Avaliação da influência dos marcadores inflamatórios na mortalidade de pacientes com AVC isquêmico / Evaluation of the influence of inflammatory markers on the mortality of patients with ischemic stroke

INTRODUÇÃO: À medida que a população envelhece e a expectativa de vida aumenta, a incidência global e a prevalência de AVC isquêmico tendem a aumentar significativamente. Nesse contexto, surge a necessidade de avaliar novos marcadores preditores de mortalidade, como a contagem absoluta de monócitos, relação linfócitos sobre monócitos, relação neutrófilos sobre linfócitos e níveis de proteína C reativa ultrassensível, que além de serem de fácil acesso e baixo custo, sugerem indicar desfecho no paciente com AVC agudo. OBJETIVOS: o objetivo deste estudo foi avaliar a associação dos marcadores inflamatórios com a mortalidade de pacientes com AVC isquêmico. MÉTODOS: trata-se de um estudo retrospectivo observacional a partir de prontuários eletrônicos e exames laboratoriais de pacientes com AVC isquêmico em uma unidade hospitalar de Cascavel/PR. Uma análise estatística descritiva foi conduzida para determinar o perfil dos pacientes segundo o desfecho e aplicado um modelo de regressão logística para verificar as variáveis associadas a mortalidade. Foram considerados significativos apenas os dados com p-valor <0,05. RESULTADOS: Dos 65 pacientes que foram admitidos no estudo, 50 receberam alta hospitalar e 15 foram a óbito no hospital. Entre os marcadores inflamatórios, a relação de neutrófilos sobre linfócitos (OR 1,55; p-valor <0,01) mostrou-se significativamente associada a maior chance de óbito. Os pacientes que faleceram apresentaram níveis superiores de PCR ultrassensível, maior contagem absoluta de monócitos, relação linfócitos sobre monócitos diminuída, e relação neutrófilos sobre linfócitos elevada. CONCLUSÃO: a relação de neutrófilos sobre linfócitos elevada pode estar significativamente associada ao desfecho desfavorável após um AVC isquêmico

IINTRODUCTION: As the population ages and life expectancy increases, the global incidence and prevalence of ischemic stroke tends to rise significantly. In this context, the need arises to evaluate new predictive markers of mortality, such as absolute monocyte count, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) levels which, besides being easily accessible and affordable, manage to predict the outcome in patients with acute stroke. OBJECTIVES: the aim of this study was to evaluate the association between inflammatory markers and the mortality in ischemic stroke patients. METHODS: this is a retrospective observational study based on the analysis of electronic medical records and laboratory tests of in-patients who suffered an ischemic stroke in Cascavel/PR. A descriptive statistical analysis was conducted to determine patients´ profile according to the outcome and a logistic regression model was applied in order to verify the variables associated with mortality. Only data with a p-value <0,05 was considered. RESULTS: Out of the 65 patients who suffered an ischemic stroke included in the study, 50 were discharged and 15 died in hospital. Among the inflammatory markers, the neutrophil-tolymphocyte ratio (OR 1.55; p-value <0,01) was associated with a greater chance of death. Patients who died presented with higher levels of ultra-sensitive CRP, higher absolute monocyte count, lower lymphocyte-to-monocyte ratio and higher neutrophil-to- lymphocyte ratio. CONCLUSION: the elevated neutrophil-to-lymphocyte ratio may be significantly associated with negative outcomes following an ischemic stroke

Improvement of cardiovascular function health level by regular sports / Melhoria do nível de saúde da função cardiovascular por meio de esportes regulares / Mejora del nivel de salud de la función cardiovascular mediante deportes regulares

ABSTRACT Introduction Regular physical activity helps improve cardiovascular and cerebrovascular skills. How to evaluate the nervous tension of the cardiovascular and cerebrovascular vessels through sports is a hot topic. Objective The paper discusses the influence of regular participation in sports on people's cardiovascular function and blood-related indicators. Methods We select 30 healthy older adults who regularly participate in sports, record their ECG changes, blood pressure, heart rate and other related cardiovascular function indicators, and analyze the blood function of the elderly. Detection of blood cell count (RBC), red blood cell volume (MCV) and hemoglobin (Hb), serum creatinine (Cr), blood glucose (BGS), triglycerides (TG), cholesterol (TC), low-density lipoprotein (LDL) and high-Density lipoprotein (HDL) is measured. Results Older adults who persist in exercise for a long time have better indicators than those who do not exercise. Conclusions Appropriate aerobic exercise can reduce the stiffness of blood vessels in the elderly. Exercise can help the elderly increase heart rate variability and improve the heart's autonomic nerve function's blood indicators, and body mass. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A atividade física regular ajuda a melhorar as habilidades cardiovasculares e cerebrovasculares. Como avaliar a tensão nervosa dos vasos cardiovasculares e cerebrovasculares por meio de esportes é um assunto quente. Objetivo o artigo discute a influência da participação regular em esportes sobre a função cardiovascular das pessoas e indicadores relacionados ao sangue. Métodos Selecionamos 30 idosos saudáveis que participam regularmente de esportes, registramos suas alterações no ECG, pressão arterial, frequência cardíaca e outros indicadores relacionados à função cardiovascular e analisamos a função sanguínea dos idosos. Detecção de contagem de células sanguíneas (RBC), volume de glóbulos vermelhos (MCV) e hemoglobina (Hb), creatinina sérica (Cr), glicose no sangue (BGS), triglicerídeos (TG), colesterol (TC), lipoproteína de baixa densidade (LDL ) e a lipoproteína de alta densidade (HDL) é medida. Resultados Idosos que persistem por muito tempo nos exercícios têm melhores indicadores do que aqueles que não praticam. Conclusão O exercício aeróbio adequado pode reduzir a rigidez dos vasos sanguíneos em idosos. O exercício pode ajudar os idosos a aumentar a variabilidade da frequência cardíaca e melhorar os indicadores sanguíneos da função nervosa autonômica do coração e a massa corporal. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La actividad física regular ayuda a mejorar las habilidades cardiovasculares y cerebrovasculares. Cómo evaluar la tensión nerviosa de los vasos cardiovasculares y cerebrovasculares a través del deporte es un tema candente. Objetivo El artículo analiza la influencia de la participación regular en deportes sobre la función cardiovascular de las personas y los indicadores relacionados con la sangre. Métodos Seleccionamos a 30 adultos mayores sanos que participan regularmente en deportes, registramos sus cambios en el ECG, presión arterial, frecuencia cardíaca y otros indicadores relacionados con la función cardiovascular, y analizamos la función sanguínea de los ancianos. Detección del recuento de glóbulos rojos (RBC), volumen de glóbulos rojos (MCV) y hemoglobina (Hb), creatinina sérica (Cr), glucosa en sangre (BGS), triglicéridos (TG), colesterol (TC), lipoproteínas de baja densidad (LDL) ) y se mide la lipoproteína de alta densidad (HDL). Resultados Los adultos mayores que persisten en el ejercicio durante mucho tiempo tienen mejores indicadores que los que no lo hacen. Conclusión El ejercicio aeróbico adecuado puede reducir la rigidez de los vasos sanguíneos en los ancianos. El ejercicio puede ayudar a los ancianos a aumentar la variabilidad de la frecuencia cardíaca y mejorar los indicadores sanguíneos y la masa corporal de la función nerviosa autónoma del corazón. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Avaliação da relação Triglicerídeo/HDL-C e da razão Neutrófilos/Linfócitos em idosos com e sem dislipidemia / Evaluation of Triglyceride/HDL-C and Neutrophil/Lymphocyte ratio in the elderly with and without dyslipidemia

