Template for the laboratorys report of 25-hydroxyvitamin D: recommendations form the Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and the Brazilian Society of Endocrinology and Metabolism (SBEM) / Modelo de laudo laboratorial para 25-hidroxivitamina D: recomendações da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML) e da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM)

ABSTRACT The Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and the Brazilian Society of Endocrinology and Metabolism (SBEM) recommend a new template for laboratory reports of 25-hydroxyvitamin D: deficiency < 20 ng/ml; normal values for the general population between 20-60 ng/ml; ideal values for at-risk population between 30-60 ng/ml; e risk of toxicity > 100 ng/ml.

RESUMEN La Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML) y la Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) sugieren un nuevo modelo de informe de laboratorio para 25-hidroxivitamina D: deficiencia < 20 ng/ml; valores normales para la población general entre 20 y 60 ng/ml; valores ideales para la población de riesgo entre 30 y 60 ng/ml; riesgo de intoxicación > 100 ng/ml.

RESUMO A Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML) e a Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) recomendam um novo modelo de laudo laboratorial para 25-hidroxivitamina D: deficiência < 20 ng/ml; valores normais para a população geral entre 20 e 60 ng/ml; valores ideais para população de risco entre 30 e 60 ng/ml; e risco de intoxicação > 100 ng/ml.

Influence of expiration date on analytical performance of rapid tests for HIV diagnosis / Influência do prazo de validade no desempenho analítico de teste rápido para o diagnóstico do HIV

ABSTRACT Introduction: Rapid tests (RTs) are ideal to provide laboratorial results within 30 minutes in a variety of situations and locations, even in underserved communities. Like any other laboratory input, they can only be used within the expiration date. Objective: The aim of this study was to compare the analytical performance of the RT Interkit HIV 1 and 2® (Interteck Katal - Belo Horizonte, Brazil) at two different times, two years before and one week before the expiration date. Material and methods: Two hundred serum samples were used, from individuals over 18 months of age, of both sexes, previously tested by electrochemiluminescence and Western Blot for HIV infection, distributed in two groups: reactive (n = 100) and non-reactive (n = 100). Results: The RT showed similar and satisfactory diagnostic accuracy in the two analyzed moments, with no statistical difference. Conclusion: The RT Interkit HIV 1 and 2® showed stable analytical performance both at the beginning and the end of its validity term.

RESUMEN Introducción: Las pruebas rápidas son ideales pues dan resultados en hasta 30 minutos, en diversas situaciones y locales, incluso en localidades carentes. Como cualquier otro insumo de laboratorio, solo pueden ser utilizados dentro de la fecha de caducidad. Objetivo: Comparar el desempeño analítico de la PR Interkit HIV 1 y 2® (Interteck Katal, Belo Horizonte, Brasil) en dos momentos: dos años antes y una semana antes del vencimiento de la fecha de caducidad. Material y método: Se utilizaron doscientas muestras de sueros de individuos mayores de 18 meses de edad, de ambos sexos. Las muestras fueron previamente probadas por electroquimioluminiscencia y Western Blot para infección por VIH y distribuidas en dos grupos: reactivas (n = 100) y no-reactivas (n = 100). Resultados: La PR presentó precisión diagnóstica satisfactoria y semejante en ambos momentos analizados, sin diferencia estadística. Conclusión: La PR Interkit HIV 1 y 2® presentó desempeño analítico estable, tanto al principio cuanto al final de su fecha de caducidad.

RESUMO Introdução: Os testes rápidos (TR) são ideais para fornecer resultados laboratoriais em até 30 minutos, em diversas situações e locais, mesmo em comunidades mais carentes. Como qualquer outro insumo laboratorial, eles só podem ser utilizados dentro do prazo de validade. Objetivo: O objetivo deste estudo foi comparar o desempenho analítico do TR Interkit HIV 1 e 2(r) (Interteck Katal, Belo Horizonte, Brasil) em dois momentos: dois anos antes e uma semana antes do vencimento. Material e métodos: Duzentas amostras de soro de indivíduos com mais de 18 meses de idade, de ambos os sexos, foram utilizadas. Elas foram previamente testadas por eletroquimioluminescência e Western Blot para a infecção por HIV e distribuídas em dois grupos: reagentes (n = 100) e não reagentes (n = 100). Resultados: O TR apresentou acurácia diagnóstica satisfatória e semelhante nos dois momentos analisados, sem diferença estatística. Conclusão: O TR Interkit HIV 1 e 2® apresentou desempenho analítico estável, tanto no início quanto no final do prazo de validade.

