Celular/genética , Potenciais da Membrana/efeitos dos fármacos , Potenciais da Membrana/genética , Miosinas/genética , Órgão Espiral/citologia , Precursores de Proteínas/genética
8.
J. bras. nefrol ; 36(4): 496-501, Oct-Dec/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-731149

RESUMO

Introduction: Polyphenols contained in natural sources such as grapes, have been considered pharmacological agents to combat oxidative stress and inflammation, common features in Chronic Kidney Disease patients. Objective: To evaluate the effects of grape powder supplementation on inflammatory and antioxidant biomarkers in hemodialysis (HD) patients. Methods: The double-blind placebo-controlled randomized clinical trial evaluated non-diabetic HD patients that received grape powder (500 mg of polyphenols/day) (n = 16, 9 men, 53.0 ± 9.8 years of age, 111.6 ± 58.2 HD months) or placebo (n = 16, 9 men, 52.7 ± 13.7 years of age, 110.4 ± 93.1 HD months) for five weeks. The glutathione peroxidase (GSH-Px) activity and C-reactive protein (CRP) levels were evaluated by ELISA method. Results: After the intervention period, the patients receiving grape powder showed an increase in the GSH-Px activity (16.5 (41.0) to 42.0 (43.3) nmol/min/ml) (p < 0.05) and they did not have the CRP levels increased as seen in placebo group (2.6 (0.28) to 2.8 (0.23 mg/L) (p < 0.05). Conclusion: The use of grape powder as phenolic source could play an important role as an antioxidant and anti-inflammatory agent in non-diabetic HD patients. .


Introdução: Polifenóis contidos em fontes naturais, como as uvas, têm sido considerados agentes farmacológicos no combate ao estresse oxidativo e inflamação, condições comuns na Doença Renal Crônica. Objetivo: Avaliar os efeitos da suplementação de farinha de uva sobre marcadores inflamatórios e antioxidantes em pacientes submetidos à hemodiálise (HD). Métodos: Estudo randomizado, duplo-cego, placebocontrolado, no qual foram avaliados pacientes não diabéticos em HD que receberam farinha de uva (500 mg de polifenóis/dia) (n = 16, 9 homens, 53,0 ± 9,8 anos, 111,6 ± 58,2 meses em HD) ou placebo (n = 16, 9 homens, 52,7 ± 13,7 anos, 110,4 ± 93,1 meses em HD) por cinco semanas. A atividade da glutationa peroxidase (GSH-Px) e os níveis plasmáticos de proteína C-reativa (PCR) foram mensurados por meio do método ELISA. Resultados: Após o período de intervenção, os pacientes que receberam farinha de uva apresentaram elevação na atividade da GSH-Px (16,5 (41,0) para 42,0 (43,3) nmol/min/ml) (p < 0,05) e não foi observada elevação nos níveis de PCR, como visto no grupo placebo (2,6 (0,28) para 2,8 (0,23) mg/L) (p < 0,05). Conclusão: O uso da farinha de uva como fonte de polifenóis pode desempenhar um importante papel anti-inflamatório e antioxidante em pacientes não diabéticos submetidos à HD. .


Assuntos
Humanos , Proteínas de Ligação a DNA , Regulação da Expressão Gênica , Mutação , Proteínas Nucleares , Transativadores/metabolismo , Fatores de Transcrição/metabolismo , Sítios de Ligação , Carcinoma Hepatocelular , DNA Viral/metabolismo , Fator 1 Nuclear de Hepatócito , Fator 1-alfa Nuclear de Hepatócito , Fator 1-beta Nuclear de Hepatócito , Vírus da Hepatite B/genética , Vírus da Hepatite B/metabolismo , Testes de Precipitina , Plasmídeos/genética , Precursores de Proteínas/genética , Precursores de Proteínas/metabolismo , Transfecção , Células Tumorais Cultivadas , Transativadores/genética , Fatores de Transcrição/genética , Proteínas do Core Viral/genética , Proteínas do Core Viral/metabolismo
9.
Salud pública Méx ; 56(6): 660-665, nov.-dic. 2014.
Artigo em Espanhol | LILACS | ID: lil-733346

RESUMO

Este artículo fue concebido para analizar la función de la Escuela de Salud Pública de México (ESPM) desde el año 2000 hasta el presente. Uno de sus puntos centrales es el análisis del proceso de reorientación de la labor educativa de la escuela con la finalidad de responder a los retos en materia de salud y educación surgidos a finales del siglo XX. Para exponer cómo ha evolucionado dicho proceso, retomamos tres ejes rectores que caracterizan la labor de la escuela en la actualidad: el cambio de modelo pedagógico, la incorporación de las tecnologías de la información y las comunicaciones, y la profesionalización de la docencia. Con la exposición de este tema, y a través del contraste entre el pasado y el presente, buscamos completar la historia de trabajo ininterrumpido de la Escuela durante sus 92 años de existencia, que ha trascendido los confines del país.