RESUMO: Introdução: As doenças cardiovasculares(DCV)estão entre as principais causas de mortalidade entre idosos, sendo a dislipidemia um importante fator de risco. Além disso, a relação Triglicerídeo/HDL-C e a razão Neutrófilos/Linfócitos apresentam estreita relação com os fatores de riscos para DCV. Objetivo: Comparar as relações Triglicerídeo/HDL-C e Neutrófilos/Linfócitos na população idosa sem e com dislipidemia. Métodos: Estudo documental, transversal, retrospectivo, com abordagem quantitativa e comparativa. A amostra foi de conveniência e incluiu os 110 idosos residentes em uma Instituição de Longa Permanência de Idosos. Foram coletados dados do perfil lipídico, hemograma, idade e sexo. Os idosos foram divididos em dois grupos: Com Dislipidemia e Sem Dislipidemia. As relações Triglicerídeo/HDL-C e Neutrófilos/Linfócitos foram calculadas e comparadas. Os resultados foram apresentados como mediana e intervalo interquartil e analisados pelo teste de Mann-Whitney. As variáveis categóricas foram representadas como frequência absoluta (n) e relativa (%) e avaliadas pelo teste de Qui-Quadrado (X2). Utilizou-se o programa estatístico SPSS 20.0®e nível de significância < 0,05. Resultados: Foram selecionados 84 idosos com resultados do perfil lipídico e hemograma, sendo 56 (67%) idosos do sexo feminino e 28 (33%) do sexo masculino, com idade mediana de 75 (69-81) anos. O grupo Com Dislipidemia apresentou valores superiores para Triglicerídeo/HDL-C e para a relação Neutrófilos/Linfócitos não houve diferença estatística. Conclusão: A relação Triglicerídeo/HDL-C pode ser utilizada como uma medida preventiva de doenças cardiovasculares nos idosos participantes do estudo. Porém, a relação Neutrófilos/Linfócitos deve ser interpretada com cautela nos idosos que apresentam características particulares quanto ao desenvolvimento das DCV. (AU)

ABSTRACT: Introduction: Cardiovascular diseases (CVD) are the leading causes of mortality among the elderly, and dyslipidemia is an important risk factor. Moreover, the Triglyceride/HDL-C and Neutrophils/Lymphocytes ratios are closely related to CVD risk factors. Objective: Comparing the Triglyceride/HDL-C and Neutrophils/Lymphocytes ratios in elderlies' groups, with and without dyslipidemia. Methods: Documentary, cross-sectional, and retrospective study with a quantitative and comparative approach. The sample was of convenience and included 110 elderlies' residents in a Long-Term Care for Elderlies. Data on lipid profile, full blood count, age, and sex were obtained and the residents divided into two groups, With Dyslipidemia and Without Dyslipidemia. The Triglyceride/HDL-C and Neutrophils/Lymphocytes ratios for both groups were measured and compared. Results were presented as median and interquartile range and analyzed by the Mann-Whitney test. Categorical variables were represented as absolute (n) and relative (%) frequencies and evaluated by the Chi-square (X2). The statistical program SPSS 20.0® was used with a significance level p < 0,05. Results: Eighty-four elderlies with results of lipid profile and blood count were selected, 56 (67%) were female and 28 (33%) male, with a median age of 75 (69-81) years. The group With Dyslipidemia showed higher values for Triglyceride/HDL-C and Neutrophils/Lymphocytes ratios, there was no statistical difference between the groups studied. Conclusion: The Triglyceride/HDL-C ratio can be used as a preventive measure of cardiovascular diseases in the elderlies' participants of the study. However, the Neutrophils/Lymphocytes ratio should be interpreted with caution in the elderly, who have particular characteristics regarding the development of cardiovascular diseases. (AU)

Association between Hemogram Parameters and Coronary Collateral Development in Subjects with Non-ST-Elevation Myocardial Infarction

SUMMARY OBJECTIVE Coronary collateral development (CCD) predicts the severity of coronary heart disease. Hemogram parameters, such as mean platelet volume (MPV), eosinophil, red cell distribution width, and platelet distribution width (PDW), are supposed novel inflammatory markers. We aimed to compare hemogram parameter values in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) with adequate or inadequate CCD. METHODS A total of 177 patients with NSTEMI undergoing coronary arteriography were enrolled and divided into two groups based on the development of CCD: one group with adequate CCD (n=88) and the other with impaired CCD (n=89). RESULTS Baseline demographics and clinical risk factors were similar between the groups. Hemogram parameters were not significantly different between the two groups. However, compared to the inadequate CCD group, the median PDW was significantly higher in the adequate CCD group, 17.6 (1.4) vs. 17.8 (1.6) p=0.004. In a multivariate analysis, PDW (p=0.001, 95% CI for OR: 0.489(0,319-0,750) was found to be significantly different in the adequate CCD group compared to the inadequate CCD group. Pearson's correlation analysis revealed that PDW was significantly correlated with the Rentrop score (r=0.26, p<0.001). CONCLUSIONS We suggest that since PDW is an index that is inexpensive and easy to assess, it could serve as a marker of CCD in patients with NSTEMI.

