A Graphene-Based Enzymatic Biosensor Using a Common-Gate Field-Effect Transistor for L-Lactic Acid Detection in Blood Plasma Samples.

Lactate is an important organic molecule that is produced in excess during anaerobic metabolism when oxygen is absent in the human organism. The concentration of this substance in the body can be related to several medical conditions, such as hemorrhage, respiratory failure, and ischemia. Herein, we describe a graphene-based lactate biosensor to detect the concentrations of L-lactic acid in different fluids (buffer solution and plasma). The active surface (graphene) of the device was functionalized with lactate dehydrogenase enzyme using different substances (Nafion, chitosan, and glutaraldehyde) to guarantee stability and increase selectivity. The devices presented linear responses for the concentration ranges tested in the different fluids. An interference study was performed using ascorbic acid, uric acid, and glucose, and there was a minimum variation in the Dirac point voltage during detection of lactate in any of the samples. The stability of the devices was verified at up to 50 days while kept in a dry box at room temperature, and device operation was stable until 12 days. This study demonstrated graphene performance to monitor L-lactic acid production in human samples, indicating that this material can be implemented in more simple and low-cost devices, such as flexible sensors, for point-of-care applications.

Application of the MISSCARE scale in an Oncology Service: a contribution to patient safety.

OBJECTIVE: To investigate the prevalence of and reasons for missed nursing care in oncology units. METHOD: A cross-sectional study was conducted at inpatient oncology units at a private hospital. Eighty-three professionals from the nursing team took part. The MISSCARE instrument and a sociodemographic questionnaire were administered. Simple descriptive statistics were used for analyses. Pearson's chi-square test was used to detect associations between variables. RESULTS: The care tasks missed most frequently were assisting with toileting needs within 5 minutes of a request (57.8%), ambulation 3 times per day or as ordered (44.6%), and turning patients every 2 hours (36.1%). The main reasons for missed care were related to communication: tension or communication breakdowns within the nursing team, and the caregiver responsible off unit or unavailable (both 66.2%). CONCLUSIONS: there is a need to develop nursing interventions that neutralize and/or reduce the negative results of this missed care in order to improve the quality of care provided to cancer patients.

Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study. / Razão neutrófilo-linfócito no diagnóstico precoce de sepse em unidade de terapia intensiva: um estudo de caso-controle.

OBJECTIVE: To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit. METHODS: Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant. RESULTS: The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm3/mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality. CONCLUSION: The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

OBJETIVO: Avaliar a razão neutrófilo-linfócito na predição de sepse e mortalidade em pacientes admitidos em uma unidade de terapia intensiva. MÉTODOS: Estudo de caso-controle de pacientes adultos admitidos em terapia intensiva. Foram incluídos como casos pacientes que tiveram sepse como razão de admissão e possuíam exame laboratorial de hemograma prévio. As análises estatísticas realizadas foram curva ROC, regressão logística binária, Mann Whitney e qui-quadrado de Pearson. Foi considerado significativo valor de p < 0,05. RESULTADOS: Os valores de curva ROC foram 0,62 para razão neutrófilo-linfócito, 0,98 para neutrófilos bastonados e 0,51 para leucócitos totais. A presença de razão neutrófilo-linfócito superior a 5,0, o número de leucócitos acima de 12.000mm3/mL e número de neutrófilos bastonados acima 10% foram fatores de risco para sepse, entretanto somente os escores SAPS 3 e SOFA estavam relacionados a mortalidade dos pacientes. CONCLUSÃO: A razão neutrófilo-linfócito e os neutrófilos bastonados em combinação com outros parâmetros podem ser marcadores na detecção precoce de sepse em terapia intensiva.