This article was conceived to analyze the work of the School of Public Health of Mexico (ESPM for is acronym in Spanish) from the year 2000 to the present day. One of the highlights that we will examine is the reorientation of the educational work of the school in order to meet the challenges in health and education that emerged during the end of the twentieth century. In order to explain the evolution of this process, we will describe the three main guiding principles that characterize the present work of the school: the pedagogical model's change, the incorporation of the information and communication technologies, and the professionalization in teaching. The purpose of this work is to define those guiding principles, and to expose, through the contrast between past and present, the complete history of uninterrupted work of the School of Public Health of Mexico during its ninety-two years of existence, that has gone beyond the boundaries of the country.


Assuntos
Animais , Feminino , Humanos , Camundongos , Cisteína Endopeptidases/metabolismo , Mengovirus/enzimologia , Proteínas Virais , Sequência de Aminoácidos , Anticorpos Monoclonais/metabolismo , Anticorpos Antivirais/metabolismo , Capsídeo/metabolismo , Cloretos/farmacologia , Cisteína Endopeptidases/genética , Inibidores Enzimáticos/farmacologia , Etilmaleimida/farmacologia , Células HeLa , Iodoacetamida/farmacologia , Leucina/análogos & derivados , Leucina/farmacologia , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Peptídeos/síntese química , Peptídeos/metabolismo , Precursores de Proteínas/metabolismo , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Especificidade por Substrato , Compostos de Zinco/farmacologia
10.
Braz. j. microbiol ; 45(4): 1415-1421, Oct.-Dec. 2014. graf, tab
Artigo em Inglês | LILACS | ID: lil-741295

RESUMO

Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman's rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study.


Assuntos
Humanos , Bacteriemia/diagnóstico , Biomarcadores/análise , Biomarcadores/sangue , Proteína C-Reativa/análise , Calcitonina/sangue , Precursores de Proteínas/sangue , Bacteriemia/patologia , Diagnóstico Diferencial , Curva ROC
11.
Salud pública Méx ; 56(4): 348-354, jul.-ago. 2014. ilus, tab
Artigo em Inglês | LILACS | ID: lil-733313

RESUMO

Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.


Objetivo. Evaluar la eficiencia técnica y la presencia de potenciales economías de escala y alcance en unidades médicas privadas (UMP) mexicanas, de forma que sea posible establecer planes para la mejora de su gestión. Material y métodos. Se utilizó el método de Análisis Envolvente de Datos con información de insumos y productos para 2 105 UMP del año 2010 publicada por el Instituto Nacional de Estadística y Geografía a través del cuestionario denominado "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)". Resultados. La aplicación de los modelos encuentra una presencia marginal de economías de escala y alcance en las UMP mexicanas. Conclusiones. La operación de las UMP en México debe enfocarse a prestar servicios bajo un modelo diversificado para alcanzar mejores niveles de eficiencia técnica.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fator Natriurético Atrial/sangue , Proteínas do Tecido Nervoso/sangue , Disfunção Ventricular Esquerda/diagnóstico , Biomarcadores/sangue , Cateterismo Cardíaco , Estudos Transversais , Valor Preditivo dos Testes , Fragmentos de Peptídeos/sangue , Precursores de Proteínas/sangue
12.
Rev. chil. pediatr ; 85(2): 157-163, abr. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-711575