RESUMO OBJETIVO O desenvolvimento colateral coronariano (CCD) prediz a gravidade da doença coronariana. Parâmetros de hemograma como volume plaquetário médio (VPM), eosinófilo, largura de distribuição de glóbulos vermelhos e largura de distribuição de plaquetas (PDW) são supostos novos marcadores inflamatórios. Nosso objetivo foi comparar os valores do parâmetro hemograma em pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) com DCC adequado ou inadequado. MÉTODOS Um total de 177 pacientes com NSTEMI submetidos à arteriografia coronariana foram incluídos e divididos, com base no desenvolvimento de CCD, em dois grupos: grupo com CCD adequado (n = 88) e grupo com CCD alterado (n = 89). RESULTADOS Os dados demográficos e os fatores de risco clínicos basais foram semelhantes entre os grupos. Os parâmetros do hemograma não foram significativamente diferentes entre os dois grupos. Mas, em comparação com a mediana inadequada do grupo CCD, o PDW foi significativamente maior em CCD adequado de 17,6 (1,4) vs. 17,8 (1,6) p = 0,004. Na análise multivariada, PDW (p = 0,001, IC 95% para OR: 0,489 (0,319-0,750) foi significativamente diferente no grupo CCD adequado em comparação com o grupo CCD inadequado. A análise de correlação de Pearson revelou que PDW foi significativamente correlacionado com escore de aluguel (r = 0,26, p <0,001). CONCLUSÃO Sugerimos que, uma vez que a PDW é um índice barato e de fácil avaliação, pode servir como um marcador de DCC em pacientes com IAMSSST.

Inmunodeficiencias primarias y citopenias / Primary immunodeficiencies and cytopenias

Introducción: La visión actual de las enfermedades por inmunodeficiencia primaria (IDP) incluye un número creciente de síndromes que están asociados con la desregulación inmune y la autoinmunidad como características predominantes. Las citopenias autoinmunes pueden ser el primer signo de desregulación que precede a la presentación clásica de inmunodeficiencia primaria, con infecciones recurrentes u oportunistas. El conocimiento de un espectro de enfermedades potencialmente involucradas (hematológicas, reumatológicas e inmunológicas) es crucial para la identificación de una cierta proporción de genotipos y fenotipos de otros diagnósticos descritos. También permitirá excluir desórdenes como lupus eritematoso sistémico, inmunodeficiencia variable común, síndrome linfoproliferativo autoinmune; así como realizar diagnósticos diferenciales noveles como la deficiencia de GATA2, deficiencia de CD27, deficiencia de sensibilidad a lipopolisacáridos, síndrome fosfoinositol-3-quinasa delta activada, inmunodeficiencia ligada a X con déficit de magnesio y otros. Objetivo: Proporcionar una sinopsis conceptual de la aparición de citopenias en las IDP con el propósito de actualizar el conocimiento actual sobre dicho tema y de aumentar la percepción, tanto de hematólogos como inmunólogos, en relación a la presentación de citopenias como manifestación de estas enfermedades. Métodos: Se revisaron artículos originales y de corte experimental publicados en la década 2009 - 2019, en algunas bases de datos de la Biblioteca Virtual de Salud (BVS) de Cuba. Conclusiones: Al igual que las formas benignas autolimitadas de citopenia autoimmune post o parainfecciosas, o la neutropenia autoimmune adquirida de la infancia, que generalmente ocurren independientemente de una IDP subyacente reconocida, muchas de las citopenias que acompañan a esta enfermedad (pero no todas) están mediadas por autoanticuerpos. Es esencial entonces, que los médicos valoren, ante la evidencia clara de citopenia, que esta puede ser autoinmune(AU)

Introduction: The current view of primary immunodeficiency diseases (IDP) includes an increasing number of syndromes that are associated with immune dysregulation and autoimmunity as predominant characteristics. Autoimmune cytopenias may be the first sign of dysregulation that precedes the classic presentation of primary immunodeficiency, with recurrent or opportunistic infections. The knowledge of a spectrum of potentially involved diseases (hematological, rheumatological and immunological) is crucial for the identification of a certain proportion of genotypes and phenotypes of other diagnoses described. It will also allow excluding disorders such as systemic lupus erythematosus, common variable immunodeficiency, autoimmune lymphoproliferative syndrome; as well as making novel differential diagnoses such as GATA2 deficiency, CD27 deficiency, lipopolysaccharide sensitivity deficiency, activated delta phosphoinositol-3-kinase syndrome, X-linked immunodeficiency with magnesium deficiency and others. Objective: This review provides a conceptual synopsis of the appearance of cytopenias in the IDPs with the purpose of updating current knowledge on this topic and increasing the perception, of both hematologists and immunologists, in relation to the presentation of cytopenias as manifestation of these diseases. Methodos: Original and experimental articles published in the 2009-2019 decade were reviewed in some databases of the Virtual Health Library (VHL) of Cuba. Conclusions: As the self-limited benign forms of post or parainfectious autoimmune cytopenia, or childhood acquired autoimmune neutropenia, which generally occur independently of a recognized underlying IDP, many of the cytopenias that accompany this disease (but not all) mediated by autoantibodies. It is essential, then, that doctors assess, given the clear evidence of cytopenia, that it may be autoimmune(AU)

Blood cells profile in umbilical cord of late preterm and term newborns / Perfil de hemograma em sangue de cordão umbilical de recém-nascidos pré-termo tardio e a termo