Razão neutrófilo-linfócito no diagnóstico precoce de sepse em unidade de terapia intensiva: um estudo de caso-controle / Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

RESUMO Objetivo: Avaliar a razão neutrófilo-linfócito na predição de sepse e mortalidade em pacientes admitidos em uma unidade de terapia intensiva. Métodos: Estudo de caso-controle de pacientes adultos admitidos em terapia intensiva. Foram incluídos como casos pacientes que tiveram sepse como razão de admissão e possuíam exame laboratorial de hemograma prévio. As análises estatísticas realizadas foram curva ROC, regressão logística binária, Mann Whitney e qui-quadrado de Pearson. Foi considerado significativo valor de p < 0,05. Resultados: Os valores de curva ROC foram 0,62 para razão neutrófilo-linfócito, 0,98 para neutrófilos bastonados e 0,51 para leucócitos totais. A presença de razão neutrófilo-linfócito superior a 5,0, o número de leucócitos acima de 12.000mm3/mL e número de neutrófilos bastonados acima 10% foram fatores de risco para sepse, entretanto somente os escores SAPS 3 e SOFA estavam relacionados a mortalidade dos pacientes. Conclusão: A razão neutrófilo-linfócito e os neutrófilos bastonados em combinação com outros parâmetros podem ser marcadores na detecção precoce de sepse em terapia intensiva.

ABSTRACT Objective: To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit. Methods: Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant. Results: The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm3/mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality. Conclusion: The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

Adolescent and youth health policies in the Portuguese-Brazilian context: specificities and approximations. / Políticas de Saúde de adolescentes e jovens no contexto luso-brasileiro: especificidades e aproximações.

OBJECTIVE: To characterize the scientific production on adolescent health policies and programs in Brazil and Portugal in the period 2010-2017. METHOD: This is a literature review based on the Scoping Review method. The research guidingquestion was: "How is the scientific production on adolescent health policies and programs in Brazil and Portugal characterized?"Search was carried out in October 2017 on the BVS, EBSCO and Google Scholar platforms. RESULTS: Twenty-two studies were selected, namely, 17 Brazilian and 5 Portuguese. Seven cross-cutting thematic categories were identified, as follows: policy and program evaluation; health promotion and education; mental health; sexual and reproductive health; violence; oral health and nutritional health. We canconclude that, albeit in different social contexts, the themes reflect traditional areas of intervention of policies and programs, except for those arising from the phenomenon of structural violence, markedly present in the Brazilian reality. Also, the lack of emerging issues such as gender identities, migratory flows, and morbimortality from external causes reveal a possible care gap in policies and programs and a necessary field to be explored.

O objetivo deste artigo é caracterizar a produção científica sobre políticas e programas de saúde de adolescentes no Brasil e em Portugal no período 2010-2017. Estudo de revisão da literatura, baseado no método de "Scoping Review". A questão de investigação: como se caracteriza a produção científica sobre políticas e programas de saúde de adolescentes do Brasil e de Portugal? As buscas foram realizadas no mês de outubro de 2017, nas plataformas BVS, EBSCO e Google Acadêmico. Foram selecionados 22 estudos, 17 brasileiros e 5 portugueses. Foram identificadas sete categorias temáticas transversais: avaliação de políticas e programas; promoção e educação para a saúde; saúde mental; saúde sexual e reprodutiva; violência; saúde bucal e saúde nutricional. Conclui-se que, embora em contextos sociais distintos, as temáticas refletem áreas tradicionais de intervenção das políticas e programas, com exceção daquelas decorrentes do fenômeno da violência estrutural, marcadamente presente na realidade brasileira. Ainda, ausência de temáticas emergentes como identidades de gênero, fluxos migratórios e morbimortalidade por causas externas, revelando possível vazio assistencial das políticas e programas e um campo necessário a ser explorado.

Políticas de Saúde de adolescentes e jovens no contexto luso-brasileiro: especificidades e aproximações / Adolescent and youth health policies in the Portuguese-Brazilian context: specificities and approximations

