CMV infection of liver transplant recipients: comparison of antigenemia and molecular biology assays

BACKGROUND: CMV is a major clinical problem in transplant recipients. Thus, it is important to use sensitive and specific diagnostic techniques to rapidly and accurately detect CMV infection and identify patients at risk of developing CMV disease. In the present study, CMV infection after liver transplantation was monitored retrospectively by two molecular biology assays - a quantitative PCR assay and a qualitative NASBA assay. The results were compared with those obtained by prospective pp65 antigenemia determinations. MATERIALS AND METHODS: 87 consecutive samples from 10 liver transplanted patients were tested for CMV by pp65 antigenemia, and CMV monitor and NASBA pp67 mRNA assay. RESULTS: CMV infection was detected in all patients by antigenemia and CMV monitor, whereas NASBA assay identified only 8/10 patients with viremia. Furthermore, CMV infection was never detected earlier by molecular biology assays than by antigenemia. Only 5/10 patients with CMV infection developed CMV disease. Using a cut off value of 8 cells/50,000, antigenemia was found to be the assay that better identified patients at risk of developing CMV disease. However, the kinetics of the onset of infection detected by NASBA and CMV monitor seemed to have better identified patients at risk of developing CMV disease. Furthermore, before onset of disease, CMV pp67 mRNA was found to have similar or better negative and positive predictive values for the development of CMV disease. CONCLUSIONS: The present data, suggests that the concomitant use of antigenemia and pp67 mRNA assay gives the best identification of patients at risk of developing CMV disease

Análise clínica, radiológica, macroscópica e histológica do úmero de codornas domésticas (Coturnix japonica), submetido ao implante da poliuretana derivada do polímero de mamona (Ricinnus communis) Clinical, radiological, macroscopical and histological analysis of domestic quail (Coturnix japonica) humerus submitted to implant of polyurethane from castor oil polymer (Ricinnus communis)

Na cirurgia ortopédica, são freqüentes as situações em que o cirurgião se depara com grandes perdas ósseas, provocadas especialmente por traumatismos de alta energia, tumores ou infecções. A reparação dessas fraturas requer grande conhecimento a respeito de materiais que possam ser utilizados para preencher essas falhas. Esses materiais podem ser derivados biológicos, sintéticos ou metálicos. Dentre eles, destacam-se os enxertos ósseos e os implantes de biomateriais. Com o aumento dos animais exóticos, utilizados como animais de estimação, a casuística clínica e cirúrgica dessa especialidade vem crescendo, tanto em clínicas quanto em hospitais veterinários. Particularmente, as aves constituem a maioria desses animais, e entre seus problemas cirúrgicos as fraturas são os de maior destaque. O objetivo deste trabalho foi estudar o efeito clínico, radiológico, macroscópico e histológico da poliuretana derivada do polímero de mamona (Ricinnus communis) implantada no úmero de codornas domésticas (Coturnix japonica). Para isso, foram utilizadas 20 codornas, machos e fêmeas, separadas aleatoriamente em quatro grupos de cinco animais, os quais receberam o implante no úmero esquerdo, com exame clínico diário durante o período pós-operatório, avaliações radiológica imediata e quinzenal e macroscópica e histológica aos 15, 30, 60 e 90 dias. Clinicamente não foram observadas alterações locais, regionais nem sistêmicas. Ao exame radiológico, notou-se aumento de densidade local, sem sinais de alteração óssea, dos tecidos circunjacentes, e de sacos aéreos. A análise macroscópica revelou que a poliuretana de mamona não foi absorvida em nenhum dos quatro grupos permanecendo implantada no seio do osso pneumático, porém, notou-se alteração em sua resistência. O exame histopatológico mostra inicialmente mínima reação inflamatória, discreta fibrose ao redor do implante e osteointegração pela presença de trabéculas e medula óssea no interior do implante. Concluiu-se que a poliuretana derivada do polímero de mamona é biocompatível em aves, podendo ser utilizada na cirurgia ortopédica, ocorrendo osteointegração.<br>In orthopedic surgery there are frequently situations in which the surgeon faces severe bone losses caused by high-energy trauma, tumors or infections. Repairing these losses require knowledge about filling materials. Those materials can be biological, synthetic or metallic, with emphasis in bony grafts and biomaterial implants. The increase of the use of birds as pets is leading to an increasing number of clinical and surgical cases related to this taxon, where fractures are the most commonly observed surgical problems. The objective of this study was to evaluate clinical, radiological, macroscopic and microscopic effects of the polyurethane derived from castor oil (Ricinus communis) polymer, when implanted in the humerus of domestic quails (Coturnix japonica). Twenty male and female quails, were used randomly distributed in four groups of five individuals. The birds received the implants in the left humerus, being submitted to daily physical examination during the postoperative period, immediate and biweekly radiological examination, and macroscopic and microscopic evaluation at the 15th, 30th, 60th and 90th days. Clinically, there were not observed local, regional or systemic changes. Radiologically, increase in local density was observed with no signs of changes in bone or adjacent tissue, as well as in the air sacs. Macroscopic analysis revealed that the polyurethane derived from castor oil polymer was not absorbed in none of the four groups, remaining implanted within the pneumatic bone. Its resistance, however, has changed. Microscopic examination evidenced minimum inflammatory reaction, slight fibrosis around the implants, and osteo-integration with presence of trabeculi and bone marrow inside the implants. Concluding, implants of polyurethane derived from castor oil polymer are biocompatible in quails, with occurrence of osteo-integration, and can be used in orthopedic surgery in this species