ABSTRACT Objective: To describe the hematological profile in cord blood of late preterm and term newborns and compare blood indices according to sex, weight for gestational age and type of delivery. Methods: Cross-sectional study with late preterm and term newborns in a second-level maternity. Multiple gestation, chorioamnionitis, maternal or fetal hemorrhage, suspected congenital infection, 5-minute Apgar <6, congenital malformations, and Rh hemolytic disease were excluded. Percentiles 3, 5,10, 25, 50, 75, 90, 95 and 97 of blood indices were calculated for both groups. Results: 2,662 newborns were included in the sample, 51.1% males, 7.3% late preterms, 7.8% small for gestational age (SGA) and 81.2% adequate for gestational age (AGA). Mean gestational age was 35.6±1.9 and 39.3±1.0 weeks, respectively, for premature and term neonates. The erythrocytes indices and white blood cells increased from 34-36.9 to 37-41.9 weeks. Basophils and platelets remained constant during gestation. Premature neonates presented lower values ​​of all blood cells, except for lymphocytes and eosinophils. SGA neonates presented higher values ​​of hemoglobin, hematocrit and lower values of leukocytes, neutrophils, bands, segmented, eosinophils, monocytes and platelets. Male neonates presented similar values ​​of erythrocytes and hemoglobin and lower leukocytes, neutrophils, segmented and platelets. Neonates delivered by C-section had lower values ​​of red blood cells and platelets. Chronic or gestational hypertension induced lower number of platelets. Conclusions: Blood cells increased during gestation, except for platelets and basophils. SGA neonates had higher hemoglobin and hematocrit values and lower leukocytes. Number of platelets was smaller in male SGAs, born by C-section and whose mothers had hypertension.

RESUMO Objetivo: Descrever o perfil hematológico em sangue de cordão de recém-nascidos pré-termo tardio e a termo e comparar parâmetros hematimétricos segundo sexo, adequação peso idade gestacional e tipo de parto. Métodos: Estudo transversal com recém-nascidos pré-termo tardio e a termo, em maternidade de nível secundário. Excluíram-se gestação múltipla, corioamnionite, hemorragia materna ou fetal, suspeita de infecção congênita, Apgar no 5o minuto <6, malformações congênitas e doença hemolítica Rh. Calcularam-se os percentis 3, 5, 10, 25, 50, 75, 90, 95 e 97 dos parâmetros hematológicos. Resultados: Incluíram-se 2.662 recém-nascidos, 51,1% do sexo masculino, 7,3% prematuros tardios, 7,8% pequenos para a idade gestacional e 81,2% adequados. A idade gestacional foi 35,6±1,9 e 39,3±1,0 semanas, respectivamente, nos prematuros e termos. As séries vermelha e branca aumentaram de 34-36,9 para 37-41,9 semanas, exceto basófilos e plaquetas, que permaneceram constantes. Os prematuros apresentaram menores médias nas séries vermelha, plaquetária e branca, com exceção de linfócitos e eosinófilos. Recém-nascidos pequenos para a idade gestacional apresentaram maiores valores de hemoglobina e hematócrito e menores de leucócitos, neutrófilos, bastonetes segmentados, eosinófilos, monócitos e plaquetas. Recém-nascidos masculinos apresentaram taxas semelhantes de hemoglobina e hematócrito e menores de leucócitos, neutrófilos, segmentados e plaquetas. Na cesárea, as células vermelhas e as plaquetas foram menores que no parto vaginal. O número de plaquetas foi menor na hipertensão crônica ou gestacional. Conclusões: As células sanguíneas aumentaram durante a gestação, exceto plaquetas e basófilos. Recém-nascidos pequenos para a idade gestacional apresentaram maiores taxas de hemoglobina e hematócrito e menores de células brancas. O número de plaquetas foi menor no recém-nascido pequeno para a idade gestacional, masculino, nascido por cesárea e de mãe hipertensa.

Study of tissue inflammatory response in different mice strains infected by dematiaceous fungi Fonsecaea pedrosoi

Abstract: Background: Diseases caused by melanized fungi include mycetoma, chromoblastomycosis and phaeohyphomycosis. This broad clinical spectrum depends on the dynamic interactions between etiologic agent and host. The immune status of the host influences on the development of the disease, as, an exemple. phaeohyphomicosis is more frequently observed in immunocompromised patients. Objectives: Examine the histological inflammatory response induced by Fonsecaea pedrosoi in several different strains of mice (BALB/c, C57BL/6, Nude and SCID, and reconstituted Nude). Methods: Fonsecaea pedrosoi was cultivated on agar gel and a fragment of this gel was implanted subcutaneously in the abdominal region of female adult mice. After infection has been obtained, tissue fragment was studied histopathologically. Results: There were significant changes across the strains, with the nodular lesion more persistent in Nude and SCID mice, whereas in immunocompetent mice the lesion progressed to ulceration and healing. The histopathological analysis showed a significant acute inflammatory reaction which consisted mainly of neutrophils in the initial phase that was subsequently followed by a tuberculoid type granuloma in immunocompetent mice. Study limitations: There is no a suitable animal model for chromoblastomycosis. Conclusions: The neutrophilic infiltration had an important role in the containment of infection to prevent fungal spreading, including in immunodeficient mice. The fungal elimination was dependent on T lymphocytes. The re-exposure of C57BL/6 mice to Fonsecaea pedrosoi caused a delay in resolving the infection, and appearance of muriform cells, which may indicate that re-exposure to fungi, might lead to chronicity of infection.

The role of high sensitive C-reactive protein and histopathological evaluation in chronic gastritis patients with or without Helicobacter pylori infection

Abstract Purpose: To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in chronic gastritis patients to predict Helicobacter pylori (HP) infection, inflammatory activity, and precancerous lesions. Methods: A total of 811 patients with upper gastrointestinal symptoms and histopathological diagnosis of chronic gastritis were enrolled in the study. On endoscopy, five gastric biopsies were taken according to Modified Sydney protocol, which were stained with hematoxylin & eosin and Giemsa Results: HP infection was found in 28.6% of patients, being significantly more common in specimens with acute and chronic inflammatory activity. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl for females. hs-CRP average were significantly higher in patients with severe acute inflammation (p:0.049), in patients with severe chronic inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP infection increased significantly with the increased degree of acute inflammation, chronic inflammation and hs-CRP level (p=0.001 for both). Conclusion: Serum hs-CRP level increases in patients with chronic gastritis, it could be an indicator of severity of acute or chronic mucosal inflammation, and presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic gastritis, but it is not associated with pre-cancerous lesions.

Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients

Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

Alemtuzumab in refractory Sézary syndrome

Abstract: Sézary syndrome is a primary cutaneous T-cell lymphoma characterized by the triad of erythroderma, lymphadenopathy and circulating atypical cells. The emergence of new molecular targets has enabled the development of drugs such as alemtuzumab, an anti-CD52 monoclonal antibody, which has shown promising results in the treatment of this entity. We report the case of a 70-year-old male with refractory Sézary syndrome in whom treatment with alemtuzumab achieved an 80% skin lesion clearance with complete haematologic and radiologic response. The treatment was discontinued after 4 months due to adverse effects, with the patient showing a sustained response without disease progression after 13 months of follow-up.

Desarrollo y validación de un modelo predictor para bacteriemia en pacientes hospitalizados por el servicio de urgencias con sospecha de infección / Development and validation of a predictive model for bacteremia in patients hospitalized by the emergency department with suspected infection

Background: Positive blood cultures usually indicate disseminated infection that is associated with a poor prognosis and higher mortality. We seek to develop and validate a predictive model to identify factors associated with positive blood cultures in emergency patients. Methods: Secondary analysis of data from two prospective cohorts (EPISEPSIS: developing cohort, and DISEPSIS: validation cohort) of patients with suspected or confirmed infection, assembled in emergency services in 10 hospitals in four cities in Colombia between September 2007 and February 2008. A logistic multivariable model was fitted to identify clinical and laboratory variables predictive of positive blood culture. Results: We analyzed 719 patients in developing and 467 in validation cohort with 32% and 21% positive blood cultures, respectively. The final predictive model included variables with significant coefficients for both cohorts: temperature > 38° C, Glasgow < 15 and platelet < 150.000 cells/mm³, with calibration (goodness-of-fit H-L) p = 0.0907 and p = 0.7003 and discrimination AUC = 0.68 (95% CI = 0.65-0.72) and 0.65 (95% CI = 0.61-0.70) in EPISEPSIS and DISEPSIS, respectively. Specifically, temperature > 38 °C and platelets < 150.000 cells/mm³ and normal Glasgow; or Glasgow < 15 with normal temperature and platelets exhibit a LR between 1,9 (CI 95% = 1,2-3,1) and 2,3 (CI 95% = 1,7-3,1). Glasgow < 15 with any of low platelets or high temperature shows a LR between 2,2 (CI 95% = 1,1-4,4) and 2,6 (CI 95% = 1,7-4,3). Discussion: Temperature > 38° C, platelet count < 150,000 cells/mm³ and GCS < 15 are variables associated with increased likelihood of having a positive blood culture.

Introducción: Un hemocultivo positivo usualmente indica infección diseminada, la que se asocia con peor pronóstico y mayor mortalidad. Por tanto, buscamos desarrollar y validar un modelo de predicción que permita identificar los factores asociados con la positividad de los hemocultivos en pacientes del servicio de urgencias. Métodos: Análisis secundario de datos de dos cohortes prospectivas (EPISEPSIS: cohorte de desarrollo y DISEPSIS: cohorte de validación) de pacientes con sospecha o confirmación de infección, ensambladas en servicios de urgencias de 10 instituciones hospitalarias en cuatro ciudades de Colombia entre septiembre de 2007 y febrero de 2008. Se ajustó un modelo logístico multivariado para identificar variables clínicas y de laboratorio predictoras de hemocultivos positivos. Resultados: Se analizaron 719 pacientes en la cohorte de desarrollo y 467 en la cohorte de validación, con 32 y 21% de hemocultivos positivos, respectivamente. El modelo predictor final incluyó las variables con coeficientes significativos para ambas cohortes: temperatura ≥ 38 °C, Glasgow < 15 y plaquetas ≤ 150.000 céls/mm³ con calibración (bondad de ajuste de H-L) p = 0,0907 y p = 0,7003 y discriminación AUC: 0,68 (IC 95%: 0,65-0,72) y 0,65 (IC 95%: 0,61-0,70) en EPISEPSIS y DISEPSIS, respectivamente. Temperatura ≥ 38 °C y recuento de plaquetas ≤ 150.000 céls/mm³ con Glasgow normal; o Glasgow < 15 con temperatura y plaquetas normales tiene un LR entre 1,9 (IC 95%: 1,2-3,1) y 2,3 (IC 95%: 1,7-3,1). La escala de Glasgow < 15 puntos junto con cualquiera entre recuento de plaquetas o temperatura alteradas tiene un LR entre 2,2 (IC 95%: 1,1-4,4) y 2,6 (IC 95%: 1,7-4,3). Discusión: La temperatura ≥ 38 °C, el recuento de plaquetas ≤ 150.000 céls/mm³ y la escala de Glasgow < 15 son las variables asociadas con mayor probabilidad de tener un hemocultivo positivo.

Mean platelet volume in patients with retinal artery occlusion / Volume médio de plaquetas em pacientes com oclusão da artéria da retina

ABSTRACT Purpose: The aim of this study was to investigate the mean platelet volume (MPV) of patients with retinal artery occlusion (RAO). Methods: Thirty-seven patients diagnosed with RAO and 32 control subjects were included in this retrospective study. Retinal artery occlusion was diagnosed on the basis of clinical examination and fundus fluorescein angiography. All participants underwent complete ocular examination, and MPV, hematocrit, hemoglobin, and platelet counts were recorded. RAO patient data were compared with those of the control subjects. Results: Patients with RAO had significantly higher MPV values (7.96 ± 1.2 fL) compared with control subjects (7.33 ± 0.7 fL, p<0.001). No significant difference was found with regard to platelet count between the RAO group and the control group (262 ± 70.1 × 109/L and 251 ± 56.6 × 109/L, respectively, p=0.50). MPV was an independent predictor of RAO [odds ratio (OR)=0.50; 95% confidence interval (CI)=0.28-0.89; p=0.019). Conclusions: Our results demonstrated that MPV values were significantly higher in patients with RAO, suggesting that larger platelets may contribute to the pathogenesis of the RAOs.

