Absenteísmo no contexto profissional dos agentes de segurança penitenciária em relação ao envelhecimento / Absenteism in the professional context of safety penitentiary agents in relation to aging

Determinar as principais causas de absenteísmo por problemas de saúde em Agentes de Segurança Penitenciária (ASPs) e relacioná-las com o envelhecimento. Estudo quantitativo, observacional e transversal, por meio de análise documental, realizado em penitenciárias masculina e feminina no interior paulista. Os dados foram analisados no software SPSS com significância de 5%. A amostra foi constituída de 79 ASPs com média de idade de 41,3 anos, tempo médio trabalhado de 11,5 anos e prevalência de absenteísmo de 18,3%. As principais causas de absenteísmo foram relacionadas a quadros emocionais, problemas ortopédicos e distúrbios gastrintestinais. Não se encontrou correlação entre idade cronológica e quantidade de afastamentos. Os dados obtidos muito se assemelham a outros estudos nacionais e internacionais, entretanto há escassez de evidências científicas abordando essa classe de trabalhadores, que carece de melhorias no cotidiano de seu exercício profissional, a fim de que desempenhe suas funções com maior dignidade.

To determine the main causes of absenteeism due to health problems in Penitentiary Security Agents (ASPs) and to relate them to aging. Quantitative, observational and cross-sectional study, based on document analysis, carried out in male and female penitentiaries in the interior of São Paulo. Data were analyzed in SPSS software with a significance of 5%. The sample consisted of 79 ASPs; with a mean age of 41.3 years; mean time worked of 11.5 years and prevalence of absenteeism of 18.3%. The main causes of absenteeism were related to emotional conditions, orthopedic problems and gastrointestinal disorders. We did not find a correlation between chronological age and number of leaves. The data obtained are very similar to other national and international studies, however, there is a lack of scientific evidence addressing this class of workers, who need improvements in the daily routine of their professional practice, in order for them to perform their duties with greater dignity.

Aspectos sociodemográficos, qualidade de vida e saúde do idoso institucionalizado / Sociodemographic aspects, quality of life and health of the institutionalized elderly

Objetivo: analisar as características do idoso institucionalizado apontando correlações. Método: trata-se de um estudo quantitativo, descritivo, analítico, tipo exploratório, com idosos que vivem em instituições de longa permanência para idosos. Empregaram-se questionários: sociodemográfico; Mini Mental; índice de Barthel; avaliação autorreferida de fragilidade em idosos; Family Apgar e Perfil de Saúde de Nothingham. Resultados: revela-se que as seis instituições avaliadas eram de caráter filantrópico; foram estudados 135 idosos; a média de idade foi de 76,4 anos e o tempo médio de institucionalização, de quatro anos; de acordo com os questionários, a maioria apresentou pontuação que sugere declínio cognitivo e fragilidade, era independente para as atividades básicas de vida diária, possuía acentuada disfunção familiar e apresentou perceptível perda da sensação da qualidade de vida; a maior parte dos entrevistados mudou para a instituição sem vontade própria. Constatou-se que a preservação da cognição e o maior grau de instrução se correlacionam a uma menor satisfação e percepção de qualidade de vida. Conclusão: apresentaram-se, por este estudo, alguns aspectos próprios do idoso institucionalizado e sua percepção de saúde.(AU)

Objective: to analyze the characteristics of the institutionalized elderly by pointing out correlations. Method: this is a quantitative, descriptive, analytical, exploratory study with elderly people living in long-term care facilities for the elderly. The following questionnaires were used: sociodemographic; Mini Mental; Barthel index; self-reported assessment of frailty in the elderly; Family Apgar and Nothingham Health Profile. Results: it is revealed that the six institutions evaluated were philanthropic; 135 elderly people were studied; the average age was 76.4 years and the average institutionalization time was four years; According to the questionnaires, most had scores that suggest cognitive decline and frailty, were independent for basic activities of daily living, had marked family dysfunction and showed a noticeable loss of quality of life sensation; Most respondents moved to the institution without their own will. It was found that the preservation of cognition and the higher level of education correlate with lower satisfaction and perception of quality of life. Conclusion: this study presented some aspects of the institutionalized elderly and their perception of health.(AU)

Objective: to analyze the characteristics of the institutionalized elderly by pointing out correlations. Method: this is a quantitative, descriptive, analytical, exploratory study with elderly people living in long-term care facilities for the elderly. The following questionnaires were used: sociodemographic; Mini Mental; Barthel index; self-reported assessment of frailty in the elderly; Family Apgar and Nothingham Health Profile. Results: it is revealed that the six institutions evaluated were philanthropic; 135 elderly people were studied; the average age was 76.4 years and the average institutionalization time was four years; According to the questionnaires, most had scores that suggest cognitive decline and frailty, were independent for basic activities of daily living, had marked family dysfunction and showed a noticeable loss of quality of life sensation; Most respondents moved to the institution without their own will. It was found that the preservation of cognition and the higher level of education correlate with lower satisfaction and perception of quality of life. Conclusion: this study presented some aspects of the institutionalized elderly and their perception of health.(AU)

Clinical and laboratorial characteristics of the liver in aged and non-aged alcoholics / Características clínicas e laboratoriais do fígado em alcoolistas idosos e não idosos