Resumo O objetivo deste artigo é caracterizar a produção científica sobre políticas e programas de saúde de adolescentes no Brasil e em Portugal no período 2010-2017. Estudo de revisão da literatura, baseado no método de "Scoping Review". A questão de investigação: como se caracteriza a produção científica sobre políticas e programas de saúde de adolescentes do Brasil e de Portugal? As buscas foram realizadas no mês de outubro de 2017, nas plataformas BVS, EBSCO e Google Acadêmico. Foram selecionados 22 estudos, 17 brasileiros e 5 portugueses. Foram identificadas sete categorias temáticas transversais: avaliação de políticas e programas; promoção e educação para a saúde; saúde mental; saúde sexual e reprodutiva; violência; saúde bucal e saúde nutricional. Conclui-se que, embora em contextos sociais distintos, as temáticas refletem áreas tradicionais de intervenção das políticas e programas, com exceção daquelas decorrentes do fenômeno da violência estrutural, marcadamente presente na realidade brasileira. Ainda, ausência de temáticas emergentes como identidades de gênero, fluxos migratórios e morbimortalidade por causas externas, revelando possível vazio assistencial das políticas e programas e um campo necessário a ser explorado.

Abstract Objective To characterize the scientific production on adolescent health policies and programs in Brazil and Portugal in the period 2010-2017. Method This is a literature review based on the Scoping Review method. The research guidingquestion was: "How is the scientific production on adolescent health policies and programs in Brazil and Portugal characterized?"Search was carried out in October 2017 on the BVS, EBSCO and Google Scholar platforms. Results Twenty-two studies were selected, namely, 17 Brazilian and 5 Portuguese. Seven cross-cutting thematic categories were identified, as follows: policy and program evaluation; health promotion and education; mental health; sexual and reproductive health; violence; oral health and nutritional health. We canconclude that, albeit in different social contexts, the themes reflect traditional areas of intervention of policies and programs, except for those arising from the phenomenon of structural violence, markedly present in the Brazilian reality. Also, the lack of emerging issues such as gender identities, migratory flows, and morbimortality from external causes reveal a possible care gap in policies and programs and a necessary field to be explored.

Alterações celulares do HPV e de microflora de pacientes do SUS em São Leopoldo, RS Brasil / Cytological abnormalities from HPV and microflora of SUS patients in São Leopoldo city, RS Brazil

Objetivo: avaliar alterações celulares decorrentes do Papilomavirus Humano (HPV) e de microflora dos exames citopatológico das pacientes do SUS de São Leopoldo-RS. METODOLOGIA: estudo ecológico em base de dados do período de 2006-2014. Variáveis estudadas contemplavam alterações de microflora, alterações causadas por HPV e sociodemográficos. RESULTADOS: a cobertura do rastreamento do câncer do colo do útero estimada foi de 14,6%. Gardenerella vaginallis foi microrganismo patogênico com maior frequência (16,1%) e dentre as alterações relacionadas ao HPV, alterações atípicas apresentam 1,7%, Lesão Intraepitelial de Baixo Grau 0,96% e Lesões Intraepiteliais de Alto Grau 0,22%. DISCUSSÃO: as alterações nos laudos do Papanicolaou estão do município de acordo com os dados observados na literatura, entretanto ressalta-se que a cobertura estimada não atinge as recomendações brasileiras. CONCLUSÃO: as bases de dados disponíveis permitem uma análise da realidade local, entretanto, para isso é necessário o correto preenchimento das mesmas.

Objective: to evaluate cellular alterations due to the human papillomavirus (HPV) and the microflora of the cytopathological test of SUS patients in São Leopoldo-RS. METHODOLOGY: ecological study on a database from 2006-2014. The variables studied included changes in the microflora, changes caused by the HPV and sociodemographic changes. RESULTS: the screening coverage of the estimated cervical cancer was 14.6%. Gardenerella vaginallis was the most frequent pathogenic microorganism (16.1%), and among the HPV-related alterations, atypical alterations represented 1.7%, Low Grade Intraepithelial Lesions, 0.96%, and High Grade Intraepithelial Lesions, 0.22%. DISCUSSION: the results of the changes in Pap smears are in line with the data observed in the literature; however, it should be emphasized that the coverage estimates do not fulfil the Brazilian determinations. Conclusion: the available databases allow an analysis of the local reality. Nevertheless, for this to be feasible, it is necessary to correct them.

