Prevalence of anemia in schools of the metropolitan region of Curitiba, Brazil.

BACKGROUND: Anemia during childhood is one of the biggest public health problems worldwide, including Brazil. Insufficient or abnormal production of hemoglobin, loss of iron and excessive destruction of red blood cells are the most common causes of anemia. Among the reasons of anemia, iron deficiency accounts for 50% of anemia cases in developing countries. Affected individuals present a wide range of clinical problems, including delayed neuropsychomotor progression, impaired cellular immunity and reduction of intellectual capacity. This study aimed to evaluate the prevalence of anemia in children attending public schools in the metropolitan region of Curitiba, Paraná, Brazil. METHOD: A retrospective study was conducted of 409 children aged 8-12 years old included in an extension project of the Universidade Federal do Paraná. The results of complete blood count and hemoglobin electrophoresis of all children were evaluated. Anemia was considered when the hemoglobin levels were <11.5 g/dL. RESULTS: The prevalence of anemia was found to be 2.2% of the population studied, with hypochromic microcytic anemia being the most common type. Seven children had sickle cell trait and one had ß-thalassemia. CONCLUSION: The prevalence of anemia in this study was considered normal according the World Health Organization classification, which is different from the data found in other Brazilian regions.

Prevalence of anemia in schools of the metropolitan region of Curitiba, Brazil

ABSTRACT Background: Anemia during childhood is one of the biggest public health problems worldwide, including Brazil. Insufficient or abnormal production of hemoglobin, loss of iron and excessive destruction of red blood cells are the most common causes of anemia. Among the reasons of anemia, iron deficiency accounts for 50% of anemia cases in developing countries. Affected individuals present a wide range of clinical problems, including delayed neuropsychomotor progression, impaired cellular immunity and reduction of intellectual capacity. This study aimed to evaluate the prevalence of anemia in children attending public schools in the metropolitan region of Curitiba, Paraná, Brazil. Method: A retrospective study was conducted of 409 children aged 8-12 years old included in an extension project of the Universidade Federal do Paraná. The results of complete blood count and hemoglobin electrophoresis of all children were evaluated. Anemia was considered when the hemoglobin levels were <11.5 g/dL. Results: The prevalence of anemia was found to be 2.2% of the population studied, with hypochromic microcytic anemia being the most common type. Seven children had sickle cell trait and one had β-thalassemia. Conclusion: The prevalence of anemia in this study was considered normal according the World Health Organization classification, which is different from the data found in other Brazilian regions.

Tratamento da doença celíaca: estado da arte / Celiac disease treatment; state of the art

A falta de opções terapêuticas para a Doença Celíaca (DC) tornou-se um problema de grande relevância no setor farmacêutico em decorrência do aperfeiçoamento das técnicas sorológicas de diagnóstico e, consequentemente, do aumento do número de indivíduos com diagnóstico confirmado para esta doença. Até o momento, a única terapia eficaz na DC é a dieta isenta de glúten, um tratamento aparentemente simples, mas que tem enormes reflexos nos hábitos nutricionais e sociais do paciente. O conhecimento do complexo mecanismo patogênico da DC permitiu o gradual desenvolvimento de pesquisas em busca de novas opções terapêuticas, entre as quais podemos destacar a ingestão oral de enzimas capazes de hidrolisar o glúten, inibidores da enzima transglutaminase tecidual, inibidores da permeabilidade intestinal, e indutores da tolerância oral ao glúten. Este estudo, além de descrever algumas características da Doença Celíaca e sua relação com a estrutura do glúten, compila informações de diversos autores sobre o desenvolvimento de novos tratamentos para a doença, com objetivo de identificar as opções terapêuticas que apresentam os maiores avanços e, portanto, tem potencial para estarem à disposição dos pacientes celíacos em um futuro próximo.

The lack of therapeutic options for celiac disease (CD) has become a relevant issue in the pharmaceutical sector, as a result of the improvement on technical diagnostic serological and the following increase in the number of individuals with confirmed diagnosis for this disease. To date, the only effective therapy to CD is the gluten-free diet, a seemingly simple treatment, but that has enormous repercussions in the social and nutritional habits of the patient. New findings on the complex pathogenic mechanism of CD allowed gradually the development of researches to look for new therapeutic options, among which we can highlight the oral intake of enzymes capable to hydrolyze the gluten, inhibitors of tissue transglutaminase enzyme, inhibitors of intestinal permeability, and tolerance induction of gluten. This study, besides to describing some features of celiac disease and its relationship with the structure of gluten, compiles information from several authors regarding the development of new treatment of this disease, with the goal of identifying therapeutic options that present the biggest advances and, therefore, has the potential to be at the disposal of celiac patients in a near future.