Quantification of NGAL in Urine of Endurance Cycling Athletes.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein released during early phases of a postischemic kidney in response to kidney injury, inflammation, and oxidative stress. It can be detected in urine after 2 hours of an ischemic event. The aim was to measure and to correlate the level of urine NGAL (uNGAL) with urea, creatinine, and glomerular filtration rate (GFR) of endurance cycling athletes (n = 19) and physically active individuals (control, n = 17). METHODS: Quantification of urea and creatinine were performed by dry chemical method, and GFR was calculated using the modification of diet in renal disease formula, according to Brazilian Society of Nephrology. uNGAL analyses were performed by enzyme linked immunoabsorbent assay. Analyses were performed 48 hours after exercises. RESULTS: uNGAL (in ng/mL) levels, expressed as median, minimum, and maximum, in cyclist group, 387.7 (109.7-1691.0), was significantly higher than that observed in control (physically active) group, 141.5 (4.8-657.0), (P < .05). No significant correlations were observed between uNGAL and creatinine, urea, or GFR (P > .05). CONCLUSIONS: Results have pointed to increased uNGAL levels in endurance cycling athletes. Increase of uNGAL in absence of clinical signs or alterations in creatinine, urea, or GFR might suggest that there is metabolic adaptation to endurance exercise, or possibly predisposition to acute kidney injury over time.

Consensus - reference ranges of vitamin D [25(OH)D] from the Brazilian medical societies. Brazilian Society of Clinical Pathology/Laboratory Medicine (SBPC/ML) and Brazilian Society of Endocrinology and Metabolism (SBEM) / Posicionamento oficial da Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML) e da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) sobre intervalos de referência da vitamina D [25(OH)D]

ABSTRACT Introduction: Vitamin D is considered a pre-hormone and plays a crucial role in calcium homeostasis and, consequently, in bone health. The best source of vitamin D is the skin in response to sunlight. Only small amounts of this vitamin are found in some foods (especially fatty fish), which makes availability of vitamin D in the diet limited. Brazilian population studies show that the prevalence of hypovitaminosis D in our country is high. Objective: To define the reference intervals for vitamin D [25(OH)D]. Discussion: Consensus of specialists - literature review. Conclusion: The standardization of reference intervals is fundamental for the correct diagnosis and treatment of hypovitaminosis D.

RESUMO Introdução: A vitamina D é considerada um pré-hormônio e apresenta papel crucial na homeostase do cálcio e, consequentemente, na saúde óssea. A maior fonte de vitamina D é a pele, em resposta à luz solar. Apenas pequenas quantidades dessa vitamina são encontradas em alguns alimentos (especialmente peixes gordurosos), o que faz com que a disponibilidade da vitamina D na dieta seja limitada. Estudos populacionais brasileiros demonstram que a prevalência da hipovitaminose D no nosso país é elevada. Objetivo: Definição dos intervalos de referência para vitamina D [25(OH)D]. Discussão: Consenso de especialistas - revisão da literatura. Conclusão: A padronização dos intervalos de referência é fundamental para o correto diagnóstico e tratamento da hipovitaminose D.

Implementation of criteria for automatic release of clinical chemistry test results in a laboratory at an academic public hospital / Implantação de critérios de liberação automática de resultados de bioquímica em um laboratório de hospital público universitário

ABSTRACT Introduction: Autoverification is the release of laboratory test results from clinical instruments to hospital interface, or to patients' records, with no human intervention. Verification rules are inserted in the middleware and/or in the laboratory information system (LIS), based on criteria established by the laboratory. As a result, it ensures that every result is consistently reviewed in the same way, improving the entire verification process and patient safety. Objective: Describe the implementation of autoverification of clinical chemistry tests results at the core laboratory of Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG), Brazil. Material and methods: Twenty-six automated chemistry assays were chosen. They were fully automated including internal quality control, interfaced with LIS, available 24 hours a day, seven days a week. Rules were set up in the middleware and in the LIS. Instrument flags, evaluation of sample integrity, test linearity, delta check and critical values were used to construct the verification algorithms. Results: An autoverification algorithm was constructed; delta check values were calculated and defined, as well as automatic verification ranges. The results retained for manual verification followed a flowchart prepared for this purpose. Conclusion: Autoverification implementation led to a more consistent reviewing process of test results, efficiency and improved patient safety.

