Quantificação do ácido 5-hidroxi-indolacético urinário por técnica caseira do nitrosonaftol comparada com ensaio de nitrosonaftol em microcoluna de cromatografia e imunoensaio enzimático

The aim of this study was to compare the colorimetric kit and enzyme-linked immunosorbent assay (ELISA) methods to quantify urinary 5-hydroxyindoleacetic acid through the Goldenberg's technique, exploring the potential of replacing it. 24-hour urine samples were tested by Goldenberg's assay and compared with kits. The agreement was almost perfect for the comparison of Goldenberg's assay with both colorimetric kit, and with ELISA kit, considering ≤ 7.5 mg/24h normal cutoff value. Therefore, both kits would be good alternatives to Goldenberg's technique due to practicality and agreement between values.O objetivo deste estudo foi comparar métodos por kit colorimétrico e por ensaio imunossorvente ligado à enzima (ELISA) para quantificar o ácido 5-hidroxi-indolacético urinário com a técnica de Goldenberg, explorando o potencial de substituí-la. Amostras de urina de 24 horas foram testadas pela técnica de Goldenberg e com os kits. A concordância foi quase perfeita, tanto para a comparação do ensaio de Goldenberg com o kit colorimétrico quanto para com o kit ELISA, considerando normal o valor de corte de ≤ 7.5 mg/24h. Portanto, ambos os kits seriam boa alternativa para a técnica de Goldenberg devido à praticidade e à concordância entre os valores.Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUNIFESPFMUSP Hospital das Clínicas Gastroenterology and Hepatology DepartmentUSP Medicine SchoolUNIFESPSciEL

Clinical Features of Refractory Ascites in Outpatients

OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month. RESULTS: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262). CONCLUSION: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes

Modelos para estimativa da radiação de onda longa atmosférica no cerrado Mato-Grossense

This study aimed to evaluate and parameterize models to estimating the atmospheric long wave radiation (Ld) in the Cerrado Mato-grossense, considering the sky coverage in terms of clear-sky, partly cloudy and overcast. Taking into account that measurements of Ld are rare, and that this parameter is usually obtained indirectly through various models available in the literature we decided in this study, analyze 107 models for the estimation of Ld. The data used in this study were obtained of equipment installed in a micrometeorological tower 19 meters at Miranda farm in Santo Antônio de Leverger - MT, between the months of june and july, and october and november 2009 totalizing 5856 measures. Estimates of Ld obtained from these formulations, the best performing ones were the ones with the smallest statistical errors and the highest index and coefficients as of determination (R2 ), the Pearson correlation (r), the Wilmott index of “agreement” (1982) (d) and the Camargo & Sentelhas index of “performance” (1997) (c). It can be observed that for conditions clear skies, partly cloudy and overcast, the models to estimate the long-wave irradiance, in its original formulation, which showed the best statistical indices and, therefore, those best adapted for the “Cerrado Mato-grossense” (Brazilian savanna in the Mato Grosso state), in the period studied were, respectively, Ramanadham & Viswanadham (1970), Idso and Jackson (1969) and Bignami et al. (1995) and after parameterization of models: Bárbaro et al. (2010); Aubinet (1994) and Andreas & Ackley (1982).Este trabalho teve por objetivoavaliar e parametrizar os modelos para a estimativa da radiação de onda longa atmosférica (Ld) no Cerrado Mato-grossense, considerando a cobertura do céu nas condições decéu-claro, parcialmente nublado e nublado. Levando-se em conta que medidas da Ld são raras, e que esteparâmetro quase sempre é obtido de forma indireta através de vários modelosdisponíveis na literatura, optou-se neste trabalho por analisar 107 modelos paraa estimativa da Ld. Osdados utilizados neste trabalho foram obtidos de instrumentos instalados em umatorre microclimatológica de 19 metros na fazenda Miranda no município de SantoAntônio de Leverger – MT, entre os meses de junho e julho; e outubro e novembrode 2009 totalizando 5856 medidas. Das estimativas da Ld obtidas a partir destas formulações,aquelas com melhores desempenhos foram as que apresentaram como critérios, osmenores erros estatísticos e os maiores índices e coeficientes como os dedeterminação (R2), decorrelação de Pearson (r), deconcordância de Wilmott (1982) e o de desempenho de Camargo & Sentelhas(1997). Pode-se observar que, para as condições de céu claro, parcialmentenublado e nublado, os modelos de estimativa da irradiância de ondas longas, emsua formulação original, que apresentaram os melhores índices estatísticos e,portanto, aqueles que melhor se adaptaram ao Cerrado Mato-grossense, para operíodo estudado foram, respectivamente, Viswanadham & Ramanadham (1970),Idso& Jackson (1969) e Bignami et al. (1995) e após aparametrização os modelos de: Bárbaro et al. (2010); Aubinet(1994)) e Andreas & Ackley (1982)