Objetivo: evaluar alteraciones celulares derivadas del Papilomavirus Humano (HPV) y de microflora de los exámenes citopatológicos de las pacientes del SUS de São Leopoldo-RS. METODOLOGÍA: estudio ecológico en base de datos del período 2006-2014. Las variables estudiadas incluían cambios de microflora, cambios causados por el HPV y sociodemográficos. RESULTADOS: la cobertura del rastreo del cáncer del cuello del útero estimada, fue de 14,6%. Gardenerella vaginallis fue el microorganismo patógeno más frecuente (16,1%) y entre las alteraciones relacionadas con el HPV, las alteraciones atípicas presentan 1,7%, Lesiones Intraepiteliales de Bajo Grado 0,96% y Lesiones Intraepiteliales de Alto Grado 0,22%. DISCUSIÓN: los resultados de los cambios en los frotis de Papanicolaou están de acuerdo con la literatura, sin embargo se enfatiza que las estimaciones de cobertura no alcanzan las determinaciones brasileñas. CONCLUSIÓN: las bases de datos disponibles permiten un análisis de la realidad local, sin embargo, para eso es necesario llenar adecuadamente

Effect of Aqueous Extract of Giant Horsetail (Equisetum giganteum L.) in Antigen-Induced Arthritis.

Equisetum giganteum is a plant used in traditional medicine as diuretic. From our knowledge this is the first time this plant is tested in an in vivo model of acute inflammation. To evaluate the effect of aqueous extract of giant horsetail (AEGH) as immunomodulatory therapy, antigen-induced arthritis (AIA) was generated in mice with methylated bovine serum albumin (mBSA). Inflammation was evaluated by articular nociception, leukocytes migration and lymphocyte proliferation. AEGH reduced nociception at 3, 6 and 24 h (P < 0.01), decreased leukocyte migration (P < 0.015), and inhibited lymphocyte proliferation stimulated with Concanavalin A and Lipopolysaccharide (P < 0.05). In conclusion, AEGH has an anti-inflammatory potential in acute model of inflammation, as well as immunomodulatory effect on both B and T lymphocytes, with an action independent of cytotoxicity.

Diminished expression of complement regulatory proteins on peripheral blood cells from systemic lupus erythematosus patients.

CD55, CD59, CD46, and CD35 are proteins with complement regulatory (Creg) properties that ensure cell and tissue integrity when this system is activated. The aim of this study was to evaluate the Creg expression on peripheral blood cells from SLE patients and its association with cytopenia and disease activity. Flow cytometric analyses were performed on blood cells from 100 SLE patients and 61 healthy controls. Compared with healthy controls, we observed in SLE patients with lymphopenia and neutropenia decreased expression of CD55, CD59, and CD46 (P < 0.05). In SLE patients with anemia, CD59 and CD35 were decreased on red blood cells. Furthermore, there was a negative correlation between CD55 and CD59 on neutrophils and the disease activity. The results suggest there is an altered pattern of Creg expression on the peripheral blood cells of SLE patients, and the expression is correlated with disease activity and/or with activation of the complement system.

Dynamic culture improves MSC adhesion on freeze-dried bone as a scaffold for bone engineering.

AIM: To investigate the interaction between mesenchymal stem cells (MSCs) and bone grafts using two different cultivation methods: static and dynamic. METHODS: MSCs were isolated from rat bone marrow. MSC culture was analyzed according to the morphology, cell differentiation potential, and surface molecular markers. Before cell culture, freeze-dried bone (FDB) was maintained in culture for 3 d in order to verify culture medium pH. MSCs were co-cultured with FDB using two different cultivation methods: static co-culture (two-dimensional) and dynamic co-culture (three-dimensional). After 24 h of cultivation by dynamic or static methods, histological analysis of Cell adhesion on FDB was performed. Cell viability was assessed by the Trypan Blue exclusion method on days 0, 3 and 6 after dynamic or static culture. Adherent cells were detached from FDB surface, stained with Trypan Blue, and quantified to determine whether the cells remained on the graft surface in prolonged non-dynamic culture. Statistical analyses were performed with SPSS and a P < 0.05 was considered significant. RESULTS: The results showed a clear potential for adipogenic and osteogenic differentiation of MSC cultures. Rat MSCs were positive for CD44, CD90 and CD29 and negative for CD34, CD45 and CD11bc. FDBs were maintained in culture for 3 d and the results showed there was no significant variation in the culture medium pH with FDB compared to pure medium pH (P > 0.05). In histological analysis, there was a significant difference in the amount of adhered cells on FDB between the two cultivation methods (P < 0.05). The MSCs in the dynamic co-culture method demonstrated greater adhesion on the bone surface than in static co-culture method. On day 0, the cell viability in the dynamic system was significantly higher than in the static system (P < 0.05). There was a statistical difference in cell viability between days 0, 3 and 6 after dynamic culture (P < 0.05). In static culture, cell viability on day 6 was significantly lower than on day 3 and 0 (P < 0.05). CONCLUSION: An alternative cultivation method was developed to improve the MSCs adhesion on FDB, demonstrating that dynamic co-culture provides a superior environment over static conditions.