The medical bibliography is deficient in research involving structural and laboratory abnormalities of the liver in asymptomatic and oligosymptomatic male alcoholics. The present study describes the alterations in tests that evaluate liver aggression, lesion and dysfunction, also correlating these with the changes in the consistency and sensitivity of the liver in aged and non-aged alcoholics. Cross-sectional study involving 100 alcoholic men, 50 aged and 50 non-aged. Of the aged and non-aged, respectively, the liver was palpable in 68% and 80%, the spleen was percutable in 72% and 74% and palpable in 12% and 22%, non-painful soft hepatomegaly was observed in 14% and 8%, painful hepatomegaly in 0% and 2%, firm hepatomegaly (painful and non-painful) in 54% and 70%, hepatomegaly and splenomegaly (percutable and palpable spleen) in 84% and 84%, and portal hypertension in 10 % and 14%. Elevated levels of aspartate aminotransferase were observed in 66% and 84%, alanine aminotransferase in 24% and 60%, gamma glutamyl transferase in 46% and 82% and alkaline phosphatase in 0% and 16% of the aged and non-aged, respectively. Elevation of aspartate aminotransferase greater than twice the reference value and the ratio aspartate aminotransferase to alanine aminotransferase greater than 2 were observed in 18% and 42% and 18% and 10% of the aged and non-aged, respectively. Hypoalbuminemia and hyperbilirubinemia were observed in 70% and 24% of the aged and 40% and 44% of the non-aged, respectively. The clinical and laboratory alterations observed are compatible with acute liver disease in 18% and 42%; chronic liver disease in 54% and 70%; portal hypertension in 10% and 14% of aged and non-aged patients, respectively.

A bibliografia médica carece de pesquisas que envolvem anormalidades estruturais e laboratoriais do fígado em homens alcoolistas assintomáticos e oligossintomáticos. O presente estudo descreve as alterações de testes que avaliam a agressão, lesão e disfunção, correlacionando-as com as mudanças da consistência e sensibilidade do fígado em alcoolistas idosos e não idosos. Este estudo transversal envolve 100 homens alcoolistas, 50 idosos e 50 não idosos. Em idosos e não idosos, respectivamente, o fígado estava palpável em 68% e 80%, o baço estava percutível em 72% e 74% e palpável em 12% e 22%, hepatomegalia mole dolorosa foi observada em 14% e 8%, hepatomegalia mole não dolorosa em 0% e 2%, hepatomegalia firme (dolorosa e não dolorosa) em 54% e 70%, hepatomegalia e esplenomegalia (baço percutível e palpável) em 84% e 84% e hipertensão portal em 10% e 14%. Foram observados níveis elevados da aspartato aminotransferase em 66% e 84%, da alanino aminotransferase em 24% e 60%, da gamaglutamiltransferase em 46% e 82% e da fosfatase alcalina em 0% e 16% dos idosos e não idosos, respectivamente. Foi observada a elevação da aspartato aminotransferase maior que duas vezes o valor de referência e a relação aspartato aminotransferase sobre alanino aminotransferase maior que 2, em 18% e 42% e 18% e 10% dos idosos e não idosos, respectivamente. Hipoalbuminemia e hiperbilirrubinemia ocorreram em 70% e 24% dos idosos e 44% e 30% dos não idosos, respectivamente. As alterações clínicas e laboratoriais observadas são compatíveis com doença aguda do fígado em 18% e 42%, doença crônica do fígado em 54% e 70%, hipertensão portal em 10% e 14% dos pacientes idosos e não idosos, respectivamente

Imunodeficiência comum variável associada à doença de Crohn-like: relato de caso e revisão da literatura / Common variable immunodeficiency associated with Crohn-like disease: case report and literature review

OBJETIVOS: relatar o caso de um paciente diagnosticado com imunodeficiência comum variável e doença de Crohn-like, descrevendo o quadro clínico, o processo de investigação diagnóstica, as abordagens terapêuticas e a evolução clínica do paciente. Realizar revisão bibliográfica de relatos de caso que abordem pacientes com a associação imunodeficiência comum variável e doença de Crohn-like. Enfatizar a importância do diagnóstico e tratamento precoces. DESCRIÇÃO DO CASO: Um paciente masculino foi diagnosticado com imunodeficiência comum variável aos nove anos de idade e doença inflamatória intestinal inespecífica aos 10 anos, após realização de colonoscopia e biópsia colônica indicando moderado infiltrado linfoplasmocitário, eosinofílico e alguns neutrófilos em lâmina própria, com ausência de granulomas. Aos 14 anos, foi confirmado o diagnóstico de doença de Crohn-like por especialista após correlação entre história clínica e exames complementares. Atualmente com 18 anos, o paciente está em tratamento com imunoglobulina humana endovenosa, infliximabe e azatioprina, com estabilização do quadro clínico. CONCLUSÕES: A revisão da literatura identificou 11 relatos de caso sobre a associação imunodeficiência comum variável e doença de Crohnlike, inexistindo trabalhos brasileiros, o que ressalta a raridade de tal associação. Neste relato, o paciente recebeu tratamentos amplos e empíricos devido à dificuldade em se chegar a um diagnóstico específico, o qual somente foi realizado aos 14 anos, quando se iniciou tratamento mais direcionado e individualizado. Apesar de atualmente estável, o paciente apresentou diversas complicações durante a investigação diagnóstica, o que ressalta a importância de diagnóstico precoce e tratamento mais preciso e dirigido às necessidades de saúde desses pacientes.

AIMS: To report the case of a patient diagnosed with common variable immunodeficiency and Crohn-like disease, describing the clinical picture, the diagnostic investigation process, the therapeutic approaches and the clinical outcome of the patient. To carry out a literature review of case reports addressing patients with the common variable immunodeficiency and Crohn-like disease association. Emphasize the importance of early diagnosis and treatment. CASE DESCRIPTION: A male patient was diagnosed with common variable immunodeficiency at nine years of age and with non-specific inflammatory bowel disease at 10 years, after colonoscopy and colonic biopsy indicated moderate lymphoplasmacytic, eosinophilic infiltrate and some neutrophils in lamina propria, with absence of granulomas. At age 14, the diagnosis of Crohn-like disease was confirmed by specialist after correlation between clinical history and complementary exams. Currently with 18 years of age, the patient is under treatment with intravenous human immunoglobulin, infliximab and azathioprine, with stabilization of the clinical picture. CONCLUSIONS: The literature review identified 11 case reports on the association between common variable immunodeficiency and Crohn-like disease, with no Brazilian studies, which highlights the rarity of such association. In this report, the patient received extensive and empirical treatments due to the difficulty in reaching a specific diagnosis, which was only performed at age 14, when more targeted and individualized treatment was started. Although currently stable, the patient presented several complications during the diagnostic investigation, which emphasizes the importance of early diagnosis and more precise treatment, targeted to meet the health needs of these patients.

