Hypercitratemia is a mortality predictor among patients on continuous venovenous hemodiafiltration and regional citrate anticoagulation.

The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74-46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.

Acute Kidney Injury and Renal Replacement Therapy in Critically Ill COVID-19 Patients: Risk Factors and Outcomes: A Single-Center Experience in Brazil.

BACKGROUND: Critically ill patients with COVID-19 may develop multiple organ dysfunction syndrome, including acute kidney injury (AKI). We report the incidence, risk factors, associations, and outcomes of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients. METHODS: We performed a retrospective cohort study of adult patients with COVID-19 diagnosis admitted to the intensive care unit (ICU) between March 2020 and May 2020. Multivariable logistic regression analysis was applied to identify risk factors for the development of AKI and use of RRT. The primary outcome was 60-day mortality after ICU admission. RESULTS: 101 (50.2%) patients developed AKI (72% on the first day of invasive mechanical ventilation [IMV]), and thirty-four (17%) required RRT. Risk factors for AKI included higher baseline Cr (OR 2.50 [1.33-4.69], p = 0.005), diuretic use (OR 4.14 [1.27-13.49], p = 0.019), and IMV (OR 7.60 [1.37-42.05], p = 0.020). A higher C-reactive protein level was an additional risk factor for RRT (OR 2.12 [1.16-4.33], p = 0.023). Overall 60-day mortality was 14.4% {23.8% (n = 24) in the AKI group versus 5% (n = 5) in the non-AKI group (HR 2.79 [1.04-7.49], p = 0.040); and 35.3% (n = 12) in the RRT group versus 10.2% (n = 17) in the non-RRT group, respectively (HR 2.21 [1.01-4.85], p = 0.047)}. CONCLUSIONS: AKI was common among critically ill COVID-19 patients and occurred early in association with IMV. One in 6 AKI patients received RRT and 1 in 3 patients treated with RRT died in hospital. These findings provide important prognostic information for clinicians caring for these patients.

Intermittent hemodiafiltration as a down-step transition therapy in patients with acute kidney injury admitted to intensive care unit who initially underwent continuous venovenous hemodiafiltration.

BACKGROUND/AIMS: Continuous renal replacement therapies (CRRT) are initially employed in patients with acute kidney injury (AKI) in ICU setting. After the period of serious illness, hemodialysis is usually used as a mode of transition from CRRT. Intermittent hemodiafiltration (HDF) is not commonly applied in this scenario. OBJECTIVES: To evaluate the feasibility of using HDF as transition therapy after CVVHDF in critically patients with AKI. METHODS: An observational and prospective pilot study was conducted in ICU patients with dialysis-requiring AKI. Patients were initially treated with CVVHDF and, after medical improvement, those who still needed renal replacement therapy were switched to HDF treatment. RESULTS: Ten Patients underwent 53 HDF sessions (mean of 5.3 sessions/patient). The main cause of renal dysfunction was sepsis (N = 7; 70%). The APACHE II mean score was 27.6 ± 6.9. During HDF treatment, the urea reduction ratio was 64.5 ± 7.5%, for ß-2 microglobulin serum levels the percentage of decrease was 42.0 ± 7.8%, and for Cystatin C was 36.2 ± 6.9%. Five episodes of arterial hypotension occurred (9.4% of sessions). There were 20 episodes of electrolytic disturbance (37.7% of sessions), mainly hypophosphatemia. No pyrogenic or suggestive episode of bacteremia was observed. CONCLUSION: Hemodiafiltration was safe and efficient to treat critically ill patients with acute kidney injury during the transition phase from continuous to intermittent dialysis modality. Special attention should be paid regarding the occurrence of electrolytic disturbance, mainly hypophosphatemia.

