Necrose tubular aguda comprovada por biopsia em paciente com dengue e rabdomiolise

Resultados de histologia renal são muito escassos em pacientes com rabdomiólise e injúria renal aguda (IRA) associada a dengue. Descrevemos caso de dengue complicado por rabdomiólise e IRA no qual a biópsia renal mostrou necrose tubular aguda (NTA) e deposição renal de mioglobina. Paciente de 28 anos que apresentou dengue complicado por IRA grave e rabdomiólise é descrito. Ele necessitou de diálise por três semanas. A biópsia renal mostrou NTA, com imunohistoquímica fortemente positiva para mioglobina nos túbulos renais. O paciente recebeu alta com recuperação da função renal. Em conclusão, descrevemos caso de dengue complicado por IRA e rabdomiólise, em que a biópsia renal mostrou NTA e deposição de mioglobina. Sugerimos que creatinofosfoquinase deve ser monitorizada em pacientes com dengue para permitir o diagnóstico precoce de rabdomiólise e a instituição de medidas protetoras para o rim.Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures

The effect of method, standard and sample components on the total antioxidant capacity of commercial waters assessed by optical conventional assays

The total antioxidant capacity (TAC) of 28 flavoured water samples was assessed by ferric reducing antioxidant potential (FRAP), oxygen radical absorbance capacity (ORAC), trolox equivalent antioxidant capacity (TEAC) and total reactive antioxidant potential (TRAP) methods. It was observed that flavoured waters had higher antioxidant activity than the corresponding natural ones. The observed differences were attributed to flavours, juice and vitamins. Generally, higher TAC contents were obtained on lemon waters and lower values on guava and raspberry flavoured waters. Lower and higher TACs were obtained by TRAP and ORAC method, respectively. Statistical analysis suggested that vitamins and flavours increased the antioxidant content of the commercial waters

Efficiency of different techniques in flexural strengthening of RC beams under monotonic and fatigue loading

In the context of flexural strengthening of concrete structures, fiber reinforced polymers (FRP) have been used mostly by two main techniques: Externally Bonded Reinforcement (EBR) and Near-Surface Mounted (NSM). Both strengthening techniques are applied on the cover concrete, which is normally the weakest region of the element to be strengthened. Consequently, the most common problem is the premature failure of the strengthening system that occurs more frequently in the EBR one. In an attempt of overcoming this weakness, another technique has been proposed, called MF-EBR – Mechanically Fastened and Externally Bonded Reinforcement, which uses multi-directional carbon fiber laminates, simultaneously glued and anchored to concrete. To compare the efficiency of NSM, EBR and MF-EBR techniques, four-point bending tests with RC beams were carried out under monotonic and cyclic loading. In this work the tests are described in detail and the obtained results are discussed. Additionally, to assess the performance of a FEM-based computer program for the prediction of the behaviour of RC beams strengthening according to these techniques, the beams submitted to monotonic loading were numerically simulated.FCT; Hilti Portugal - Productos e Serviços Lda.; S&P Clever Reinforcement Ibérica Lda.; SECIL; TSwaterjet, Lda

Experimental and numerical study of distinct techniques to strengthen beams failing in bending under monotonic loading

With the purpose of study three distinct techniques to strengthen beams failing in bending under monotonic loading, an experimental program was carried out. Three techniques are analyzed: Externally Bonded Reinforcement (EBR), Near-Surface Mounted (NSM) and Mechanically Fastened and Externally Bonded Reinforcement (MF-EBR). Unidirectional CFRP laminates were used for the case of the EBR and NSM techniques, whereas multi-directional CFRP laminates were used with the MF-EBR system. In this work the tests are described in detail, and the obtained results are presented and discussed. Numerical simulations of the tests are presented to evaluate the ability of current FEM tools in the simulation of these strengthening techniques

Efficiency of different FRP-based flexural strengthening techniques in beams submitted to fatigue loading