Update on Biologic Therapies for Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic multisystemic autoimmune disease driven by genetic, hormonal, and environmental factors. Despite the advances in diagnostic and therapeutic approaches in the last decades, SLE still leads to significant morbidity and increased mortality. Although a cure for SLE is still unknown, treatment is required to control acute disease exacerbation episodes (flares), decrease the frequency and severity of subsequent lupus flares, address comorbidities, and prevent end-organ damage. While conventional SLE pharmacotherapy may exhibit suboptimal efficacy and substantial toxicity, a growing knowledge of the disease pathogenesis enabled the research on novel therapeutic agents directed at specific disease-related targets. In this paper, we review the recent progress in the clinical investigation of biologic agents targeting B cells, T cells, cytokines, innate immunity, and other immunologic or inflammatory pathways. Although many investigational agents exhibited insufficient efficacy or inadequate safety in clinical trials, one of them, belimumab, fulfilled the efficacy and safety regulatory requirements and was approved for the treatment of SLE in Europe and the USA, which confirms that, despite all difficulties, advances in this field are possible.

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil.

OBJECTIVE: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. SUBJECTS AND METHODS: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave's disease was diagnosed in 143 (56.3%) and Hashimoto's thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. RESULTS: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto's thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. CONCLUSION: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves' disease and one was male, all three patients with confirmed CD were female and had Hashimoto's thyroiditis.

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil / Pesquisa de doença celíaca em pacientes com doença autoimune de tireoide do sul do Brasil

Objective: The objective of this study was to determine the prevalence of celiac disease (CD) in adults with autoimmune thyroid disease (ATD) from the endocrinology outpatient setting in a university hospital in Southern Brazil. Subjects and methods: From the years 2007 to 2011, 254 patients with ATD were enrolled consecutively, Grave’s disease was diagnosed in 143 (56.3%) and Hashimoto’s thyroiditis in 111 (43.7%) of them. All patients answered a questionnaire related to symptoms that could be associated with CD and serum samples to screen for IgA anti-endomysial (EmA-IgA) were collected. EmA-IgA-positive patients were offered upper gastrointestinal endoscopy and biopsy of duodenum. Results: A total of 254 patients were included; 222 (87.4%) female, mean age 45.4 ± 13.43 years (18 to 79 years). EmA-IgA was positive in seven patients (2.7%) and five done endoscopy with biopsy. Of these, three diagnosis of CD was confirmed (1.2%). All the three patients with CD had higher EmA-IgA titration, were female and had Hashimoto’s thyroiditis. Like other patients with ATD, CD patients had nonspecific gastrointestinal symptoms, such as heartburn and gastric distention. In our study, one in each 85 patients confirmed the diagnosis of CD. Conclusion: We found a prevalence of 1.2% (1:85) of confirmed CD among Brazilian patients with ATD. Although some IgA-EmA positive patients had Graves’ disease and one was male, all three patients with confirmed CD were female and had Hashimoto’s thyroiditis. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Objetivo: O objetivo do presente estudo foi determinar a prevalência de doença celíaca (DC) em adultos com doenças autoimunes de tireoide (DAT) que foram atendidos em um serviço de endocrinologia de um hospital universitário do sul do Brasil. Sujeitos e métodos: Entre os anos de 2007 a 2011, 254 pacientes com DAT foram consecutivamente incluídos, sendo 143 (56,3%) desses diagnosticados com doença de Graves e 111 (43,7%) com doença de Hashimoto. Todos os pacientes responderam a um questionário relatando sintomas que poderiam ser associados com DC, e amostras de soro para a pesquisa de anticorpo antiendomisial (EmA-IgA) foram coletadas. Os pacientes com sorologia positiva foram encaminhados para endoscopia gastrointestinal com biópsia duodenal. Resultados: No total, 254 pacientes foram incluídos, sendo 222 (87,4%) mulheres com média de idade 45,4 ± 13,43 anos (18 a 79 anos). EmA-IgA foi positivo em sete (2,7%) pacientes e cinco fizeram endoscopia com biópsia. Desses, três (1,2%) tiveram o diagnóstico de DC confirmada. Todos os três pacientes com DC apresentaram altos títulos de EmA-IgA, eram mulheres e tinham doença de Hashimoto. Assim como outras pacientes com DAT, os pacientes celíacos tinham sintomas gastrointestinais inespecíficos, como queimação e distensão gástrica. Em nosso estudo, um em cada 85 pacientes com DAT tiveram o diagnóstico de DC confirmado. Conclusão: Em nosso estudo, foi observada prevalência de 1,2% (1:85) de DC confirmada entre os pacientes com DAT, sendo todas mulheres e com doença de Hashimoto. Arq Bras Endocrinol Metab. 2014;58(6):625-9 .