RESUMO

Introducción: No hay ningún marcador hematológico que diferencie con seguridad entre gastroenteritis aguda (GEA) bacteriana y no bacteriana. Nuestro objetivo fue evaluar la procalcitonina (PCT) como marcador de GEA de origen bacteriano y analizar su correlación con el ingreso hospitalario. Pacientes y Método: Estudio prospectivo de niños diagnosticados de GEA en el departamento de Urgencias durante un período de 7 meses que requirieron de analítica sanguínea y muestras de heces. Se analizaron variables epidemiológicas, clínicas y analíticas. Se excluyeron pacientes con enfermedad digestiva crónica, diarrea prolongada, inmunodeficiencia o tratamiento antibiótico previo. El estudio fue aprobado por el Comité de Ética y se solicitó consentimiento informado. Resultados: Se analizaron 45 pacientes. Los niños con GEA bacteriana tenían mayor edad (p = 0,027), mayor mediana de PCT y proteína C reactiva (PCR) (p = 0,001). Los valores de PCT y PCR que mejor discriminaron la etiología bacteriana fueron PCT > 0,5 mg/L (sensibilidad: 64,3 por ciento, especificidad: 83,9 por ciento, cociente de probabilidad positivo (CPP): 4) y PCR > 3 mg/dL (sensibilidad: 78,6 por ciento, especificidad: 90,3 por ciento, CPP: 8). No se encontró asociación entre la elevación de dichos marcadores y una mayor probabilidad de hospitalización. Conclusión: La procalcitonina, al igual que la PCR, se eleva en gastroenteritis bacterianas (p = 0,001), no siendo estos marcadores predictores de hospitalización.


Introduction: There is no hematological marker that reliably differentiates between bacterial and nonbacterial acute gastroenteritis (AGE). The objective of this study is to evaluate procalcitonin (PCT) as a marker for bacterial AGE and analyze its relationship with hospital admission. Patients and Method: A prospective study of children diagnosed with AGE was conducted at the emergency room during a period of seven months, which required blood and stool samples. Epidemiological, clinical and analytical variables were analyzed. Patients with chronic digestive disease, prolonged diarrhea, immunodeficiency or prior antibiotic treatment were excluded. The study was approved by the Ethics Committee and an informed consent was requested. Results: 45 patients were analyzed. Children with bacterial GEA were older (p = 0.027) and presented higher median PCT and C-reactive protein concentrations (CRP) (p = 0.001). The PCT and CRP values that best discriminated bacterial infection were PCT > 0.05 mg/L (sensibility 64.3 percent specificity 83.9 percent, positive probability coefficient (PPC): 4), and CRP > 3mg/dL (sensibility 78.6 percent, specificity 90.3 percent, PPC: 8). No association between the elevation of these markers and higher hospitalization probability was found. Conclusion: Procalcitonin, like CRP, is elevated in bacterial gastroenteritis (p = 0.001), but these markers are not a predictor of hospitalization.


Assuntos
Humanos , Calcitonina , Gastroenterite/diagnóstico , Gastroenterite/microbiologia , Infecções Bacterianas/complicações , Precursores de Proteínas , Doença Aguda , Diagnóstico Diferencial , Biomarcadores , Estudos Prospectivos , Proteína C-Reativa , Curva ROC , Sensibilidade e Especificidade , Viroses/complicações
13.
Medicina (B.Aires) ; 73(5): 411-416, oct. 2013. graf, tab
Artigo em Inglês | LILACS | ID: lil-708526

RESUMO

Procalcitonin (PCT) has emerged as a marker of infection, a frequent complication in hemodialysis (HD). We analyzed PCT levels in chronic non-acutely infected HD subjects, assessed its correlation with inflammatory and nutritional markers and propose a PCT reference value for non-infected HD patients.In an observational cross-sectional study, 48 chronic HD patients and 36 controls were analyzed. Variables: age, gender, time on HD; diabetes; vascular access, PCT, C-reactive protein (CRP), albumin, malnutrition inflammatory score (MIS), hematocrit, leukocyte count, and body mass index (BMI). Subsequently, control (G1, n = 36, 43%) vs. non-infected patients (G2, n = 48, 57%) groups were compared. In control subjects (G1), age: 54.3 ± 13.7 years, range (r): 30-81; males: 19 (53%); median PCT 0.034 ng/ml (r: 0.02-0.08); median CRP 0.80 mg/dl (r: 0.36-3.9); p95 PCT level: 0.063 ng/ml. In G2, age: 60.2 ± 15.2 years; males 32 (67%), time on HD: 27.0 ± 24.4; diabetics: 19 (32%); median PCT: 0.26 ng/ml (r: 0.09-0.82); CRP: 1.1 mg/dl (r: 0.5-6.2); p95 PCT level: 0.8 ng/ml. In control subjects, PCT and CRP were significantly lower than in G2: PCT: 0.034 vs. 0.26 ng/ml, p = 0.0001; CRP: 0.8 vs. 1.1 mg/dl, p = 0.0004. PCT-CRP correlation in G2: ρ = 0.287, p = 0.048. PCT and CRP concentrations are elevated in chronic non-acutely infected HD subjects, independently of infection, diabetes and vascular access. A p95 PCT level of 0.8 ng/ml may be considered as the upper normal reference value in non-acutely infected HD subjects. The PCT cut-off level in HD is yet to be determined in HD.