RESUMO Introdução: A verificação automática dos resultados consiste na liberação dos resultados dos exames diretamente do equipamento, sem intervenção humana. São inseridas regras para avaliar os resultados no middleware e/ou no sistema de informação laboratorial (SIL), com base em critérios estabelecidos pelo laboratório. A autoverificação uniformiza os critérios de liberação e melhora a eficiência no processo, garantindo a segurança do paciente. Objetivo: Descrever a implantação da autoverificação nos testes bioquímicos do menu de urgência no Serviço de Medicina Laboratorial (SML) do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC/UFMG). Material e métodos: Foram configurados 26 testes bioquímicos disponíveis 24 horas por dia, plenamente interfaceados, inclusive o controle interno da qualidade. Definiram-se parâmetros e algoritmos usados para configuração do SIL e no middleware. No algoritmo elaborado para autoverificação, foram incluídos flags de equipamento, presença de interferentes na amostra, linearidade, delta check e valores críticos. Resultados O algoritmo de liberação automática de resultados, os valores de delta check, os intervalos de liberação automática e o fluxograma para liberação manual dos resultados retidos foram definidos e implantados. Conclusão: A implantação da autoverificação nos testes bioquímicos do menu de urgência no serviço possibilitou padronização e segurança na liberação dos resultados.

Prevention of abdominal adhesions and healing skin after peritoniectomy using low level laser.

BACKGROUND: Adhesions commonly occur after abdominal surgery and can cause bowel obstruction, chronic abdominal pain, and infertility. Their prevention remains a challenge. OBJECTIVES: To evaluate the effects of the application of low-level lasers on the prevention of adhesions and scarring of the skin after peritoniectomia. METHOD: Twenty-four New Zealand breed male rabbits, approximately 2 months of age, were randomly divided into 3 groups (n = 8): GC-control group not subjected to laser, GL1-group with laser application at a dose of 0.2 J, and GL2-group with laser application at a dose of 3.6 J. All animals received a longitudinal midline incision and a bilateral resection of the peritoneal fragment, measuring 3 × 1 cm(2) . The animals received a laser treatment of one application every 24 hours, beginning at the time of surgery and lasting for a period of 4 days. After 14 days post-surgery, the animals were killed and adhesion formation was evaluated qualitatively and quantitatively by means of a laparotomy shaped inverted "U", which allowed for the verification of the broad wall of the abdominal cavity and organs. Differences were considered significant at P < 0.05. RESULTS: The adhesion formation was observed in 100% of the rabbits from groups GC and GL1, as compared to 37.5% of the rabbits from group GL2 (P < 0.01). The evaluation of the vascularization and tenacity of adhesions among the groups showed no significant difference. In groups CG and GL1, 72% and 83% of adhesions were verified between visceras, respectively whereas in GL2 occurred among abdominal wall. The tensile strength of the skin between the groups was not significant (P = 0.3106). The resistance of abdominal wall segments without skin he resistance of skin segments between groups GL2 and GC were higher than in GL1 (P = 0.01). CONCLUSION: Low-level LASER is effective in preventing intra-abdominal adhesions in rabbits without compromising strength and healing of the abdominal wall.

Allogeneic and autologous ovarian orthotopic transplantation without a vascular pedicle: morphological, endocrinologic and natural pregnancy assessment.