Artrite reumatoide: uma visão atual / Rheumatoid arthritis: a current view

INTRODUÇÃO: A artrite reumatoide (AR) é uma doença autoimune inflamatória e crônica que afeta aproximadamente 1 por cento da população adulta mundial. A doença caracteriza-se pela inflamação do tecido sinovial de múltiplas articulações, levando a destruição tecidual, dor, deformidades e redução na qualidade de vida do paciente. Sua etiologia é complexa e em grande parte desconhecida, porém estudos demonstram a influência de fatores genéticos e ambientais em sua patogênese. Devido à forte influência genética, familiares de pacientes com AR formam um grupo de risco para o desenvolvimento da doença, principalmente em sua forma mais grave. Apesar de seu elevado potencial incapacitante, o curso da AR pode ser modificado por meio do diagnóstico precoce e do manejo adequado do paciente. No entanto, o diagnóstico precoce da AR é ainda bastante difícil diante da heterogeneidade das manifestações clínicas da doença, o que acaba retardando a implantação terapêutica. O tratamento da AR baseia-se no uso de anti-inflamatórios não esteroidais (AINEs), corticosteroides, drogas antirreumáticas modificadoras do curso da doença (DMARD) e agentes imunobiológicos. Além da terapia medicamentosa, também são adotadas medidas como educação do paciente e terapias psico-ocupacionais. Atualmente, estudos têm se voltado à identificação de fatores preditores de doença mais grave, como autoanticorpos como fator reumatoide (FR) e anticorpo antipeptídio cíclico citrulinado (anti-CCP), que constituem importantes marcadores imunológicos de diagnóstico e prognóstico da AR. DISCUSSÃO E CONCLUSÃO: Apesar dos significativos avanços tanto no entendimento como no diagnóstico e no tratamento da AR, ainda persistem inúmeros desafios a serem superados.

INTRODUCTION: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease, which affects approximately 1 percent of the world's adult population. It is characterized by the inflammation of synovial tissue from multiple articulations, leading to tissue destruction, pain, deformities and reduced quality of life. RA etiology is complex and largely unknown, although studies support the influence of genetic and environmental factors on its pathogenesis. Due to its major genetic component, relatives from RA patients are part of the risk group, mainly as to the development of the most severe forms. In spite of its high disability risk, RA development can be affected through early diagnosis and adequate therapy. Nonetheless, its early diagnosis is still very demanding due to the heterogeneity of its clinical presentations, which delays therapeutic approach. RA treatment includes non-steroidal anti-inflammatory drugs, corticosteroids, disease-modifying antirheumatic drugs (DMARD), and immunobiologic agents. Furthermore, raising patient's awareness and developing psyco/occupational therapies are also part of the therapeutic approach. Currently, several studies focus on the identification of predictive factors for severe RA such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) autoantibodies, which are major immunological diagnostic and prognostic markers for RA. DISCUSSION AND CONCLUSION: Despite the fact that there has been substantial progress in the investigation, diagnosis and treatment of RA, there are still several challenges to be overcome.

Antibodies anti-Saccharomyces cerevisiae (ASCA) do not differentiate Crohn's disease from celiac disease.