Conhecimento prático e sobrecarga na vida de cuidadores de idosos com demência / Practical knowledge and life overload of caregivers of elderly with dementia

OBJETIVOS: Analisar o nível de conhecimento e a sobrecarga na vida de cuidadores de idosos com demência, correlacionando essas variáveis com aspectos sociodemográficos e tipo de relação entre cuidador e idoso. MÉTODOS: Um estudo transversal foi realizado entre 2016 e 2017, com cuidadores de idosos com demência atendidos no ambulatório de Geriatria do Hospital das Clínicas da Faculdade de Medicina de Marília, em Marília/SP. Foram incluídos no estudo cuidadores que acompanhavam os idosos às consultas e participavam de forma importante nos seus cuidados, compreendendo cuidadores familiares e contratados sem vínculo de parentesco. Os dados foram coletados por meio de dois instrumentos: o questionário Caregiven Burden Scale, que avalia o impacto subjetivo de sobrecarga ao cuidador, cujo escore global pode variar de 01 (menor sobrecarga) até 04 (maior sobrecarga); e um questionário elaborado pelos próprios autores, que avaliou os conhecimentos usuais do cuidador sobre a prática do cuidado, cuja pontuação variou de zero (nenhum acerto) até 08 (todas as respostas corretas). A curva de distribuição das variáveis foi analisada pelo teste de Kolmogorov-Smirnov, as correlações foram analisadas pelo teste de Spearman e na comparação das médias utilizou-se a Análise de Variância. Os resultados foram considerados estatisticamente significativos quando p<0,05. RESULTADOS: Foram incluídos no estudo 52 cuidadores, cuja média de idade foi de 55,9±14,4 anos, sendo 85% do sexo feminino. Quarenta e quatro (84,6%) cuidadores possuíam algum grau de parentesco com o idoso. Em relação ao conhecimento sobre a prática do cuidado, a média de respostas corretas foi de 5,5±1,8. Houve correlação positiva com significância estatística entre o grau de escolaridade do cuidador e o conhecimento prático sobre o cuidado. Na avaliação da sobrecarga dos cuidadores encontrou-se a média geral de 1,83±0,16. A dimensão com maior média (2,06±0,37) foi a tensão geral, que faz menção às dificuldades de resolver problemas ao cuidar do idoso. Quanto ao tipo de relação entre cuidador e idoso, a maior sobrecarga (2,48±0,53) foi identificada nas esposas. CONCLUSÕES: O maior grau de escolaridade do cuidador foi associado à melhor qualidade do cuidado. A maior sobrecarga na vida dos cuidadores foi identificada nas esposas.

AIMS: To analyze the level of knowledge and the life overload of caregivers of elderly people with dementia, correlating these variables with sociodemographic aspects and type of relationship between caregiver and elderly. METHODS: A cross-sectional study was conducted between 2016 and 2017, with caregivers of elderly people with dementia seen at the Geriatrics outpatient clinic of the Hospital das Clínicas, Medical School of Marília, in Marília/SP, Brazil. The study included caregivers who accompanied the elderly to the consultations and participated in an important way in their care, comprising family caregivers and contractors without kinship ties. The data were collected through two instruments: the first was the Caregiven Burden Scale questionnaire, which evaluates the subjective impact of overload on the caregiver, and whose overall score can vary from 01 (lower overload) to 04 (higher overload). The second was a questionnaire prepared by the authors, which evaluated the caregiver's usual knowledge about the practice of care, whose scores ranged from zero (no correct answers) to 08 (all correct answers). The distribution curve of the variables was analyzed by the KolmogorovSmirnov test, the correlations were analyzed by the Spearman test and the comparison of the means used the Analysis of Variance. The results were considered statistically significant when p<0.05. RESULTS: Fifty-two caregivers were included in the study, with a mean age of 55.9±14.4 years, of which 85% were female. Forty-four (84.6%) caregivers had some degree of kinship with the elderly. Regarding knowledge about the practice of care, the mean number of correct answers was 5.5±1.8. There was a positive correlation with statistical significance between the caregiver's level of education and the practical knowledge about care. In the assessment of the caregivers overload, the overall mean was 1.83±0.16. The dimension with the highest mean (2.06±0.37) was the general tension, which refers to the difficulties of solving problems when caring for the elderly. Regarding the type of relationship between caregiver and elderly, the highest overload (2.48±0.53) was identified in the wives. CONCLUSIONS: The higher level of education of the caregiver was associated with better quality of care. The greatest caregiver life overload was identified in wives.

Effects of Immunosenescence on the Lower Expression of Surface Molecules in Neutrophils and Lymphocytes.

BACKGROUND: Immunosenescence is a remodeling of the immune system, caused by aging, with changes in the function of neutrophils, lymphocytes, and Treg cells. OBJECTIVE: This study aimed to evaluate the expression of molecules CD11b, CD16 and CD64 (neutrophils), CD154 (T lymphocytes), CD40 (B lymphocytes), and to quantitatively analyze the Treg cell subpopulation. METHODS: 49 elderlies (≥60 years) and 49 adults (≤35 years) were studied. Flow cytometry was used to analyze the expression of surface molecules and the subpopulation of Treg cells, and the results between the groups were compared statistically by the t-test. RESULTS: There was a decreased significance in the expression of CD11b and CD40 in the elderly. CONCLUSION: Decreased CD11b expression can result in susceptibility to infectious diseases, and impairment of phagocytic capacity. Decreased CD40 expression can result in a decline in B lymphocyte activation. The other molecule studied presented alterations not significant, but compatible with the immunological changes in aging.

