Lack of Interleukin-6 Affects IFN-γ and TNF-α Production and Early In Vivo Control of Brucella abortus Infection.

Interleukin-6 (IL-6) is a pleiotropic cytokine promptly produced in response to infections, which contributes to host defense through the stimulation of acute phase immune responses. Brucella abortus is an intracellular bacterium that causes chronic disease in humans and domestic animals and triggers a robust immune response, characterized by the production of inflammatory cytokines. However, the mechanisms of IL-6-related immune responses in the context of Brucella infections are not completely understood. In this report, we describe an increased susceptibility of IL-6 knockout (KO) mice in the early phase of Brucella infection. Furthermore, we demonstrate that IL-6 is required for interferon (IFN)-γ and tumor necrosis factor (TNF)-α induction by infected splenocytes, indicating a protective role for IL-6 against B. abortus that parallels with Th1 type of immune response. Additionally, IL-6 KO mice exhibited reduced splenomegaly during the early phase of the infection. Corroborating this result, IL-6 KO mice displayed reduced numbers of macrophages, dendritic cells, and neutrophils in the spleen and reduced myeloperoxidase activity in the liver compared to wild-type infected mice. However, we demonstrate that IL-6 is not involved in B. abortus intracellular restriction in mouse macrophages. Taken together, our findings demonstrate that IL-6 contributes to host resistance during the early phase of B. abortus infection in vivo, and suggest that its protective role maybe partially mediated by proinflammatory immune responses and immune cell recruitment.

Evaluation of the clinicai analysis service provided to an emergency department / Avaliação do serviço de análises clínicas prestado a uma unidade de emergência

ABSTRACT Introduction: Time for releasing test results and critical value communication by the clinical laboratory are considered important determinants of patients' length of stay in the Emergency Department (ED). As well as physician satisfaction, they are used as quality indicators of the Clinical Analysis Service (CAS). Objective: The aim of this study was to evaluate the time to return a test result, the communication of critical values and the level of satisfaction of the ED physicians of a university hospital with the CAS. Material and methods: A physician satisfaction survey was conducted using a questionnaire. The test turnaround time for emergency requests was analyzed by observation of the pre-analytical phase and monitoring the analytical and post-analytical phases through the laboratory information system. In order to evaluate the communication of critical values by the CAS, a document analysis of the process was performed. Results: Physicians' overall satisfaction with the CAS was considered average. Greater satisfaction was observed with reliability of the results and the staff courtesy and lesser with the delivery time of results. The test turnaround time exceeded clinicians' expectations and the average described in the literature. No experience with critical-value communication was perceived. Conclusion: The results show several opportunities for progress in the relationship between ED and CAS. The improvement of laboratory quality indicators also depends on the involvement of ED physicians and nurses and embraces monitoring, planning, education and investment in system computerization.

RESUMEN Introducción: El tiempo de entrega de pruebas y la comunicación de valores críticos por el laboratorio clínico son considerados factores determinantes del tiempo de permanencia del paciente en la Sección de Urgencias (SU). Por lo tanto, así como la satisfacción de los médicos, estos datos también son utilizados como indicadores de calidad del Servicio de Análisis Clínicos (SAC). Objetivo: Evaluar el tiempo de entrega de pruebas, la comunicación de valores críticos y el grado de satisfacción de los médicos de la SU de un hospital universitario con el SAC. Material y método: Se realizó una encuesta de satisfacción de los médicos, utilizando un cuestionario. El tiempo de reporte de resultados en la SU ha sido analizado por medio de observación presencial de la fase preanalítica y monitoreo en el sistema computorizado de las fases analítica y postanalítica del laboratorio. Para evaluar la comunicación de valores críticos por el SAC, un análisis documental del proceso ha sido realizado. Resultados: La satisfacción general con el SAC fue considerada regular por los médicos participantes; hubo mayor satisfacción con la confianza en los resultados y con la atención del personal, y menor con el tiempo de entrega de resultados. Los tiempos de reporte han sido más largos que las expectativas de los médicosy la media descripta en la literatura. No se ha observado una cultura de comunicación de valores críticos. Conclusión: Los resultados han ensenado varias oportunidades deprogreso en la relación entre SUy SAC. La mejoría de los indicadores de calidad de laboratorio evaluados depende también del envolvimiento de los médicos y enfermeros del SU e incluye monitoreo, planeamiento, educación e investimento en informatización del sistema.

RESUMO Introdução: O tempo de liberação de exames e a comunicação de valores críticos pelo laboratório clínico são considerados importantes determinantes do tempo de permanência do paciente no Serviço de Emergência (SE). Portanto, assim como a satisfação dos médicos, esses dados também são utilizados como indicadores de qualidade do Serviço de Análises Clínicas (SACL). Objetivo: Avaliar o tempo de liberação de exames, a comunicação de valores críticos e o nível de satisfação dos médicos do SE de um hospital universitário em relação ao SACL. Material e métodos: Foi realizada uma pesquisa de satisfação dos médicos, utilizando um questionário. O tempo de liberação dos resultados de exames de emergência foi analisado por meio de observação presencial da fase pré-analítica e monitoramento no sistema informatizado das fases analítica e pós-analítica do laboratório. Para avaliar a comunicação de valores críticos pelo SACL, foi realizada análise documental do processo. Resultados: A satisfação geral com o SACL foi considerada regular pelos médicos participantes, com maior satisfação quanto à confiança nos resultados e à cortesia dos servidores e menor quanto ao tempo de entrega de resultados. Os tempos de liberação de resultados dos exames ultrapassaram as expectativas dos médicos e a média descrita na literatura. Não foi observada cultura de comunicação de valores críticos. Conclusão: Os resultados demonstraram várias oportunidades de progresso na relação entre o SE e o SACL. A melhoria dos indicadores da qualidade laboratorial avaliados depende também do envolvimento dos médicos e dos enfermeiros do SE e inclui monitoramento, planejamento, educação e investimento em informatização do sistema.