Flexural strengthening of reinforced concrete (RC) structures with fiber reinforced polymers (FRP) has been used mostly by two main techniques: Externally Bonded Reinforcement (EBR) and Near-Surface Mounted (NSM). In both strengthening techniques the FRP systems are applied on the cover concrete, which is normally the weakest region of the element to be strengthened. Consequently, the most common problem is the premature failure of the system, which occurs more frequently when using the EBR technique. In an attempt of overcoming this weakness, another flexural strengthening technique, named MF-EBR – Mechanically Fastened and Externally Bonded Reinforcement, is analyzed in the present paper. This technique uses multidirectional carbon fiber laminates that are simultaneously glued and anchored to concrete. To compare the efficiency of NSM, EBR and MF-EBR techniques, four-point bending tests with RC beams were carried out under monotonic and fatigue loading. In this work the tests are described and the obtained results are presented and discussed.Fundação para a Ciência e a Tecnologia (FCT) - PTDC/ECM/74337/200

Eficiência de diferentes técnicas de reforço à flexão de vigas de betão armado

A utilização de polímeros reforçados com fibras (FRP) no contexto do reforço de estruturas de Engenharia Civil tem crescido nas últimas décadas. Propriedades como baixo peso, elevado rácio rigidez/peso, imunidade e à corrosão e grande variedade de tamanhos e formatos disponíveis são algumas das razões que justificam a crescente utilização deste tipo de materiais. A sua aplicação tem sido realizada a essencialmente através de duas técnicas de reforço: colagem externa (Externally Bonded Reinforcement – EBR) e inserção no betão de recobrimento (Near-Surface Mounted – NSM). A eficiência dessas técnicas depende, principalmente do desempenho da ligação. Dado que este e tipo de reforço é aplicado ao nível do betão de recobrimento, que e é normalmente a região com as pioores propriedades mecânicas do elemento a ser reforçado, é frequente a ocorrência de e rotura precoce do reforço pelo seu destacamento. Na tentativa de solucionar esse problema, outras técnicas têm sido propostas. A técnica que a aqui se apresenta utiliza laminados multi-direccionais de fibra de carbono simultaneamente colados e ancorados ao betão, tendo sido designada por técnica MF-EBR – Mechanically Fastened and Externally Bonded Reinforcement. Com vista à comparação da eficiência da técnica proposta com as técnicas s EBR e NSM procedeu-se à realização de um programa de ensaios experimentais com vigas de betão armado. Assim, no presente trabalho os ensaios realizados são descritos e os resultados mais significativos são apresentados e analisados

In vivo assessment of a novel biodegradable ureteral stent

Purpose: To perform an in vivo assessment of a newly developed biodegradable ureteral stent (BUS) produced with natural-based polymers. Methods: The BUS is based on a patented technology combining the injection process with the use of supercritical fluid technology. The study was conducted at ICVS-University of Minho (Braga, Portugal) and a total of ten domestic pigs were used. In seven animals, the experimental BUS stent was inserted, whereas in the remaining a commercially available stent was used (6-Fr Biosoft(®) duo stents, Porges Coloplast, Denmark). Post-stenting intravenous pyelogram was used to evaluate the degree of hydronephrosis. The in vivo stent degradation was measured as a function of the weight loss. Moreover, the tensile properties of the BUS were tested during in vivo degradation. After maximum 10 days, animals were killed and necropsy was performed. Tissues were compared between the stented groups as well as between the non-stented contralateral ureters and stented ureters in each group. Biocompatibility was assessed by histopathological grading. Results: In all cases, the BUS was only visible during the first 24 h on X-ray, and in all cases, the BUS was completely degraded in urine after 10 days, as confirmed on necropsy. During the degradation process, the mechanical properties of the BUS decreased, while the commercial ureteral stents remained constant. At all time-points after stent insertion, the level of hydronephrosis was minimal. Overall, animals stented with BUS had an average grade of hydronephrosis which was lower compared to the controls. The BUS showed better pathological conditions, and hence better biocompatibility when compared with commercial stents. Conclusions: Notwithstanding the limitations of the present study, the in vivo testing of our novel natural origin polymer-based BUS suggests this device to feature homogeneous degradation, good urine drainage, and high biocompatibility. Next steps will be to increase its stability and to improve the radiopacity without compromising its degradation. Ultimately, clinical studies will be required to determine the safety and feasibility of its use in humans.FCT -Fuel Cell Technologies Program(POCI-01-0145-FEDER-007038)info:eu-repo/semantics/publishedVersio