New red blood cell and reticulocyte parameters and reference values for healthy individuals and in chronic kidney disease / Novos parâmetros e valores de referência eritrocitários e reticulocitários normais e na doença renal crônica

Introduction: The importance of local references values has been well described in the literature; this is because the characteristics of the population may influence the laboratory tests. Objective: To establish the reference range for traditional and extended red blood cell parameters and reticulocyte indices in order to investigate its application in patients with chronic kidney disease (CKD). Materials and methods: 249 blood donors (125 males and 124 females) were selected to establish the reference values. The hemodialysis sample consisted of 62 patients with terminal CKD (48 male and 14 female). All analyzes were performed using the Sysmex XE-5000 automated hematology analyzer. Results: Differences between reference values was observed in relation to gender: red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), percentage of hyperchromic red blood cells (%HYPER), percentage of microcytosis (%MICRO), percentage of macrocytosis (%MACRO), absolute reticulocyte count (RET), reticulocyte hemoglobin content (RET-He), immature reticulocyte fraction (IFR), low fluorescence reticulocytes (LFR), medium fluorescence reticulocytes (MFR), and high fluorescence reticulocytes (HFR). Individuals with CKD presented RBC, HGB, HCT, MCHC, red cell distribution width expressed as coefficient of variation (RDW-CV), percentage of hypochromic red blood cells (%HYPO), percentage of reticulocytes (RET%), RET (female group), IFR, LFR, MFR, and HFR results compatible with the anemic state, which can be observed in 91.8% of patients. All studied parameters were in the area under the curve (AUC) > 0.4. In male group, %HYPO (AUC: 0.806) and IFR (AUC: 0.762) presented higher AUC values, while female group presented %HYPO (AUC: 0.806), %HYPER (AUC: 0.815), and IFR (AUC: 0.660). Conclusion: The medical advancement, the development of new techniques and hematological parameters have revealed important information ...

Introdução: A importância dos valores de referências locais tem sido bastante descrita na literatura, isso porque características da população podem influenciar os testes laboratoriais. Objetivos: Estabelecer o intervalo de referência para parâmetros eritrocitários tradicionais e estendidos e índices reticulocitários a fim de investigar sua aplicação em pacientes com doença renal crônica (DRC). Materiais e métodos: Dos doadores de sangue, 249 pacientes foram selecionados para estabelecimento dos valores de referência (125 homens e 124 mulheres); dos pacientes em hemodiálise, a amostra foi composta por 62 indivíduos com DRC terminal (48 homens e 14 mulheres). Todas as análises foram realizadas no avaliador hematológico Sysmex XE-5000. Resultados: Foi observada uma distinção entre os valores de referência em relação ao gênero: células vermelhas do sangue (RBC), hemoglobina (HGB), hematócrito (HCT), concentração de hemoglobina corpuscular média (CHCM), porcentagem de eritrócitos hiper-hemoglobinizados (%HIPER), porcentagem de microcitose (%MICRO), porcentagem de macrocitose (%MACRO), contagem absoluta de reticulócitos (RET), contagem relativa de reticulócitos (RET-He), fração de reticulócitos imaturos (IFR), reticulócitos de baixa fluorescência (LFR), reticulócitos de média fluorescência (MFR) e reticulócitos de alta fluorescência (HFR). Os indivíduos com DRC apresentaram resultados de RBC, HGB, HCT, CHCM, coeficiente de variação do tamanho dos eritrócitos (RDW-CV), %HIPO, RET%, RET (grupo das mulheres), IFR, LFR, MFR e HFR compatíveis com o estado anêmico, que pode ser observado em 91,8%. Todos os parâmetros estudados apresentaram área sob a curva (AUC) > 0,4. Para o grupo dos homens, a %HIPO (AUC: 0,806) e a IFR (AUC: 0,762) apresentaram melhores valores de AUC; já para o grupo das mulheres foram a %HIPO (AUC: 0,806), a %HIPER (AUC: 0,815) e a IFR (AUC: 0,660). Conclusão: Avanço da medicina e surgimento de novas técnicas e parâmetros ...

A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection.