CONTEXT: Anti-Saccharomyces cerevisiae antibodies (ASCA), considered serologic markers for Crohn's disease, were described in patients with celiac disease, disappearing after a gluten-free diet. OBJECTIVES: Evaluation of ASCA positivity in patients with Crohn's disease and celiac disease in relation to healthy individuals. METHODS: A total of 145 individuals were studied: 36 with Crohn's disease and 52 with celiac disease, that fulfilled the diagnostic criteria for both affections, and 57 healthy individuals for control. The celiac patients were divided as follow: group CeD I at diagnosis (n = 34), group CeD II with gluten-free diet compliance (n = 13) and group CeD III with transgressions to the diet (n = 5). ASCA IgA and IgG were determined by ELISA. RESULTS: With statistical significance, ASCA IgA were positive in Crohn's disease, celiac disease at diagnosis and celiac disease with diet transgressions; ASCA IgG in Crohn's disease and in all groups with celiac disease. CONCLUSIONS: The detection of ASCA in patients with celiac disease allows to suggest that ASCA is not a specific marker for Crohn's disease, but was associated with the inflammation of the small intestine. The increased levels of positive ASCA may be due to genetic factors and increased intestinal permeability.

Antibodies anti-Saccharomyces cerevisiae (ASCA) do not differentiate Crohn's disease from celiac disease / Anticorpos anti-Saccharomyces cerevisiae não diferenciam doença de Crohn de doença celíaca

CONTEXT: Anti-Saccharomyces cerevisiae antibodies (ASCA), considered serologic markers for Crohn's disease, were described in patients with celiac disease, disappearing after a gluten-free diet. OBJECTIVES: Evaluation of ASCA positivity in patients with Crohn's disease and celiac disease in relation to healthy individuals. METHODS: A total of 145 individuals were studied: 36 with Crohn's disease and 52 with celiac disease, that fulfilled the diagnostic criteria for both affections, and 57 healthy individuals for control. The celiac patients were divided as follow: group CeD I at diagnosis (n = 34), group CeD II with gluten-free diet compliance (n = 13) and group CeD III with transgressions to the diet (n = 5). ASCA IgA and IgG were determined by ELISA. RESULTS: With statistical significance, ASCA IgA were positive in Crohn's disease, celiac disease at diagnosis and celiac disease with diet transgressions; ASCA IgG in Crohn's disease and in all groups with celiac disease. CONCLUSIONS: The detection of ASCA in patients with celiac disease allows to suggest that ASCA is not a specific marker for Crohn's disease, but was associated with the inflammation of the small intestine. The increased levels of positive ASCA may be due to genetic factors and increased intestinal permeability.

RACIONAL: Anticorpos anti-Saccharomyces cerevisiae antibodies, considerados marcadores sorológicos para a doença de Crohn, foram descritos em pacientes com doença celíaca, desaparecendo após dieta isenta de glúten. OBJETIVOS: Avaliação da positividade de anti-Saccharomyces cerevisiae antibodies em pacientes com doença de Crohn e doença celíaca, em relação a indivíduos sadios da mesma área geográfica. MÉTODOS: Foram estudados 145 pacientes, 36 com doença de Crohn e 52 com doença celíaca que preencheram os critérios diagnósticos para ambas as afecções, e 57 indivíduos sadios para controle. Os pacientes celíacos foram divididos como segue: ao diagnóstico (grupo doença celíaca I: n = 34), obedientes à dieta isenta de glúten (grupo doença celíaca II: n = 13) e não-aderentes à dieta isenta de glúten (grupo doença celíaca III: n = 5). Anti-Saccharomyces cerevisiae antibodies IgA e IgG foram determinados por ELISA. RESULTADOS: Anti-Saccharomyces cerevisiae antibodies IgA foi positivo na doença de Crohn, nos celíacos ao diagnóstico e nos transgressores à dieta, com significado estatístico. Anti-Saccharomyces cerevisiae antibodies IgG foi positivo na doença de Crohn e em todos os grupos de celíacos, com significado estatístico. CONCLUSÕES: A detecção de anti-Saccharomyces cerevisiae antibodies em pacientes com doença celíaca permite sugerir que o mesmo não seja marcador específico para a doença de Crohn, mas que esteja associado à inflamação do intestino delgado. A positividade de anti-Saccharomyces cerevisiae antibodies pode ser decorrente de fatores genéticos e aumento da permeabilidade intestinal.

Diagnostic role and clinical association of ASCA and ANCA in Brazilian patients with inflammatory bowel disease.

