Análise de custos de pacientes cirróticos descompensados recebendo albumina a longo prazo versus tratamento médico padrão nos sistemas de saúde público e privado do Brasil / Albumin versus standard medical treatment in brazilian public and private healthcare systems

ABSTRACT Background: Cirrhosis is one of the final stages of chronic liver disease. Common causes of cirrhosis include alcoholism and viral hepatitis infections. Cirrhosis can progress from an asymptomatic, compensated phase to decompensation and the appearance of overt symptoms. There is no specific treatment for decompensated cirrhosis. The ANSWER trial positioned long-term albumin infusions as a potential treatment for patients with cirrhosis and uncomplicated ascites. Objective: This study assesses the economic impact of albumin infusions following the ANSWER trial regimen in Brazilian patients with decompensated cirrhosis from the public and private healthcare systems perspectives. Methods: The incremental cost per patient per year was calculated for standard medical treatment (SMT) plus long-term albumin infusions versus SMT alone. Costs of diuretics and albumin were obtained from Banco de Preços em Saúde and the Drug Market Regulation Chamber. Costs for complication and procedures were gathered from the published literature. Costs were transformed to 2021 Brazilian reals (BRL). Incidences of clinical complications and treatments were gathered from the ANSWER trial. Univariate sensitivity analysis was performed by increasing and decreasing all inputs by 20%. Results: The cost per patient per year was 118,759 BRL and 189,675 BRL lower for patients treated with SMT and albumin (compared to SMT only) for the public and private healthcare systems, respectively. The additional cost of albumin was offset by reduced complications and treatments (149,526 BRL and 249,572 BRL, respectively). The univariate sensitivity analysis showed cost savings for both healthcare systems in all the scenarios assessed. Conclusion: This economic analysis suggests that, if the ANSWER trial clinical outcomes translate into real-world effectiveness, addition of albumin infusions to SMT in patients with decompensated cirrhosis may lead to cost savings for the public and private healthcare systems in Brazil.

RESUMO Contexto: A cirrose representa o estágio final da doença hepática crônica. Causas comuns de cirrose incluem alcoolismo e infecções por hepatite viral. A cirrose pode progredir de uma fase compensada assintomática para descompensação e aparecimento de sintomas evidentes. Não há tratamento específico para cirrose descompensada. O estudo ANSWER demonstrou que a administração de albumina a longo prazo pode representar um potencial tratamento para pacientes com cirrose e ascite não complicada. Objetivo: Nosso estudo avalia o impacto econômico da administração de albumina a longo prazo seguindo o protocolo do estudo ANSWER em pacientes brasileiros com cirrose descompensada, sob a perspectiva dos sistemas de saúde público e privado. Métodos: O custo incremental por paciente por ano foi calculado para o tratamento médico padrão (SMT) associado a administração de albumina a longo prazo comparado a SMT apenas. Os custos de diuréticos e albumina foram obtidos no Banco de Preços em Saúde e na Câmara de Regulação do Mercado de Medicamentos. Os custos de complicações e procedimentos foram coletados da literatura publicada. Os custos foram transformados em Reais de 2021 (BRL). As incidências de complicações clínicas e tratamentos foram coletadas do estudo ANSWER. Uma análise de sensibilidade univariada foi realizada aumentando e diminuindo todas as variáveis em 20%. Resultados: O custo por paciente por ano foi de R$ 118.759 e R$ 189.675 menor para pacientes tratados com SMT e albumina (comparado apenas com SMT) para os sistemas de saúde público e privado, respectivamente. O custo adicional da albumina foi compensado pela redução de complicações e tratamentos (149.526 BRL e 249.572 BRL, respectivamente). A análise de sensibilidade univariada mostrou redução de custos para ambos os sistemas de saúde em todos os cenários avaliados. Conclusão: Esta análise econômica sugere que, se os resultados clínicos do estudo ANSWER se confirmarem no mundo real, a administração de albumina associada ao SMT em pacientes com cirrose descompensada pode levar a redução de custos para os sistemas de saúde público e privado no Brasil.

Primeras recomendaciones de consenso SLANH - COLABIOCLI / Primeiras Recomendações de Consenso SLANH - COLABIOCLI / (Sociedad Latinoamericana de Nefrología e Hipertensión - Confederación Latinoamericana de Bioquímica Clínica) / Informe de la tasa de filtración glomerular estimada junto a la determinación de la creatininemia en población adulta / First SLANH-COLABIOCLI Consensus Recommendations

Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.

Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.

Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.

Relación del consumo de calcio con el síndrome metabólico en adultos de la Amazonía Ecuatoriana / Relationship of calcium consumption with metabolic syndrome in adults from the Ecuadorian Amazon

Introducción. El Síndrome Metabólico (SM) comprende un conjunto de factores de riesgo cardiometabólico representado por obesidad central, dislipidemia, hipertensión arterial y glucosa alterada, se ha evidenciado que el consumo adecuado de calcio representa una disminución del riesgo para este síndrome. Objetivo. Analizar la relación entre el consumo de calcio total, de origen animal y vegetal con el SM y sus indicadores. Materiales y métodos. Estudio transversal de eje correlacional, con una muestra de 100 adultos de la región amazónica ecuatoriana, durante el último trimestre del 2020. La ingesta dietética de calcio se determinó mediante un recordatorio de 24 horas y el SM según los criterios de Adult Treatment Panel-IV (ATP-IV). Resultados. La población estuvo conformada por adultos maduros (40 a 60 años) que evidenciaron una ingesta de calcio deficiente (182,50 mg y 228,60 mg en mujeres y hombres respectivamente). Se evidenció, además, una relación directamente proporcional entre la circunferencia abdominal (r=0,391 ­ p=0,000), presión arterial sistólica (r=0,290 ­ p=0,000) y glucosa en ayuno (r=0,326 ­ p=0,000) con la edad. La ingesta de calcio total se relacionó positivamente con los triglicéridos, (r=0,221 ­ p=0,027). Conclusiones. La ingesta dietética de calcio en ambos sexos no alcanza el requerimiento diario y se relaciona positivamente con los triglicéridos(AU)