Ausência por doença na carreira do policial militar / Absence due to illness in the military police career

Objetivo: verificar a distribuição do número de dias de absenteísmo por motivos de saúde, no ano de 2012. Método: estudo retrospectivo e transversal, de abordagem quantitativa, com policiais militares do 9ºBatalhão da Polícia Militar do Interior (9º BPM/I), do 10º Grupamento de Incêndio (10º GI), da Polícia Ambiental (PAmb) e do Policiamento Rodoviário (PRv), que trabalham na região de Marília (SP), Brasil, e são atendidos na Unidade Integrada de Saúde (UIS) do 9º BPM/I. Resultados: nos 12 meses de pesquisa, predominaram os dias de absenteísmo por motivos relacionados a traumas e a problemas ortopédicos, correspondendo a um total de 154 dias de absenteísmo. Conclusão: a pesquisa possibilitou verificar o absenteísmo dos policiais militares. Conhecer esses dados é crucial para propor ações de saúde.

Principais sensibilizantes em pacientes idosos e não idosos com dermatite de contato / Main allergens in elderly and non-elderly patients with contact dermatitis

OBJETIVOS: Avaliar a prevalência dos principais sensibilizantes da dermatite de contato alérgica em pacientes idosos e não idosos. MÉTODOS: Estudo retrospectivo com revisão dos prontuários de pacientes com diagnóstico clínico de dermatite de contato, atendidos no período de agosto de 2000 a janeiro de 2012 no Ambulatório de Alergia da Faculdade de Medicina de Marília e em clínica particular de Alergia e Dermatologia na cidade de Marília, estado de São Paulo. Os critérios de inclusão foram diagnóstico clínico de dermatite de contato, realização de teste cutâneo de contato (patch test) no período do estudo e não uso de corticosteroide sistêmico ou outra medicação imunossupressora. Foram analisados idade, sexo, história de outros tipos de alergia e sensibilizantes utilizados. Os resultados do patch test foram lidos 48 horas e 72 horas após a colocação dos contensores. RESULTADOS: Foram incluídos 362 pacientes, entre o quais 60 idosos (idade maior ou igual a 60 anos) e 302 não idosos. Além da dermatite de contato foram observados outros tipos de alergias em 20 (33,3%) dos idosos e em 113 (37,4%) dos não idosos (p=0,54). Houve um total de 162 reações positivas ao patch test entre os idosos e 738 reações positivas entre os não idosos (p=0,24). Quanto às reações positivas fortes ocorreram 41 (68,3%) entre os idosos e 156 (51,6%) entre os não idosos (p=0,02). Somando-se reações positivas fortes e muito fortes, foram 44 (73,3%) em idosos e 214 (70,8%) em não idosos (p=0,69). As substâncias mais sensibilizantes foram o sulfato de níquel (em 33,3% dos idosos e 38 % dos não idosos) e o perfume mix (em 25% dos idosos e 27,8% dos não idosos), sem diferença estatística entre os dois grupos etários. CONCLUSÕES: A taxa de positividade do patch test entre os pacientes com dermatite de contato foi alta, não havendo diferença entre idosos e não idosos, sendo o sulfato de níquel e o perfume mix as substâncias mais sensibilizantes. Na investigação etiológica da dermatite de contato deve-se pensar principalmente na possibilidade de sensibilização aos perfumes e ao níquel, independentemente da faixa etária.

AIMS: To evaluate the prevalence of the main allergens found in allergic contact dermatitis among elderly and non-elderly patients. METHODS: Retrospective study of the medical records of patients clinically diagnosed with contact dermatitis treated from August 2000 to January 2012 at the Allergy Outpatient Clinic of Marília Medical School and at an Allergy and Dermatology private clinic in Marília, state of São Paulo, Brazil. The inclusion criteria were clinical diagnosis of contact dermatitis, patch test performed during the study period, and no treatment with systemic corticosteroids or any other immunosuppressants. Age, sex, history of other types of allergy and allergens used were assessed. The patch test results were read 48 hours and 72 hours after application of the test chambers. RESULTS: A total of 362 patients were included in the study: 60 elderly patients (aged 60 years or older) and 302 non-elderly patients. In addition to contact dermatitis, other types of allergies were observed in 20 (33.3%) of elderly patients and in 113 (37.4%) of non-elderly patients (p=0.54). There were 162 positive reactions on the patch test among elderly patients and 738 positive reactions among non-elderly patients (p=0.24). Strong positive reactions were present in 41 (68.3%) elderly patients and in 156 (51.6%) non-elderly patients (p=0.02). Strong and very strong positive reactions, when assessed together, were detected in 44 (73.3%) elderly patients and in 214 (70.8%) non-elderly patients (p=0.69). The most common allergens were nickel sulfate (in 33.3% of elderly and 38% of non-elderly patients) and fragrance mix (in 25% of elderly and 27.8% of non-elderly patients), with no statistical difference between the groups. CONCLUSIONS: There was a high rate of positive reactions on the patch test among patients with contact dermatitis, with no difference between elderly and non-elderly individuals, and the most common allergens were nickel sulfate and fragrance mix. Therefore, it is important that allergy to nickel and fragrances be included in the etiologic investigation of contact dermatitis, regardless of age.

Absenteísmo e envelhecimento no contexto ocupacional do Policial Militar / Absenteeism and aging in the military police workforce

Contexto: A atividade do Policial Militar é desgastante por vivenciar o perigo. As suas condições de trabalho ocasionam danos e favorecem o envelhecimento funcional e o absenteísmo. Objetivos: Identificar as causas do absenteísmo na atividade do Policial Militar e compreender suas condições de trabalho, relacionando-as com o envelhecimento funcional. Métodos: Trata-se de um estudo quanti-qualitativo, retrospectivo e transversal. Os sujeitos de pesquisa foram Policiais Militares do 9° Batalhão do Interior de São Paulo, do Grupamento de Incêndio, da Polícia Ambiental e do Policiamento Rodoviário, atendidos na Unidade Integrada de Saúde (UIS). Os dados foram coletados dos prontuários (n=285) relativos ao ano de 2012. Uma entrevista semiestruturada foi aplicada para conhecer a percepção dos policiais sobre suas condições de trabalho, relacionando-as com o envelhecimento funcional. Resultados: Verificou-se predomínio de absenteísmo por traumas e problemas ortopédicos. Constataram-se, nas entrevistas, queixas relacionadas ao estresse da profissão como fator preponderante para o envelhecimento funcional. Conclusão: Esta pesquisa possibilitou verificar o absenteísmo e as condições de trabalho dos Policiais Militares atendidos na UIS. Conhecer essas vertentes é relevante para propor ações de saúde. A pesquisa bibliográfica demonstrou carência de estudos nessa área.