BACKGROUND: Anti-Saccharomyces cerevisae antibody (ASCA) and perinuclear anti-neutrophil cytoplasmatic antibody (pANCA) remain the most well-established markers in inflammatory bowel disease (IBD), and both may be associated with disease phenotype. AIM: To determine the utility of ASCA and pANCA as markers in a Brazilian cohort of IBD patients. MATERIALS AND METHODS: A total of 90 patients with ulcerative colitis (UC), 77 patients with Crohn's disease (CD), and 57 healthy individuals were included in the study. ASCA was determined by enzyme-linked immunosorbent assay (ELISA) and pANCA by immunofluorescence assay. RESULTS: In support of diagnosis of UC, the sensitivity and specificity of pANCA were 51% and 100%, respectively. ASCA (IgA or IgG isotypes) presented sensitivity of 62% and specificity of 93% for CD. The combination of ASCA negativity and pANCA positivity (ASCA-/pANCA+) displayed sensitivity of 43% and specificity of 100% for diagnosis to UC. In CD patients, ASCA+/pANCA- presented sensitivity and specificity of 57% and 93%, respectively. Additionally, ASCA positivity correlated with early age at disease onset and ileal location in CD patients. In UC patients, pANCA positivity was correlated with pancolitis or left colitis. CONCLUSIONS: The results evidenced that low sensitivity of ASCA and pANCA markers limits their use in IBD screening in the general population; however, their specificity may contribute to differentiation between CD and UC in IBD patients. Our study lends further support to the suggestion that serologic assessment identifies different subtypes of IBD.

Celiac disease in native Indians from Brazil: A clinical and epidemiological survey.

BACKGROUND: Celiac disease has been described in populations from around the world, with recent data emphasizing the occurrence of the disease in ethnic minorities. There are only a few studies evaluating celiac disease in native Indians. AIMS: This study aimed to screen the anti-endomysial antibody (IgA-EmA) in Kaingang and Guarani Indians from southern Brazil, in order to establish a clinical serological evaluation of celiac disease in these individuals. MATERIAL AND METHODS: Serum samples from 321 individuals (125 male and 196 female; 4-86 years old) from Mangueirinha Indigenous Reserve, State of Parana, Brazil, and 180 non-Indigenous healthy individuals (62 male and 118 female; 2-81 years old) were analysed to the presence of anti-endomysial antibody class IgA by indirect immunofluorescence assay. Amongst the Indians, 158 were Kaingang, 98 Guarani and 65 of mixed race. Indians presenting complaints of diarrhea (N=12) were also evaluated to the IgG class of anti-endomisyal antibody. RESULTS: None of the individuals showed positive results either to IgA or IgG anti-endomysial antibodies. CONCLUSIONS: Although the results indicate an absence of celiac disease in Kaingang and Guarani Indians, the authors call attention to the importance of following up indigenous children or adults presenting gastrointestinal complaints or other symptoms related to the disease. Consideration should be given to the genetic background of these individuals, allied to the inter ethnic marriages and the changing habits or occupational activities, that have gradually introduced diseases previously not described in indigenous populations.

High prevalence of rheumatoid factor associated with clinical manifestations of rheumatic disease in Kaingang and Guarani Indians from Southern Brazil.

The aim of the present study was to perform a screening for rheumatoid factor (RF) and anti-nuclear antibody in Kaingang, Guarani and Mestizos individuals from Mangueirinha Reservation, State of Paraná, Brazil, and associate it with demographic and clinical data. Serum samples from 321 aborigines (125 male and 196 female; 4-86 years old) and 180 non-Indians healthy individuals were analysed (62 male and 118 female; 2-81 years old). Antinuclear antibody (ANA) was tested by indirect immunofluorescence, and RF by agglutination in latex and turbidimetry. RF was higher in Kaingang when compared to Guarani (P = 0.009), Mestizos (P = 0.061) and non-Indians (P = 0.010). A significant increase of RF was observed in Kaingang women versus Kaingang men (P = 0.002) and, among the women, in Kaingang when compared to Mestizos and Guarani (P

Pesquisa de anticorpos anti-endomísio no laboratório de imunopatologia da UFPR: dez anos de experiência na triagem de doença celíaca em pacientes, grupos de risco e populações / Antiendomysium antibodies evaluation in the laboratory of immunopathology of the UFPR: ten years of experience in the screening of celiac disease in patients, groups ato risk and in the general population