BACKGROUND: To assess the natural pregnancy of rabbits submitted to bilateral oophorectomy and orthotopic allogeneic or autologous intact and sliced ovarian transplantation without a vascular pedicle, and to determine the morpho-functional aspects of the transplanted ovaries. METHODS: Fifty-six female rabbits were studied. The ovaries were removed and orthotopically transplanted or replaced without vascular anastomoses: Group 1 (n = 8), only laparotomy and laparorrhaphy; Group 2A (n = 8), intact ovaries were transplanted on both sides; Group 2B (n = 8), both ovaries were sliced and orthotopically transplanted; Group 2C (n = 8), an intact ovary was transplanted on one side and a sliced ovary on the other side; Groups 3A-C, the ovaries were reimplanted according to the procedure and subgroups described for Group 2. Three months later, the animals were paired with males for copulation. Estradiol, progesterone, FSH and LH hormone levels were assessed. A histological study was carried out, and the number of pregnancies and litters were also determined. Chi-squared test compared the number of pregnancies and litters. One-way anova and the Tukey-Kramer tests compared the hormonal dosages. RESULTS: Pregnancies occurred in seven rabbits of Group 1, in 37.5% of rabbits in Groups 2A and 3A, in 50% of groups 2B, 3B and 3C, and in 62.5% of group 2C. Hormone levels and histology confirmed the vitality of all ovaries. CONCLUSIONS: Intact or sliced orthotopic allogeneic and autologous ovarian transplantation without a vascular pedicle is viable in rabbits, and preserves their hormonal and fertile functions.

Morphologic, endocrinologic and natural pregnancy assessment of allogeneic ovarian orthotopic transplantation without a vascular pedicle in rabbits.

OBJECTIVE: The objective was to assess the natural pregnancy of rabbits subjected to bilateral oophorectomy and orthotopic allogeneic intact and sliced ovarian transplantation without a vascular pedicle, and to determine the morphofunctional aspects of the transplanted ovaries. STUDY DESIGN: Thirty-two female rabbits were studied. The ovaries were removed and orthotopically transplanted without vascular anastomoses between the two breeds of rabbits. In Group 1 (n=8), only laparotomy and laparorrhaphy were performed, in Group 2A (n=8) intact ovaries were transplanted on both sides, in Group 2B (n=8) both ovaries were sliced and orthotopically transplanted, and in Group 2C (n=8) an intact ovary was transplanted on one side and a sliced ovary on the other side. Three months later, the animals were paired with males for copulation. Estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone levels were assessed. A histologic study was carried out and the numbers of pregnancies and litters were also determined. RESULTS: Pregnancies occurred in seven rabbits in Group 1, 37.5% of rabbits in Group 2A, 50% in Group 2B, and 62.5% in Group 2C. Hormone levels and histology confirmed the vitality and function of all ovaries. CONCLUSIONS: Intact or sliced orthotopic allogeneic ovarian transplantation without a vascular pedicle is viable in rabbits, and preserves their hormonal and fertile functions.

Influência da ooforectomia na variação ponderal em ratas jovens e adultas / Influence of oophorectomy on the weight variance in young and adult female rats

Para avaliar a influência do tempo de ooforectomia na variação ponderal, foram utilizadas 60 ratas, divididas em dois grupos (30 em cada grupo): Grupo A - jovens; e Grupo B - adultas. Os animais de cada grupo foram subdivididos em três subgrupos: Subgrupo 1 - controle (n= 6); Subgrupo 2 - laparotomia (n= 6); Subgrupo 3 (n= 18) - ooforectomia total bilateral. Os animais foram pesados semanalmente durante 13 semanas e os resultados foram avaliados pelo teste t de Student, com significância para p<0,05. As ratas ooforectomizadas tiveram ganho ponderal maior do que as demais, sendo a diferença significativa a partir da 11ª semana no Grupo A e 9ª semana no Grupo B, persistindo até o fim do experimento. No presente trabalho, a ooforectomia bilateral em ratas relacionou-se com maior ganho ponderal, independente da idade dos animais.

[Influence of oophorectomy on weight variance in young and adult female rats]. / Influência da ooforectomia na variação ponderal em ratas jovens e adultas.

To assess the effects of oophorectomy on body weight, 60 adult female rats were divided into two groups (30 in each group): Group A -- young rats; Group B -- adult rats. The animals of each group were divided into three subgroups: Subgroup 1 (n= 6) -- control; Subgroup 2 (n= 6) -- laparotomy; Subgroup 3 (n= 18) -- bilateral oophorectomy. The weight of the animals was weekly assessed during 13 weeks and the results were compared by Student t test, with significance for p<0.05. The oophorectomized rats presented higher weight gain than those of the other groups. The difference was significant after eleven weeks, in Group A, and nine weeks, in Group B, until the end of the experiment. In the present work, bilateral oophorectomy in rats was related to higher body weight, independent on the age of the animals.

