Uses and limits of the clinical laboratory in the COVID-19 pandemic: a didactic review.

The world is currently experiencing an unprecedented pandemic of a new disease, the coronavirus disease (COVID-19), which has unusual clinical and immunological presentations. This is especially true regarding the choice and interpretation of laboratory test results. In this review, we have provided didactic information for physicians on the current concepts and practical guidance regarding COVID-19.

Uses and limits of the clinical laboratory in the COVID-19 pandemic: a didactic review

SUMMARY The world is currently experiencing an unprecedented pandemic of a new disease, the coronavirus disease (COVID-19), which has unusual clinical and immunological presentations. This is especially true regarding the choice and interpretation of laboratory test results. In this review, we have provided didactic information for physicians on the current concepts and practical guidance regarding COVID-19.

A continuous fall of PSA use for prostate cancer screening among Brazilian doctors since 2001. Good or bad notice?

ABSTRACT Purpose: To evaluate the trend of use of Prostate Specific Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories. Material and Methods: A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed. Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models. Results: During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically significant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant. Conclusions: Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefit potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and <40 years), is a matter of concern. Follow-up studies of these trends are advisable.

A continuous fall of PSA use for prostate cancer screening among Brazilian doctors since 2001. Good or bad notice?

PURPOSE: To evaluate the trend of use of Prostate Specifi c Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories. MATERIAL AND METHODS: A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed. Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models. RESULTS: During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically signifi cant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant. CONCLUSIONS: Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefi t potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and < 40 years), is a matter of concern. Follow-up studies of these trends are advisable.

Hearing alterations in systemic sclerosis. / Alterações auditivas na esclerose sistêmica.

PURPOSE: Describe hearing complaints and alterations in individuals with systemic sclerosis (SS) and to verify the development of audiological manifestations. METHODS: This is a cross-sectional study with a prospective phase, conducted in the period from 2012 to 2015, with patients with medical diagnosis of SS. Sociodemographic data, year of disease onset, year of diagnosis and disease subtype were collected. Later, audiological anamnesis was performed to identify complaints and symptoms and to investigate the performance of audiometry before the study and, after that, a basic audiological evaluation was conducted. RESULTS: Fifty individuals participated in the study. Dizziness and tinnitus were the most frequent symptoms. Hearing loss was identified in 23 (46%) individuals; most of them were of sensorineural type, of variable degrees and configurations. The analysis of hearing thresholds obtained in the audiological evaluation performed in 2012 and, later, in 2015, indicated onset or progression of hearing loss, with aggravation of 10dB in most frequencies evaluated, being more expressive in acute frequencies. CONCLUSION: High rate of hearing complaints and alterations in individuals with SS and onset and/or progression of hearing loss in those who underwent serial audiological evaluation were observed.

OBJETIVO: Descrever as queixas e alterações auditivas em indivíduos com esclerose sistêmica (ES), bem como verificar a evolução do quadro audiológico. MÉTODO: Trata-se de estudo seccional, com uma fase prospectiva, realizado no período de 2012 e 2015, com pacientes com diagnóstico médico de ES. Foram coletados dados sociodemográficos, ano de início da doença, ano de diagnóstico e subtipo da enfermidade. Posteriormente, foram realizadas a anamnese audiológica, para identificação de queixas e sintomas e para a investigação de realização de audiometria pregressa ao estudo, e, em seguida, a avaliação audiológica básica. RESULTADOS: Participaram do estudo 50 indivíduos. Tontura e zumbido foram os sintomas mais frequentes. A perda auditiva foi identificada em 23 (46%) indivíduos, sendo a maioria do tipo sensorioneural, de grau e configurações variáveis. A análise dos limares auditivos obtidos na avaliação audiológica realizada em 2012 e, posteriormente, em 2015 indicou desencadeamento ou progressão da perda auditiva, com piora de 10dB na maioria das frequências avaliadas, sendo mais expressiva nas frequências agudas. CONCLUSÃO: Elevada frequência de queixas e alterações auditivas em indivíduos com ES e desencadeamento e/ou progressão da perda auditiva naqueles que realizaram avaliação audiológica sequencial.

Current guidelines for prostate cancer screening: A systematic review and minimal core proposal.

OBJECTIVE: Considering the importance of screening for prostate cancer, the possibility of damage resulting from indiscriminate screening and the difficulty of disclosure and adherence to the main guidelines on the subject, we aimed to identify current guidelines, look for common approaches and establish a core of conducts. METHOD: Systematic review of the literature on screening practice guidelines for prostate cancer searching the databases PubMed, Lilacs and Google Scholar and active search in the sites of several national health entities. RESULTS: Twelve (12) guidelines were selected, whose analysis resulted in the identification of six common points of conduct, with the following minimum core of recommendations: (1) screening indication or not: must be individualized, and preceded by an informed decision; (2) tests used: PSA with or without rectal digital examination; (3) age at which initiate testing in men in general risk: 50-55 years; (4) age at which to initiate testing in men at increased risk: 40-45 years; (5) the interval between screening: annual or biennial; and (6) age at which to discontinue testing: 70 years-old or life expectancy less than 10 years. CONCLUSION: Although there are differences between them, it was possible to establish a minimum core of conducts that may be useful in the daily practice of the physician.