Introduction. The Metabolic Syndrome (MS) comprises a set of cardiometabolic risk factors represented by central obesity, dyslipidemia, high blood pressure and altered glucose, it has been shown that adequate calcium intake represents a decreased risk for this syndrome. Objective. To analyze the relationship between the consumption of total calcium, animal and vegetable origin, with MS and its indicators. Materials and methods. Cross-sectional study of correlational axis, with a sample of 100 adults from the Ecuadorian Amazon region, during the last quarter of 2020. Dietary calcium intake was determined through a 24-hour recall and the diagnosis of MS according to the Adult Treatment Panel- IV (ATP-IV) criteria. Results. The population consisted of mature adults (40 to 60 years) who showed a deficient calcium intake in both sexes (182.50 mg and 228.60 mg in women and men respectively). There is also evidence of a directly proportional relationship between abdominal circumference (r=0.391 - p=0.000), systolic blood pressure (r=0.290 - p=0.000) and fasting glucose (r=0.326 - p=0.000) with age. Total calcium intake was positively related to triglycerides (r=0.221 ­ p=0.027). Conclusions. Calcium dietary intake in both sexes does not reach the daily requirement and is positively related to triglycerides(AU)

Serum amyloid A levels in acute and chronic urticaria

Abstract: Background: Serum amyloid A is an acute-phase protein. There is no available data regarding serum amyloid A levels in patients with acute and chronic urticaria (CU). Objective: To investigate the association between serum amyloid A and urticaria. Methods: This was a case-control study of 81 patients who visited our Hospital between June and December 2016 with a diagnosis of urticaria. Eighty healthy controls (HC) who visited for routine health examination and physical checkups were recruited. Serum amyloid A and C-reactive protein levels were measured by automated methods. Results: Serum amyloid A and C-reactive protein levels were significantly higher in AU (Serum amyloid A: 207.1 (6.7-439.0) mg/L; C-reactive protein: 16.0 (0.2-90.0) mg/L) and CU (Serum amyloid A: 6.5 (2.5-35.8) mg/L; C-reactive protein: 1.0 (0.1-16.0) mg/L) compared with HC (Serum amyloid A: 5.04 (2.0-9.1) mg/L; C-reactive protein: 1.2 (0.1-5.6) mg/L), and in AU compared with CU (all P<0.05). There were no differences between the CU and HC group. In CU, Serum amyloid A levels in those with moderate/severe urticaria (median, 16.4 (9.7-35.8) mg/L) were higher than in those with mild urticaria (median, 5.7 (2.5-9.5) mg/L) and HC (all P<0.05). Serum amyloid A and C-reactive protein levels exceeded the normal lab range in 90.7% and 72.1% patients with AU compared with 28.9% and 13.2% patients with CU, respectively. Significant positive correlations were found between serum amyloid A and C-reactive protein (r = 0.562, P < 0.001). Study limitations: There was no comparison between active disease and remission. Conclusion: There was an association between serum amyloid A levels and urticaria. Higher serum amyloid A levels were associated with AU and more severe CU. Serum amyloid A may help to identify CU patients earlier.

Utilidad de la cistatina C como biomarcador precoz de daño renal en pacientes con diabetes mellitus de tipo 2 / Use of Cystatin C as early biomarker of renal damage in patients with diabetes mellitus type 2

Se llevó a cabo un estudio observacional, descriptivo, de serie de casos, en 144 pacientes con diabetes mellitus de tipo 2, atendidos en el Laboratorio Clínico del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba, de mayo de 2017 a igual de 2018, procedentes de la consulta de Endocrinología del propio hospital, con vistas a evaluar la utilidad de la cistatina C como biomarcador precoz de daño renal. En la investigación predominaron los pacientes de más de 50 años de edad y del sexo femenino, además de la hipertensión arterial como enfermedad asociada y la neuropatía periférica como complicación. Se concluyó que la cistatina C es útil como biomarcador precoz de daño renal en pacientes con diabetes mellitus de tipo 2, fundamentalmente si existen comorbilidades y complicaciones que pudieran conducir a la enfermedad renal crónica, lo que puede prevenirse.

An observational, descriptive series of cases study, was carried out in 144 patients with diabetes mellitus type 2, assisted in the Clinical Laboratory of Saturnino Lora Torres Teaching Provincial Hospital in Santiago de Cuba from May, 2017 to the same month of 2018, who were from the Endocrinology Service of the same hospital, with the aim of evaluating the utility of the Cystatin C as early biomarker of renal damage. Patients older than 50 years of age and female sex, besides hypertension as associated disease and the outlying neuropathy as complication prevailed in the investigation. It was concluded that Cystatin C is useful as early biomarker of renal damage in patients with diabetes mellitus type 2, fundamentally if there are comorbidities and complications that could cause chronic renal failure, which can be prevented.