La procalcitonina (PCT) puede ser un marcador de infección en la hemodiálisis (HD). Analizamos los niveles de PCT en sujetos sin infección aguda en HD crónica, su correlación con marcadores inflamatorios y nutricionales y, de acuerdo a ello, proponemos niveles de referencia de PCT. En un estudio observacional transversal se estudiaron 48 pacientes en HD y 36 controles. Variables: edad; sexo, tiempo en HD; diabetes; acceso vascular, PCT, proteína C-reactiva (PCR), albúmina, score de malnutrición-inflamación, hematocrito, recuento leucocitario, e índice de masa muscular (IMC). En los controles se determinaron PCT y PCR. Se comparó grupo control (G1, n = 36, 43%) vs. pacientes (G2, n = 48, 57%). G1: edad, 54.3 ± 13.7, rango (r): 30-81 años; hombres: 19 (53%); PCT mediana: 0.034 ng/ml (r: 0.020-0.080); PCR mediana: 0.8 mg/dl (r: 0.36-3.9); el nivel p95 de PCT: 0.063 ng/ml. En el G2, edad media 60.2 ± 15.2 años, hombres: 32 (66%), tiempo en HD: 27.0 2 4.4; diabéticos: 19 (32%); PCT: 0.26 ng/ml (r: 0.09-0.82); PCR: 1.1 mg/dl (r: 0.5-6.2); p95 PCT: 0.8 ng/ml. En G1 los niveles de PCT y PCR fueron significativamente más bajos que en G2: PCT: 0.034 vs. 0.26 ng/ml, p = 0.0001; PCR: 0.8 vs 1.1 mg/dl, p = 0.0004. Correlación PCT- PCR en G2: ρ = 0.287, p = 0.048. La PCT y la PCR están elevadas en HD crónica independientemente de infección, diabetes y acceso vascular. Se propone p95 de PCT de 0.8 ng/ml como límite superior del intervalo de referencia en sujetos sin infección aguda en HD. El valor de PCT en HD está por determinarse.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Calcitonina/sangue , Precursores de Proteínas/sangue , Diálise Renal/efeitos adversos , Vasculite/sangue , Fatores Etários , Infecções Bacterianas/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Estudos Transversais , Falência Renal Crônica/terapia , Estado Nutricional , Valor Preditivo dos Testes , Valores de Referência , Fatores Sexuais , Fatores de Tempo , Vasculite/etiologia
14.
An. bras. dermatol ; 88(4): 604-607, ago. 2013.
Artigo em Inglês | LILACS | ID: lil-686506

RESUMO

Inflammatory linear verrucous epidermal nevus is a variant of verrucous epidermal nevus, characterized by recurrent inflammatory phenomena. Despite well-established clinical manifestations, the differential diagnosis between inflammatory linear verrucous epidermal nevus and linear psoriasis remains difficult. Clinical history, physical examination and histopathology analysis may not be sufficient to confirm the diagnosis. We report the case of a 4-year-old girl in which the involucrin immunostaining was helpful in the diagnosis of inflammatory linear verrucous epidermal nevus. Our findings confirm that involucrin immunohistochemistry is a useful tool in such cases.


O nevo epidérmico verrucoso inflamatório linear é uma variante do nevo epidérmico verrucoso caracterizada por fenômenos inflamatórios recorrentes. A despeito das manifestações clínicas bem estabelecidas o diagnóstico diferencial entre nevo epidérmico verrucoso inflamatório linear e psoríase linear permanece difícil. A história clínica, o exame físico e análise histopatológica podem não ser suficientes para a confirmação diagnóstica. Nós relatamos o caso de uma menina de 4 anos de idade no qual o uso da involucrina foi útil para o diagnóstico do nevo epidérmico verrucoso inflamatório linear . Nossos achados corroboram a imunohistoquímica com a involucrina como uma ferramenta importante nestes casos.