Análise retrospectiva do resultado do tratamento com iodo radioativo em 120 pacientes tirotóxicos por doença de Basedow-graves

We studied retrospectively the outcome of radioactive iodine therapy (RAI) in 120 thyrotoxic patients with Graves' disease (96 F/ 24 M) who were primarily treated with anti-thyroid drugs (ATD). The decision to use RAI was due either to relapse after ATD-induced remission, lack of compliance on ATD, goiter larger than 60g, old age or association with severe diseases. ATD were discontinued one week before RAI administration, calculated by the formula: glandular volume (g) vs. effective radiation (80 mCi/g of tissue) divided by 24h thyroid uptake (%). We reexamined the patients for 48 months after RAI. Medians of age, goiter size and 24h thyroid uptake were 34y (17-69), 54.5g (20-210) and 73% (21-99), respectively. After RAI, patients became gradually hypothyroid on a rate of 15%/ 6mo until the first 18mo, followed by a rate of 2-5%/ 6mo until the end of 48mo. The number of patients in thyrotoxicosis decreased continuously, being 52.2% 6mo after RAI, 25% after 18mo and 6.7% after 48mo; at the end of the study 8 patients were still thyrotoxic. The total of patients without thyrotoxicosis at the end of observation, that is, the sum of those in euthyroidism and hypothyroidism on T4 therapy (cure of thyrotoxicosis) reached 46.8% in 6mo, 63.3% in 12mo, 81.7% in 24mo, 87.5% in 36mo and 93.3% in 48mo. Transient hypothyroidism, that is, elevation of TSH higher than 4.5 mU/L until 12mo after RAI, followed by normalization of TSH was found in 7.5% of patients. The following correlations were found in this study: a) initial T3 values and absence of cure of thyroxicosis (p=0.2); b) total RAI doses in relation to time for cure of thyrotoxicosis (p=0.01); c) dose of 131l/thyroid volume in relation to time for cure of thyrotoxicosis (p=0.02). Adverse effects included exarcebation of thyrotoxicosis in 3 patients and pain in the anterior cervical area in one, all reversible and of short duration. Two patients became pregnant after RAI but both gestations and their outcomes were normal.Estudamos retrospectivamente 120 pacientes (96 F/ 24 M) portadores de tirotoxicose por doença de Basedow-Graves submetidos à terapia com iodo radioativo (131I), que receberam inicialmente, para compensação da moléstia, drogas anti-tiroidianas (DAT). A indicação terapêutica posterior de radioiodo deveu-se a uma das seguintes condições clínicas: recidiva após compensação com DAT, falta de compensação devida à baixa aderência às DAT, bócios maiores que 60g, idade avançada ou doença grave associada. As DAT foram suspensas uma semana antes da administração da dose de 131I, calculada pela fórmula: volume glandular (em g) X radiação efetiva (80 mCi/g de tecido) ¸ captação tiroideana de 24hs. Reavaliamos os pacientes por até 48 meses após a radioiodoterapia. As medianas iniciais de idade, bócio e captação tiroideana de 24hs dos 120 pacientes foram, respectivamente, 34 anos (17-69), 54,5g (20-210) e 73% (21-99). A evolução para hipotiroidismo foi gradual, com 15% dos pacientes a cada 6m até o 18º mês, seguidos de 2 a 5% dos pacientes a cada 6m até o 48º mês. O número de pacientes em tirotoxicose decresceu continuamente, representando 52,2% do total inicial após 6m, 25% após 18m e 6,7% após 48m. Ao final, 8 pacientes continuaram em tirotoxicose. O número de pacientes sem tirotoxicose após o tratamento com 131I, ou seja a soma daqueles em eutiroidismo com aqueles em hipotiroidismo com reposição com T4 (denominada por nós de cura da tirotoxicose), alcançou 46,8% dos pacientes em óm, 63,3% em 12m, 81,7% em 24m, 87,5% em 36m e 93,3% em 48m. O número de pacientes que apresentaram hipotiroidismo transitório, ou seja, elevação do TSH acima de 4,5 mU/L até 12m após a dose de 131I, com normalização posterior, foi 7,5%. Correlacionaram-se positivamente: a) valores iniciais de T3 e ausência de evolução para a cura da tirotoxicose (p=0,02); b) doses totais de 131I administradas, únicas ou múltiplas, em relação ao tempo de cura da tirotoxicose (p=0,01); c) dose de 131 l/volume glandular em relação ao tempo de cura da tirotoxicose (p=0,02). Os efeitos adversos incluíram exacerbação da tirotoxicose em 3 pacientes e dor na região cervical anterior em um, com reversão dos quadros em todos. Outras duas pacientes engravidaram após o dose terapêutica de 131I para a tirotoxicose e tiveram gestações sem intercorrência e recém-nascidos normais.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Desenvolvimento, caracterização e validação clínica de um novo ensaio sensível para a dosagem da tiroglobulina sérica