Atividade fagocitária do sistema mononuclear fagocitário na gravidez / Phagocytic function of reticuloendothelial system during pregnancy

As alterações imunitárias que ocorrem durante a gravidez são ainda pouco compreendidas. Para determinar a influência da gravidez na atividade fagocitária do sistema mononuclear fagocitário (SMF) foram utilizadas vinte ratas adultas. Os animais foram divididos em dois grupos (n-10): Grupo 1 - controle, Grupo 2 - ratas prenhas. A função do sistema mononuclear fagocitário foi determinada pela captação de enxofre coloidal marcado com 99mTc pelos órgãos do SMF, além de avaliar a permanência do radiofármaco em coágulo sangüíneo. O peso e a radiação de cada amostra foram medidas. Realizou-se também análise histológica desses órgãos. Os resultados foram comparados pelo teste t de Student. Em todos os animais, a captação do radiofármaco foi maior no fígado, seguido pelo baço e pulmão. O coágulo sangüíneo apresentou uma quantidade mínima de radiação. As ratas grávidas registraram menor captação do colóide no fígado e maior captação no pulmão em relação ao grupo controle. Não foram evidenciadas alterações na histoarquitetura desses órgãos. Em rata grávida, a atividade fagocitária do SMF diminuiu no fígado, porém aumentou no pulmão.

Alterations of the immune function during thepregnancy are not well understood. To assess theinfluence of pregnancy on the phagocytic function ofthe reticuloendothelial system twenty adult female ratswere divided into two groups: Group 1 (n=10) –control, Group 2 (n=10) – pregnant rats. The assessmentof the phagocytic function of the reticuloendothelialsystem was by the uptake of sulphur colloid labeled withTc99m by the reticuloendothelial system organs as wellas to assess the permanence of the radio isotope inblood clots. The weights and radioactive levels of thesamples were measured. Histologic analyses of theseorgans were performed as well. The results werecompared using the Student t-test, with significanceat p<0.05. The scintigraphic values were higher in theliver followed by spleen and lung. The blood clotpresented with only a low amount of radiation. Thepregnant rats registered lower radiation levels in theliver and higher in the lung when compared with thecontrol group. The histo-architecture of the studiedorgans did not show any alterations. Pregnancyreduces the phagocytic function of the liver butincreases the role of the reticuloendothelial systemfunction of the lung.

Avaliaçäo morfofuncional do auto-implante ovariano no retroperitônio / Morphofunction assessment of ovarian autotransplantation in the retroperitoneum

Introduçäo: Em muitos procedimentos pélvicos e abdominais, a ooforectomia bilateral se impõe, porém suas complicações sistêmicas, como insuficiências hormonais, podem ser de difícil controle. Objetivo: Visando a preservaçäo da funçäo gonadal, em casos de ooforectomia, avaliaram-se aspectos funcionais e histológicos de tecido ovariano auto-implantado, em posiçäo heterotópica. Material e Métodos: Foram selecionadas 36 ratas Wistar, com ciclos estrais, normais, divididas aleatoriamente em quatro grupos (n=9): G1- controle- submetido a laparotomia, sem procedimento cirúrgico adicional; G2- ooforectomia bilateral; G3- os ovários retirados foram implantados integralmente no retroperitônio; G4- os ovários retirados foram fatiados e também implantados no retroperitônio. Nos 30 e 60 meses pós-operatórios, realizaram-se esfregaços vaginais e estudos histológicos dos implantes ovarianos. Resultados: Os animais do grupo G1 tiveram seus ciclos normalmente. As ratas dos grupos G2 permaneceram durante todo o período em diestro. No grupo G3, no sexto mês, duas ratas tiveram ciclos completos, compatíveis com a fase estral; três animais apresentaram ciclos irregulares e os restantes permaneceram em diestro. No grupo G4, no sexto mês pós-operatório, três ratas apresentaram ciclos incompletos, cinco ratas apresentaram ciclos estrais completos, e apenas uma permaneceu fixa em diestro. O estudo anatomopatológico confirmou viabilidade ovariana em ambos os grupos de auto-implante (G3 e G4) com melhores resultados para o G4. Conclusões: O auto-implante ovariano no retroperitônio, na forma fatiada, apresentou melhor preservaçäo morfofuncional do que a do íntegro