A lung image reconstruction from computed radiography images as a tool to tuberculosis treatment control

Background: Tuberculosis (TB) is an infectious lung disease with high worldwide incidence that severely compromises the quality of life in affected individuals. Clinical tests are currently employed to monitor pulmonary status and treatment progression. The present study aimed to apply a three-dimensional (3D) reconstruction method based on chest radiography to quantify lung-involvement volume of TB acute-phase patients before and after treatment. In addition, these results were compared with indices from conventional clinical exams to show the coincidence level. Methods: A 3D lung reconstruction method using patient chest radiography was applied to quantify lung-involvement volume using retrospective examinations of 50 patients who were diagnosed with pulmonary TB and treated with two different drugs schemes. Twenty-five patients were treated with Scheme I (rifampicin, isoniazid, and pyrazinamide), whereas twenty-five patients were treated with Scheme II (rifampicin, isoniazid, pyrazinamide, and ethambutol). Acute-phase reaction: Serum exams included C-reactive protein levels, erythrocyte sedimentation rate, and albumin levels. Pulmonary function was tested posttreatment. Results: We found strong agreement between lung involvement and serum indices pre- and posttreatment. Comparison of the functional severity degree with lung involvement based on 3D image quantification for both treatment schemes found a high correlation. Conclusions: The present 3D reconstruction method produced a satisfactory agreement with the acute-phase reaction, most notably a higher significance level with the C-reactive protein. We also found a quite reasonable coincidence between the 3D reconstruction method and the degree of functional lung impairment posttreatment. The performance of the quantification method was satisfactory when comparing the two treatment schemes. Thus, the 3D reconstruction quantification method may be useful tools for monitoring TB treatment. The association with serum indices are not only inexpensive and sensitive but also may be incorporated into the assessment of patients during TB treatment.(AU)

Epidemiologia dos acidentes por animais peçonhentos e a distribuição de soros: estado de arte e a situação mundial / Epidemiology of accidents by venomous animals and distribution of antivenon: state of art and world status / Epidemiología de accidentes por animales venenosos y distribución de suero: estado de arte y situación mundial

RESUMO Acidentes por animais peçonhentos são discutidos sob perspectiva histórica de ações de estado. Considerados doenças negligenciadas eles causam prejuízos sociais e econômicos, em pessoas em idade produtiva de regiões rurais em países pobres. Poucos países dispõem de políticas públicas de saúde para profilaxia e tratamento adequados e as maiores perdas ocorrem na África e Ásia. Os 46 produtores mundiais de soros não suprem as necessidades globais e acesso ao tratamento é difícil, mesmo em países com produção própria. Sistemas de Notificação produzem levantamentos imprecisos sobre necessidades de soro e apesar da notificação compulsória. O Brasil carece de bancos de dados robustos de amplo acesso, que permita uma distribuição do soro em tempo seguro para o atendimento de qualidade. Muito se avançou em testes diagnóstico, porém sua aplicação em áreas pobres é inviabilizada pelos custos. Melhorias na qualidade de produção dos soros, via boas práticas laboratoriais e fabris, minimizam resultados insatisfatórios de tratamentos com produtos de origem e ação duvidosa. Desenvolvimento de soros empregando Biotecnologia e Ensaios Clínicos bem desenhados, são chave para tratamento de envenenamentos por agentes aparentados em diferentes regiões (soros continentais ou universais). Parcerias internacionais são fundamentais, além de estoques reguladores, semelhantes aos adotados em vacinas, para suprir a demanda mundial. A qualificação dos soros antivenenos certamente minimizará equívocos de uso. Apoio governamental à pesquisa é alavanca propulsora e a ferramenta mais eficiente de preservação da vida, evitando sobrecargas social e previdenciária principalmente em países em desenvolvimento.(AU)

ABSTRACT Accidents by venomous animals are discussed under the historical perspective of state actions. Considered as neglected diseases, they cause social and economic losses in the working age population from rural areas of poor countries, as few of them have public health policies for adequate prophylaxis and treatment; in fact, the largest life losses occur in Africa and Asia. The 46 world producers of antivenin do not meet the global needs, making access to treatment difficult, even in countries with own production. Notification systems lead to inaccurate surveillance surveys and antivenin needs. Despite mandatory notification, Brazil lacks robust databases with full open access in order to allow the timely distribution of antivenin for quality care of these patients. Progress has been made in diagnostic testing, but its application in poor areas is not feasible due to high costs. Improvements in quality antivenin production through good laboratory practices and manufacturing minimize unsatisfactory results of treatments carried out with products of dubious origin. Antivenin development using biotechnology and well-designed clinical trials are key for the treatment of envenoming by agents phylogenetically related from different regions (continental or universal antivenins). International partnerships are fundamental, besides regulatory stocks, similarly to those adopted for vaccines, to supply world demand. The qualification of antivenin will certainly minimize treatment mistakes. Government support to research is a driving force and the most efficient tool for preserving life and avoiding social security surcharges, particularly in developing countries.(AU)

RESUMEN Accidentes por animales venenosos se discuten desde una perspectiva histórica de acciones de estado. Consideradas enfermedades olvidadas, causan perjuicios sociales y económicos, en personas en edad productiva de regiones rurales en países pobres. Pocos países disponen de políticas públicas de salud para profilaxis y tratamiento adecuados y las mayores pérdidas ocurren en África y Asia. Los 46 productores mundiales de sueros no suplen las necesidades globales y el acceso al tratamiento es difícil, incluso en países con producción propia. Los sistemas de notificación generan levantamientos imprecisos sobre las necesidades de suero ya pesar de la notificación obligatoria, Brasil carece de bases de datos robustas de amplio acceso, permitiendo la llegada del suero en tiempo seguro para la atención de calidad. Se ha avanzado mucho en pruebas diagnósticas, pero su aplicación en áreas pobres es inviabilizada por los costos. Mejoras en la calidad de producción de los sueros, a través de buenas prácticas de laboratorio y fabril, minimizan resultados insatisfactorios de tratamientos con productos de origen y acción dudosa. El desarrollo de sueros empleando Biotecnología y Ensayos Clínicos bien diseñados, son clave para el tratamiento de envenenamientos por agentes emparentados en diferentes regiones (sueros continentales o universales). Las alianzas internacionales son fundamentales, además de stocks reguladores, similares a los adoptados en vacunas, para suplir la demanda mundial. La pre cualificación de los sueros antivenenos ciertamente minimizará equívocos de uso. El apoyo gubernamental a la investigación es la palanca propulsora y la herramienta más eficiente de preservación de la vida, evitando sobrecargas social y previsional principalmente en países en desarrollo.(AU)