Context: The activity of the Military Police is exhausting because they experience danger. Their working conditions cause damage and favor the functional aging and absenteeism. Objectives: To identify the causes of absenteeism in the military police activity and to understand their working conditions related to the functional aging. Methods: This is a quantitative-qualitative, retrospective and transversal study. The research subjects were Military Police of a Battalion of the São Paulo's countryside, the Fire Combat Team, the Environmental Police and Road Policing seen at the Integrated Health Unit (IHU). Data was collected from medical records (n=285) from the year 2012. A semi-structured interview was used to understand the perception of the police about their working conditions, relating them to the functional aging. Results: There was a predominance of absenteeism by orthopedic trauma and problems. As regards the interviews, complaints related to the stress of the job were found to be a major factor for the functional aging. Conclusion: This research enabled to verify the absenteeism and working conditions of the Military Police seen at IHU. Knowing these strands is relevant to propose health actions. The literature search has shown a lack of studies in this area.

Chronic spontaneous urticaria: cutaneous reaction and laboratory aspects / Urticária crônica espontânea: reatividade cutânea e aspectos laboratoriais

ABSTRACT Introduction: The chronic spontaneous urticaria (CSU) is a cutaneous reaction characterized by the formation of episodic and recurrent erythematous papules, usually pruritic, which etiology may be associated with an autoimmune response resulting from the action of immunoglobulin subclass G (IgG) of autoantibodies directed against the immunoglobulin subclass E (IgE) receptors of cutaneous mast cells or against IgE bound to mast cells. The autologous serum skin test (ASST) is a screening test that indicates the presence of these autoantibodies in patients with CSU. Objective: To check for differences in ASST results among patients with CSU and the control group with other hypersensitivities. Material and method: This is a cross-sectional case-control study, in which 49 adults were analyzed, 27 with CSU and 22 with other hypersensitivity reactions. ASST, CD123, estimation of IgG bound to basophil, mean platelet volume (MPV), antinuclear antibody (ANA), thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPOab), erythrocyte sedimentation rate (ESR) and the total IgE were performed in both groups. Results: The ASST, shown positive results in 16 (59.2%) the patients with CSU and in five (22.7%) from the control group, with statistical significance. For the other variables above described, there was no statistical difference. Conclusion: A higher ASST positivity was found in CSU patients compared to patients with other hypersensitivities, and further studies with larger sample are needed for better analysis of other variables.

RESUMO Introdução: A urticária crônica espontânea (UCE) é uma reação cutânea caracterizada pela formação de pápulas eritematosas episódicas e recorrentes, em geral, pruriginosas, cuja etiologia pode estar relacionada com uma reação autoimune decorrente da ação de autoanticorpos de imunoglobulinas da classe G (IgG), dirigidos contra receptores da imunoglobulina da classe E (IgE) dos mastócitos cutâneos, ou contra IgE ligadas aos mastócitos. O teste do soro autólogo (TSA) é um exame de triagem que sugere a presença desses autoanticorpos em pacientes com UCE. Objetivo: Verificar se existem diferenças nos resultados do TSA entre os pacientes com UCE e os de um grupo-controle com outras hipersensibilidades. Material e método: Trata-se de um estudo transversal de caso-controle, no qual foram analisados 49 adultos, sendo 27 com UCE e 22 com outras reações de hipersensibilidades. Foram realizados TSA, CD123, pesquisa de IgG ligada ao basófilo, volume plaquetário médio (VPM), fator antinuclear (FAN), hormônio estimulador da tireoide (TSH), antitireoperoxidase (anti-TPO), velocidade de hemossedimentação (VHS) e IgE total em ambos os grupos. Resultados: O TSA demonstrou resultados positivos em 16 (59,2%) pacientes com UCE e em cinco (22,7%) do grupo-controle, com significância estatística. Para as demais variáveis descritas acima, não se encontrou diferença estatística. Conclusão: Constatou-se maior positividade do TSA nos pacientes com UCE em relação aos pacientes com outras hipersensibilidades, sendo que, para melhor análise das demais variáveis, são necessários outros estudos envolvendo maior amostragem.

Immunotherapy in allergies / Imunoterapia nas alergias

The allergen specific immunotherapy is the administration, in IgE-mediated allergic patients, of a specific allergen in a gradually increased number to provide protection against allergic symptoms and inflammatory reaction. The current immunotherapeutic approaches occur by modulating the release of inflammatory mediators involved in allergic reaction and consequently the inhibition of allergic inflammatory process. Since 1997 several World Associations of Allergy, Asthma and Immunology, have reviewed this issue, seeking to establish standards for its use. Also many publications about the immunotherapy's efficacy, as well as, several guidelines on the use of immunotherapy in the treatment of allergic are available. This article will focus on the most current evidence about the immunotherapy in allergies regarding its mechanism of action, effectiveness and practical considerations.

Sintomas de alergia em idosos atendidos em um ambulatório de geriatria / Symptoms of allergy in elderly attended by a geriatric outpatient clinic

Objetivos: Descrever as características epidemiológicas de manifestações alérgicas observadas nos idosos atendidos em um ambulatóriode geriatria.Métodos: Foi realizado um estudo transversal com pacientes de mais de 60 anos de idade, atendidos no Ambulatório de Geriatria da Faculdadede Medicina de Marília, estado de São Paulo, em condições de responder a uma entrevista ou com acompanhantes capacitados pararespondê-la.Resultados: Foram entrevistados 106 pacientes. Dentre os 106 pacientes avaliados, 56 (52,8%) relataram alergia respiratória, 47 (44,3%)possível manifestação alérgica de pele e 14 (13,2%) referiram alergia a medicamentos. Os principais medicamentos responsabilizados pelospacientes como causadores de reações alérgicas foram os antibióticos (42,8%) e os anti-inflamatórios não esteroides (28,6%), enquanto osoutros 28,6% foram atribuídos a outros tipos de medicamentos.Conclusões: Os idosos incluídos no estudo apresentaram uma relevante prevalência de sintomas alérgicos.