Adherence to BCLC recommendations for the treatment of hepatocellular carcinoma: impact on survival according to stage

OBJECTIVES: This study sought to assess the adherence of newly diagnosed hepatocellular carcinoma patients to the Barcelona Clinic Liver Cancer system treatment guidelines and to examine the impact of adherence on the survival of patients in different stages of the disease. METHODS: This study included all patients referred for the treatment of hepatocellular carcinoma between 2010 and 2012. Patients (n=364) were classified according to the Barcelona Clinic Liver Cancer guidelines. Deviations from the recommended guidelines were discussed, and treatment was determined by a multidisciplinary team. The overall survival curves were estimated with the Kaplan-Meier method and were compared using the log-rank test. RESULTS: The overall rate of adherence to the guidelines was 52%. The rate of adherence of patients in each scoring group varied as follows: stage 0, 33%; stage A, 45%; stage B, 78%; stage C, 35%; and stage D, 67%. In stage 0/A, adherent patients had a significantly better overall survival than non-adherent patients (hazard ratio=0.19, 95% confidence interval (CI): 0.09-0.42;

Analysis of HFE And Non-HFE Gene Mutations in Brazilian Patients with Hemochromatosis

BACKGROUND: Approximately one-half of Brazilian patients with hereditary hemochromatosis (HH) are neither homozygous for the C282Y mutation nor compound heterozygous for the H63D and C282Y mutations that are associated with HH in Caucasians. Other mutations have been described in the HFE gene as well as in genes involved in iron metabolism, such as transferrin receptor 2 (TfR2) and ferroportin 1 (SCL40A1). AIMS: To evaluate the role of HFE, TfR2 and SCL40A1 mutations in Brazilian subjects with HH. PATIENTS AND METHODS: Nineteen male subjects (median age 42 [range: 20-72] years) with HH were evaluated using the Haemochromatosis StripAssay A®. This assay is capable of detecting twelve HFE mutations, which are V53M, V59M, H63D, H63H, S65C, Q127H, P160delC, E168Q, E168X, W169X, C282Y and Q283, four TfR2 mutations, which are E60X, M172K, Y250X, AVAQ594-597del, and two SCL40A1 mutations, which are N144H and V162del. RESULTS: In our cohort, nine (47%) patients were homozygous for the C282Y mutation, two (11%) were heterozygous for the H63D mutation, and one each (5%) was either heterozygous for C282Y or compound heterozygous for C282Y and H63D. No other mutations in the HFE, TfR2 or SCL40A1 genes were observed in the studied patients. CONCLUSIONS: One-third of Brazilian subjects with the classical phenotype of HH do not carry HFE or other mutations that are currently associated with the disease in Caucasians. This observation suggests a role for other yet unknown mutations in the aforementioned genes or in other genes involved in iron homeostasis in the pathogenesis of HH in Brazil

Imunização ativa contra o virus da Hepatite B com baixas doses da vacina plasma derivada por via intradérmica