OBJECTIVE: In the last decade, data published stressed the role of highly-sensitive thyroglobulin (Tg) assays in the follow-up of differentiated thyroid carcinoma (DTC) patients. The present study describes a new, highly-sensitive Tg assay, compares it with an available commercial assay, and validates it in the follow-up of DTC patients. SUBJECTS AND METHODS: The immunofluorometric high-sensitivity Tg assay is based on monoclonal and polyclonal antibodies produced at our laboratories. It was validated in 100 samples of 87 patients with DTC submitted to total thyroidectomy, 87% of whom also received radioiodine. For correlation, all samples were also tested using a commercial Tg assay (Beckman Access) with functional sensitivity (FS) of 0.1 ng/mL. RESULTS: The new method showed FS of 0.3 ng/mL. The correlation between the two methods was good (r = 0.74; p < 0.0001). The diagnostic sensitivity was 88.9%, and it was increased to 100% when combined with neck US. CONCLUSION: This new, high-sensitivity Tg assay presented a good correlation with Beckman Access assay and with the clinical outcome of the patients. The continuous availability of a validated assay is an additional advantage for long term follow-up of DTC patients. Arq Bras Endocrinol Metab. 2012;56(9):658-65OBJETIVO: Na última década, estudos mostraram a importância dos ensaios de tiroglobulina (Tg) com melhor sensibilidade funcional no seguimento dos pacientes com carcinoma diferenciado de tiroide (CDT). Neste estudo, descrevemos o desenvolvimento de um novo ensaio de Tg de alta sensibilidade, que foi validado no seguimento de pacientes com CDT e correlacionado com um ensaio comercialmente disponível. SUJEITOS E MÉTODOS: O ensaio imunofluorométrico de Tg baseia-se em anticorpos, um monoclonal e um policlonal desenvolvidos em nosso laboratório. Avaliamos 100 amostras de soro de 87 pacientes com CDT submetidos à tiroidectomia total, sendo que 87% deles também receberam 131I. A Tg foi dosada também em ensaio comercial (Beckman Access). RESULTADOS: A correlação entre os dois métodos foi de 0,74 (p < 0,0001). O novo ensaio mostrou uma sensibilidade funcional de 0,3 ng/mL. A sensibilidade diagnóstica foi de 88,9%, que aumentou para 100% quando associada ao ultrassom cervical (US). CONCLUSÃO: O novo método de dosagem de Tg mostra boa correlação com o ensaio comercial Beckman Access e com a evolução clínica dos pacientes. O novo ensaio será fundamental no seguimento dos nossos pacientes com CDT. Arq Bras Endocrinol Metab. 2012;56(9):658-65Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Diagnosis of hyperglycemia in a cohort of Brazilian subjects

Fleury Inst, Ctr Diabet, BR-04344070 São Paulo, BrazilUniversidade Federal de São Paulo, Mol Endocrinol Lab, Escola Paulista Med, São Paulo, BrazilINSERM U695, Paris, FranceUniversidade Federal de São Paulo, Mol Endocrinol Lab, Escola Paulista Med, São Paulo, BrazilWeb of Scienc