Assuntos
Pré-Escolar , Feminino , Humanos , Nevo Sebáceo de Jadassohn/diagnóstico , Precursores de Proteínas/análise , Psoríase/diagnóstico , Biomarcadores/análise , Diagnóstico Diferencial
15.
Rev. Col. Bras. Cir ; 39(6): 456-461, nov.-dez. 2012. tab
Artigo em Português | LILACS | ID: lil-662772

RESUMO

OBJETIVO: Avaliar a tendência da concentração plasmática e do clearance de procalcitonina (PCT-c) como biomarcadores de prognóstico de pacientes com sepse grave e choque séptico, comparado a um outro marcador precoce de prognóstico representado pelo número de critérios de SIRS no momento do diagnóstico da sepse. MÉTODOS: Estudo de coorte prospectivo observacional onde foram incluídos pacientes com sepse grave e choque séptico. A concentração sérica de procalcitonina foi determinada no momento do diagnóstico da sepse e após 24 e 48 horas. Foram coletados dados demográficos, escore APACHE IV, escore SOFA na chegada, número de critérios de SIRS no momento do diagnóstico, sitio da infecção e resultados microbiológicos. RESULTADOS: Vinte e oito pacientes foram incluídos, 19 clínicos e nove cirúrgicos. Em 13 (46,4%) a fonte da sepse foi pulmonar, em sete abdominal (25,0%), em cinco urinária (17,9%) e de partes moles em três casos (10,7%). Quinze pacientes tinham sepse grave e 13 choque séptico. A mortalidade global foi cinco pacientes (17,9%), três deles com choque séptico. Vinte e oito determinações de PCT foram realizadas no momento do diagnóstico da sepse, 27 após 24 horas e 26 após 48 horas. A concentração inicial não se mostrou expressivamente diferente entre os grupos sobreviventes e não sobreviventes, mas as diferenças entre os dois grupos após 24 e 48 horas alcançaram significância estatística expressiva. Não se observou diferença em relação ao número de critérios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028). Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos não sobreviventes, a diferença não alcançou significância estatística. CONCLUSÃO: Concentrações persistentemente elevadas de procalcitonina no plasma, assim como, redução do PCT-c 24 horas, associaram-se à elevação expressiva da mortalidade de pacientes com sepse grave e choque séptico.


OBJECTIVE: To evaluate the tendency of the plasma concentration and clearance of procalcitonin (PCT-c) as biomarkers of prognosis of patients with severe sepsis and septic shock, compared to another early prognosis marker, the number of SIRS criteria at sepsis diagnosis. METHODS: We conducted a prospective, observational, cohort study, with patients with severe sepsis and septic shock. The serum procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. Demographic data, APACHE IV, SOFA score on arrival, number of SIRS criteria at diagnosis, site of infection and microbiological results were recorded. RESULTS: Twenty-eight patients were included, 19 clinical and nine surgical. In 13 (46.4%) the source of sepsis was pulmonary, abdominal in seven (25.0%), urinary in five (17.9%) and soft tissue in three cases (10.7%). Fifteen patients had severe sepsis and 13 septic shock. Overall mortality was 17.9% (five patients), three with septic shock. Twenty-eight PCT determinations were performed at sepsis diagnosis, 27 after 24 hours and 26 after 48 hours. The initial concentration was not significantly different between survivors and non-survivors groups, but the differences between the two groups after 24 and 48 hours were statistically significant. There was no difference in the number of SIRS criteria. The 24-hour procalcitonin clearance proved to be significantly higher in the group of survivors (-3.0 versus -300.0, p = 0.028). Although the 48-hour procalcitonin clearance has shown to be higher in the group of survivors when compared to non-survivors, the difference did not reach statistical significance. CONCLUSION: Persistently high procalcitonin concentrations in plasma, as well as reduced 24-hours PCT clearence, were associated with a significant increase in mortality in patients with severe sepsis and septic shock.


Assuntos
Feminino , Humanos , Masculino , Calcitonina/sangue , Precursores de Proteínas/sangue , Sepse/sangue , Choque Séptico/sangue , Biomarcadores/sangue , Estudos de Coortes , Estudos Prospectivos
16.
Rev. chil. infectol ; 29(5): 511-516, oct. 2012. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-660023

RESUMO

Procalcitonin (PCT), a prohormone of calcitonin has been described as a specific biomarker of sepsis. Objectives: To compare the predictive value of PCT, C reactive protein (CRP) and white blood cell count (WBC) for the diagnosis of late onset sepsis (LOS) in very low birth weight (VLBW) neonates. Methods: We prospectively determined the serum concentration of PCT, CRP and WBC in 53 VLBW newborns with clinical suspicion of LOS. 25 had confirmed sepsis with positive blood culture; 28 had clinical sepsis (negative blood cultures) Results: PCT levels were significantly higher in the infected group (3.0 ng/ml) compared to the non infected group (0.4 ng/ml) (p < 0.05). PCT had the highest area under the ROC curve 0.83 (95% CI 0.70-0.92) p = 0.001 compared to CRP 0.51 (95%CI 0.37-0.65) and WBC 0.53 (95%CI 0.38-0.66) for the diagnosis of LOS .The best PCT cut off value was 0.9 ng/ml. The sensitivity, specificity and negative predictive value were 88%, 72% and 87%, respectively. Conclusions: The determination of PCT could be more useful than CRP and WBC in the diagnosis of LOS in VLBW newborns.