Desenvolvimento de artrite induzida por colágeno em camundongos DBA/1J entre os gêneros / Development of collagen-induced arthritis in DBA/1J mice between genders

Introdução: A artrite reumatoide (AR) é uma doença autoimune inflamatória sistêmica de etiologia desconhecida. Modelos animais de artrite são extremamente úteis para o estudo da fisiopatologia da doença e de novas terapias. Objetivo: Considerando a predominância da AR em mulheres e escassez de estudos sobre influência do sexo no desenvolvimento da artrite experimental, o objetivo deste trabalho foi avaliar o impacto do sexo no desenvolvimento clínico da artrite experimental induzida por colágeno do tipo II (CIA). Métodos: Camundongos DBA1J foram divididos em machos e fêmeas, ambos n=6. CIA foi induzida por duas injeções intradérmicas com colágeno no dia zero e 18. Escore clínico da artrite e do edema articular foram avaliados diariamente por 10 dias após o desenvolvimento da doença. Resultados: A evolução do escore clínico não demonstrou diferença entre os machos e fêmeas. O escore clínico avaliado separadamente - patas dianteiras e traseiras, apresentou diferença significativa (p<0,001) – patas traseiras dia 5 (machos 5,8±1,1; fêmeas 3,1±1,8 - p<0,05). Entretanto, o edema articular foi significativamente maior nos machos (p<0,001) no dia 5 (machos 4,5±0,4; fêmeas 3,8±0,5 - p<0,05). Conclusões: Apesar de não serem claras as diferenças entre machos e fêmeas na CIA em camundongos, a maioria dos pesquisadores da área optam por trabalhar com machos. Como em humanos, acredita-se na influência da genética e dos hormônios no desenvolvimento da CIA. Conclui-se que a diferença encontrada no desenvolvimento da artrite experimental entre machos e fêmeas é um parâmetro a ser avaliado de acordo com o tipo de estudo a ser realizado no modelo de CIA.

Background: Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease of unknown etiology. Animal models of arthritis are extremely useful to investigate the pathophysiology of the disease and its new therapies. Aim: Considering that RA affects predominantly women, and acknowledging the lack of studies about the influence of gender in the development of experimental arthritis, the objective of this study was to assess the impact of gender on the clinical development of type II collagen-induced arthritis (CIA). Methods: Animals were divided in two groups (male and female), both n = 6. CIA was induced using intradermal injections with collagen on day zero and 18. Clinical score of arthritis and joint edema were evaluated daily for 10 days after the onset of the disease. Results: Clinical score showed no difference between males and females. The clinical score assessed separately – front and rear paws, showed a significant difference (p<0.001) – rear paws on day 5 (males 5.8±1.1; females 3.1±1.8, p<0.05). However, joint edema was significantly larger (p<0.001) on day 5 (males 4.5±0.4; females 3.8±0.5; p<0.05). Conclusion: Although the differences between male and female mice with CIA are not clear, most researchers choose to work with males. Similarly to humans, genetics and hormones seem to have an influence on the development of CIA. In conclusion, the difference in the development of experimental arthritis between males and females should be assessed according to the type of study to be conducted using a CIA model.