Relação entre eficiência da hemodiálise e estado nutricional em pacientes com doença renal crônica / Relationship between dialytic efficiency and nutritional status of patients with chronic kidney disease on hemodialysis

OBJETIVOS: Verificar as relações entre índice de eficiência dialítica (Kt/V) e parâmetros de estado nutricional de indivíduos com doença renal crônica em hemodiálise. MÉTODOS: Foi realizado um estudo retrospectivo em um instituto de hemodiálise. Foram coletados dados dos prontuários sobre sexo, idade, exames bioquímicos, peso seco, altura, circunferência do braço (CB) e prega cutânea tricipital (PCT). Foram calculados índice de risco nutricional (IRN), índice de massa corporal (IMC), circunferência muscular do braço (CMB), área muscular do braço corrigida (AMBc), Kt/V e taxa de redução da ureia (urea reduction rate ­ URR). Para a análise estatística foram empregados o teste de Mann-Whitney e a Correlação de Spearman, sendo considerados significativos valores de p<0,05. RESULTADOS: Foram avaliados 164 pacientes, com média de idade de 58±14,4 anos, sendo 96 (59%) do sexo masculino. A mediana do tempo em que os pacientes se encontravam em hemodiálise foi 35,0 (5-234) meses. Entre os 164 pacientes, 60 (37%) apresentavam risco nutricional. Na avaliação do estado nutricional, os valores médios obtidos foram de 25,0±4,5kg/m2 para o IMC, 99,0±12,3% para a adequação da CB, 86,7±14,5% para a adequação da CMB, 122,9±66,8% para a adequação da AMBc e 1,4±0,4 para o Kt/V. A mediana de adequação para PCT foi de 107,8% (11,5%-305,4%). Observou-se ausência de correlação do Kt/V com albumina sérica, CB, CMB, AMBc e IRN. O Kt/V apresentou correlação positiva baixa com o tempo em hemodiálise (r=0,2197) e correlação negativa baixa com a PCT (r=-0,1692) e com o IMC (r=-01970). A correlação entre Kt/V e peso seco foi negativa moderada (r=-0,3710) e entre Kt/V e URR foi positiva forte (r=0,81129). CONCLUSÕES: Verificou-se adequada eficiência dialítica e bom estado nutricional na maioria da amostra avaliada, com correlações significativas entre eficiência dialítica e parâmetros de avaliação do estado nutricional.

AIMS: To verify the relationships between the dialysis adequacy index (Kt/V) and nutritional parameters of individuals with chronic renal disease on hemodialysis. METHODS: A retrospective study was performed at a hemodialysis institute. Data on sex, age, biochemical tests, dry weight, height, arm circumference (AC) and triceps skin fold (TSF) were collected from the medical charts. Nutritional risk index (NRI), body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (AMAc), Kt/V and urea reduction rate (URR). The Mann-Whitney test and the Spearman correlation were used for the statistical analysis, and a p<0.05 was considered significant. RESULTS: A total of 164 patients were evaluated, with a mean age of 58±14.4 years, of which 96 (59%) were male. The median time on hemodialysis was 35.0 (5-234) months. Among the 164 patients, 60 (37%) presented nutritional risk. In the evaluation of nutritional status, the mean values obtained were 25.0±4.5 kg/m2 for BMI, 99.0±12.3% for CB adequacy, 86.7±14.5% for WBC adequacy, 122.9±66.8% for CBA adequacy and 1.4±0.4 for Kt/V. The median adequacy for PCT was 107.8% (11.5%-305.4%). There was no correlation of Kt/V with serum albumin, CB, CMB, AMAc and NRI. Kt/V had a low positive correlation with time on hemodialysis (r=0.2197) and a low negative correlation with PCT (r=-0.1692) and with BMI (r=-01970). The correlation between Kt/V and dry weight was moderate and negative (r=-0.3710) and between Kt/V and URR the correlation was strongly positive (r=0.81129). CONCLUSIONS: Adequate dialysis efficiency and good nutritional status were observed in most patients of the evaluated sample, with significant correlations between dialysis adequacy and parameters of nutritional status assessment.

Analysis of serum microRNA expression in male workers with occupational noise-induced hearing loss

Occupational noise-induced hearing loss (ONIHL) is a prevalent occupational disorder that impairs auditory function in workers exposed to prolonged noise. However, serum microRNA expression in ONIHL subjects has not yet been studied. We aimed to compare the serum microRNA expression profiles in male workers of ONIHL subjects and controls. MicroRNA microarray analysis revealed that four serum microRNAs were differentially expressed between controls (n=3) and ONIHL subjects (n=3). Among these microRNAs, three were upregulated (hsa-miR-3162-5p, hsa-miR-4484, hsa-miR-1229-5p) and one was downregulated (hsa-miR-4652-3p) in the ONIHL group (fold change >1.5 and Pbon value <0.05). Real time quantitative PCR was conducted for validation of the microRNA expression. Significantly increased serum levels of miR-1229-5p were found in ONIHL subjects compared to controls (n=10 for each group; P<0.05). A total of 659 (27.0%) genes were predicted as the target genes of miR-1229-5p. These genes were involved in various pathways, such as mitogen-activated protein kinase (MAPK) signaling pathway. Overexpression of miR-1229-5p dramatically inhibited the luciferase activity of 3′ UTR segment of MAPK1 (P<0.01). Compared to the negative control, HEK293T cells expressing miR-1229-5p mimics showed a significant decline in mRNA levels of MAPK1 (P<0.05). This preliminary study indicated that serum miR-1229-5p was significantly elevated in ONIHL subjects. Increased miR-1229-5p may participate in the pathogenesis of ONIHL through repressing MAPK1 signaling.