RESUMO Objetivo: O objetivo deste estudo foi investigar o volume plaquetário médio (MPV) de pacientes com oclusão da artéria da retina (RAO). Métodos: Trinta e sete pacientes com diagnóstico de RAO e 32 indivíduos do grupo controle foram incluídos neste estudo retrospectivo. A oclusão da artéria da retina foi diagnosticada com base em exame clínico e angiofluoresceinografia. Todos os participantes foram submetidos ao exame ocular completo. MPV, hematócrito, hemoglobina e contagem de plaquetas dos participantes foram registrados. Os dados dos pacientes com RAO foi comparado com os de sujeitos do grupo controle. Resultados: Pacientes com RAO apresentaram valores significativamente mais elevados MPV (7,96 ± 1,2 fL) em comparação aos indivíduos do grupo controle (7,33 ± 0,7 fL) (p<0,001). Nenhuma diferença significativa foi encontrada no número de plaquetas entre os grupos RAO e controle (262 ± 70,1 109/L and 251 ± 56,6 109/L, respectivamente, p=0,50). MPV foi um preditor independente de RAO (odds ratio (OR)=0,50; intervalo de confiança de 95% (IC)=0,28-0,89; p=0,019). Conclusões: Os resultados demonstraram que os valores de MPV foram significativamente maiores nos pacientes com RAO, sugerindo que plaquetas maiores podem contribuir na patogênese da RAO.

Aerobic training modulates T cell activation in elderly women with knee osteoarthritis

Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of walking, particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3×/week) on the leukocyte profile and quality of life (QL) of elderly women with kOA. Sixteen women (age: 67±4 years, body mass index: 28.07±4.16 kg/m2) participated in a walking program. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30–55 min) and higher intensity (72–82% of HRmax determined using a graded incremental treadmill test). The QL was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and blood samples were collected for analysis with a cell counter and the San Fac flow cytometer. Walking training resulted in a 47% enhancement of the self-reported QL (P<0.05) and a 21% increase in the VO2max (P<0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (pre=46.59±7%, post=44.58±9%, P=0.0189) and a higher fluorescence intensity for CD18+CD4+ (pre=45.30±10, post=64.27±33, P=0.0256) and CD18+CD8+ (pre=64.2±27, post=85.02±35, P=0.0130). In conclusion, the walking program stimulated leukocyte production, which may be related to the immunomodulatory effect of exercise. Walking also led to improvements in the QL and physical performance in elderly women with kOA.

Anemia in inflammatory bowel disease: prevalence, differential diagnosis and association with clinical and laboratory variables / Anemia na doença inflamatória intestinal: prevalência, diagnóstico diferencial e associação com variáveis clínicas e laboratoriais

CONTEXT AND OBJECTIVES: Anemia is the most frequent extraintestinal complication of inflammatory bowel disease. This study aimed to: 1) determine the prevalence of anemia among patients with inflammatory bowel disease; 2) investigate whether routine laboratory markers are useful for diagnosing anemia; and 3) evaluate whether any association exists between anemia and clinical/laboratory variables. DESIGN AND SETTING: Cross-sectional at a federal university. METHODS: 44 outpatients with Crohn's disease and 55 with ulcerative colitis were evaluated. Clinical variables (disease activity index, location of disease and pharmacological treatment) and laboratory variables (blood count, iron laboratory, vitamin B12 and folic acid) were investigated. RESULTS: Anemia and/or iron laboratory disorders were present in 75% of the patients with Crohn's disease and in 78.2% with ulcerative colitis. Anemia was observed in 20.5% of the patients with Crohn's disease and in 23.6% with ulcerative colitis. Iron-deficiency anemia was highly prevalent in patients with Crohn's disease (69.6%) and ulcerative colitis (76.7%). Anemia of chronic disease in combination with iron deficiency anemia was present in 3% of the patients with Crohn's disease and in 7% of the patients with ulcerative colitis. There was no association between anemia and disease location. In ulcerative colitis, anemia was associated with the disease activity index. CONCLUSIONS: Most patients present iron laboratory disorders, with or without anemia, mainly due to iron deficiency. The differential diagnosis between the two most prevalent types of anemia was made based on clinical data and routine laboratory tests. In ulcerative colitis, anemia was associated with the disease activity index. .

CONTEXTO E OBJETIVOS: Anemia é a mais frequente complicação extraintestinal na doença inflamatória intestinal. Este estudo objetivou: 1) determinar a prevalência de anemia em portadores de doença inflamatória intestinal; 2) investigar se os marcadores laboratoriais de uso rotineiro são úteis para o diagnóstico da anemia; 3) avaliar se existe associação entre anemia e variáveis clínico-laboratoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal em uma universidade federal. MÉTODOS: Foram avaliados 44 pacientes ambulatoriais com doença de Crohn e 55 com retocolite ulcerativa. Foram investigados aspectos clínicos (índice de atividade da doença, localização da doença e tratamento farmacológico) e laboratoriais (hemograma, ferrocinética, vitamina B12 e ácido fólico). RESULTADOS: Anemia e/ou anormalidades na ferrocinética estavam presentes em 75% dos pacientes com doença de Crohn e em 78,2% dos pacientes com retocolite. Anemia foi observada em 20,5% do grupo com doença de Crohn e em 23,6% do grupo com retocolite. Anemia por deficiência de ferro predominou entre os pacientes com doença de Crohn (69,6%) e com retocolite (76,7%). Anemia de doença crônica associada à anemia ferropriva estava presente em 3% dos pacientes com doença de Crohn e em 7% daqueles com retocolite. Na retocolite, a anemia estava associada com o índice de atividade da doença. CONCLUSÕES: A maioria dos pacientes apresentava alterações na ferrocinética com ou sem anemia, principalmente decorrente da ferropenia. O diagnóstico diferencial entre os dois tipos mais prevalentes de anemia foi baseado nos dados clínicos e nos testes laboratoriais de rotina. Anemia estava associada com o índice de atividade na retocolite. .