BACKGROUND: Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. We observed decreased carbapenem susceptibility among K. pneumoniae isolated from patients at a tertiary private hospital that showed a phenotype compatible with carbapenemase production although this group of enzymes was not detected in any sample. The aim of this study was to describe the epidemiology and clinical outcomes associated with carbapenem-resistant K. pneumoniae and to determine the antimicrobial resistance mechanisms. METHODS: Risk factors associated with carbapenem-resistant K. pneumoniae infections were investigated by a matched case-control study from January 2006 through August 2008. A cohort study was also performed to evaluate the association between carbapenem resistance and in-hospital mortality. Bacterial identification and antimicrobial susceptibility were determined by Vitek 2 and Etest. Carbapenemase activity was detected using spectrophotometric assays. Production of beta-lactamases and alterations in genes encoding K. pneumoniae outer membrane proteins, OmpK35 and OmpK36, were analyzed by PCR and DNA sequencing, as well as SDS-Page. Genetic relatedness of carbapenem resistant isolates was evaluated by Pulsed Field Gel Electrophoresis. RESULTS: Sixty patients were included (20 cases and 40 controls) in the study. Mortality was higher for patients with carbapenem-resistant K. pneumoniae infections compared with those with carbapenem-susceptible K. pneumoniae (50.0% vs 25.7%). The length of central venous catheter use was independently associated with carbapenem resistance in the multivariable analysis. All strains, except one, carried blaCTX-M-2, an extended-spectrum betalactamase gene. In addition, a single isolate also possessed blaGES-1. Genes encoding plasmid-mediated AmpC beta-lactamases or carbapenemases (KPC, metallo-betalactamases or OXA-carbapenemases) were not detected. CONCLUSIONS: The K. pneumoniae multidrug-resistant organisms were associated with significant mortality. The mechanisms associated with decreased K. pneumoniae carbapenem susceptibility were likely due to the presence of cephalosporinases coupled with porin alterations, which resulted from the presence of the insertion sequences in the outer membrane encoding genes.

Política alimentar brasileira: fome e obesidade, uma história de carências / Brazilian food policy: hunger and obesity, a history of deprivation

O presente artigo tem como foco o fato de como as políticas sociais vêm atentando, no Brasil, à questão da alimentação. Assim, este artigo pretende analisar a questão da fome, da desnutrição e da obesidade da população brasileira. Historicamente, a luta contra a fome tem sido uma preocupação central e, paradoxalmente, a obesidade atinge índices de epidemia. Ao longo do período brasileiro, ocorreram lutas em torno da fome e, em resposta, foram apresentados planos e ações governamentais, ainda não satisfatórios; a questão ampliou-se da fome à obesidade e hoje se sugere que os debates do Estado brasileiro precisam considerar o caráter especial da política pública: o seu propósito emancipatório. Neste contexto, o Serviço Social tem o compromisso de abordar esta realidade, lançando um olhar para a totalidade do fenômeno, desvendando e compreendendo as contradições inerentes à fome e obesidade.

This article focuses on the fact of how social policies have been paying attention, in Brazil, the issue of feed. Thus, this paper aims to analyze the issue of hunger, malnutrition and obesity of the population. Historically the fight against hunger has been a central concern and, paradoxically, obesity has reached epidemic levels. Brazil over the period, there were struggles over hunger and in response plans were presented and government actions, still not satisfactory; the question was extended to obesity and hunger and today suggests that the debates of the Brazilian state must consider the special character of public policy: its emancipatory purpose. In this context, the Social Service is committed to address this reality, casting a look at the totality of the phenomenon, uncovering and understanding the inherent contradictions of hunger and obesity.

N-acetilcisteína e frutose-1, 6-bisfosfato: efeito imunomodulador em cultura de células mononucleares / N-acetilcisteína e frutose-1,6-bisfosfato: efeito imunomodulador em cultura de células mononucleares