Relation between anaemia and bone marrow features and serum erythropoietin in dogs with chronic kidney disease / Relação entre anemia e achados de medula óssea e eritropoetina sérica em cães com doença renal crônica

Chronic anaemia is one of the most severe complications of chronic kidney disease, contributing to morbidity and mortality caused by the disease; therefore, bone marrow cytological evaluation is needed to monitor the progression of anaemia. This study aimed to correlate the anaemia in dogs at different stages of chronic kidney disease with their serum biochemistry, myelogram results and serum erythropoietin findings. Sixty-three dogs were grouped according to International Renal Interest Society (IRIS) classification in stages 1, 2, 3 and 4. Haematologic, serum and urinary biochemistry and serum erythropoietin were performed for comparison with the findings of bone marrow cytology obtained by aspiration of the manubrium. Cytological findings for erythroid hypoplasia were described in 93.65% of dogs, and the anaemia was observed in 84.1% of them. The haematological findings were correlated with azotaemia (p<0.05). It was concluded that the erythroid hypoplasia has correlation with persistent anaemia in dogs at all stages of chronic kidney disease, with iron deficiency in dogs in the early stages and with peripheral destruction of erythrocytes caused by azotaemia.(AU)

A anemia crônica é umas das complicações mais graves da doença renal crônica, contribuindo para a morbidade e mortalidade causada pela doença; Portanto, a avaliação citológica da medula óssea é necessária para monitorar a progressão da anemia. Assim, esse estudo objetivou correlacionar a anemia em cães em diferentes estágios da doença renal crônica aos achados de bioquímica sérica, mielograma e concentração sérica de eritropoietina. Sessenta e três cães foram agrupados de acordo com a classificação da International Renal Interest Society (IRIS) em estágios 1, 2, 3 e 4. Foram realizadas análises hematológicas, bioquímicas séricas e urinárias, e dosagem sérica de eritropoetina para comparação com os achados medulares obtidos por citologia aspirativa do manúbrio. Os achados citológicos de hipoplasia eritróide foram descritos em 93,65% dos cães, e a anemia foi observada em 84,1% dos cães. Os resultados hematológicos foram correlacionados com azotemia (p<0,05). Concluiu-se que a hipoplasia eritróide teve associação com a anemia persistente em cães em todas as fases de doença renal crônica, com deficiência de ferro em cães em fases iniciais e com a destruição periférica dos eritrócitos causada pela azotemia.(AU)

Radioyodo como tratamiento de hipertiroidismo en un paciente en hemodiálisis: Caso clínico / Treatment of hyperthyroidism with radioiodine during hemodialysis: Report of one case

Although radioiodine (131-I) can be used as treatment of hyperthyroidism for patients in hemodialysis, its use is limited and the experience is mainly related to differentiated thyroid carcinoma. We report a 58 years old female on hemodialysis with recurrent hyperthyroidism after propylthiouracil treatment. She was successfully treated with 131-I and four months after the intervention her euthyroid state was confirmed. We measured 131-I activity in blood, dialysate liquid and other waste products, as well as patient radiation exposure rates. We found that 131-I elimination was prolonged through time with no major dependence on hemodialysis, as opposed to the elimination of 131-I in patients with thyroid carcinoma. This was probably due to high radiotracer uptake in hyper functioning thyroid tissue. Conversely, radiation content in dialysate wastes or equipment was minimal. Furthermore, the rate of both environmental exposure and exposure of nursing staff in charge of hemodialysis sessions, was minimal and met international security standards. In conclusion, I-131 therapy showed both appropriate effectiveness and safety in this case and may be considered as a suitable treatment alternative to thyroidectomy when antithyroid drugs are unsuccessful.

Impact of free thyroxine levels and other clinical factors on bare metal stent restenosis

ABSTRACT Objective Thyroid hormones have both direct and indirect effects on thermogenesis such as modulating vascular smooth muscle cell proliferation. However, the influence of more subtle changes in thyroid hormones on coronary atherosclerosis remains a matter of speculation. Smooth muscle cells play a crucial role in the pathogenesis of in-stent restenosis (ISR). However, the relationship between free thyroxine (fT4) and ISR has not been studied. In the present study, we aimed to assess the role of preprocedural serum fT4 level on the development of ISR in patients undergoing coronary bare metal stent (BMS) implantation. Materials and methods We enrolled and analyzed clinical, biochemical, and angiographic data from 705 consecutive patients without a history of primary thyroid disease [mean age 60.3 ± 9.3 years, 505 (72%) male]; all patients had undergone BMS implantation and further control coronary angiography owing to stable or unstable angina pectoris. Patients were divided into 3 tertiles based on preprocedural serum fT4 levels. Results ISR was observed in 53 (23%) patients in the lowest tertile, 82 (35%) patients in the second tertile, and 107 (46%) patients in the highest fT4 tertile (p < 0.001). Using multiple logistic regression analysis, five characteristics emerged as independent predictors of ISR: diabetes mellitus, smoking, HDL-cholesterol, stent length, and preprocedural serum fT4 level. In receiver operating characteristics curve analysis, fT4 level > 1.23 mg/dL had 70% sensitivity and 73% specificity (AUC: 0.75, p < 0.001) in predicting ISR. Conclusion Higher preprocedural serum fT4 is a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris.