O laboratório de imunopatologia do Hospital de Clínicas da Universidade Federal do Paraná, através da pesquisa do anticorpo anti-endomísio (EmA-IgA), tem contribuído ao longo dos últimos dez anos com a triagem e diagnóstico diferencial da doença celíaca (DC) em pacientes, grupos de risco e populações do sul do Brasil. No presente estudo, tem-se uma síntese das investigações mais relevantes que foram realizadas e que possibilitaram diagnóstico da doença e no monitoramento da dieta isenta de glúten, assim como sua correlação com os anticorpos anti-transgluta-minase e o grau de lesão na mucosa intestinal. O EmA-IgA tem sido avaliado por imunofluorescência indireta, utilizando cordão umbilical humano como substrato, e conjugado fluorescente anti-IgA. O compilamento de dados dos estudos com familiares de celíacos (n=200), pacientes com síndrome de Down (n=150), diabetes mellitus (n=104), cardiomiopatias (n=74), artrite reumatóide (n=85), doadores de banco de sangue (n=2000) e indivíduos da população sadia (n=180), permitiu demonstrar significativa diferença na freqüência do EmA-IgA no grupo de familiares (p<0,001), pacientes síndrome de Down (p=0.0024) e diabetes mellitus (p<0.001), em relação à população sadia. Os dados obtidos nos últimos dez anos de pesquisa nessa área indicam os familiares de celíacos como ogrupo de maior risco ao desenvolvimento da doença, e ressaltam a importância de screenings periódicos para DC em pacientes com doenças autoimunes e/ou outras afecções.

[Serological screening of relatives of celiac disease patients: antiendomysium antibodies, anti-tissue transglutaminase or both?]. / Triagem sorológica de familiares de pacientes com doença celíaca: anticorpos anti-endomísio, antitransglutaminase ou ambos?

BACKGROUND: Celiac disease is the most common intestinal disorder of caucasian populations and presents a prevalence of 8% to 18% between the relatives of patients. The anti-endomysial (IgA-EmA) and anti-tissue transglutaminase antibodies (IgA-tTG) have represented an important non invasive and sensitivity method of screening and diagnosis of celiac disease in risk groups and populations. AIM: To investigate the prevalence of IgA-EmA and IgA-tTG antibodies in relatives of celiac patients and verify the degree of concordance between them. METHODS: One hundred and seventy seven relatives of celiac patients (76(feminino); 101(masculino); 2-79 years) and 93 healthy individuals were evaluated (34(feminino); 59(masculino); 2-71 years). IgA-EmA were detected by indirect immunofluorescence, with human umbilical cord as substrate, while anti-IgA-tTG titers were measured by enzyme-linked immunosorbent assay (ELISA), using commercial kit. RESULTS: Total positivity to antibodies in relatives of celiac patients was of 21% (37/177), and showed significant difference compared to control group (0%; 0/93). Twelve percent (21/177) of celiac disease relatives were positive to IgA-EmA, 13.56% (24/177) to IgA-tTG, and 4.52% (8/177) to both assays simultaneously. The concordance between both methods was 83.6% (148/177) and the discordance was 16.4% (29/177), with a positive and significant correlation (r = 0.435). Among the concordant results, 79.1% (140/177) were negative and 4.52% (8/177) were positive to both antibodies. Among the discordant results, 7.34% (13/177) were positive to IgA-EmA and negative to IgA-tTG, while 9.04% (16/177) were negative to IgA- EmA and positive to IgA-tTG. CONCLUSION: Although the high positivity to IgA-EmA and IgA-tTG emphasizes the importance of the serological screening in relatives of celiac patients, the discordances detected in this study showed that the use of only one method can lead to false negative results. Consequently these relatives will not be submitted to intestinal biopsy to confirm the diagnosis of celiac disease, and to the correct and earlier treatment.

Rheumatoid Arthritis and anti-endomysial antibodies.

BACKGROUND: Several autoimmune diseases may occur in the same patient. Celiac disease (CD) is found in patients with diabetes mellitus type-1 and thyroiditis. Few studies have addressed the association between CD and rheumatic disorders such as rheumatoid arthritis (RA). OBJECTIVE: To study the prevalence of anti-endomysial antibodies in RA patients. METHODS: The presence of IgA anti-endomysial antibodies (EmA-IgA) was evaluated in 85 RA patients and 97 healthy controls through indirect immunoflourescence using human umbilical cord as substrate. RESULTS: None of the RA patients or healthy controls was positive for EmA-IgA. CONCLUSION: We could not find an association between RA and anti-endomysial antibodies in the studied population.