Schedule for vaccination against HBV infection has usually been based on three separate injections of 20 meg of the vaccine by intramuscular route. One of the main shortcomings to its use in large scale programs has been its high cost. Ninety out of 300 health workers were submitted to three injections of 2 meg of plasma-derived vaccine (PDV) by intradermal (ID) route on days 0, 30, and 180. Anti-HBs was detected in 74 (82.2%) after the second dose and in 80 (88.9%) after the third dose, a non-significant difference. However, levels above 10 times the cut-off were observed in 29 (32.2%) and 77 (85.5%), respectively (p < 0.001). The results showed that a low-dose schedule is effective when used in health workers and should be tried with other risk groups.O esquema habitualmente utilizado para imunização ativa contra o vírus da hepatite B (VHB) consiste em 3 doses de 20 meg por via intramuscular (IM) no deltóide. Um dos problemas quanto à sua utilização em larga escala refere-se ao seu custo elevado. Poucas publicações têm se referido a doses menores, de 10 meg IM ou 2 meg intradérmica (ID). Pesquisou-se em 300 funcionários da área da saúde o anti-HBc-total. Todos os marcadores foram determinados pela técnica de ELISA. Em 43 (14,3%) o marcador foi positivo, correspondendo a 9 (3,0%) com AgHBs e a 34 (11,3%) com anti-HBs. Aos 257 funcionários sem anti-HBc propôs-se um esquema de vacinação, que foi aceito por 90 (35,0%). Idade média de 37,4 ± 8,4 anos, limites de 22 - 56 anos e 68 do sexo feminino. Esquema: 3 doses de 2 meg por via ID com intervalos de 1 e 6 meses. O anti-HBs, pesquisado após a 2ª dose mostrou-se positivo em 74 (82,2%) e após a 3ª dose em 80 (88,9%) - diferença não significativa. Contudo, a quantificação do anti-HBs mostrou níveis 10 vezes acima do "cut-off em 29 (32,2%) e em 77 (85,5%) após a 2ª e 3ª doses, respectivamente (p < 0,001). Portanto, o esquema proposto mostrou-se válido para este tipo de população e, apesar da freqüência semelhante de sero-conversão após a 2ª e 3ª doses, há necessidade desta última para aumentar o título de anticorpos

Aspectos moleculares da carcinogênese hepática

Agentes exógenos correlacionados com o carcinoma hepatocelular (HCC) têm sido identificados e bem caracterizados. Esses agentes, entre os quais se incluem os diferentes vírus que causam hepatite e cirrose hepática, podem provocar o aparecimento de nódulos regenerativos e nódulos displásicos/hiperplasia adenomatosa. Essas condições associadas com diversas alterações moleculares do hepatócito podem culminar com o aparecimento do HCC. Recentemente, grandes progressos têm ocorrido na identificação de mutações somáticas ou germinativas que estariam correlacionadas com o desenvolvimento do HCC, justificando ampla revisão do tema. Procuramos discutir nesta revisão os fatores envolvidos no processo de carcinogênese hepática, tal como a infecção pelos vírus das hepatites B e C, com ênfase nas alterações moleculares descritas nos últimos anos, assinalando áreas em que potenciais avanços na abordagem clínica poderão surgir em futuro próximo.Exogenous agents correlated with hepatocellular carcinoma (HCC) have been identified and well characterized. These agents, including the different viruses that cause chronic hepatitis and cirrhosis, can lead to regenerative nodules and dysplastic nodules/adenomatous hyperplasia. These conditions associated with several molecular alterations of hepatocyte ultimately culminate in hepatocellular carcinoma. Recently, there has been a great progress in the identification of somatic and germinative mutations that may be correlated with the development of HCC, justifying a review on the subject. Hence, the factors involved in the process of hepatic carcinogenesis, such as infection by the hepatitis B and C viruses, with a special focus in the molecular alterations described in recent years are discussed herein, pointing out areas potentially relevant for clinical development