INTRODUCTION: Sepsis is a complex syndrome caused by an uncontrolled systemic inflammatory response. Inflammatory cytokines play a pivotal role in septic shock pathogenesis. Therapeutic strategies have been tested in order to modulate the excessive generation or function of sepsis mediators. OBJECTIVE: The objective of the present study was to investigate the therapeutic effect of N-acetylcysteine (NAC) and its association with fructose-1,6-bisphosphate (FBP) on T-lymphocytes proliferation, interleukin-1β (IL-1β) and monocyte chemotactic protein-1 (MCP-1) levels. MATERIAL AND METHODS: Peripheral blood mononuclear cell samples were isolated from healthy individuals. T-lymphocytes were stimulated with phytohemagglutinin for 96 hours and submitted to different concentrations of NAC or NAC associated with FBP. RESULTS: NAC (10 and 15 mM) and NAC (15 mM) associated with FBP reduced T-lymphocytes proliferation. IL-1β levels rose in the presence of both NAC (15 mM) and NAC with FBP (1.25 mM). MCP-1 levels were reduced only by NAC (15 mM) associated with FBP (1.25 mM). CONCLUSION: The results suggest that both NAC itself and NAC associated with FBP inhibit cellular proliferation, acting as potent immunomodulatory agents, which corroborates its use in the treatment of inflammatory diseases.

INTRODUÇÃO: A sepse é uma síndrome complexa causada pela resposta inflamatória sistêmica descontrolada. As citocinas inflamatórias representam papel central na patogênese do choque séptico. Têm sido testadas estratégias terapêuticas a fim de modular a geração ou a função excessiva de mediadores na sepse. OBJETIVO: O objetivo deste estudo foi investigar o efeito terapêutico da N-acetilcisteína (NAC) e sua associação com a frutose-1,6-bisfosfato (FBP) sobre a proliferação de linfócitos T e a geração de interleucina-1β (IL-1β) e proteína quimiotática de monócitos 1 (MCP-1) em cultura celular. MATERIAL E MÉTODOS: Foram isoladas células mononucleares de sangue periférico de indivíduos saudáveis. Os linfócitos T foram estimulados por 96 horas com fitohemaglutinina e submetidos a diferentes concentrações de NAC ou NAC associada à FBP (1,25 mM). RESULTADOS: O tratamento com NAC (10 e 15 mM) ou NAC (15 mM) associado à FBP reduziu a proliferação celular. Os níveis de IL-1β aumentaram com a presença de NAC (15 mM) e NAC + FBP. A concentração de MCP-1 mostrou-se reduzida apenas no grupo tratado com NAC associada à FBP. CONCLUSÃO: Os resultados sugerem que tanto a NAC quanto a NAC associada à FBP são capazes de inibir a proliferação celular, atuando como potentes agentes imunomoduladores, sugerindo seu uso em doenças inflamatórias.

Fructose-1,6-bisphosphate reduces the mortality in Candida albicans bloodstream infection and prevents the septic-induced platelet decrease.

Due to the fact that an increased number of patients have experienced bloodstream infections caused by Candida species and the high mortality of this infection, there is a need for a strategy to reduce this scenery. One possible strategy is the use of new drugs, such as fructose-1,6-bisphosphate (FBP), which is a high-energy glycolytic metabolite and has shown to have therapeutic effects in several pathological conditions such as ischemia, shock, toxic injuries, and bacterial sepsis. The aim of this manuscript was to determine the role of FBP in experimental Candida albicans bloodstream infection. We used mice that were divided into three experimental groups: sham (not induced), bloodstream infection (induced with intratracheal instillation of C. albicans) and FBP (bloodstream infection plus FBP 500 mg/kg i.p.). Blood was taken for assessment of complete hematological profile and cytokine assay (IL-6 and MCP-1). Results of the study demonstrated that mortality decreased significantly in groups that received FBP. All cytokine and hematological indexes of FBP group were similar to bloodstream infection group with exception of platelets count. FBP significantly prevented the decrease in platelets. Taken together, our results demonstrate that FBP prevented the mortality in C. albicans bloodstream infection.

Fructose-1,6-bisphosphate protects against Zymosan-induced acute lung injury in mice.