Association between polymorphisms in the APOB gene and hyperlipidemia in the Chinese Yugur population

We investigated the influence of apolipoprotein B gene (APOB) variants on the risk of hyperlipidemia (HL) in 631 middle-aged and elderly members of the Chinese Yugur population (HL, n=336; normolipidemia, n=295). APOB polymorphisms were identified using mass spectrometry, and five single nucleotide polymorphisms (rs1042034, rs2163204, rs512535, rs676210, and rs679899) and serum lipids were further analyzed. rs1042034 and rs676210 were significantly associated with HL (P<0.05). Compared with the GG or AA genotype, individuals with AG and AG+AA in rs1042034 and with AG and AG+GG in rs676210 had a 1.67-fold (95%CI=1.20-2.33),1.63-fold (95%CI=1.19-2.24), 1.72-fold (95%CI=1.24-2.40), and 1.67-fold (95%CI=1.21-2.291) increased risk of high HL, respectively. rs2163204 was in strong linkage disequilibrium with rs1042034, rs676210, and rs679899, and strong disequilibrium was observed between rs1042034 and rs676210 (D′>0.9). Compared with the GTGAA haplotype, haplotypes ATGGA and ATAGG were more strongly associated with HL [odds ratio (OR)=1.46, 95%CI=0.02-2.11; OR=1.63, 95%CI=1.03-2.60, respectively]. The risk factors age (P=0.008), body mass index (P<0.0001), GA+GG genotype in rs676210 (P=0.009), and alcohol consumption (P=0.056) contributed strongly to HL development. The A allele of rs1042034 and the G allele of rs676210 may thus predispose middle-aged and elderly members of the Chinese Yugur population to HL in combination with other genetic or nutritional factors, and could be used as new genetic markers for HL screening.

La creatinina sérica. Desde la clínica a la epidemiología, a través de la estandarización de su determinación y el control de los laboratorios / Serum creatinine. From clinical practice to epidemiology through determination standards and quality control across clinical laboratories

El presente artículo intentará demostrar por qué es necesario mejorar el control de calidad de los laboratorios clínicos y avanzar hacia la estandarización de la creatininemia para contribuir a mejorar el diagnóstico clínico y epidemiológico de la Enfermedad Renal Crónica especialmente en América Latina. El rol del laboratorio de análisis clínico es brindar información útil, confiable y reproducible para la práctica clínica de la medicina, cualquiera sea la metodología empleada y el laboratorio interviniente. Para ello se implementó calidad para mejorar los errores sistemático y aleatorio en las determinaciones de los laboratorios clínicos. Los programas de estandarización se ponen en marcha en el año 2006. Por otra parte se fue incorporando la creatinina sérica y el clearance de creatinina a la clínica, hasta arribarse a un hito histórico que fue la determinación de la Tasa Filtrado Glomerular estimada (TFGe) a partir de fórmulas (MDRD y CKD-EPI). La necesidad de la estandarización de la determinación de la creatinina fue establecida en la Guía 4, KDOQUI en el año 2002. Respecto a la determinación de la creatinina sérica para la estimación del TFGe, un largo camino se ha recorrido desde la identificación del concepto de clearance, su aplicación a la determinación de la función renal, su utilización en la clínica para el diagnóstico, la progresión y el pronóstico, la identificación de la misma como un indicador epidemiológico a la hora de establecer riesgo poblacional. En ese marco, se manifiesta la necesidad de promover su estandarización

This article attempts to show why it is necessary to improve quality control of clinical laboratories and move toward standardization of serum creatinine to help improve clinical and epidemiological diagnosis of chronic kidney disease especially in Latin America. The role of clinical laboratory is to provide useful, reliable and reproducible information to be used in clinical practice, regardless of the methodology used and the intervening laboratory. For this, quality was implemented to improve the systematic and random errors in the determinations of clinical laboratories. Standardization programs are launched in 2006.Moreover serum creatinine and creatinine clearance joined the clinic, to be arrived at a milestone that was the determination of the estimated Glomerular Filtration Rate (eGFR) from formulas (MDRD and CKD-EPI). The need for standardization of the determination of creatinine was established in the Guide 4 KDOQUI in 2002. Regarding the determination of serum creatinine for estimating eGFR, a long way has come: from identification of the concept of clearance, its application to the determination of renal function, its use in the clinic for diagnosis, progression and prognosis, identifying it as an epidemiological indicator in population risk setting. In this context the need for standardization is established

Índice de conhecimento das gestantes portadoras do Vírus da Imunodeficiência Humana (HIV) acerca de sua patologia / knowledge index of pregnant women with the virus Human Immunodeficiency Virus (HIV) about their disease

O presente estudo trata-se de pesquisa quantitativa realizada com Gestantes Portadoras do Vírus da Imunodeficiência Humana (HIV) acerca de sua Patologia, realizada no Instituto de Medicina Integrada Professor Fernando Figueira-IMIP, com a finalidade de verificar o índice de conhecimento das gestantes portadoras do Vírus da Imunodeficiência Humana (H IV) a cerca de sua patologia. Os dados foram coletados através de um questionário semi-estruturado. Na análise dos dados verificou-se que grande parte das gestantes passando de 50% das entrevistadas, tem conhecimento sobre o seu tratamento, autocuidado, prevenção conhecimento da medicação tipo de parto importância da realização do pré-natal exames entre outros O presente estudo permitiu conhecer melhor a realidade de cada gestante a respeito do seu conhecimento diante de todo o tratamento e a importância de um acompanhamento integrado para si e para o seu filho...