Aims: To describe the epidemiological characteristics of allergic manifestations observed in elderly attended in an outpatient clinic of geriatrics.Methods: A cross sectional study was conducted with patients over 60 years of age, attended in the Outpatient Clinics of Geriatrics of theFaculty of Medicine of Marilia in Sao Paulo state, who were able to respond to an interview or were accompanied by caregivers able to do it.Results: A total of 106 patients were interviewed. Among the 106 patients evaluated, 56 (52.8%) reported respiratory allergy, 47 (44.3%)possible allergic skin manifestation, and 14 (13.2%) reported drug allergies. The main medicines perceived by patients as drugs that causedallergic reactions were antibiotics (42.8%) and non-steroidal anti-inflammatory (28.6%), while the other 28.6% of reactions were attributedto other types of drugs.Conclusions: The elderly included in the study had a relevant prevalence of allergic symptoms.

Estudo comparativo sobre a prevalência de alergias entre idosos e não idosos / A comparative study of the prevalence of allergies in elderly and non-elderly patients

Doenças alérgicas também estão presentes no idoso e apesar do impacto em sua qualidade de vida, podem ser subdiagnosticadas ou desvalorizadas pela concomitância de outras doenças consideradas de maior gravidade e de risco à vida. Este estudo teve como objetivo analisar a prevalência de doenças alérgicas observadas em idosos com 60 anos ou mais, comparando-se com a de não idosos, atendidos em clínica especializada em alergia. Métodos: Realizou-se uma análise retrospectiva de prontuários de uma clínica particular, supervisionada pela Disciplina de Alergia da Faculdade de Medicina de Marília. Resultados: Dentre os 398 prontuários analisados, 51 (12,8%) eram de pacientes com 60 anos ou mais, com os seguintes diagnósticos de doenças alérgicas ou de hipersensibilidade: 31,4% dermatite de contato; 15,7% urticária crônica; 13,7% reação adversa a fármaco(s) (RAF); 11,8% rinite; 7,8% asma; 7,8% prurido; e 3,9% tosse. Os demais 347 pacientes tinham menos que 60 anos, com os seguintes diagnósticos de doenças alérgicas ou de hipersensibilidade: 24,2% urticária crônica; 23,6% rinite; 21,6% dermatite de contato; 11,5% asma; 4,3% RAF; 3,4% urticária aguda; 2,6% conjuntivite alérgica; 1,4% tosse; 1,1% dermatite atópica; 1,1% prurido. Houve prevalência significantemente maior de RAF e de prurido no grupodos idosos. Conclusões: Conclui-se que os idosos apresentaram prevalências semelhantes para as diversas doenças alérgicas ou de hipersensibilidade em relação aos não idosos, exceto para RAF e prurido, os quais predominaram na população idosa...

Allergic diseases are also present in the elderly. Despite their impact on the quality of life of elderly patients, allergies may be underdiagnosed or undervalued because of the concurrent presence of other more severe and life-threatening conditions. The objective of the present study was to assess the prevalence of allergic diseases in elderly patients aged 60 years or older, as compared to non-elderly patients, all assisted at an allergy specialty clinic. Methods: Patients’ medical records were retrospectively analyzed at a private clinic supervised by the Discipline of Allergy at Faculdade de Medicina de Marília. Results: Of the 398 records analyzed, 51 (12.7%) were from elderly patients who had the following diagnoses of allergy or hypersensitivity: 31.4% contact dermatitis; 15.7% chronic urticaria; 13.7% adverse drug reaction (ADR); 11.8% rhinitis;7.8% asthma; 7.8% pruritus; and 3.9% cough. The remaining 347 patients were younger than 60 years and had the following diagnoses: 24.2% chronic urticaria; 23.6% rhinitis; 21.6% contact dermatitis; 11.5% asthma; 4.3% ADR; 3.4% acute urticaria; 2.6% allergic conjunctivitis; 1.4% cough; 1.1% atopic dermatitis; and 1.1% pruritus. There was a significantly higher prevalence of ADR and pruritus in the elderly group. Conclusions: Our findings suggest that elderly patients tend to show similar prevalence rates for different allergic and hypersensitivity conditions when compared to non-elderly patients, except for ADR and pruritus, which were more prevalent in the elderly...

Risk factors for cardiovascular disease in psoriasis: relation to inflammation assessed by the severity and duration of illness.

BACKGROUND: Recent studies have shown that psoriasis is associated with risk factors for cardiovascular diseases (CVDs). OBJECTIVES: To evaluate the epidemiological profile of patients with psoriasis, focusing on the risk factors for CVDs and inflammation. MATERIALS & METHODS: Patients with a diagnosis of psoriasis who were attended at the dermatology outpatient clinic of a university hospital were evaluated. RESULTS: 229 adult patients of mean age 50 years, among whom 52% were male, were evaluated. Twenty patients (8.7%) were concomitantly affected by psoriatic arthritis. From analysis on laboratory tests from 177 patients, we saw that 111 (62.7%) were dyslipidemic and that among these, only 9 (8%) were undergoing treatment. 35.6% presented abnormal glycemia tests, but 22% were not having any treatment for the glycemic alteration observed. We analyzed possible associations of the severity of psoriasis and length of time with the disease with lipid disorders, glycemic disorders and systemic arterial hypertension, but did not find any significant associations. CONCLUSION: The findings observed in this study corroborate previous findings in similar studies, thus demonstrating that the prevalence of risk factors for CVDs among patients with psoriasis is greater than in the general population, but that a large proportion of such patients do not undergo treatment for this. We did not find any possible association between the inflammatory process and the genesis of risk factors for CVDs, although the magnitude of this evidence is not strong. These findings serve to alert dermatologists to remain attentive to these factors, among patients with psoriasis.