Triagem sorológica de familiares de pacientes com doença celíaca: anticorpos anti-endomísio, antitransglutaminase ou ambos? / Serological screening of relatives of celiac disease patients: antiendomysium antibodies, anti-tissue transglutaminase or both?

RACIONAL: A doença celíaca representa, na atualidade, a doença intestinal mais comum em populações caucasóides e apresenta prevalência que varia de 8 por cento a 18 por cento nos familiares dos pacientes. A pesquisa dos anticorpos anti-endomísio (EmA-IgA) e antitransglutaminase tecidual (anti-tTG-IgA) constitui importante recurso não-invasivo e sensível de triagem e diagnóstico da doença celíaca em grupos de risco e populações. OBJETIVO: Avaliar a prevalência do EmA e anti-tTG em um grupo de familiares de celíacos e verificar o grau de concordância entre os dois métodos. MÉTODOS: Foram estudados 177 familiares (76(feminino); 101(masculino); 2-79 anos) e 93 indivíduos voluntßrios e sadios (34 (feminino); 59 (masculino); 2-71 anos) como grupo controle. O EmA foi detectado por imunofluorescência indireta (substrato: cordão umbilical humano) e o anti-tTG pelo método de ELISA (kit comercial). RESULTADOS: A positividade total de anticorpos nos familiares em estudo foi de 21 por cento (37/177), mostrando significativa diferença em relação aos controles (0 por cento; 0/93). Doze por cento (21/177) dos familiares foram positivos para o EmA e 13,56 por cento (24/177) para o anti-tTG, sendo 4,52 por cento (8/177) positivos concomitantemente para os dois anticorpos. A concordância de resultados entre os dois métodos foi de 83,6 por cento (148/177) e a discordância de 16,4 por cento (29/177), caracterizando uma correlação positiva significante (r= 0.435) entre ambos. Dentre os concordantes, 79,1 por cento (140/177) eram negativos para o anti-tTG e EmA, e 4,52 por cento (8/177) positivos para ambos. Nos casos discordantes, 7,34 por cento (13/177) apresentaram EmA positivo e anti-tTG negativo e 9,04 por cento (16/177) eram anti-tTG positivo e EmA negativo. CONCLUSÃO: Embora a alta positividade obtida para o EmA e anti-tTG destaque a importância da triagem sorológica em familiares de pacientes com doença celíaca, as discordâncias detectadas no estudo...

BACKGROUND: Celiac disease is the most common intestinal disorder of caucasian populations and presents a prevalence of 8 percent to 18 percent between the relatives of patients. The anti-endomysial (IgA-EmA) and anti-tissue transglutaminase antibodies (IgA-tTG) have represented an important non invasive and sensitivity method of screening and diagnosis of celiac disease in risk groups and populations. AIM: To investigate the prevalence of IgA-EmA and IgA-tTG antibodies in relatives of celiac patients and verify the degree of concordance between them. METHODS: One hundred and seventy seven relatives of celiac patients (76(feminino); 101(masculino); 2-79 years) and 93 healthy individuals were evaluated (34(feminino); 59(masculino); 2-71 years). IgA-EmA were detected by indirect immunofluorescence, with human umbilical cord as substrate, while anti-IgA-tTG titers were measured by enzyme-linked immunosorbent assay (ELISA), using commercial kit. RESULTS: Total positivity to antibodies in relatives of celiac patients was of 21 percent (37/177), and showed significant difference compared to control group (0 percent; 0/93). Twelve percent (21/177) of celiac disease relatives were positive to IgA-EmA, 13.56 percent (24/177) to IgA-tTG, and 4.52 percent (8/177) to both assays simultaneously. The concordance between both methods was 83.6 percent (148/177) and the discordance was 16.4 percent (29/177), with a positive and significant correlation (r = 0.435). Among the concordant results, 79.1 percent (140/177) were negative and 4.52 percent (8/177) were positive to both antibodies. Among the discordant results, 7.34 percent (13/177) were positive to IgA-EmA and negative to IgA-tTG, while 9.04 percent (16/177) were negative to IgA- EmA and positive to IgA-tTG. CONCLUSION: Although the high positivity to IgA-EmA and IgA-tTG emphasizes the importance of the serological screening in relatives of celiac patients, the discordances detected in this study...