Expressão de proteínas reguladoras do complemento CD55, CD59, CD35 e CD46 na artrite reumatoide / Expression of complement regulatory proteins CD55, CD59, CD35, and CD46 in rheumatoid arthritis

A artrite reumatoide (AR) é uma doença autoimune, associada à sinovite poliarticular inflamatória, que acomete principalmente as articulações periféricas. Cerca de 1 por cento da população mundial é afetada, sendo duas a três vezes mais prevalente em mulheres. Apresenta patogênese complexa e multifatorial. A sinóvia das articulações afetadas é infiltrada por linfócitos T e B, macrófagos e granulócitos. A sinóvia reumatoide adquire características proliferativas, formando o pannus, e invade a cartilagem articular e o osso, levando à destruição da arquitetura normal da articulação e à perda de função. A diminuição da expressão de proteínas reguladoras do complemento (PCR) parece desempenhar papel importante na atividade da AR, associada ao agravamento dos sintomas clínicos. A superativação do sistema complemento (SC) é a causa da exacerbação da doença em vários modelos de doenças autoimunes. O presente artigo tem por objetivo revisar os principais aspectos relacionados à regulação do SC na AR, a fim de propiciar melhor compreensão do potencial papel desse sistema na fisiopatologia e na atividade da doença.

Rheumatoid arthritis (RA) is an autoimmune disease associated with polyarticular inflammatory synovitis affecting mainly peripheral joints. It affects approximately 1 percent of the world population, being two to three times more prevalent in women. Rheumatoid arthritis has a complex and multifactorial pathogenesis. The synovium of the affected joints is infiltrated by T and B lymphocytes, macrophages, and granulocytes. The rheumatoid synovium has proliferative characteristics, forming the pannus, which invades cartilage and bone, leading to normal architecture destruction and function loss. The decreased expression of complement regulatory proteins (CRP) seems to play an important role in RA activity, and is associated with worsening of the clinical symptoms. In several models of autoimmune diseases, the overactivation of the complement system (CS) is the cause of disease exacerbation. This article aimed at reviewing the main aspects related to CS regulation in RA in order to provide a better understanding of the potential role of this system in the pathophysiology and activity of the disease.

Clinical diagnostic performance of different methods for the detection of antibodies to extractable nuclear antigens in connective tissue diseases: a cohort study.

BACKGROUND: Different methods for anti-ENA identification have been used. This can lead to confusion regarding the interpretation of the test results in clinical practice. Some studies have reported differences in sensitivity and specificity, but few compare clinical outcomes. Based on that, our aim was to compare the performance characteristics of various methods commonly used to detect anti-ENA antibodies in the sera of patients suspected to have connective tissue diseases (CTDs). METHODS: 189 patients with orders for anti-ENA were analyzed. Three common methods were used: DID, ELISA, and HA. Sensitivity, specificity, PPV, NPV, and LR were calculated using CTDs as the reference standard. RESULTS: 69.3% of the patients had a CTD and 32.8% had SLE. Sensitivity and specificity, respectively, according to the technique were: ELISA (50.0% - 78.9%); DID (31.3% - 89.5%); HA (40.9% - 87.7%). PPV were: 88.5% (HA), 87.2% (DID) and 84.6% (ELISA), and NPV were: 40.5% (ELISA), 39.1% (HA) and 36.2% (DID). CONCLUSIONS: Based on the very similar predictive test values, we believe that, at least in a moderate to high pretest probability, in our methodological scenario, there are no significant differences in the interpretation of test results when using ELISA, HA, and DID for anti-ENA detection.

Expression of complement regulatory proteins CD55, CD59, CD35, and CD46 in rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease associated with polyarticular inflammatory synovitis affecting mainly peripheral joints. It affects approximately 1% of the world population, being two to three times more prevalent in women. Rheumatoid arthritis has a complex and multifactorial pathogenesis. The synovium of the affected joints is infiltrated by T and B lymphocytes, macrophages, and granulocytes. The rheumatoid synovium has proliferative characteristics, forming the pannus, which invades cartilage and bone, leading to normal architecture destruction and function loss. The decreased expression of complement regulatory proteins (CRP) seems to play an important role in RA activity, and is associated with worsening of the clinical symptoms. In several models of autoimmune diseases, the overactivation of the complement system (CS) is the cause of disease exacerbation. This article aimed at reviewing the main aspects related to CS regulation in RA in order to provide a better understanding of the potential role of this system in the pathophysiology and activity of the disease.