La procalcitonina (PCT) ha sido descrita como un marcador especifico de infecciones bacterianas. Objetivos: Comparar el valor predictor de la PCT, Proteína C reactiva (PCR) y recuento de leucocitos (RL) en el diagnostico de sepsis tardía en recién nacidos de muy bajo peso (RNMBP). Métodos: Estudio prospectivo. Niveles de PCT, PCR y RL fueron determinados en 53 RNMBP con sospecha clínica de sepsis. 25 presentaron sepsis confirmada por hemocultivo, 28 sepsis clínica (hemocultivo negativo). Resultados: Los niveles de PCT fueron significativamente mas elevados (p < 0,05) en los RNMBP con sepsis confirmada (3,0 ng/ml) comparados a aquellos con sepsis clínica (0,4 ng/ml) La PCT presentó el área mas alta bajo la curva ROC 0,83 (95%IC 0,7-0,92) (p = 0,0001) comparada a la PCR 0,51 (95%IC 0,37-0,65) y el RL 0,53 (95%IC 0,38-0,66) para el diagnóstico de sepsis. Un valor de corte de PCT de 0,9 ng/ml presentó una sensibilidad y especificidad de 88 y 72% respectivamente para el diagnóstico de sepsis, con un valor predictor negativo de 87%. Conclusiones: La medición de la PCT podria ser un biomarcador de mayor utilidad que la PCR y el RL en el diagnóstico de la sepsis tardía en RNMBP.


Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Proteína C-Reativa/análise , Calcitonina/sangue , Recém-Nascido de muito Baixo Peso/sangue , Contagem de Leucócitos , Precursores de Proteínas/sangue , Sepse/diagnóstico , Biomarcadores/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Sepse/sangue
17.
Clinics ; 67(4): 327-334, 2012. ilus, tab
Artigo em Inglês | LILACS | ID: lil-623111

RESUMO

OBJECTIVES: During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection. METHODS: The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs. RESULTS: Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients. CONCLUSION: Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.


Assuntos
Adolescente , Adulto , Feminino , Humanos , Adulto Jovem , Proteína C-Reativa/análise , Calcitonina/sangue , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Interleucina-1beta/sangue , Precursores de Proteínas/sangue , Síndrome do Desconforto Respiratório do Adulto/etiologia , Biomarcadores/sangue , Estado Terminal , Diagnóstico Diferencial , Influenza Humana/complicações , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Viroses/diagnóstico
18.
Int. j. morphol ; 29(3): 747-753, Sept. 2011. ilus
Artigo em Inglês | LILACS | ID: lil-608653

RESUMO

Duodenum, spleen and liver have a crucial role in iron balance on the whole organism and are the major sites of Ferroportin (FPN) expression. Specific regulations between FPN and hepcidin are responsible for changes seen in physiopathological conditions such as inflammation. We studied in vivo effects of turpentine oil-induced acute inflammation on FPN expression, and its relation with prohepcidin and iron mobilization. Immunohistochemical procedures were performed using rabbit anti-mouse FPN and prohepcidin antibodies with goat-labeled polymer-HRP anti-rabbit (DAB) as secondary antibody. Plasma and tissular iron were also studied. Our results showed a notable expression and redistribution of duodenal FPN to basolateral membrane in turpentine-treated mice, compared with supranuclear and the weak basolateral expression observed in healthy mice. Red pulp macrophages of healthy mice showed FPN-hemosiderin co-localization, compared with turpentine-treated mice which showed lack of FPN. In liver of healthy mice, FPN was seen in Kupffer cells, whereas in turpentine-treated mice decreased. In addition, we observed an increment of hepatic pro-hepcidin with a significant hypoferremia. Our findings demonstrated that acute inflammation induced a differential distribution of FPN, showing a cell type specific response. In macrophages, increased hepatic prohepcidin induced degradation of FPN, resulting in hypoferremia. In enterocytes, the redistribution observed of duodenal FPN reflects a different regulation in this tissue. The observed response of the proteins studied may be part of a cyclical pattern of systemic effects of acute inflammation on mouse tissue.