Celiac disease and hypothyroidism in an adult Brazilian female with Down syndrome

A high prevalence of celiac disease (CD) in pa»tients with Down syndrome (DS) has been re»ported, mainly in children. The authors present the case of a 47-years-old woman with a history of diarrhea in childhood and since adolescence; and with a treatment for pulmonary tuberculo»siso Currently she reports diarrhea, abdominal distension, weight loss, anemia and treatment for hypothyroidism with levothyroxine. CD was di»agnosed by intestinal biopsy and by positive IgA antiendomysium antibodies. Increased levels of thyroid stimulating hormone and positive anti»thyroperoxidase antibodies were detected. Ultra»sonography of the thyroid gland suggested chronic Iymphocytic thyroiditis. With a gluten»free diet she improved and could control the hypothyroidism. After 2 years, when the family reintroduced gluten she presented the same clin»ical complaints. Laboratory data confirmed the previous diagnosis. The same orientation was offered, with clinical recovery. The authors em»phasize the importance of 5creening for infec»tious and autoimmune diseases in patients with DS, in ali ages, because nowadays individuais with DS live 50 years or more. Both DS and CD can predispose the patients to malignancies, mainly in adult life.

Principais auto-anticorpos envolvidos na infertilidade masculina e feminina com ênfase nos aspectos clínicos e laboratoriais / Manin autoantibodies involved in female and male infertility, emphasizing the clinical and laboratorial aspects

A auto-imunidade pode interferir na capacidade de fertilização de um casal ou na manutenção de uma gestação. O organismo pode desenvolver auto-anticorpos contra estruturas próprias. É importante conhecer quais são esses auto-anticorpos e como atuam. Cerca de 18% dos casais das metrópoles brasileiras em idade fértil não conseguem ter filhos e pesquisas recentes indicam que osfatores auto-imunes representam 10 a 15% das causas de infertilidade. Para se efetuar um tratamento adequado é necessário um diagnóstico através da pesquisa de anticorpos antiespermatozóides, anticorpos antifosfolipídeos, anticardiolipina, alfa-2 glicoproteína, anticoagulante lúpico e KPTT. Os estudos relativos aos mecanismos imunopatogênicos dos auto-anticorpos envolvidos nos casos de infertilidade podem auxiliar no diagnóstico e na prevenção da infertilidade e dos abortos de repetição.

The autoimmunity can affect the fertilization capacity and the pregnancy success of a couple. The immune system can develop autoantibodies against self-antigens. It is important to recognize this autoantibodies and to know how they act. It is estimated that the infertility affect 18% of brazilian couples in fertile age and actual researches indicate that the autoimmune factors represent 10-15% of the infertility causes. Laboratorial tests are necessary to assure an adequate diagnostic and treatment. Some of these tests are: antisperm antibodies, antiphospholipids antibodies, anticardiolipin antibodies, â-2 glicoprotein antibodies, lupus anticoagulant and KPTT. Researches about the immunopathogenics mechanisms of the auto antibodies involved with the infertility can help on prevention and diagnostic of the infertility and recurrent miscarriage.

[Genetics and immunopathogenics aspects of the celiac disease: a recent vision]. / Aspectos genéticos e imunopatogênicos da doença celíaca: visão atual.

BACKGROUND: Celiac disease, or gluten-sensitive enteropathy, is a strongly inherited condition. Although the genetic association of CD with the DQ2 and DQ8 HLA haplotypes has been known for long, others HLA and non-HLA genes are also important in the development of the disease. Celiac disease results of the combined effect of different normally functioning genes' products. The tissue damage in celiac disease is immunologically mediated and several effector mechanisms are responsible for the disease expression. The interplay between genetic, immunological and environmental factors explains the large spectrum of clinical, histological and serological alterations observed in the different stages of the disease development, pointing out to the polygenic nature of celiac disease. CONCLUSION: The recent advances in the understanding of the immunopathogenesis, genetics and diagnoses of celiac disease have allowed the revision of strict concepts and previous criteria and their adequation to the new evidences, aiming a better diagnostic and orientation to celiac patients and relatives.