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).

Influência do tratamento periodontal não cirúrgico sobre parâmetros hematológicos e bioquímicos de pacientes renais crônicos em pré-diálise / Influence of non-surgical periodontal treatment on hematological and biochemical parameters of patients with chronic renal failure in pre-dialysis

Objetivo: Avaliar e correlacionar o efeito do tratamento não cirúrgico da periodontite crônica sobre parâmetros hematológicos e bioquímicos em pacientes portadores de doença renal crônica. Métodos: 56 pacientes (36 casos e 20 controles) foram submetidos previamente ao exame clínico periodontal e à coleta de 10 mL de sangue periférico, por meio dos quais foram avaliados hemograma completo e marcadores de ferro. Os parâmetros clínicos periodontais utilizados foram nível de inserção clínica; profundidade de sondagem; sangramento à sondagem e profundidade de bolsa à sondagem >4 mm. Resultados: Após 90 dias da conclusão do tratamento, foi realizada reavaliação e constatada melhora estatisticamente significativa de todos os parâmetros clínicos. A hemoglobina aumentou significativamente (p=0,03) nos pacientes controles e houve tendência ao aumento no número de hemácias (p=0,05). Houve diminuição significativa no número de leucócitos global (p=0,004). Quanto aos marcadores de ferro, pacientes controles apresentaram redução significativa (p=0,03) no índice de saturação de transferrina e aumento nos níveis de ferritina (p=0,03). Pacientes experimentais não apresentaram alterações significativas em seus parâmetros hematológicos e bioquímicos, apesar da tendência ao aumento no número de hemácias (p=0,07). Conclusão: O tratamento não cirúrgico da periodontite crônica foi efetivo, e após o mesmo, pacientes do grupo controle apresentaram aumento significativo nos níveis de hemoglobina, diminuição no número de leucócitos global e tendência ao aumento no número de hemácias. Pacientes com doença renal crônica apresentaram uma tendência ao aumento no número de hemácias

Objective: To evaluate and correlate the effect of nonsurgical treatment of chronic periodontitis on hematological and biochemical parameters in patients with chronic kidney disease and healthy controls. Methods: Fifty six patients (36 experimental group and 20 control group) were previously submitted to periodontal and clinical examination, and to collection of 10 mL of peripheralblood by means the complete blood count and markers of iron were assessed. The clinical periodontal parameters used were: clinical attachment level, probing depth, bleeding on probing and probing pocket depth > 4 mm. Results: After 90 days of completion of treatment there was reevaluation and it was found statistically significant improvement (p <0.05) of all clinical parameters. Hemoglobin increased significantly (p = 0.03) in patients in the controlgroup and tended to increase in the number of red blood cells (p = 0.05). It was found a significant reduction in the overall number of leukocytes (p = 0.004). Regarding markers of iron, control patients showed a significant reduction (p = 0.03) in the rate of transferrin saturation and ferritin levels increased (p = 0.03). Patients in the experimental group showed no significant changes in their hematological and biochemical parameters, despite the upward trend in blood cells (p = 0.07). Conclusion: The nonsurgical treatment of chronic periodontitis was effective, and after it, the control group showed a significant increase in hemoglobin levels, decrease in the number of leukocytes and global trend to increase the number of red blood cells. Patients with chronic kidney disease tended to increase in number of red blood cells.

Perfil hematológico e sorológico dos pacientes suspeitos de dengue atendidos no centro de saúde escola Germano Sinval Faria – ENSP/FIOCRUZ durante a epidemia de 2008 no Rio de Janeiro / Serological blood profile of patients suspected of dengue attended in the School Health Center Germano Sinval Faria - ENSP / FIOCRUZ during the epidemic of 2008 in Rio de Janeiro

No mundo atual, onde a globalizac;ao e as mudanc;as climaticas nos obrigam a considerar novos temasecol6gicos, politicos, demograficos e sociais, ocupa urn espac;o importante o problema das doenc;as emergentes e re­ emergentes, entre as quais a dengue se destaca por sua rapida extensao e aumento da morbi-mortalidade. A dengue e uma arbovirose mais frequente em todo mundo, e causada por urn virus pertencente ao genero Flavivirus, cuja transmissao ocorre atraves da picada do mosquito Aedes aegypti, ou atraves da transmissao mecanica realizada pelo mesmo. A infecc;ao por dengue causa urn doenc;a cujo espectro inclui desde infecc;Oes inaparentes ate quadros de hemorragia e choque, podendo evoluir para exito letal. uma doenc;a que apresenta urn comprometimento clfnico individual, contudo o diagn6stico se divide em especifico (isolamento e sorologia) e nao-especffico (hemograma completo e plaquetometria). 0 objetivo deste trabalho e expor o perfil hematol6gico e sorol6gico que os pacientes suspeitos de dengue atendidos no Laborat6rio de Diagn6stico Ensino e Pesquisa apresentaram. Foi analisado o perfil de 1635 hemogramas e 610 sorologias. Com esse estudo observamos que o indice de positividade entre crianc;as com idade entre 6 meses e 5 anos foi superior a outras faixas etarias, atingindo urn percentual de 23%.

In today's world, where globalization and climate change require us to consider new ecological, political,demographic and social characteristics, issue occupies an important area the issue of emerging diseases and re-emerging, including dengue fever is marked by its Rapid expansion and increase of morbidity and mortality. Dengue is an arbovirus most common worldwide. It is caused by a virus belonging to the genus Flavivirus, whose transmission occurs through the bite of the Aedes aegypti mosquito, or by mechanical transmission by the same. The dengue infection causes a diseasewhose spectrum includes since inapparent infections until bleeding and shock, can may evolve into lethal success. It is a disease that presents a individual clinical consequences, but the diagnosis is divided into specific (isolation and serology) and non-specific (complete blood count and plaquetometria). The aim is to expose the blood profile and serological that patients suspected of dengue attended at Diagnostic Laboratory Teaching and Research showed. We analyzed the profile of blood and 610 serology 1635. With this study we observed that the rate of positivity among children aged 6 months and 5 years was higher than other age groups, reaching a percentage of 23%.