El duodeno, bazo e hígado desempeñan un rol clave en el balance de Fe del organismo y son los mayores sitios de expresión de ferroportina (FPN). Regulaciones específicas entre FPN y hepcidina son las responsables de los cambios observados en condiciones fisiopatológicas como la inflamación. Nuestro objetivo fue estudiar los efectos in vivo de la inflamación aguda inducida con turpentina sobre la expresión de FPN y su relación con prohepcidina y la movilización de hierro. Los procedimientos inmunohistoquímicos fueron desarrollados utilizando anticuerpos anti FPN y prohepcidina de ratón, desarrollados en conejo y un polímero conjugado con anticuerpos secundarios anti conejo desarrollado en cabra (HRP-DAB). Se evaluaron los niveles de Fe plasmático y tisular. Nuestros resultados mostraron una clara expresión y redistribución de FPN duodenal hacia la membrana basolateral en ratones tratados con turpentina, con respecto a la expresión perinuclear y leve expresión basolateral observada en ratón sano. Macrófagos de la pulpa roja esplénica mostraron co-localización de FPN y hemosiderina, comparado con la ausencia de expresión en ratón tratado con turpentina. En hígado de ratón sano, se observó expresión de FPN en células de Kupffer, mientras que en ratón tratado con turpentina la expresión fue menos evidente. Además, observamos un aumento en la expresión de prohepcidina hepática con una hipoferremia significativa. Nuestros resultados demostraron que la inflamación aguda indujo una distribución diferencial de FPN, mostrando una respuesta específica del tipo celular. En macrófagos, el aumento de prohepcidina hepática indujo degradación de FPN, resultando en hipoferremia. En enterocitos, la redistribución observada de FPN duodenal, refleja una regulación diferente en este tejido. La respuesta observada de las proteínas estudiadas podría ser parte de un patrón cíclico de efectos sistémicos de la inflamación aguda en tejidos murinos.


Assuntos
Ratos , Baço , Baço/metabolismo , Duodeno , Duodeno/metabolismo , Inflamação/induzido quimicamente , Imuno-Histoquímica/métodos , Precursores de Proteínas/análise , Precursores de Proteínas/metabolismo
19.
J. bras. pneumol ; 37(4): 495-503, jul.-ago. 2011. tab
Artigo em Português | LILACS | ID: lil-597202

RESUMO

OBJETIVO: Níveis de procalcitonina, midregional pro-atrial natriuretic peptide (MR-proANP, pró-peptídeo natriurético atrial midregional),, C-terminal provasopressin (copeptina), proteína C reativa (CRP) e escore do Sequential Organ Failure Assessment (SOFA) são associados a gravidade e descritos como preditores de desfechos na pneumonia associada a ventilação mecânica (PAVM). Este estudo procurou comparar o valor preditivo de mortalidade desses biomarcadores na PAVM. MÉTODOS: Estudo observacional com 71 pacientes com PAVM. Níveis de procalcitonina, MR-proANP, copeptina e PCR, bem como escore de SOFA foram obtidos no dia do diagnóstico de PAVM, designado dia zero (D0), e no quarto dia de tratamento (D4) Os pacientes receberam tratamento antimicrobiano empírico, com modificações baseadas nos resultados de cultura. Os pacientes que morreram antes de D28 foram classificados como não sobreviventes. RESULTADOS: Dos 71 pacientes, 45 sobreviveram. Dos 45 sobreviventes, 35 (77,8 por cento) receberam tratamento antimicrobiano adequado, comparados com 18 (69,2 por cento) dos 26 não sobreviventes (p = 0,57). Os sobreviventes apresentaram valores significativamente mais baixos em todos os biomarcadores estudados, inclusive no escore de SOFA (exceto PCR) em D0 e D4. Em D0 e D4, a área sob a curva ROC foi maior para procalcitonina. Em D0, MR-proANP teve a maior razão de verossimilhança positiva (2,71) e valor preditivo positivo (0,60), mas a procalcitonina apresentou o maior valor preditivo negativo (0,87). Em D4, a procalcitonina apresentou a maior razão de verossimilhança positiva (3,46), o maior valor preditivo positivo (0,66) e o maior valor preditivo negativo (0,93). CONCLUSIONS: Os biomarcadores procalcitonina, MR-proANP e copeptina podem predizer mortalidade na PAVM, assim como o escore de SOFA. A procalcitonina tem o maior poder preditivo de mortalidade na PAVM.