Experiência da adoção do I e II Consensos Brasileiros de Fator Antinuclear por Imunofluorescência Indireta em Células HEp-2 em um hospital universitário / Experience of an university hospital on the implementation of I and II Brazilian Consensuses for Standardization of ANA in HEp-2 Cells

OBJETIVO: Analisar a prevalência, padrões e títulos do Fator Antinuclear (FAN) por imunofluorescência indireta (IFI) em células HEp-2 em um hospital universitário após a adoção do I e II Consensos Nacional para Padronização dos Laudos de FAN em Células HEp-2. MÉTODO: Foi realizado um estudo transversal, em que foram revisados os laudos de FAN por IFI originários de solicitações encaminhadas ao Serviço de Patologia Clínica do Hospital de Clínicas de Porto Alegre (SPC/HCPA) entre 2002 e 2005. RESULTADOS: Foram analisados 12.095 testes de FAN no período entre 2002 e 2005. As solicitações com resultado reagente foram de 2.577 (21,30 por cento), com média anual de 644±233). Houve um aumento significativo na proporção de resultados reagentes posterior à adoção dos Consensos (p < 0,001). A Reumatologia foi a especialidade que mais solicitou exames por paciente atendido, mas houve um declínio nesse número nos anos posteriores à adoção do Consenso, ocorrido em 2004 (p < 0,001). O padrão de imunofluorescência de FAN mais frequentemente encontrado foi o padrão nuclear pontilhado fino, presente em 52,3 por cento dos resultados reagentes (453/866), e os títulos mais encontrados foram 1/80 e 1/160 (27,8 por cento e 29,4 por cento, respectivamente). CONCLUSÃO: Após a adoção do Consenso Nacional de Padronização de Laudos de FAN, observou-se um aumento de exames com resultados reagentes, na sua maioria, com títulos baixos e padrão nuclear pontilhado fino. Na Reumatologia, observou-se uma diminuição no número de solicitações desse exame. As potenciais causas para essas observações são discutidas, mas seu real impacto sobre a situação clínica do paciente e seu tratamento merece ser mais bem estudado.

OBJECTIVE: To evaluate the prevalence of patterns and titers of antinuclear antibodies (ANA) detected by indirect immunofluorescence (IIF) technique on HEp-2 cells in a university hospital following the introduction of I and II Brazilian Consensuses for Standardization of ANA in HEp-2 Cells. METHODS:A transversal study was performed between 2002 and 2005 during which all ANA orders to Serviço de Hospital de Clínicas de Porto Alegre (SPC/HCPA) and cognate results were reviewed. RESULTS:12.095 tests of ANA were revised. The number of positive results during this period was 2.577 (21.30 percent), annual mean 644 (SD: 233). A marked increase in the number of positive results was observed following the introduction of the Consensuses (p < 0.001). Rheumatology was the medical specialty which requested the highest number of ANA testing per patient although a significant decrease of these numbers was observed after the introduction of the Consensus in 2004 (p < 0,001). Nuclear fine speckled immunofluorescence labeling was the most frequently ANA pattern observed, 52.3 percent (453/866), and low ANA titers (1/80 and 1/160) more commonly detected (27.8 percent and 29.4 percent, respectively). CONCLUSION: Following the introduction of the Brazilian Consensus for standardization of ANA in HEp-2 cells an increased number of positive results was observed, mostly in low titers and with nuclear fine speckled immunofluorescence pattern. Moreover, there were decreasing numbers of ANA orders by rheumatologists in the same period. Potential causes for these observations are discussed but the real impact in the clinical condition of the patient and therapy deserves to be better studied.