Assessment of the pre-analytical phase of a clinical analyses laboratory / Avaliação da fase pré-analítica de um laboratório de análises clínicas

ABSTRACT Introduction: The pre-analytical phase encompasses the procedures prior to the performance of the laboratory tests, which are the physician's requisition, patient and tests registration, collection and transport of samples. This phase involves different professionals and is responsible for the majority of the laboratory errors. Objective: To assess the pre-analytical phase of a public laboratory through quality indicators (QI). Method: Nonconformities (NC) in the physician's requisitions and in the patients and tests registrations were evaluated during the quality checking process. A questionnaire was applied to evaluate the service and the satisfaction of the laboratory's client. The QI were calculated considering the number of NC in the processes in relation to the total opportunities, compared with specifications described in the literature and evaluated by the Sigma metric. Results: The pre-analytical phase was evaluated by 34 QI. From these, 18 presented Sigma score lower than 3.0, six between 3.0 and 4.0, six above 4.0 and four presented Sigma score of 6.0. The completiton of requisitions presented worse performance than the process of tests registration. Regarding the three stages of the pre-analytical phase evaluated, the scheduling presented the worst performance, followed by the service at the reception and the sample collection. Conclusion: The evaluation of the QI allowed organizing the improvements that should be prioritized in the laboratory. The Sigma metric was useful for assessing the QIs considered important to the laboratory, for which there are no published specifications. The questionnaire for evaluating the laboratory's service and client's satisfaction was not a reliable tool for assessing the quality of the pre-analytical phase.

RESUMO Introdução: A fase pré-analítica abrange os procedimentos antes da execução dos testes laboratoriais, sendo eles a requisição, o cadastro de clientes e exames, a coleta e o transporte de amostras. Essa fase envolve diferentes profissionais e é responsável pela maioria dos erros de laboratório. Objetivo: Analisar a fase pré-analítica de um laboratório público por meio de indicadores da qualidade (IQ). Método: As não conformidades (NC) nas requisições e no cadastro dos clientes e dos exames foram avaliadas durante o processo de checagem. Foi aplicado um questionário para avaliar o atendimento e a satisfação dos clientes do laboratório. Os IQ foram calculados considerando o número de NC nos processos em relação ao total de oportunidades, comparando-os com as especificações encontradas na literatura e avaliando-os pela métrica Sigma. Resultados: A fase pré-analítica foi avaliada por 34 IQ. Desses, 18 apresentaram Sigma menor que 3,0; seis, entre 3,0 e 4,0; seis, acima de 4,0; e quatro, Sigma 6,0. O preenchimento das requisições apresentou pior desempenho do que o processo de cadastro dos exames. Em relação às três etapas da fase pré-analítica avaliadas, a que apresentou pior desempenho foi o agendamento, seguido do atendimento na recepção e da coleta. Conclusão: A avaliação dos IQ permitiu ordenar as melhorias que devem ser priorizadas no laboratório. A métrica Sigma foi útil para avaliar IQ, considerados importantes para o laboratório, para os quais não há especificações publicadas. O questionário de avaliação do atendimento e da satisfação do cliente não se mostrou uma ferramenta confiável para avaliar a qualidade da fase pré-analítica.

Original Research: ACE2 activator associated with physical exercise potentiates the reduction of pulmonary fibrosis.

The interstitial lung diseases are poorly understood and there are currently no studies evaluating the association of physical exercise with an ACE2 activator (DIZE) as a possible treatment for this group of diseases. We evaluate the effects of pharmacological treatment with an angiotensin-converting enzyme 2 activator drug, associated with exercise, on the pulmonary lesions induced by bleomycin. From the 96 male Balb/c mice used in the experiment, only 49 received 8 U/kg of bleomycin (BLM, intratracheally). The mice were divided into control (C) and bleomycin (BLM) groups, sedentary and trained (C-SED, C-EXE, BLM-SED, BLM-EXE), control and bleomycin and also sedentary and trained treated with diminazene (C-SED/E, C-EXE/E, BLM-SED/E, BLM-EXE/E). The animals were trained five days/week, 1 h/day with 60% of the maximum load obtained in a functional capacity test, for four weeks. Diminazene groups were treated (1 mg/kg, by gavage) daily until the end of the experiment. The lungs were collected 48 h after the training program, set in buffered formalin and investigated by Gomori's trichrome, immunohistochemistry of collagen type I, TGF-ß1, beta-prolyl-4-hydroxylase, MMP-1 and -2. The BLM-EXE/E group obtained a significant increase in functional capacity, reduced amount of fibrosis and type I collagen, decreased expression of TGF-ß1 and beta-prolyl-4-hydroxylase and an increase of metalloproteinase -1, -2 when compared with the other groups. The present research shows, for the first time, that exercise training associated with the activation of ACE2 potentially reduces pulmonary fibrosis.