Current guidelines for prostate cancer screening: A systematic review and minimal core proposal / Guias de conduta vigentes para o rastreamento do câncer de próstata: uma revisão sistemática e proposta de núcleo mínimo

Summary Objective: Considering the importance of screening for prostate cancer, the possibility of damage resulting from indiscriminate screening and the difficulty of disclosure and adherence to the main guidelines on the subject, we aimed to identify current guidelines, look for common approaches and establish a core of conducts. Method: Systematic review of the literature on screening practice guidelines for prostate cancer searching the databases PubMed, Lilacs and Google Scholar and active search in the sites of several national health entities. Results: Twelve (12) guidelines were selected, whose analysis resulted in the identification of six common points of conduct, with the following minimum core of recommendations: (1) screening indication or not: must be individualized, and preceded by an informed decision; (2) tests used: PSA with or without rectal digital examination; (3) age at which initiate testing in men in general risk: 50-55 years; (4) age at which to initiate testing in men at increased risk: 40-45 years; (5) the interval between screening: annual or biennial; and (6) age at which to discontinue testing: 70 years-old or life expectancy less than 10 years. Conclusion: Although there are differences between them, it was possible to establish a minimum core of conducts that may be useful in the daily practice of the physician.

Resumo Objetivo: Considerando a importância do rastreamento de câncer de próstata, a possibilidade de dano decorrente do rastreamento indiscriminado, a dificuldade de divulgação e adesão às diretrizes sobre o assunto, objetivamos identificar as principais diretrizes vigentes, procurar pontos de abordagem comuns e estabelecer um núcleo mínimo de condutas. Método: Revisão sistemática da literatura sobre guias de prática de rastreamento para câncer de próstata nas bases Pubmed, Lilacs e Google Scholar, além de busca ativa nos sítios de diversas entidades de saúde nacionais. Resultados: Foram selecionadas 12 diretrizes, cuja análise resultou na identificação de seis pontos comuns de conduta, com o seguinte núcleo mínimo de recomendações: (1) a indicação ou não de rastreamento: deve ser individualizada e precedida de uma decisão informada; (2) os exames utilizados: PSA com ou sem exame digital retal; (3) a idade de início geral: 50-55 anos; (4) a idade de início em homens com risco aumentado: 40 anos; (5) o intervalo entre os rastreamentos: anual ou bienal; e (6) a idade de suspensão do rastreamento: 70 anos ou expectativa de vida menor que 10 anos. Conclusão: Embora existam divergências entre elas, foi possível estabelecer um núcleo mínimo de condutas que podem ser úteis na prática diária do médico.

Estudo do fator von Willebrand em pacientes com esclerose sistêmica / Evaluation of serum von Willebrand factor in systemic sclerosis

Objetivo: Avaliar o papel do fator de von Willebrand (vWf:Ag) como possível marcador sorológico de atividade ou gravidade na esclerodermia sistêmica. Métodos: Determinaçao do vWf:Ag pela técnica de ELISA em 26 portadores de esclerodermia sistêmica que preenchiam os critérios do Colégio Americano de Reumatologia e sua correlaçao com vários parâmetros clínicos e laboratoriais. Especial atençao foi dada a parâmetros de extensao (forma limitada x difusa, número de sistemas envolvidos) e gravidade (escore clínico de gravidade, velocidade de progressao) da doença. Foi utilizado grupo-controle com 46 indivíduos saos,doadores de sangue. A significância estatística foi determinada pelo teste do qui-quadrado ou pelo exato de Fisher. Resultados: O vWf:Ag estava significativamente aumentado nos pacientes esclerodérmicos, quando comparado a controles normais (p<0,01). Nao houve diferença estatisticamente significante entre pacientes em atividade quando comparados àqueles em remissao (p=0,07) ou quando comparamos: extensao (difusa x limitada, p=0,33) ou gravidade (grave x moderada, p=0,65) da doença. Também nao encontramos correlaçao entre aumento vWf:Ag e qualquer outra alteraçao clínica ou laboratorial, em especial as clássicas provas de atividade inflamatórias (p=0,62). Conclusoes: O aumento do vWf:Ag encontrado na ES parece se dever à lesao vascular presente nesta doença e nao a uma simples reaçao de fase aguda. O reduzido número de nossa amostra e a nao disponibilidade de gold standard confiável podem ser sido em parte responsáveis pela falha em estabelecer um papel marcador de atividade para o vWf:Ag. Mais estudos, com ampliaçao do número de casos, fazem-se necessários

Fator von Willebrand e de doenças reumáticas: marcador de lesao vascular ou reagente de fase aguda? / Von Willebrand factor and rheumatic diseases: marker of endothelial injury or acute phase protein?

Objetivo: Verificar o significado da dosagem plasmática do antígeno do fator von Willebrand (vWf:Ag) em doenças reumáticas como marcador de lesao vascular e como reagente de fase aguda. Material e métodos: Determinaçao do vWf:Ag, pela técnica de ELISA, em portadores de LES (31 pacientes) e AR (26 pacientes) e sua correlaçao com vários parâmetros clínicos e laboratoriais. Foi utilizado grupo-controle com 46 indivíduos saos, doadores de sangue. A significância estatística foi determinada pelo teste do qui quadrado ou pelo exato de Fisher. Resultados: Os títulos de vWf:Ag mostraram-se significantemente alterados apenas nos pacientes com LES em atividade (p<0,001). Nos pacientes com AR sem vasculopatia, nao houve aumento estatisticamente significante, mesmo naqueles em franca atividade. Nao houve correlaçao significante entre os títulos de vWf:Ag e outros parâmetros clínicos e laboratoriais, em especial com a velocidade de hemossedimentaçao (VHS). Conclusao: Os autores concluem que o vWf:Ag pode se constituir em marcador plasmático útil de lesao vascular e nao parece comportar-se como mero reagente da fase aguda