Evaluación de control de calidad, gestión y costos del hemograma en un hospital complejo tipo 1 / Evaluation of hemogram quality control, management and cost in a complex hospital type 1

Determinar criterios de evaluación morfológica del hemograma, basados en parámetros clínicos y resultados del contador hematológico, en términos de gestión, costos y clínica en un hospital tipo 1. Pacientes, materiales y métodos: muestras de hemogramas de pacientes del hospital de carabineros de Chile durante el mes de agosto de 2009, analizadas en un equipo HMX Beckman-Coulter y evaluadas morfológicamente por Tecnólogo Médico(TM). Se registraron parámetros clínicos como hemoglobina, leucocitos y plaquetas; además se consideró el lugar de derivación, especialidad y edad del paciente. Se determinaron los costos e ingresos en función de los resultados obtenidos. Resultados: de los 2.222 pacientes evaluados, existió concordancia entre el Tecnólogo Médico y el analizador en 93,3 por ciento de los casos, con una sensibilidad de 97,3 por ciento y una especificidad de 88,9 por ciento con valores predictivos positivo y negativo de 95,9 por ciento y 92,7 por ciento respectivamente, para detectar una muestra anormal. Con los criterios de selección fue posible eliminar la evaluación morfológca en 79,5 por ciento de los casos, permitiendo un ahorro de $3655929 en el mes por concepto de hemogramas. Discusión: el estudio demostró que es posible disminuir el número de evaluaciones morfológicas realizadas al hemograma a valores similares obtenidos en estudios internacionales, con reducción significativa de los costos y tiempos de TM.

Objective: to determine criteria for the morphological analysis of the full blood count, based on the clinical parameters and the results of the full blood count using an automatic counter in terms of cost and clinicla implications in a distric hospital. Patients, Materials and Method: Full blood count samples from patients attended in the Hospital de Carabineros de Chile during the month of August 2009 were analyzed using HmX Beckman-Coulter and evaluated morpholigically by the Medical Science Officer(Medical Technologist). Clinical parameters, hemoglobin, white cell count platete count were registered, as well the origin of the specimen, medical speciality an patient age. The cost an income derived from the full blood count were determined by the Unit of Cost, Hospital of Carabineros and the changes in costs calculated in function of the results obtained. Results: Of the 2,222 patients evaluated, there was a concordance between the Clinical Science Officer(Medical Technologist) and the automatic counter in 93,9 percent of the samples, with a sensitivity of 97,3 percent and a specificy of 88,9 percent, a positive and negative predictive evalues of 95,9 percent and 92,7 percent respectively for detecting an abnormal sample. Using the criteria of selection it was possible to eliminate the evaluation morphological in 79,5 percent of the samples permitting a saving of $3655929 per month for the analysis of full morphological evaluations of the blood count without losing clinically important data in 80 percent of the samples, which is similar to that reported internationally, with a significant decrease in cost an Medical Scientific Officer time.

Índices plaquetários em indivíduos com doença hepática alcoólica crônica / Platelet indices in chronic alcoholic liver disease patients with thrombocytopenia

OBJETIVO: Detectar alterações nos índices plaquetários em indivíduos com doença hepática alcoólica crónica e trombocitopenia e determinar o seu grau de correlação com outros parâmetros hematológicos. MÉTODOS: Foram estudados um total de 65 indivíduos, divididos em dois grupos: controlos (n = 35) e com doença hepática alcoólica crónica e trombocitopenia (n = 30). O grupo controlo foi emparelhado por idade e sexo com o grupo de doentes. A todos eles, foi efectuado hemograma completo, incluindo índices plaquetários. RESULTADOS: Os doentes com doença hepática alcoólica crónica apresentaram contagem de eritrócitos, leucócitos e plaquetas significativamente inferiores aos encontrados na população controlo. O mesmo se verificou com os valores de hemoglobina, hematócrito e valores absolutos de linfócitos e neutrófilos. O volume globular médio, a hemoglobina globular média e o RDW ("red cell distribution width") revelaram-se significativamente superiores no grupo de doentes. Relativamente aos índices plaquetários, foi encontrado aumento estatisticamente significativo do PDW ("platelet distribution width") e uma diminuição estatisticamente significativa no plaquetrócrito no grupo de doentes quando comparado com o grupo controlo. Em relação ao volume plaquetário médio não se encontraram diferenças estatisticamente significativas entre os dois grupos. Foi encontrada correlação estatisticamente significativa entre a contagem de plaquetas e os outros parâmetros hematológicos analisados. O plaquetrócito revelou-se o índice plaquetário que mais se relaciona com os restantes parâmetros hematológicos. CONCLUSÃO: Os doentes com doença hepática alcoólica crónica apresentam diminuição nas três linhas hematopoiéticas, possivelmente associada com o hiperesplenismo que estes doentes apresentam. Adicionalmente às alterações numéricas, encontraram-se alterações morfológicas a nível dos eritrócitos e plaquetas, demonstráveis pelos índices eritrocitários e plaquetários.

AIM: To detect alterations in platelet indices in patients with chronic alcoholic liver disease and thrombocytopenia, and its correlation with other haematological parameters. METHODS: We studied 65 individuals separated in two groups: controls (n = 35) and chronic alcoholic liver disease patients with thrombocytopenia (n = 30). The control group was age and gender matched with patients group. In all, controls and patients, a haematological evaluation was done, including platelets indices. RESULTS: In the patients group we found a low number of erythrocytes, leucocytes and platelet when we compare with controls. The same is true when we compare haemoglobin, hematocrit and absolute count of lymphocyte and neutrophil. The mean globular volume, mean globular haemoglobin and red cell distribution width where significantly higher in patients group. Platelet indices showed a statistical significant increased in platelet distribution width and decreased in platelet crit in the patient group. No differences where found on mean platelet volume between the two groups. Correlation between platelet number and other haematological parameters was found. CONCLUSION: Chronic alcoholic liver disease patients showed a decrease in all haematopoietic cell lines, probably associated with hypersplenism found in those patients. Additionally to the numeric alterations the erythrocyte and platelets showed morphologic alteration revelled by respective indices.