Basophil activation test with indomethacin to assess hypersensitivity to non-steroidal anti-inflammatory drugs: a preliminary study.

BACKGROUND: The basophil activation test has been investigated for diagnosing hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). This has not yet been done in relation to indomethacin. OBJECTIVE: First seek to establish the viable concentrations of indomethacin and the diluent propylene glycol (PPG) in relation to basophils then test this in patients with hypersensitivity to NSAIDs. MATERIALS & METHODS: The ideal concentrations of PPG and indomethacin were assessed by incubating them with basophils from an atopic donor and evaluating the intensity of expression of CD63 molecules by means of flow cytometry. We also evaluated the cell viability directly using the trypan blue in seven controls. Then indomethacin was tested in ten patients with hypersensitivity to NSAIDs compared with eight persons in control group. RESULTS: In relation to the toxicity of propylene glycol, concentrations less than or equal to 0.5% are safe. There was no cytotoxicity or nonspecific stimulation from using indomethacin at concentrations of 10 mcg/mL, 1 mcg/mL and 0.1 mcg/mL. Then indomethacin was tested at concentration of 10 mcg/mL diluted in 0.5% propylene glycol in both groups. There was no statistical difference in the intensity of activation of basophils comparing the group of patients with hypersensitivity to NSAIDs and the control group. CONCLUSIONS: As a diluent for indomethacin, PPG should be used at concentrations less than or equal to 0.5%. The indomethacin at concentration of 10 mcg/mL was not able to differentiate patients with and without hypersensitivity to NSAIDs.

Immunotherapy in allergies: an update.

The allergen specific immunotherapy is the administration, in IgE-mediated allergic patients, of a specific allergen in a gradually increased number to provide protection against allergic symptoms and inflammatory reaction. The current immunotherapeutic approaches occur by modulating the release of inflammatory mediators involved in allergic reaction and consequently the inhibition of allergic inflammatory process. Since 1997 several World Associations of Allergy, Asthma and Immunology, have reviewed this issue, seeking to establish standards for its use. Also many publications about the immunotherapy's efficacy, as well as, several guidelines on the use of immunotherapy in the treatment of allergic are available. This article will focus on the most current evidence about the immunotherapy in allergies regarding its mechanism of action, effectiveness and practical considerations.

Chronic spontaneous urticaria: epidemiological characteristics focusing on the histocompatibility profile and presence of antibodies.

BACKGROUND: Understanding the etiopathogenesis of chronic spontaneous urticaria (CSU) remains a challenge. The clinical and laboratory characteristics relating to its histocompatibility profile and autoimmunity are constant research topics. OBJECTIVES: To analyze the clinical and laboratory characteristics of patients with CSU by means of a cross-sectional study, focusing on the histocompatibility profile, presence of antinuclear antibodies (ANA) and presence of antithyroperoxidase antibodies (anti-TPO). MATERIALS & METHODS: Sixty-seven adults with CSU were analyzed. The autologous serum skin test (ASST), ANA and anti-TPO were performed in all cases and MHC classes I and II (loci A, B and DR) were evaluated in 49 patients. RESULTS: The factors that worsened urticaria included use of non-steroid anti-inflammatory drugs, emotional stress and physical stimuli, reported by 27%, 16% and 15% of these patients, respectively. The ASST test was positive in 49 patients (73%) and anti-TPO and ANA were present in 15 (22.4%) and 7 (10.5%), respectively. The OR (with 95% CI) for the association between ANA and anti-TPO was 5.94 (1.16-30.42), and thus statistically significant. There was a favorable association (with statistical significance) between HLA B*50 and patients with CSU, with OR (95% CI) of 2.96 (1.17- 7.48). CONCLUSION: A significant favorable association was found between these patients and HLA B*50, and between the presence of anti-TPO and ANA. The greater prevalence of HLA B*50 in these patients and the association between ANA and anti-TPO reinforce the possibility that an immunogenic mechanism may be the triggering factor for CSU.

HLA among Brazilian patients with spontaneous chronic urticaria and positive autologous serum skin test.

BACKGROUND: An association between class I and II alleles of the major histocompatibility complex and idiopathic chronic urticaria has previously been observed in different populations, but there are still no studies on Brazilian populations in this regard. OBJECTIVE: The involvement of the major histocompatibility complex classes I and II (loci A, B and DR) in Brazilian patients with idiopathic chronic urticaria and a positive autologous serum skin test was investigated and compared with a healthy population group. METHODS: DNA was extracted from the blood of 42 patients with idiopathic chronic urticaria and major histocompatibility complex classes I and II alleles were determined using the polymerase chain reaction and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients' clinical history and routine laboratory tests. Only the patients with positive autologous serum skin test were selected. The allele distribution resulted from the patient and control groups were analyzed using odds ratios and 95% confidence intervals. RESULTS: No statistically significant differences were found between the positive autologous serum skin test patients with chronic urticaria and the control group. CONCLUSIONS: We found that in this population group, there was no specific association between the HLA alleles studied and chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.