The Present Study this is quantitative research conducted with pregnant women with human immunodeficiency virus (HIV) to their About Pathology, held at the Institute of Integrated Medicine Professor Fernando Figueira-IMIp, with the purpose of verifying the content knowledge of pregnant women with human immunodeficiency virus (HIV) about its pathology. Data were collected through a semi-structured questionnaire. In analyzing the data it was found that most pregnant women from 50% of respondents, is knowledgeable about your treatment, care, prevention, knowledge of medication, type of delivery, the importance of performing prenatal examinations, among other . This study allowed us to know better the reality of every pregnant woman about her knowledge before any treatment and the importance of an integrated monitoring for you and your son...

Este estudio trata de un estudio cuantitativo de las mujeres embarazadas con el virus de inmunodeficiencia humana (VIH) sobre su patología, que se celebró en el Instituto de Medicina Integrada Profesor Fernando Figueira, IMIP, con el fin de verificar el índice de conocimiento de las mujeres embarazadas con virus de la inmunodeficiencia humana (VIH) a cerca de su condición. Los datos fueron recolectados a través de un cuestionario semi-estructurado. En el análisis de datos se encontró que las mujeres más embarazadas aumentó dei 50% de los encuestados, es conocedor de su tratamiento, el cuidado, la prevención, el conocimiento de la medicación, tipo de parto, la importancia de la realización de exámenes prenatales, entre otros . Este estudio nos permitió comprender mejor la realidad de cada mujer acerca de su conocimiento antes de que todo el tratamiento y la importancia de un seguimiento integrado para ti y tu hijo...

Risk factors for postoperative complications following oral surgery

AbstractObjective The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer.Material and Methods This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital.Results Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (<4.0 g/dL) and operation time (≥120 minutes) were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively).Conclusion Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery.

Early changes in serum albumin: impact on 2-year mortality in incident hemodialysis patients / Alterações precoces da albumina sérica: impacto sobre a mortalidade aos 2 anos em pacientes incidentes em hemodiálise

Abstract Introduction/objective: We evaluated the predictability of early changes in serum albumin (sAlb) on the two-year mortality of incident hemodialysis patients. Methods: Observational, longitudinal retrospective study using the database of Fresenius Medical Care of Latin America. Adult patients starting dialysis from January/2000 to June/2004, from 25 centers were included. Changes in sAlb during the first 3 months on hemodialysis were used as the main predictor. The outcome was death from any cause. Results: 1,679 incident patients were included. They were 52 ± 15 years old, 58.7% male and 21.5% diabetic, with a median sAlb of 38 g/L (bromocresol green). 923 patients had sAlb < 38 g/L (Low sAlb Group) and 756 ones had sAlb > 38.0 g/L (Adequate sAlb Group). The mortality was significantly higher in Low sAlb Group (17% vs. 11%, p < 0.001). Early changes in sAlb significantly affected two-year mortality. Factoring the Kaplan Meier curve of Low sAlb Group by the presence of an increase in sAlb uncovered of a statistically significant difference in mortality favoring the ones whose sAlb went up (19% vs. 15%, p = 0.043). Differently, patients from Adequate sAlb Group with a decrease in their sAlb had a statistically higher mortality rate (13% vs. 8%, p = 0.029). Conclusions: Early sAlb changes showed a significant predictive power on mortality at 2 years in incident hemodialysis patients. Those with low initial sAlb may have a better prognosis if their sAlb rises. In contrast, patients with satisfactory initial levels can have a worsening of their prognosis in the case of an early reduction in sAlb. .

Resumo Introdução/objetivo: Avaliou-se o impacto das alterações precoces na albumina sérica (sAlb) na mortalidade em 2 anos de hemodialisados incidentes. Métodos: Estudo longitudinal retrospectivo usando o banco de dados da Fresenius Medical Care da América Latina. Adultos iniciando diálise de janeiro de 2000 a junho de 2004, originados de 25 centros de diálise foram incluídos. Mudanças na sAlb durante os primeiros 3 meses em hemodiálise foram usadas como a variável de principal interesse. O desfecho foi morte por qualquer causa. Resultados: Um total de 1.679 pacientes incidentes foi incluído. Eles tinham 52 ± 15 anos, 58,7% eram do sexo masculino e 21,5%, diabéticos, com sAlb mediana de 38,0 g/L (bromocresol verde). Novecentos e vinte e três pacientes tiveram sAlb ≤ 38,0 g/L (Grupo sAlb baixa) e 756, sAlb > 38,0 g/L (Grupo sAlb adequada). A mortalidade foi significativamente maior no Grupo sAlb baixa (17% vs. 11%, p < 0,001). Alterações precoces na sAlb afetaram significativamente a mortalidade em dois anos. Fatoração da curva de Kaplan-Meier do Grupo sAlb baixa pela presença de um aumento na sAlb revelou uma diferença na mortalidade favorecendo aqueles cuja sAlb subiu (19% vs. 15%, p = 0,043). Em contraste, pacientes do Grupo sAlb adequada que mostraram diminuição na sAlb tiveram maior taxa de mortalidade (13% vs. 8%, p = 0,029). Conclusão: Alterações precoces na sAlb mostraram um poder previsor significativo sobre a mortalidade em 2 anos em hemodialisados incidentes. Casos com sAlb inicial baixa melhoraram seu prognóstico quando houve elevação na sAlb, enquanto que aqueles com níveis iniciais satisfatórios tiveram um agravamento de seu prognóstico quando houve redução na sAlb. .