Padrões de imunofluorescência do fator antinuclear (FAN) em células HEp-2 de soros reagentes para anti-SSA/Ro / Antinuclear antibodies (ANA) immunofluorescent patterns in HEp-2 cells on samples positive for anti-SSA/Ro

OBJETIVO: avaliar os padrões de imunofluorescência do fator antinuclear (FAN) em soros reagentes para anticorpos anti-SSA/Ro e sua associação clínica. MÉTODO: foi realizado um estudo transversal retrospectivo, no qual foram revisadas as solicitações de anticorpos antiantígenos nucleares extraíveis (anti-ENA) encaminhadas ao SPC/HCPA no período de dois anos. Das solicitações com resultado positivo para anti-ENA identificou-se qual ou quais auto-anticorpos estavam envolvidos (anti-SSA/Ro, anti-SSB/La, anti-RNP, anti-Sm, anti-Scl-70), bem como os padrões de imunofluorescência do FAN e os quadros clínicos dos pacientes anti-SSA/Ro positivo. As técnicas usadas para detecção e identificação foram FAN por imunofluorescência indireta (IFI) em células HEp-2 e anti-ENA por hemaglutinação. RESULTADOS: das 392 solicitações analisadas 90 eram anti-ENA positivo. Houve um predomínio do sexo feminino (94 por cento) (86/91) e a idade média foi de 42 anos. O anti-SSA/Ro foi o mais freqüente (67,8 por cento) (61/90), sendo que todas as amostras anti-SSA/Ro positivas eram positivas para o FAN. O padrão de imunofluorescência nuclear pontilhado fino foi o predominante (68,9 por cento) (42/61) nos pacientes com anti-SSA/Ro positivo, e o quadro clínico mais encontrado foi de lúpus eritematoso sistêmico, em 50,8 por cento (31/61) dos pacientes. CONCLUSÃO: o teste de FAN por IFI utilizando células HEp-2 é um bom método de triagem para detecção de auto-anticorpos anti-SSA/Ro, apresentando maior associação com o padrão nuclear pontilhado fino. Diferente do que tem sido descrito na literatura, não encontramos nenhuma amostra de pacientes com anti-SSA/Ro que tenham apresentado FAN falso-negativo na IFI. Pelo menos na nossa experiência, esses dados questionam o custo-efetividade da solicitação de rotina desse exame em pacientes FAN negativo pelo teste de IFI.

OBJECTIVE: to evaluate the pattern at immunofluorescence of the antinuclear antibodies (ANA) detected by the indirect immunofluorescence (IIF) technique in positive samples for anti-SSA/Ro autoantibody and the clinical associations. METHODS: a retrospective transversal study was performed in a period of two years where the all the solicitations of testing for the presence of anti-extractable nuclear antigen (anti-ENA) antibodies delivered to the SPC/HCPA were analyzed. We selected the positive samples and identified which autoantibodies were involved (anti-SSA/RO, anti-SSB/La, anti-RNP, anti-Sm and anti-Scl70) as well as the immunofluorescence patterns by ANA testing and the clinical associations found in the patients presenting anti-SSA/Ro positive serum. IIF was used for ANA using HEp-2 cells and hemagglutination for anti-ENA antibodies detection. RESULTS: 90 out of the 392 solicitations analyzed were anti-ENA positive, with a predominance of women (86/91 - 94 percent) and the mean age was 42 years old. The most frequent autoantibody was anti-SSA/Ro (61/90 - 67.8 percent) and all samples that were anti-SSA/Ro positive were also ANA positive. Speckled nuclear immunofluorescence was the most frequent ANA pattern (42/61 - 68.9 percent) among the anti-SSA/Ro positive samples and systemic lupus erythematosus was the most common clinical diagnosis (31/61 - 50.8 percent). CONCLUSION: ANA testing by IIF using HEp-2 cells proved to be a good screening test for the detection of anti-SSA/Ro antibodies, that showed a strong positive association to the speckled nuclear IIF pattern. As opposed to what has been described in the literature, there was no ANA negative among the anti-SSA/Ro positive samples. At least in our experience, these data question the cost-effectiveness of performing routine screening for anti-SSA/Ro antibodies in ANA negative samples by IIF testing.