HLA among Brazilian patients with spontaneous chronic urticaria and positive autologous serum skin test / HLA em brasileiros com urticária crônica espontânea e teste cutâneo do soro autólogo positivo

BACKGROUND: An association between class I and II alleles of the major histocompatibility complex and idiopathic chronic urticaria has previously been observed in different populations, but there are still no studies on Brazilian populations in this regard. OBJECTIVE: The involvement of the major histocompatibility complex classes I and II (loci A, B and DR) in Brazilian patients with idiopathic chronic urticaria and a positive autologous serum skin test was investigated and compared with a healthy population group. METHODS: DNA was extracted from the blood of 42 patients with idiopathic chronic urticaria and major histocompatibility complex classes I and II alleles were determined using the polymerase chain reaction and a laboratory test for oligonucleotide hybridization using a single-filament probe. The frequencies of these alleles in patients with chronic urticaria were compared with the frequencies in 1000 genetically unrelated voluntary blood donors from the same region of Brazil. The diagnosis of idiopathic chronic urticaria was based on the patients' clinical history and routine laboratory tests. Only the patients with positive autologous serum skin test were selected. The allele distribution resulted from the patient and control groups were analyzed using odds ratios and 95% confidence intervals. RESULTS: No statistically significant differences were found between the positive autologous serum skin test patients with chronic urticaria and the control group. CONCLUSIONS: We found that in this population group, there was no specific association between the HLA alleles studied and chronic urticaria. We believe that further population studies are needed in order to investigate the possible existence of this association.

FUNDAMENTOS: A associação entre os alelos do MHC classe I e II e a urticária crônica idiopática tem sido previamente constatada em diferentes populações, sendo que na população brasileira ainda não existem estudos a este respeito. OBJETIVOS: Foi estudado o envolvimento do MHC classe I e II (locci A, B e DR) em pacientes brasileiros com urticária crônica idiopática e teste cutâneo do soro autólogo positivo, comparando-se com um grupo populacional saudável. MÉTODOS: O DNA foi extraído do sangue de 42 pacientes com urticária crônica idiopática e o MHC classe I e II determinado por reação em cadeia da polimerase e teste laboratorial de hibridização de oligonucleotídeo com sonda de filamento único. A freqüência destes alelos em pacientes com urticária crônica idiopática foi comparada com a de 1000 doadores de sangue voluntários e geneticamente não relacionados, da mesma região do Brasil. O diagnóstico de urticária crônica idiopática foi baseado na história clínica do paciente e exames laboratoriais de rotina; foram selecionados apenas os pacientes com teste cutâneo do soro autólogo positivo. O resultado da distribuição alélica entre o grupo de pacientes e o grupo controle foi analisado através do odds rate com o cálculo do intervalo de confiança de 95% (95% IC). RESULTADOS: Não foram encontradas diferenças com significância estatística entre os pacientes com urticária crônica teste cutâneo do soro autólogo positivos e o grupo controle. CONCLUSÕES: Verificamos que neste grupo populacional estudado não houve associação específica entre os alelos HLA estudados e a urticária crônica; acreditamos na necessidade de outros estudos populacionais, para podermos verificar a possível existência desta associação.

CD63 e CD123 expressão, autoanticorpos IgG e acurácia do teste do soro autólogo em pacientes com urticária crônica / CD63 and CD123 expression, IgG autoantibody and accuracy of autologous serum test in patients with chronic urticaria

INTRODUÇÃO: Na urticária crônica (UC), o teste cutâneo do soro autólogo (TCSA) pode sugerir a etiologia autoimune. Recentemente, uma nova técnica laboratorial denominada teste de ativação de basófilos (TAB) vem sendo utilizada para esse diagnóstico. OBJETIVOS: Analisar o TCSA em relação ao TAB, assim como avaliar os receptores da interleucina 3 (IL3) (CD123) e a presença de autoanticorpos da classe de imunoglobulina G (IgG) inespecíficos ligados aos basófilos de pacientes com UC. MÉTODOS: Estudamos 33 adultos com UC espontânea com idade média de 42,5 + 14 anos. Por meio da citometria de fluxo foi feita a análise da expressão das moléculas CD63 em basófilos de um doador atópico após o estímulo pelo soro dos pacientes com UC. Também realizamos a pesquisa da expressão da molécula CD123 e de autoanticorpos IgG inespecíficos. RESULTADOS: O odds ratio (OR) entre o TCSA e o TAB foi de 1 (intervalo de confiança [IC] 95 por cento: 0,22-4,5). O TCSA para o diagnóstico da UC autoimune mostrou acurácia de 54,5 por cento, sensibilidade de 66 por cento, especificidade de 33 por cento, valor preditivo positivo de 63 por cento e valor preditivo negativo de 36 por cento. Não houve diferença estatística entre os grupos estudados quanto à média de expressão dos anticorpos IgG inespecíficos e das moléculas CD123 (para um p < 0,05). DISCUSSÃO: Este estudo demonstrou baixa precisão do TCSA no diagnóstico da UC autoimune; o grupo de pacientes com TCSA positivo não mostrou diferença estatística em relação ao grupo com TCSA negativo nos demais aspectos analisados. CONCLUSÃO: Pelos poucos estudos existentes e pela relevância do assunto, acreditamos na necessidade de mais estudos abordando esses aspectos.

INTRODUCTION: The autologous serum skin test (ASST) may suggest an autoimmune etiology in chronic urticaria (CU). A new laboratory technique called basophil activation test (BAT) has been currently employed for its diagnosis. OBJECTIVE: To analyze ASST in relation to BAT as well as to evaluate interleukin 3 (IL3) receptors (CD123) and non-specific immunoglobulin G (IgG) autoantibodies bound to basophils in patients with chronic urticaria. METHODS: We studied 33 adults with CU and mean age of 42.5 + 14 years. After stimulation by serum from patients with CU, CD63 expression on basophils from one atopic donor was analyzed by flow cytometry. Furthermore, we investigated CD123 and IgG autoantibody expressions. RESULTS: The odds ratio (OR) between ASST and BAT was 1.00 (95 percent confidence interval [CI]: 0.22 to 4.5). The ASST for autoimmune CU diagnosis showed an accuracy of 54.5 percent, sensitivity of 66 percent, specificity of 33 percent, positive predictive value of 63 percent, and negative predictive value of 36 percent. There was no statistical difference between the studied groups as to mean non-specific IgG and CD123 expressions (for a p < 0.05). DISCUSSION: This study demonstrated that ASST has low accuracy in the diagnosis of autoimmune CU. Concerning other analyzed aspects, there was no statistical difference between positive ASST and negative ASST. CONCLUSIONS: Due to insufficient studies in this area and the relevance of this issue, further investigation is required.