Serum alkaline phosphatase predicts survival outcomes in patients with skeletal metastatic nasopharyngeal carcinoma

OBJECTIVE: Bone metastasis is frequently associated with nasopharyngeal carcinoma. The diagnosis and follow-up of bone metastatic patients usually relies on skeletal X-ray and bone scintigraphy, which are time-consuming and costly. This study aimed to evaluate whether serum alkaline phosphatase offers clinical value in predicting the clinical response and survival outcome for skeletal metastatic nasopharyngeal carcinoma. METHODS: Serum alkaline phosphatase was measured at baseline and then before each cycle of treatment in 416 nasopharyngeal carcinoma patients with bone metastasis. The correlations between the pre-treatment and post-treatment alkaline phosphatase levels and the treatment efficacy were analyzed using the chi-square test. Survival was analyzed using the Kaplan–Meier method and then compared using the log-rank test. RESULTS: Patients with elevated pre-treatment alkaline phosphatase (>110 IU/L) had significantly worse progression-free survival (P<0.001) and overall survival (P<0.001) than those with a normal level of this marker (≤110 IU/L). Patients with elevated post-treatment alkaline phosphatase had worse progression-free survival (P<0.001) and overall survival (P<0.001) compared with those with a normal level. Patients with normal pre-treatment and post-treatment alkaline phosphatase showed the most favorable prognosis. The Cox multivariate analysis revealed that only the pre-treatment and post-treatment alkaline phosphatase levels were independent prognostic factors for progression-free survival (HR ϝ 1.656, P<0.001; HR ϝ 2.226, P<0.001) and for overall survival (HR ϝ 1.794, P<0.001; HR ϝ 2.657, P<0.001). CONCLUSIONS: Serum alkaline phosphatase appears to be a significant independent prognostic index in patients with skeletal metastatic nasopharyngeal carcinoma, which could reflect the short-term treatment response ...

Serum 25-hydroxyvitamin D and biochemical markers of bone metabolism in patients with juvenile idiopathic arthritis

Our objective was to evaluate the concentrations of serum 25-hydroxyvitamin D [25(OH)D], serum calcium, serum phosphorus, alkaline phosphatase, and parathormone (PTH) in patients with polyarticular juvenile idiopathic arthritis (JIA) and to associate them with disease duration and activity, bone mineral density and use of medications. In a cross-sectional and controlled study, 30 patients with polyarticular JIA were evaluated and compared to 30 healthy individuals matched for age and gender. Clinical status, anthropometry, laboratory markers in both patients and controls, and bone mineral density, only in the patients, were measured. Of the 30 patients included in the study, 23 (76.7%) were female and 16 (53.3%) non-Caucasian; mean age was 14 years (range = 4 to 20 years). Mean disease duration was 5 years (range = 1 to 12 years). The mean concentrations of serum albumin-corrected calcium (9.04 ± 0.41 mg/dL) and alkaline phosphatase (153.3 ± 100.1 IU) were significantly lower in patients with JIA than in controls (P < 0.0001 and P = 0.001, respectively). No differences in 25(OH)D, PTH or serum phosphorus were observed between JIA and control subjects. Regarding 25(OH)D concentration, 8 patients (26.7%) and 5 controls (16.7%) had 25(OH)D concentrations compatible with deficiency (lower than 20 ng/mL) and 14 patients (46.7%) and 18 controls (60%) had concentrations compatible with insufficiency (20-32 ng/mL). These values were not associated with disease activity, use of medications or bone mineral density. We observed a high frequency of 25(OH)D insufficiency and deficiency in the study sample. The compromised bone metabolism emphasizes the importance of follow-up of JIA patients.

Prevalencia de pseudohipercaliemia en pacientes con enfermedad renal crónica en terapia hemodialítica / Prevalence of pseudohyperkalemia in patients with chronic renal disease in hemodialysis therapy

Objetivo: determinar si a la hipercaliemia prolongada en pacientes en hemodiálisis con enfermedad renal crónica (ERC) contribuye en valor significativo la presencia de pseudohipercaliemia (diferencia entre potasio sérico a plasmático mayor a 0.5 mEq/L) Pacientes: aquellos con ERC en terapia hemodialítica por más de 12 meses de evolución en quienes se detectara hipercaliemia persistente por más de tres meses. Material y métodos: determinación simultánea de potasio sérico y plasmático, y adicionalmente las variables sodio sérico, gases arteriales, cuadro hemático completo, glucemia en ayunas, Kt/v y electrocardiograma Resultados: en 110 pacientes evaluados 17 cumplieron los criterios de inclusión, en ellos en 13 (76.47%) se detectó pseudohipercaliemia y en 4 (23.52%) hipercaliemia verdadera (diferencia entre potasio sérico a plasmático menor a 0.5 mEq/L). No se detectaron diferencias significativas entre grupos en las variables analizadas Conclusión: la pseudohipercaliemia representa un porcentaje muy importante del reporte de hipercaliemias en pacientes con ERC en terapia hemodialítica, y lo ideal en ellos es siempre determinar potasio plasmático. (Acta Med Colomb 2013; 38: 12-15).

Objective: determine if to prolonged hyperkalemia in hemodialysis patients with chronic kidney disease (CKD) contributes significantly the presence of pseudohyperkalemia (difference between serum to plasma potassium greater than 0.5 mEq/L) Patients: those with CKD on hemodialysis therapy for more than 12 months duration in whom persistent hyperkalemia is detected for more than three months. Materials and methods: simultaneous determination of serum and plasma potassium and in addition the variables serum sodium, arterial blood gases, complete blood count, fasting blood glucose, Kt / v and electrocardiogram Results: in 110 patients evaluated 17 met the inclusion criteria. In 13 of them (76.47%) we detected pseudohyperkalemia and in 4 (23.52%) true hyperkalemia (difference between serum to plasma potasium less than 0.5 mEq / L ). No significant differences between groups in the variables analyzed were detected. Conclusion: the pseudohyperkalemia represents a very important percentage of the report of hiperkalemias in CKD patients on hemodialysis therapy, and ideally plasma potasium has to be determined always in these patients. (Acta Med Colomb 2013; 38: 12-15).