It has been previously showed that fructose-1,6-bisphosphate (FBP) has anti-inflammatory and immunomodulatory effects on several experimental inflammation models. However, the effects and mechanism of FBP on Zymosan-induced acute lung injury (ALI) in mice had not been tested. In this study, our aim was to assess the anti-inflammatory activities of FBP on Zymosan-induced ALI. We found that in vivo treatment with FBP (500 mg/kg i.p.) markedly decreased the nitric oxide (NO) levels in the lungs and significantly reduced bronchoalveolar lavage fluid total cell and neutrophil counts and protein exudation after Zymosan challenge. Furthermore, FBP inhibited inducible nitric oxide synthase (iNOS) activities in RAW macrophages. Meanwhile, FBP did not inhibit the cyclooxigenase 2, interleukin-6, and nuclear factor kappa B transcription. Taken together, these results suggest that FBP shows anti-inflammatory effects through inhibiting lung edema, NO, and iNOS activities.

Evaluation of the brain and kidney renin-angiotensin system and oxidative stress in neonatal handled rats.

The aim of this study was to test the hypothesis that the renin-angiotensin system (RAS) components, as well as the oxidative stress system, would respond to early environmental changes. Thus, we have evaluated the effects of neonatal handling on both brain and kidney RAS and oxidative stress. Pups were divided into two groups: nonhandled and handled. The procedure consisted of handling them for 1 min/day in the first 10 days of life. On days 1, 5, and 10, animals were killed by decapitation. Blood samples were collected and the brain and kidneys were removed. Renin, AT(1), and AT(2) mRNA expression were evaluated through RT-PCR. Angiotensin II (ANG II) serum concentration was also measured. An increased ANG II concentration, brain and kidney AT(2) mRNA expression were demonstrated. The kidney mRNA AT(1) expression was decreased. There was also a kidney lipid peroxidation increase and a brain superoxide dismutase and catalase decrease. In conclusion, handling in the neonatal period induces the activation of the angiotensinergic system, as well as modulates its mRNA receptor expression. The oxidative stress balance system seems not to be involved.

Effect of N-acetylcysteine and fructose-1,6-bisphosphate in the treatment of experimental sepsis.

Sepsis is a syndrome caused by uncontrolled systemic inflammatory response of the individual, which represents a serious epidemiological problem worldwide. The aim of this study was to investigate the effect of N-acetylcysteine (NAC) and fructose-1,6-bisphosphate (FBP) in the treatment of experimental sepsis. We used rats that were divided into five experimental groups: normal control (not induced), septic control (induced using a capsule with non sterile fecal content and Escherichia coli), treated with FBP (500 mg/kg i.p.), treated with NAC (150 mg/kg i.p.), and treated with the combination of FBP with NAC. In the group treated with NAC, 16.68% of the mice survived, the FBP reduced the mortality of mice during the acute stage of the disease and increased the animals' survival time in 33.34%, and the combination of drugs had no effect. Our results show that NAC prevented the mortality of animals after septic induction. These data confirm the validity of the use of NAC in the treatment of sepsis. Our data also show that the synergistic action with FBP does not improve the picture.

Perfil clínico-epidemiológico de glomerulopatia membranosa primária em brasileiros (71 casos) / Clinical-epidemiological profile of primary membranous glomerulopathy in Brazilian patients (71 cases)

Introdução: A glomerulopatia membranosa (GNM) é uma das causas mais comuns de síndrome nefrótica em adultos, podendo ser idiopática ousecundária. Inicialmente, a maioria dos pacientes apresenta função renal preservada. O curso clínico é variável, contemplando um espectro que vai desde a remissão espontânea da proteinúria até a progressão para insuficiência renal. Objetivo: O objetivo deste estudo foi traçar o perfil clínico-epidemiológico dos pacientes portadores de GNM primária no nosso Serviço e comparar nossos dados com o de levantamentos similares. Pacientes e Métodos: Foram avaliados, retrospectivamente, dados clínicos, epidemiológicos, laboratoriais e histopatológicos de 71 pacientes portadores de GNM primária, acompanhados no Ambulatório de Nefrites da UNIFESP-EPM, no período de 1976 a 2006. Resultados: Foram registrados 71 pacientes (43% do total)com a forma primária da doença, seguidos por pelo menos seis meses. Todos eram adultos, com idade mediana de 43 anos, predominantemente brancos e homens. Creatinina sérica e proteinúria medianas iniciais eram de, respectivamente, 1,1mg/dl e 6,4g/24h e as finais foram de 1,1mg/dl e 1,2g/24h. Hipertensão Arterial Sistêmica (HAS) e hematúria microscópica estiveram presentes em, respectivamente, 50% e 77,5% dos pacientes. A sobrevida livrede insuficiência renal em dez anos foi de 74,3%. Conclusões: No nosso serviço, as características clínicas, epidemiológicas, laboratoriais e morfológicas não diferiram, na sua grande maioria, de estudos semelhantes em todo o mundo, exceto por uma freqüência mais elevada de hematúria microscópica e HAS. Ao final de 30 anos, a probabilidade de apresentar algum grau de insuficiência renal foi de 28%.