OBJECTIVE: Levels of procalcitonin, midregional pro-atrial natriuretic peptide (MR-proANP), C-terminal provasopressin (copeptin), and C-reactive protein (CRP), as well as Sequential Organ Failure Assessment (SOFA) scores, are associated with severity and described as predictors of outcome in ventilator-associated pneumonia (VAP). This study sought to compare the predictive value of these biomarkers for mortality in VAP. METHODS: An observational study of 71 patients with VAP. Levels of procalcitonin, MR-proANP, copeptin, and CRP, together with SOFA scores, were determined at VAP onset, designated day 0 (D0), and on day 4 of treatment (D4). Patients received empirical antimicrobial therapy, with modifications based on culture results. Patients who died before D28 were classified as nonsurvivors. RESULTS: Of the 71 patients evaluated, 45 were classified as survivors. Of the 45 survivors, 35 (77.8 percent) received appropriate antimicrobial therapy, compared with 18 (69.2 percent) of the 26 nonsurvivors (p = 0.57). On D0 and D4, the levels of all biomarkers (except CRP), as well as SOFA scores, were lower in eventual survivors than in eventual nonsurvivors. For D0 and D4, the area under the ROC curve was largest for procalcitonin. On D0, MR-proANP had the highest positive likelihood ratio (2.71) and positive predictive value (0.60), but procalcitonin had the highest negative predictive value (0.87). On D4, procalcitonin had the highest positive likelihood ratio (3.46), the highest positive predictive value (0.66), and the highest negative predictive value (0.93). CONCLUSIONS: The biomarkers procalcitonin, MR-proANP, and copeptin can predict mortality in VAP, as can the SOFA score. Procalcitonin alone has the greatest predictive power for such mortality.


Assuntos
Feminino , Humanos , Masculino , Biomarcadores/sangue , Insuficiência de Múltiplos Órgãos/mortalidade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Área Sob a Curva , Fator Natriurético Atrial/sangue , Brasil/epidemiologia , Proteína C-Reativa/análise , Estudos de Coortes , Calcitonina/sangue , Glicopeptídeos/sangue , Insuficiência de Múltiplos Órgãos/sangue , Valor Preditivo dos Testes , Hormônios Peptídicos/sangue , Pneumonia Associada à Ventilação Mecânica/sangue , Precursores de Proteínas/sangue , Curva ROC , Índice de Gravidade de Doença
20.
Clinics ; 66(4): 657-662, 2011. graf, tab
Artigo em Inglês | LILACS | ID: lil-588919

RESUMO

OBJECTIVE: To determine the impact of periodontal treatment on serum levels of prohepcidin (the prohormone of hepcidin) and systemic inflammation markers, as well as correlations among these markers, in patients with chronic periodontitis and chronic kidney disease who were not undergoing dialysis. METHODS: We included 56 chronic periodontitis patients, 36 with chronic kidney disease and 20 without systemic diseases and with normal renal function (control group). Chronic kidney disease was defined as suggested by the clinical practice guidelines in the National Kidney Foundation. Chronic periodontitis was defined through clinical attachment level and by probing pocket depth, according to the American Association of Periodontology. The inflammatory markers ultrasensitive C-reactive protein, interleukin-6, and prohepcidin were evaluated before and 3 months after periodontal treatment. RESULTS: The efficacy of periodontal treatment was confirmed by the improvement in clinical parameters of chronic periodontitis in the control and chronic kidney disease groups. Periodontal treatment resulted in significant reductions in ultrasensitive C-reactive protein, interleukin-6 and serum prohepcidin levels in both groups. Moreover, in multivariate linear regression, the reduction in prohepcidin after periodontal treatment was significantly and independently associated with interleukin-6 levels in the control group. CONCLUSIONS: By inducing a decline in the systemic inflammatory response and a decrease in serum prohepcidin, successful periodontal treatment may represent an important means of ameliorating the inflammatory burden seen in patients with chronic kidney disease.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Catiônicos Antimicrobianos/sangue , Periodontite Crônica/terapia , Falência Renal Crônica/sangue , Precursores de Proteínas/sangue , Curetagem Subgengival/efeitos adversos , Biomarcadores/sangue , Proteína C-Reativa/análise , Periodontite Crônica/diagnóstico , Inflamação/sangue , /sangue , Resultado do Tratamento
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