Introduction: Membranous glomerulopathy is one of the most frequent causes of nephrotic syndrome in adults. It can be idiopathic or secondary. Initially the majority of the patients has normal renal function. The clinical course is variable, i.e., it includes since spontaneous remission of proteinuria to chronic renal failure. Objective: The aim of this study was to determine the clinical and epidemiological profile of the patients with membranous glomerulopathy of our service and to compare these results to data from similar surveys. Patients and Methods: We evaluated retrospectively clinical, epidemiological, laboratorial and histological data from 71 patients with primary membranous glomerulopathy, followed up in the Glomerulopathies Section of the NephrologyService (UNIFESP-EPM), from 1976 to 2006. Results: Considering all cases of membranous glomerulopathy, 71 (43%) had the primary form of the disease and they were followed up for at least six months. All of them were adults, predominantly white males, with median age of 43 years. The median serum creatinine and proteinuria at presentation of disease were 1.1 mg/dl and 6.4 g/24h and at the end of follow-up were 1.1 mg/dl and 1.2 g/24h, respectively. Hypertension and microscopic hematuria were seen in 50 and 75% of the patients, respectively. Renal survival was 74.3% by 10 years of follow-up. Conclusions: In our service, the clinical, epidemiological, laboratorial and morphological features of membranous glomerulopathy were not different from those of other similar studies in the world, except for a higher frequency of hypertension and microscopic hematuria. At presentation patients had normal renal function and at the end of 30 years the renal survival was 28%.

Primitive reflexes and cognitive function.

BACKGROUND: Data on the prevalence of primitive reflexes (PR) in adulthood, their pathological significance and relationship to age and cognition are controversial. OBJECTIVE: To study the relationship between PR and cognition in 30 patients with probable Alzheimer's disease (AD) and 154 control subjects. METHOD: Diagnosis of probable AD was based on DSM-IV, NINCDS-ADRDA, and CAMDEX criteria. Primitive reflexes were quantified from zero (absent) to 1 (mild) or 2 (markedly present). The Cognitive Abilities Screening Instrument-Short Form (CASI-S) was used to evaluate registration, temporal orientation, verbal fluency and recall. A drawing test was added. RESULTS: Most frequent PR among demented and controls were suck (77% and 62%, respectively) and snout (60% and 27%), followed by glabellar (30% and 19%), paratonia (37% and 5%), and palmomental (23% and 5%). None of controls had more than three PR. Frequency of PR tended to increase with age and cognitive deterioration. Grasp and Babinski responses were found only in dementia patients. Primitive reflexes were not correlated with each other, except snout with suck, and snout with glabellar reflex. CONCLUSION: The finding of grasp and Babinski sign, or the presence of more than three primitive signs, particularly the combination of paratonia, snout, suck, and palmomental reflexes strongly suggests brain dysfunction, especially when these signs are marked and accompanied by deficits in orientation, recall, verbal fluency, and constructional praxis.

Primitive reflexes and cognitive function

CONTEXTO: A prevalência e significado patológico dos reflexos primitivos (RP) no adulto, bem como sua relação com a idade e a cognição, são questões controversas. OBJETIVO: Estudar a relação entre RP e cognição em 30 pacientes com doença de Alzheimer (DA) e 154 sujeitos controles normais. MÉTODO: O diagnóstico de DA baseou-se nos critérios DSM-IV, NINCDS-ADRDA e CAMDEX. Os RP foram quantificados de 0 (ausente) a 1 (leve) ou 2 (acentuado). CASI-S (Cognitive Abilities Screening Instrument -Short Form) foi usado para avaliar o registro, orientação temporal, fluência verbal e evocação. Um teste de cópia de pentágonos foi acrescentado. RESULTADOS: Os RP mais frequentes nos pacientes e controles foram o de sucção (77% e 62%, respectivamente) e "snout" (60% e 27%), seguidos do glabelar (30% e 19%), paratonia (37% e 5%) e palmomentoniano (23% e 5%). Nenhum sujeito controle teve mais que três RP. A frequência dos RP tendeu a aumentar com a idade e a deterioração cognitiva. O reflexo de preensão e o sinal de Babinski foram encontrados apenas nos pacientes com DA. Os RP não se correlacionaram uns com os outros, exceto o reflexo "snout" com o de sucção e com o glabelar.CONCLUSÃO: O achado de reflexo de preensão e sinal de Babinski, ou a presença de mais de três sinais primitivos, particularmente a combinação de paratonia e reflexos "snout", sucção e palmomentoniano, são sugestivos de disfunção cerebral, especialmente quando esses sinais são acentuados e acompanhados de déficits de orientação, evocação, fluência verbal e praxia construcional.

[Validation of the Brazilian version of mini-test CASI-S].

OBJECTIVE: To determine CASI-S accuracy in the diagnosis of dementia. METHOD: The Cognitive Abilities Screening Instrument - Short Form (CASI-S) was applied in 43 Alzheimer's disease (AD) patients and 74 normal controls. AD diagnosis was based on DSM-IV, NINCDS-ADRDA, and CAMDEX. CASI-S includes: registration, temporal orientation, verbal fluency (4-legged animals in 30s), and recall (3 words). Its maximum score is 33 points. A copy of 2 pentagons was added. RESULTS: ROC curve showed an accuracy of 0.87, with standard error of 0.032, and 95% confidence intervall between 0.795 and 0.925. The cut-off score for cognitive deficit was 23, with sensitivity of 76.7%, specificity 86.5%, positive likelihood ratio (LR) 5.68, and negative LR 0.27. The cut-off score for subjects 70 years or older was 20, with sensitivity of 71.4% and specificity 97.1%. CONCLUSION: CASI-S is a practical test, with high specificity, particularly in individuals above 70 years of age. The adding of the drawing test did not improve its accuracy.

Validation of the Brazilian version of mini-test CASI-S

OBJETIVO: Determinar a acurácia do CASI-S no diagnóstico de demência. MÉTODO: O CASI-S (Cognitive Abilities Screening Instrument - Short Form) foi aplicado em 43 pacientes com doença de Alzheimer (DA) e 74 controles normais. O diagnóstico de DA baseou-se no DSM-IV, NINCDS-ADRDA e CAMDEX. O CASI-S inclui: registro, orientação temporal, fluência verbal (animais quadrúpedes em 30s), e evocação (3 palavras). O escore máximo é 33 pontos. Foi adicionado um teste de cópia de 2 pentágonos. RESULTADOS: A curva ROC mostrou acurácia de 0,87, com erro padrão de 0,032, e intervalo de confiança de 95% entre 0,795 e 0,925. O ponto de corte para déficit cognitivo foi 23 pontos, com sensibilidade de 76,7%, especificidade de 86,5%, valor preditivo (VP) positivo de 5,68, e VP negativo de 0,27. Para sujeitos com 70 anos ou mais, o ponto de corte foi 20, com sensibilidade de 71,4% e especificidade de 97,1%. CONCLUSION: O CASI-S é um teste prático, com alta especificidade, particularmente em indivíduos com idade acima de 70 anos. O teste de cópia dos pentágonos não melhorou sua acurácia.